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040-1214-80-000
Q c m ° °9 o p °Er, p rr ~O y4 N N a 4 0 0 2 C t Q O N - i I I ~ I III N O cC i 4. ~ N N tU N N C o z 'a z c ~ m c ~ m LL C N LL C O 3 O 3 Q Y Q II CY) LO Z N Z y rn Z O O Z 6 £ v W G1 N G7 N w a m a m z 0 0 z v c w N ~ p CD 2 d c Z <n H I' m O O c E c E -Q a~ ~ ~ .O tT v Cl) I q N D) = N Q) 3 CL cy V~ n O O N y cc O x N i 6~ c N N N • N I Q. ~ L d U L ~ C ~ O C C O U 0 O O Z M Z Z F Z Q Z N w~ N C (0 4) `T o o N _ y "It ` C: I !i O N I - N E - L O 10 LO N C. (o O o. w c L v > j=ooa a rn cca U ~N E c c E v U roi m H H H d Fes- H H? = o 0 0 0 2 0 0 0 z° • +v w m a a a a a U 0 R (9 O n- " 04 M~ 7 O y C O O U O W N N J U N O) Z W- O) O CO AV OIz O) CI E N ~ O ~ O ~ m 4. r M v ~N o 3> 'C (n Q Q z 1:11) o .o m Q z m U) Q O O od N C M N C I O O E 75 LO CD O O N j O O O U N N O O O o o o a~ c (I o c c A a) o 00 1r. 3 N N E N_ N C C 2 rfl N V O O O N co I~ N O C C N N O Z N C M ,O -zz v.r eN- N u"7 co LO CN 0 7 o N E 7 u o N m m • 1, o c° F- C~ 0 z (n N Fo Z °r o N U) w m 41 v~, m s W d a xt a' a w a w • R CL y .V a C N N c rr.~ C m = 3 3 o "~1 A U a O (o 00 o in U 1 tif FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER *6 TOWNSHIP SECTION / Ll! T 21 N_R W ADDRESS 361 S oo 4e1X1,c A-e ` ST. CROIX COUNTY, WISCONSIN ~7 UO,SD,/ ~!S_ SAO/~ SUBDIVISION ~~ov 577 7~ia-✓ LOT 3y LOT SIZE i PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i I INDICATE NORTH ARROW 'r *V Gs" w~vG h~ - 7d~o ®f BENCHMARK:Elevation and description: / _ 00,0 O Alternate benchmark ~olo '1,0': SEPTIC TANK:Manufacturer: w S SOD'`'PDo - &yoa % /GOo ~•~G,,i C ~O , Liquid Cap. Z 71-_v&S /s r r~,~,e 105 - YZ a Rings used: d Manhole cover elev: Final ~a y`S /sr T~tik: 1c23,0 grade elev: loy, YO^ ioz. Tank inlet elev.: io2,972. Tank outlet elev.: iD 2-, ! Z No. of feet from nearest road: Front 11 Side , Rear Ft. ZSd From nearest prop, line:Front Side , Rear x -Ft. No. of feet from: Well 4E// a Z 7 Peml m , Building: (Include this information n~ h above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE tJ' CM'ON 011 83N` IS3:! . „'S'd dA Lfi£E 'ON Oll 833,01_1 y!tr lH91891n 1d]:;0H 9tM SIM'N0SGftH' uU , '00 EMeAflid oac''s _t P:06/9 : 2 agKnx SSxSOIq gor xo xaswnza SyYQ U0y0sdsxl wean*4o 3nui2H M.zetY P902 499aeau ' buTPTTnq ' t :moaj 498J -ON aeag ' apTg 4UOa3:auTT •doa 49aaeau utoa; qaa; •ox F :48TUT 30 UOT49AOTg : Xue4 ucoqqoq UoT-4vAOM : pasn sbUTa 3O 'ON :1C'4toe :.z9an4oe3nuvK xNYy oNlartox buTpTTnq utoa3 4e93 *ON :TTOA ut0a3 4993 -ON •:t3 aeeg ' X OPTS ' 4uoa3:eUTt •doad 4seaveu moa; 499; -OR s 1s~.3 _ .Z~ a/- : adTd 3o doq o4 ggdOP TTTa •AOTH OPgaO TvuTd posodoad •AaTg ePezO •49Txg F Z i 4TTng eaay Z :sauTZ 30 asqumx q,45ual :144PTM Md ebedaaS x :gouoay :peg HZISxS NOIldMOS9Y 'IIOS bUTpTTng ttaM :U, 9oue4sTa •~3 aeag '-OPTS ' 4uoad :auTt •doad 489ae9 MOa3 8OU949TO UOT4e3oZ : edAL g34TMS : • UeH : ucaeTY :eToAo/suotteO : •Aata dumd : •Aata uo dmnd UOT49ASTO XUe4 90 uto og :49TUT 30 UOT4enaTg azTg dacnd : •qoe ex uogdTS/dmnd : TapoH dmnd A4Toe pTnbTZ :asan4oe3nuvH HaUHVM df+Ind Y N r