Loading...
HomeMy WebLinkAbout028-1028-50-000 7 h N O 'S O © O .T a4 y v r,. m -0 p ~ o a N N Z N y O N O N x U 0 0 ~ ~ c E -0 c a o co .0 _0 y O nl O O N C y. U N C 2 O O L C O ' LL p -O (O ,N C c O O O A? p E a ~~0 U Co M a zt o C O Z y y co co w a co N I- Z c C7 o z a v ~ ~ w v N H r I', ~ I y y • y po AJ U N O ` O Q Q Z Z o N Z p N C (D C: C £ O ~1 O U! _ O ~M 9 N L m O M m w c H y d Q`7 O m _ o a a E rn r z E t~rryr~ c333 •N m a a a 0. co 0] } N M N O N (D N J U ~ a) a) } v r y N •\N O _ N C O O O O o m ~ w M~ Q } Q l t"r O N 7 1V G > Q N p Q o 3 ° C = co o ~ ~ y S N w rn C) V ~ a N > O N O O y N LO ~ _ li w p ~ a' y ~ O W 04 N E J-- N N m O U L O N O Q' c Q O Eni Z d3. O i a dx a a 0 CL rr~~•+1 + E i c O O 1 A U a 0 in v ~yv,v AS BUILT SANITARY SYSTEM REPORT OWNER, E?L ~~/~~Sc),•r TOWNSHIP U S`, /I ~y e SECTION-,~,) _3T LA N-R____Z_W ADDRESS A) Zrr~~ ST. CROIX COUNTY, WISCONSIN MAI -~-r- 6c ~G !r SUBDIVISION LOT LOT SIZE PLAN VIEW i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (e f r 1 I ~ \ \ I -3 r f C CL INDICATE NORTH ARROW /a n1 a S G BENCHMARK: Elevation and description: /DJ_ OJ en Alternate benchmark SEPTIC. TANK: Manufacturer: We s'ev-s Liquid Cap. 1006 Rings used:-1-Manhole cover elev: ".S- Final grade elev: y'S! od Tank inlet elev.: ~/7a Tank outlet elev.: ro,- a 7~ No. of feet from nearest road:Front , Side , Rear t.-( From nearest prop. line:Front Side , Rear ✓Ft. No. of feet from: Well- Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE , PUMP CHAMBER Manufacturer: SOD Liquid Capacity: 00 ~Iliimp c Pump Model:nY3~ Pump/Siphon Manufact.: ~ ` `Size , Elevation of inlet: Bottom of tank elevation k Y--?? Pump on elev.:_3L)-~Pump off elev.: 37 Gallons/cycle: 13 D Alarm: Man.: _~j , kr Switch Type : e, eocation Me4 Distance from nearest prop. line: Front-, Side-, Rear'---Ft. i Distance from: Well / Building I SOIL ABSORPTION SYSTEM Bed: Trench: ~}l Seepage Pit: Width: tl Length Number of Lines: Area Built /~Q5_ Exist. Grade Elev. Y! 00 Proposed Final Grade Elev. 2r-47,V Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from well: J3 J No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR:- DATE: ~~~n ~7 s~ PLUMBER ON JOB: LICENSE NUMBER: /f 6/90:cj i~sgartrfl~~nf~flndu3tVER 23.28.17.173A NE SE CO. RD. Y County: Labor andtiumanRelations PRIVATE tEWAG9SYSTEM SafetyaABuiWingsDivision INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171465 Permit Holder's Name: 443 ctt , City [I Village ~Town of: State Plan ID No.: ~ [I ANDERSON LEW RUSH RIVER CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No. L 7,_ 7V Gw z 0 44d . 028-1028-50-000 TANK INFORMATION ELEVAT ON DATA&,;O_ 92002 0 ;n TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C. Benchmark 0 S l j~ Dosing Ae + Bldg. Sewe Holding St/Vt Inlet gyp, 76 92, ' 78 i TANK SETBACK INFORMATION St/,Vf Outlet 911,65 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake -,q Septic '>/&V' >IeZ' .;20 NA Dt Bottom 9'5.c~ Dosing t NA -Header / Man.'/.` , /Aermion N Dist. Pipe Holding Bot. System -c, , PUMP / SHAM"" INFORMATION 13 ze P r Final Grade Demand //y 01re Manufacturer Model Number O5p 33 GPM TDH Liftq + Lrictio System TDH g43 Ft Forcemain Length Dia. Fv?i Dist. To Well>Az SOIL ABSORPTION SYSTEM BED/TRENCH Width Length + .Of Trenches PIT NQ- Of Pits Inside Dia. Liquid Depth DIMENSIONS AP EN I N LEACHIN Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION TypeO 4 , CHAMBER Mo OR UNIT System: ILA), 4,4 A-GA --0 DISTRIBUTION SYSTEM 4 4ea~er/ Man fold y Distribution Pipe(s) , x Hoe iz@ x Hole Spacing Vent To Air Intake Length Dia. a Length k 2 Dia. Spacing d I & oc SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over „ Depth Over N xx Depth Of „r xx Seeded / Seddeel+ xx Mulched Bed / T.pem+ Center /C2 Bed / T-P n Edges /a - Topsoil ❑ No a-Ye-s ❑ No n COMMENTS: (Include code discrepancies, persons present, etc.)-)`,A3 L- i" f Plan revision required? ❑ Yes No Use other side for additional information. 1,23 SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH f , SANITARY PERMIT NUMBER: ` e y _ ~31LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Co ST. CROIX 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. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 2-40435 PROPERTY OWNER PROPERTY LOCATION LEW ANDERSON NE % SE 1/4, S 23 T 28, N, R 17 E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 920 N EVERETT N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER STILLWATER MN 55082 1(612 439-9219 N/A II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned 0 171 i6wN VILLAGE: OF: RUSH RIVER CTH Y ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL AX NUMBER(b) III. BUILDING USE: (If building type is public, check all that apply) 028-1028-50 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 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ 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 ❑ Mound 30 Q Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground At Grade 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ 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 450 1125 1125 A N/A 94.00 Feet 95.9 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 Septic Tank or Holdin Tank 1000 1000 1 Wieser Conc. Prod LiftPump Tank/Siphon Chamber 600 600 1 Wieser Conc Prod x VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum is Signature: (No S p) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature o Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination 7 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 4 1. A sanitary permit is valid for two (2) years. 2 Your sanitary permit may be renewed before the expiration date a-c, .it the time of renew iI 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 ?Yansfer/Renewal Form (SPI) 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 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. Compete 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 mainss.'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 ononies collected through these surcharges are used for mi- otor ng groundwater, ground- water contamination investigations and establishment of standards. sBD-6396 8.11/88) kMi - % f p ON IS W the 0~9 71 i ~ - i 1) oo . / ' 49 Lts C iA r ,r c . GE SY TEM 0 + gEW A 3 rm ' ED 10,it N5 ° ~1 p 'rlt~:~~ s OA ~1LUt c~1~ilj 4 ttiCiISTRY. L t ~ pFFC ~ ~ p~PA NtStGN GF SEE S p c~ AeAN'bo#,l THE EX tSr(PJ V SEPrtc Y S~M-M AS PER U H 2 $3 -03 (Z.) Owner's Name: ~-e Lo Plumber/designer Signature Date: -,C-,<' --I License Number: -19- L > S 51 B - > 5 1 