g Z a: V Z S2 . W a S9 S2 a= mo 'gw 3 O 3 ub, o a o ~j Yl x~ < - ~ o ~ O ~ v ~ r ~ W V4, `y II q L I I I I I I I I J I ' I I ~o I I I I qq~ I I I V 1 I 1 I I 11 h r4 - I I i ~oO J i I I 1 I 13, I I Cp I i 4(Zt 3< I 1 I v ' Inv a N t oc~ ''QN• TR~Y~ 76.28.19.1032 NE NW LOT #39 GLOVER STATION S.PACIFIC PF-7 s partmen o In ustry, P~ZIV~TE tEWAGE Sj(STEM County: Sa Human Relations INSPECTION REPORT ST. CROIX Safety fety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAIt INFORMATION 180274 Perm ii Holder Name: ❑ City ❑ Village (R Town of: State Plan ID No.: C d'INNIS PAUL TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: lb- 66 J eS ~ / - /l/Y "f G, r _i." 040-1214-80-000 f TANK INFORMATION LEVATION DATA A9200353 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c~-$dOr, Benchmark 160- V , Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet & A G 1 102.08 lo' k, TANK SETBACK INFORMATION St/ Ht Outlet /0a `Az a.z 6 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ~Ia 5- 7 to , NA Dt Bottom lDl. 3 a- Dosing NA Header/Man. Rk !off i Aeration NA Dist. Pipe S.o5 5~- 3 _ Holding Bot. System 9'q6 ioo- 2A g, 5 /00'a io3.9 ~a8 PUMP/ SIPHON INFORMATION Final Grade 5'.9g l03, 7- c426 / Manufacturer Demand , y q to,/, a,- Model Number GPM I Loss Friction System Head TDH Ft TDH Lift Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Tr_enfhes PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S gs er DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: Systemtx/L, 3q l A6I OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over n Depth Over nn xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Centerr Bed/ Trench Edges c1~y Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 16.28.19.1032,NE,NW,LOT #39,GLOVER STATION,S.PACIFIC ~ -I,Sid -I , a 8 • 6,1 -714 , T I 14.6 411) ~;'6 t .fib tkr 4 s / a~ o S Plan revision required? ❑ Ye ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date spector s Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ti SANITARY PERMIT NUMBER: t _Iq DILHIR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY _ C~blK STATE SANITARY PERMIT # -Attach compiete plans (to the county copy only) for the system, on paper not less than 1/(~/ 8% x 1 inches in size. ❑ Circe 1f'revis~on topre .a application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION G U L /tf li MCY. S T N, R l/ E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Z ~>tssiE cr,Pe~-/E 31` pig t' r10 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~S Sy0lCo ~8P z Crleve ' SrI-770"4_1 Ii. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned 0 VILLAGE xO y ❑ Public ~ 1 or 2 Fam. Dwelling- # of bedrooms PARCEL 'f TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 4/0 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. TYP OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure _ 01 430 Vault Privy 14 ❑ System-In-Fill 2+ 3 ee 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 TT REE /+QUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0 ELEVATION 2~v '739 0 ' Feet o 