r 2' W 11 ~ ` A 0 0 0 5' 'e115 :y 't 1/6 B v ~ A= f t G= ft g RE~p,S10 NP. 4R ARD B = ) D f t H = a" 0: W = 2 y Gay ft ~~c of voij, ~~c . ~ ~;p gvt~ r Dt?MA, y1S1U►'~ D = ft I = ft B/2 92.S-ft SEE ~ F = ft L = 7 ft B/6 =Uft Fabric Distribution Lateral SiAgtL- tZCP Observation 11 V Soil Cover Well 122 P >5~ A ~21 . >5~ L to „ A66RccaArE Fig. 8a. Plan View and Cross Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site f~ ~►.G°_ ~c_ P=RrORf~-T~-b PI Pc v_':.'41 L 1 Hf r ~L' 'c S•` AT CUD Or CN L/h'YI=~LAL ~uD tAP. Q ~v t-ES LU =.tiTE'J olJ cUTD H o` pVC ' F=P-0" Tau Fl p -PVC" ' L/~Tc--RILLS PLncE LhS'T ltOl~ t ExT -To Eub C-1P '~J\SIRlBuT7OiJ. PtPE ~`r~yT_-."; W ASE S~STtN~ a~S1TE S~ P ~n ~ FT. cojit • naf fi 1 -5 ioVE*l R AND I-~U BUILDItd p[Pi; SEE CGFkRE ~otzc~ riatu >c _.~N_ OF 1 }ULES/pJ PE pL~CE ! ST HO -C ° F P-Ct-l TEE W J7H SU CC-E'-b)A) G HDLES-. t1-T~ 11J~ERUi~CS . >_p,sT No~E `ro R~ ,.~Exr 1r) -THE n c~ P- SEPTIC TANK PUMP CIIA B6 CROSS SECTION AND SPECIFICATIONS 4" CT VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVI:I FINISHED GRADE 4" CI RISER W/ PADLOCK & 7 6" MIN. _ f----WARNING LABEL ABOVE G ADEj_ -4" MIN. 18 " IN 0NS~11~ SEW L zINLET , OR I' T H GAS- 61 }3iI "S Of INDUSTRY, LABOR AND HU T I G H T i , 411 ,ION SAFE A 'SEAL 1 ► rA PROVED CI PIPEALM INTS 41/ CI PE 3' ONTO 3' ONTO sa BON SOLID LID SOIL SOIL C RISER EXIT PUMP OFF ELEV.S~S:71 FT. OFF D RMITTED ON] TANK ANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE < TANK MANUFACTURER : ( Ue'l'Sev's NUMBER DOSES PER DAY : _ TANK SIZES: SEPTIC IC06' GAL. DOSE VOLUME INCLUDING DOSES GAL. FLOWBACK: GAL. ALARM MANUFACTURER: rj t'cf rc~ CAPACITIES: A = ;S INCHES = . < GAL. MODEL NUMBER: SWITCH TYPE: B = 2 INCHES =,_D, C~ GAL. PUMP MANUFACTURER : C = INCHES = GAL, . MODEL NUMBER: -3,3 SWITCH TYPE: e- D = P INCHES = / CAL. REQUIRED DISCHARGE RATE 33 a'g GPM PUMP & ALARM WIRING AS PER ILHR 16. 23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . ff, 9-3 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET + _ FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR . /,6 FEET TOTAL DYNAMIC HEAD = _/-3_ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID DEPTH SIGNED:,. LICENSE NUMBER: •-3c')/s- DATE: 1/88 Po +*~E F O\ui PT ! O Yld2f a- ! I^ 11,x. i . r I .p 0. C~~ EN7 7F NDUSTRY, CFI~A~ri AND H RELATIONS 0 i lSIO, Of FETY r-u BPI N A H H d E*f of y z N Gl H H x 0 w ~ z H A 'TJ C7 A' 40 Z C W ` Ho M H tr'' O Cpl n M ►C i a d r-o d x o... x r~ i CA ro~ a y H to . 15 z 0-4 0-4 tn t" t-3 C) Z V 1.4 y x y a~ ` O boo x Cod to a 3 0 v b a y ci o ri p o N cn r. H M O a W. 0 M P C*) • M Oro be r o 0~ ...'►%3 !~9C er+1 Oro z t-4 a z o r ...n i CA o- 0 o 0 ~ bx o E x H ~ to x H ~o VIII x M z -H tn oil 0-4 Hx f AT-GRADE SYSTEM CALCULATION WORKSHEET Owner's Name: :.LC uy n ~Vl~c:t .SC?, Parcel Tax Number : C_+ is G+ Legal Description: , S , T .2X N, R -~-or~l Lot Number: /LI A4 , Block Number Subdivision/CSM Name: Vsk, Town.of: County, Wisconsin At-grade Structure 1. 37 inches Limiting Factor Depth 2. percent. Land Slope 3. ~.5 gal/day. Daily Design Flow Rate (DDFR). 4. gal/ft 2/day. Design Loading Rate (DLR) 5. feet2. 'Effective Absorption Area (EAA) = DDRR A x B 6. feet Effective Absorption Width (EAW) = A 7. -D,5 feet. Effective Absorption Length (EAL) = B = EAW EAW fp DDFR 8. gal/ft.. Design Linear Loading Rate (DLLR) = EAL 9._ feet. Total Aggregate Width = A.