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 W~~I~ ~Q,v t structed -[I F] 1 7 F-1 Septic Tank or Holdin Tank 8 Lift Pump Tank/Si hon Chamber- VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er's Signa ure: (NS rP/MPRSW No.: Business Phone Number: Ro U 4#(4 330? ( Plumber' ddress (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT'USE ONLY ❑ Disapproved SanitarFy ermit Fee (Includes Groundwater Date s ue Issuing Agent Signature (No Stamps) Approved ❑ OwnerLiiven initial Surcharge Fee) 0)) Adverse Determinati n o J X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' ,A 3anit4ry permit is valid for two (2) years. 2. l~ou~r saiiiMrjr permit may be renewed before the expiration date, and at the time of renewal any new r 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 every2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the ` State of Wiscons.•in, •Safety,$rpmildings Division, 608-266-3815. To be complete and acdurate this sanitarypermit application must include: t 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. 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. 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 siiing 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 monitorinb groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) R 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), thenia 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&l/4 1/4, Section , T 2-k N-R /7 W Township Mailing address 4 N-- 0' t L` l` Cc~I~Z l Address of site Subdivision name /U.-r Lot no. _7Z other homes on property? yes =No Previous owner of property u-1fe Total size of parcel `Z S, C Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes ~No Volume'76 -?and.Page Number / S 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 & T11E 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 i t~i~ 9ffice of the County Register of Deeds as Document No. 7 I , 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-applicant Date of Signature Date of Signature ~ f ~!6 ILL Mu md 2.~ a IN" t~ V"Wft MIS rfwi/R am t+m 1M- y' ash. 11th ~t •lMMis .~~rw w G.i1. Ever ftl Zas per i~~--.... ..s~....> ......M:f Uft OUO G ow Patios ftc d PAUtiong ~ Qwfac O~tty, wisoossin. ~ { k:+ l PAW& 1 -1 ad U-M to vftiw as A. 01" ow so nu 40 isstt o a j~a~r,' d=mKT*ct lM i cost of the faw prs olaCi M Y 1r.. sir ws~M ritliw..t r. ~'~•~+~+~r~ * 4 fr..~.. rel~eiMi pct-my dw stl.e...._...., sma bass dwot 10 **P* loc. , M~ 1~1i1Al~p. K Mlle wlirn M b tM tM~ d-sn All c e 110 q t i 4~; a°•I at .r M Oaf y a test MK Priam o j"n 4 SI R w Plow idarn of !'+nirwri; 4 y "Noll w *000 ~w atai ero~t o ACZXO LBDGUsrf ....t«.w STA= or WUMNS[N ' ~ era {~~'x~ St. cruix 4~ «N U low bob No OWN& 04 w MAU v i. • off; r. M1►11r~ yY~pcp~ Z~ i ~ ~ ~ 111" or #iith Ns !a AMR v;.' S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER w f ADDRESS S~ rh i~ c ct n FIRE NUMBER CITY/STATE ~C, d, 1 % ZIP PROPERTY LOCATION:A)~ 1/4,,AZJJ-1141 SECTION, T 2 ~ N-R L1 W TOWN OF St. Croix County, SUBDIVISION 6, /0 f~"ah LOT NUMBER .7 9 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 Oiat~e. SIGNED• DATE : e St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 PROPERTY OWNER SOIL DESCRIPTION REPORT Page L of PARCEL I.D. # z Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trerch /0Yk 312- s/ sb~r ~►vf,~ ~.s z f y s ..,yr v < Y: Z 6-2-0 10 ye y - S/ ! f s hk~~ cs z f . y . S Ground 3 36 /o y/i? S/p - /S ,.+,n ,e CS ~f , 7 iolevi~t. /o /o ye S/j( s , s~ i 7 Depth to limiting ~f%00 i Remarks: _ Boring # o ~p /o %/f 3/z S/ 3,~ s6~C M,vf ~s 3 f , s l~..,h 2 0 ~S /0 ye 312- f sd/c 7r2 es /Oy R 7/ Ce Ground 141 S S elev. , 1-/0~ yle 5/7 107-109 ft. Depth to limiting factor ,>/o Remarks: Boring # z~ / a-7 /0 Ye 31 a- S/ 3,/iv shr .„.,v f2 s Z 7 20 o yie y s~ f -5,-61(- es Zf Y s f~ a s 7 Y/e s IV" Ground elev. /O Ye r/7 - S iN'► 5 d le - 7:,o /oy 8ky ft. Depth to limiting factor >//2 Remarks: Boring Ground elev. ft.' I Depth to limiting factor Remarks: S8D-8330(8.05/92) Lvvisconsin or abor abor and d Human aman n Rel Reladtio ons naustry' L SOIL AND SITE EVALUATION REPORT Page. of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT G,Po~'~C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If ' dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION P4UG A/C GOVT. LOT W,6- 1/4 Nk) 1/4,S /lo T 2S" ,N,R/7 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUED. NAME OR CSM # y92- 1-4551z- C i ~PcGE 3 9 G/ovE,P sr.~7-10.L-1 CITY, STATE IP CODE PHONE NUMBER OCITY VILLAGE [MOWN NEAREST ROAD vpSOAI S a~G (~iS) 3 PG - 3 PyL TRo y sovt~. P. %~i~ V] New Construction Use Residential / Number of bedrooms Y Addition to existing building ] Replacement Public or commercial describe Code derived daily flow '75 0 gpd Recommended design loading rate! bed, gpd/ft2 ' trench, gpd* Absorption area required X bed, ft2 7-300 trench, ft2 Maximum design loading rate / bed, gpd/ft2 `e trench, gpd/ft2 Recommended infiltration surface elevation(s) -s-~ PS • 3 ft (as referred to site plan benchmark) Additional design / site considerations ZISE Tif'E,u 44.%* - Gvi yz.- :P eW Q 0 X 3,,S7,'-e1 ea T~oN Parent material 5CS 8L ,G ~P,f~ti y,PpT S/ - 10,17749 Flood plain elevation, if applicable 41 ft 7ui S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem D S ❑ U ~ S D U 50 S❑ U p S E1U 11 S E] U O S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD/ft .•,,.•g in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch v o Yl 312- Sl 2, f s,6iC . ~QS eS Z"" S" , Z 31 /o y1P 31- S/ 2 s~~ s c s Z~ Ground .3 /-9Q lO vl s`~~ O ten, S G(•~ / / . 7 elev. /off ft. 8 Depth to limiting N factor 0,. Remarks: Boring # Z /o Ae 3/L 3 s/ 2, f, Sb r d C-r < / -2 y1$'viiiti4T.Y J Ground elev //D ~O yie 5~~ $ O C S i 7 /03. Gp ft. ' Depth to iimifng ,PPR V ED factor ThI nseptl SYSTO for a cc l. i Remarks: I CST Name:-Please Print H I SEPTIC PLUMBING Phone: ~s, 655 O'NEIL RD. HUDSON, WIS. 54016 3~ el~~s I' ddress: ROBERT ULBRIGHT •11S MASTES R' i I BER i it NO a307 n P R S Signature: -w,,i. INS rALLER & DESIGNER LIC. 140. 