+ C * 10. y2 Eby:feet. Finished Width (W) A + C* +.D + E** 11. / .3? _ feet. Finished Length (L) = 2(1) + B 1.2• Finished Height (H) = F + G 13. feet. 1/6 B.) Observation Well Locations 14 . feet. 1/2.B ) 15. 51~ _ ..Texture of Soil Cap Material. Notes: * C is 0 if the slope is 0%, otherwise C is 2 ft. On level sites, substitute another D for E. Plumber/designer Signature: License Number: 'Date: - Page of D U SOIL AND SITE EVALUATION REPORT H in accord with ILHR 83.05, Wis. Adm. Code , COUNTY Attach complete silo plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but IST CRO[Y not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 8 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ,k yK '_]PJr-U► ce- s GOVT. LOT A/ E 1/4 SF 1/4,S ?3 T a 8 N.R I I E ( W PROP RTY C1WNER'S MAILING ADDRESS LOT M 113LOCKN JSUED. NAME OR CSM N t~~ u ~ ~ N CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAR, 6462:Z_( ) oer C.7. ROAR, rE: e SII 1-0 %wg (J ONew Construction Use ( Residential / Number of bedrooms jt-J~Replacement ( J Public or commercial describe Rakes ~o f~+- G~ Code derived daily flow '4TO gpd Recommended design loading rate bed, gpd/ft2-Y-trench. gpd/ft? Absorption area required 11:25 bed, K2 trench, R2 Maximum design loading rate a bed, gpolft2_ trench, gpd/ft2 rcL-AL !e un$e _ Recommended infiltration surface elevation(s) 9y.6 i<tr~ rn t1o,. P. L It (as referred to site plan benchmark) Additional design 1 site considerations (IS Ion cL s ti ZS, 61 e Parent material /ac,.-I `1`r i Flood plain elevation, if applicable AM ft S = Suitable for system OONVENTIONAL MOU INGROUNDP SURE AATTGQ►DE SYSTI3d IN T HOLDING TAN, U = Unsuitable fors stem ❑ S On I as ❑ U ❑ S Bfi CN'S ❑ U ❑ S M ❑ S B J SOIL DESCRIPTION REPORT Boring # Horizo Depth Dominant Color Mottles Texture Structure Consistence BmrdW Roots GPD/ft in. Munsell Qu. Sz. ConL Coke Gr. Sz. Sh. Bed Tre s t b h O's vT fo 0 1-, C k< vh t -U Ground 3 3 10 A-4 r 5 c F•_. ~ c. sb C L,-) ► U ~ elev. 79'a..ft. y 31-38 `7.S K 5 1 S6k mV~► ' ( Gw~ v Depth to 33-( n lo y R ` 5 c sob tr o f limiting factor Remark's: Boring # sm o-~ ° YR s 1 s bk E 5 aS w. I Ground c elev. y 3~J-~O toy '7, s 1_1~9 AIP L Depth to - - - - limiting lactor - I Y Remarks: t CST Name:-Please Print Address: I r ^ I1 Signature: + Dale: CST Numboc /,6 a SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bour~3ry Roots Bed :Try I O`g V3 S o? Sblc1 CS 3J to j Ground 3 ly-3 ► o sc a c sbk l U ~ C CAelev. Jo 1YR As Depth to C 3 P limiting s 4' 4. 5 sbk yv.{► ' ~o - factor 37,E Remarks: Boring # 0- 1OYR :2~ - ! I YR 3 S tM x 3 sbk . Ground I-7-yo < c sbk ter e t t elev. y 40- 47 1 0 g gyn. k s i f s t", I L t Iv yak Depth to " o to Y~ 7•s K 'e- (q s ? v~ sbk mv-~v . b limiting factor Remarks: Boring # }:C Ground elev. n. Depth to limiting factor ` Remarks: Boring # 5:£ L 2 T< L n...vv. n. n:. ~rt~~ Ground elev. n. Depth to limiting factor Remarks: I I f I ~ ' I I zii 77- 1 ~ ! Lin I i f! ' e 'i ¢ Q rtS tr I I I! I i I I I I I I i ' -1 _ + H I I I ~ I ~ j iP I j ~3 j I o o i - up, - - - to I ~ I i i r3 ~ ~ C ~I I I ~ R ti I i~ II ' ' I K'• i / m I m I ~ - I p Irk I i II ~ ~ ~i I I I ~ F-TL o I I i i~ o 1 1 I ! _ -1 I I i ~ ~ I i i ! I i I ---t--i--r--~--~- - - - - Al" -+---1- -~--I ~ III ~I - j ~ - I ~ _1 -I-- - -I I t a i - it i } I - - I t i ~ i 1 i 1 ~ 1 r ~ - t r 1 1_ ~ i~ I ~ i f ~ f f l~ , I ~ I I I I I~ ~ i ~ ~ r ~ l A l i A l i I - t - - I + Y I i T- L. ~ I 1 1 i I~ ~ ~ I I , ~ I j i I -t i . l i l i I I , L I t ~ ' I 1 ~ Y I I i 1 i i; l~ ~ ~ I t l 1 fi - - - - 41- I 1 _-4- I I I ~ i I ~ I 1 I i ~ i I 1-7 rt ; Ilfill . _ L 1 - } - - L- 4 1 - - - i - - - I~- i 1 I ~ I I I I I ~ I I ~ ~ , ST C- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER Fire Number 3 . I CITY/STATE 'l. [P PROPERTY LOCATION: NE SE 14, Section 23 T - 28 N, R 17 Town of RUSH RIVER St. Croix County, Subdivision N/A Lot number N/ A_ 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 septic tank pumper. What you pUt into the system can affect the function of the septic tank as a treat- ment 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 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 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. 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 Depart- ment of Natural Resources. Certification form mtist be completed and returned to the St. Croix County Zoning Off.i.ce within 30 days of the three year expiration date. SIGNED 1) ATE -Ae St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT 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 Location. of Property NE '1L SE 14, Section 23 , TAN-R~W .r Township RUSH RIVER 'Mailing Address Z Z? Address of Site SSG Q-S &G~/G 'o' Subdivision Name N/A Lot. Number N/A - Previous Owner of Property FRED LULLING Total Size of'Y Parcel 14 r' Nte Parcel was Created 6 Are all corners and lot lines identifiable? Yes No No Is this property being developed for resale (spec house) ? Yes ----Volume' n and Page Number as recorded with the Register of Deeds. (p.I - Ct a }1~ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and 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 refer- .ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) emajy that att statements on this Soxm axe tAue to the best o6 my (ouA) knowt-edge; that I (we) am (ane) the owneA(s) o6 the pxopexty desni.bed in this .inso,-unation SoAm, by viAtue o6 a wwftanty deed Aecotded in the Oss.iee o5 the County Reg-istex oS Deeds as Doeuxtent Wo. 4 Qy5' ; and that I (We) pxesentty own the pxo pod ed site Sox the s ewaq e d igs po.s system (oA I (we) have obtained an easement, to kun-with the above descJci.bed pnopenty, Son the constAucti.on o6 said ;:.system, and the .dame has been duty %eco&ded in the Oss.iee o5 the County Regi6teA o5 Deeds, as Dact* No. gjrgb qS- ) SIGNATURE OF OWNER SIGNAT OF CO-OWNER (IF APPLICABLE) ;D E SIGNED DATE SIGNED DOCUMENT NO. WARRANTY DEED :HIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 484045 --till paGF 47 REGISTER'S OFFICE Frederick J. Lull i n g and Kari E. Lulling, STCROIXCo,M hh- u b a n- d-- a.n d_. w i f-e-- _ Recd for Record - JUN 011992 conveys and warrants to L e w A. An d e r s o n a n d C y n t h i a at 8:30 A. M - -A... _An_de_rso_n_,.._hu.sba_nd---anal- wi-f-e-- Re9isfer of Deeds RETURN TO _ . the following described real estate in St-,-_-C-ro.l-X----------- County, State of Wisconsin: Tax Parcel No_ That part of the Northeast Quarter of the Southeast Quarter (NEk of SEk) lying east of CTY "Y" in Section Twenty-three (23); and all of the Northwest Quarter of the Southwest Quarter (NWi of SWI) of Section Twenty-four (24); all in Township Twenty-eight (28) North, Range Seventeen (17) West; subject to a Farmland Preservation Agreement recorded in Volume 655, pages 237-238, as Document No. 381100. TRAN,, E6 ~r FA This 1.