00663 Date: CST Number /d/ O~ n HOkff:SITE SEPTIC PLUMBING CO. 132- 103, & .9 655 O'NEIL RD., HUDSON, WIS. 54016 ~ Z ROBERT ULBRIGIHT 3 r wr,. MASTER PLUMBER LIC. NO. 3307 MAR.S.' 3 /o6 , 56 !,1!NN. IN jTALLER 4 DESIGNER LIC. NO. D0663 y /0 7. IP-" 2- ~o (fop /r, r, of P•7,< /ram ~~~i~iN • si ZED ni 1 97- S -!v /g, y W X33' a a o /UpQ v A'UK` y T35 B~ /oy, a9 , T'hls test site APPROVED f or a conventional septic s ste r<S T-r`l~ C T S N c Y t Su 6,6 1 UAT ro A.) -5. y~7, fo $7 LpGt~,~sT' Tit'E,v at, ,rr4X7' a ? 4 16? 0, 0 lpG ,111yti,eST MEti,54_ z ' yOUSE tiIUS r- o >3LD , 547,0 47- Gi '~ovv0 so . P.9cr ~rG . J ~ 3 f 3 /O/. O~9 HOAR€SITE SEPTIC PLUMBING CO. Z D3 - 666 OWEIL RD., HUDSON, WIS. 5401' # SST ~~L ROBERT ULBRIGHT 1 c ' WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 3 lob / MtNN WALLER 8 DESIGNER LIC. NO. 00663 ° _ /3~ G /~ti of P~ T S 4 TrN lr y/P~D~ i~ rious 4el s .s ~X G 3 5 ST~''t s ysr~~, B~ yoz o ~p4~o s/ST = y90 I, ~ I - p, f3a I i~ I 1° I 11 1• I I 1 i, /J/" f/ sE r I I I I I I M I i Im , a I I I IBC I j 111 I 1 I I~ l i < ~ I i I 1 I I ~•%///fT ~3 1 1 I I I I ~O-~ ~ I I e 2 1 I I ~ 1 I /35 pO b T' .6 PIS, 2- 'f 4e T~ 10~. o QOXF~ Su 6r6 ES T, P C T peN I Iti rF ~~✓~TfOAJ S ~-'+E oLl Ad ~F 7 LO~sT 7~PE.u GGc, _ _ f E~ Posy ' ow 6vT L . Nit X 7- 7~e ,u6i~ , 7.r~ 9fi~ o /00, 0 /oG Lfi yA,l si 7le4,uc(,/t,2 D I • yOUSE tilUST" LSE ~9T L~ ST &4 tilo~°E 75-6S 7- lqr4 • Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12".Above Final Grade , X%S7/, VE 4" Cast Iron 3~P "Above Pipe . Vent Pipe' -to Final Grade Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe o 0 o 0 o . Aggregate 0 Perforated Pipe Below Beneath Pips to Coupling Terminating At Bottom Of System s~ _7C Fresh Air Inlets And Observation Pipe Approved Vent Cap J -Minimum 12" Above I!' Final Grade • Above Pipe 4" C a st Ir on Zo Final Grade Vent Pipe' • Marsh Hay Or Synthetic 94vering min. "Aggregate Ov Pipe Distributio Tee pipe 0 0 0 0 0 , " Aggregate 0 Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System ' Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12".Above v 'O/L' Z Final Grade _ 4" Cast Iron • Above Pipe Vent Pipe* 'io Final Grade Marsh Hay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe ' 0 0 0 0 0 ri Aggregate o Perfbrated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System /OZ- ,Q . IFresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above ' Final Grade 4" Cast Iron "Above Pipe - - -to Final Grade Vent Pipe' Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe ' Distribution Tee 0 0 0 0 Pie _00- . P S`/Sr :cl"Aggregate o Perforated Pipe Below Beneath P(pe Coupling Terminating At 410'~ Bottom Of System ` ov+LET Tr /OOV . Frrst~-vU- ~ ~ ti votif;4j f ietD o c(3D OVT~tiT HE qo, sy 5TH / 1 06 1 I 23, e4- JS7~H ~ ,a I i 1, f f ( r 133 v YO To T-1 eF 10 RUC roverE N~.u~ ~Do P/~E~~tsT ~ P AMP ~ti.,*MQt ~ ~l'0Y e~qv e~lc ;r25- IN LC 7- 7-0 J ir PO/.JT L/FT 7 L SIiE SEPTIC PLUMBING CO HUDSpN. WIS. 5416 y yg i ' N.Gfltr G55 O'NEIL RD NT ULBR0G 1 R09E 3307 M.P•R•S' } /02 7 7 NIS. Mrs ~`A Pt-Uh10ER LIC g LIC. N0.OOfi63 Z n ;,DESIGNER q Z /o ~Z P,6~4 3 q, S m fay i°a•S z N_ 5ctt % / 30' s 's T E~~ y So; / PI ,Ts EYT2~~ae S Co •f;~' E- ZISE/~ 1 a = rs r%~ ~ s~ 3 C J = BOTTOM /OWEST Tpeo~ . f5 ' ~ of S r~ / cam: MiDD~~ EN~1.. 