$----------------- homestead property. (is not) Exception to warranties: Easements and restrictions of record. Dated this day of - 19--92 (SEAL) . (SEAL) * Fred ck J. Lulling I - - ---------------(SEAL) ----.(SEAL) - * K ri E L_ul l-ing AUTHENTICATION ACKNOWLEDGMENT ° STATE OF WISCONSIN. r. as. - • - St. C r o i x - County. • RR 1 t ad, Z y of___________________________ 19______ Personally came before me this __!p _______day of elp • G t ~a _ , 19-.9.Z- the above name L d ~ y- c F_r e d r_i_-- k ---1.1-ing and K a r i-------- --1------- 1 i n g--------------------------•---•------•---------- k~a,, ,j LVFik1Q1V .R•STATE BAR OF WISCONSIN '('F!€">!tlt', . - tli()*I* by § 706.06, Wis. State.) person .5_-------- to me known to be the who executed the foregoing instrument d acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack - ~C ~1~ B a l d w i n WI 5 4 0 0 2 - - - - Notary Public ------6ir C Q ------------------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: IvZ J? 19'x._.) - i *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 2 - 1982 Milwaukee, Wisconsin 040 (C) (For use by: ACA, FCB, FLCA, PCA) VOL 9~3PAGE 45 Pagel oft LIMITED WARRANTY DEED REGISTER'S OFFICE THIS INDENTURE, made this 28th day of May , 19 92 , between AgriBank, FCB, formerly known as ST. CROIX CO., WI Federal Land Bank of St. Paul Reed for Record a federally chartered corporation, with a post office address of JUN 011992 375 Jackson St. St. Paul, Minnesota 55101 at 8:30 A. M party of the first part, and Frederick J. Lulling and Kari E. f nnAA Lulling, as survivorship marital property, whose post office address is Route #2, 243 County Road Y, Baldwin Wisconsin 54002 , party of the second part, (hereinafter referred to as party whether singular or plural), WITNESSETH, that the said party of the first part, for and in consideration of the sum of Forty-five Thousand and no/100- Recording Information - DOLLARS 45,000.00 to it paid by the said party of the second part, the receipt whereof is hereby acknowledged, does grant, bargain, sell, and convey unto the said party of the second part, his/her/their heirs, successors and assigns forever, the following described real estate, situated in the County of St. Croix , and State of Wisconsin , to-wit: That part of the NE4SE4 lying east of CTH "Y" in Section 23; and all of the NW4SW4 of Section 24; all in T28N-R17W; subject to a Farmland Preservation Agreement recorded in Vol. 655, pages 237-238, Doc. No. 381100. _ EXEMPT subject to all existing easements and rights of way; also subject to all taxes on said premises for the year 19 2 and following years; also subject to all unpaid parts and installments of special assessments on said premises which have fallen due, or will fall due hereafter. EXCLUDING therefrom and excepting and reserving to said party of the first part all mineral and royalty rights, interests, estates and titles heretofore reserved or excepted of record by The Federal Land Bank of Saint Paul prior do January 22, 1986, if any, with such easements for ingress, egress and use of surface as may be incidental or necessary to use of such rights. The foregoing exclusion, exception and reservation shall include, but not be limited to, all oil, gas, hydrocarbons, coal and other minerals of whatsoever nature lying in or under the above- described lands and all royalty interests as to oil, gas and other minerals produced and saved therefrom. It is expressly understood that the said party of the first part will make no warranty as to the extent of its ownership of minerals, or as to its title thereto. TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. TO HAVE AND TO HOLD the said premises as above described, with the hereditaments and appurtenances unto the said party of the second part, and to his/her/their heirs, successors and assigns FOREVER. AND THE SAID party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said party of the second part, his/her/their heirs, successors and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, by, through or under said party of the first part, and none other, it will forever WARRANT and DEFEND. 13140 (c) v ` 53PAGE 46 . Page 2 of 2 ` IN WKrNESS WHEREOF, the said party of the first part, has caused these presents to be executed in its corporate name the day and year first above written. WITNESSESS: By: Je Le Vtz Regional Vice President (144 (nue) of Farm Credit Services of Northwest Wisconsin, FLCA Acting as Attorney-in-fact for Farm Credit Bank of St. Paul. or: i By: I (Name) (Title) STATE OF WISCONSIN ss• COUNTY OF ST. CROIX ~ Ma _ Me foregoing instrument was acknowledged before me on (date) 28, 1992 by (name) -Jer Lehnertz (title) - -Tonal Vice President of as Att n- t ha of Farm Credit Bank of St. Paul. r 15'00 . M. 'I r Notaryry lic"r S *x County, Wisconsin My commission expires 4-9 1 95 n 0 ;any SIN STATE OF . ss. COUNTY OF The foregoing instrument was acknowledged before me on (date) , by (name) (title) Of , on behalf of said corporation. Notary Public, County, My commission expires This instrument was drafted by: Farm Credit Services of Northwest Wisconsin, FLCA R. Anderson, P O Box'199 V River Falls WI'54022 N 'G1 . ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE -e 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 May 22, 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 Farm Credit Service property, located in the NE 1/4 of the SE 1/4 of Sec. 23, T28N-R17W, Town of Rush River, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 37" making this site suitable for an at-grade replacement septic system. Should you have any questions, please feel free to contact this office. ly , -titere_v James K. Thompson Zoning Administrator cj RAPE) NOTE FROM -4 TO DATE J X '..1. 1. ' r G lee, ToaS NO. 3702 SIGNED''- LITHO O U.S.A. J(NA GVotx ~i2o M. F .S~fZ't SW t M 1 ~ L I t~ t J i ~L.-aS E r-(LL 60T .aa t1 S cC-JQ~ WC, (T'e F© f2,M F-CIR LJGAJ A ni D~2~ ~fZOP ART`( . .TH(S tS -CH;-- QVtQ inn Tvi&T 5%c>vvz> 8E uMr_-> AT-- GRAD C- crT>t-C'Es . "fmO(Z, ~t~ Pt J ~s-ce~~o TfflS ^A ~ Y FtLe _ c.s S S~r~~ CT SACK 03fftrl ia%3 C&R1. 6 ? 8 ti do _elk 2 `