2 7• w/1eAL ii- HEt7 Alo ck G/n i,rI.tld F y _ ~ >a rJ = /OQi ~ Tl0 /7i ~rff~5 T Tit~E,v ~ GL • Fresh Air Inlets And Observation Pipe ' Approved Vent Cap Minimum 12"Above Final Grade 102-5.-0 -9 4" Cast Iron 30 "Above Pipe Vent 'Pipe' 1'o Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 . Aggregate 0 Perforated Pipe Below i Beneath Pipe 0 Coupling Terminating At Bottom Of System 9 9.0 2~ . s%5TE e j . Fresh Air Inlets And Observation Pipe Approved Vent Cap -Minimum 12" Above ' Final Grade %elf-PE" z Above Pipe 4" Cast Iron -ro Final Grade Vent Pipe' • Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution Tee pipe _00- 0 0 0 0 rgate ePipe 0 Perforated Pipe Below syST~i~ Be eagth 0 Coupling Terminating At Bottom Of System 0 W47 5 7- • Fresh Air Inlets And Observation Pipe - Approved Vent Cop Minimum 12" Above ~i iv/s 1142) r%1fW 9:E=' Final Grade s'J 9 3 -tb /J Above Pipe 4" Cast Iron 7y " . to Final Grade Vent Pipe Mo•sh Hay Or Synthetic Covering ' Min. 2" Aggregate Over Pipe Distribution Tee • Pipe 0 0 0 0 0 . r7el 61 Aggregate o Perforated Pipe Below • Beneath Pipe o -Coupling Terminallng At Bottom Of System sys T~~ ~Ss~d • Fresh Air Inlets And Observation Pipe Approved Vent Cap -Minimum 12" Above Final Grade 4" Cast Iron "Above Pipe to Final Grade Vent Pipe • Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe ' Distribution Tee Pipe 0 0 0 0 0 " Aggregate o Perforated Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System d PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS pAJE g of 5- VEWT CAP 4"C.I. VENT PIPE APPROVED LOCKIWG WEATHER PROOF JUNCTIOW BOX MAWHOLE COVER 25' FROM DOOR, w/4VtVA0J'v&, 1AAf1 WINDOW OR FRESH 12"MIU. AIR INTAKE <JIZAI~E v^TYON GRADE I 4" MIW. J I ~ C/_ fJO' 16" M►IJ. ~D b COWDUIT ` ~IEv~n/oti J PROVIDE I - INLET AIRTIGHT SEAL I III ` L_,,, - I III SIDE I I APPROVED JOINTS APPROVED JOINT IN ~aN K I I i W/C.i. PIPE 1J/C.I. PIPE I ~(UM ( III ExTE1J011JG 3' LXTENDING 3' ALARM ONTO SOLID SOIL ONTO SOLID SOIL B Zy ~3 Z5 j I I l 39 I I OW ELEV. FT. { PUMP OFF D 12>,i5 ~i trio / BLOCK 4^N k G ~7 16 VA RISER EXIT PERMIT( ED OWL4 IF TANK MAWUFACTURER HAS SUCH APPROVAL SEPTIC f SPECIFICATIONS DOSE CQ vG,P~ T~ NUMBER OF DOSES: 3 PER DAy TANKS MAIJUFACTURE.R• I' TANK SIZE: Poe) `P GALLOWS DOSE VOLUME 1S0 J. LtUG INCLUDING~S CKFLOW' GALLONS ALARM MAWUFACTUKER: INCHES OR 311(F GALLONS ~Ly CAPACITIES: A= ~ -7 R MODEL NUMBER: B = L INCHES OR GALLONS SWITCH TYPE: PUMP MAMUFACTURER: C= IIJCHES OR //pf GALLONS I, ~ / z 2f~G i' MODEL WUMBER:~`~~~- D= INCHES OR GALLOWS SWITCH TYPE: P«~"FI"04TNOTE: PUMP AMD ALARM ARE TO BE GPM INSTALLED OW SEPARATE CIRCUITS -30 MINIMUM DISCHARGE RATE S. VERTICAL DIFFEREMCE BETWEEW PUMP OFF AWD DISTRIBUTION PIPE.. FEET. Aok ~fGS ^J + MIWIMUM NETWORK SUPPLY PRES LIKE , FEET EAL~ Off" } loo FtFRICTION FACTOR.. FEET t••(~UA C 20.5 FEET OF FORCE MAIM X /J F j .39 ~ y ~/rl r{.S• TOTAL OtiWAMIC. HEAD = FEET J INTERWAL DIMEWS%ONS OF TAWK: LEKIGTH;WIDTH ;LIQUID DEPTH i 12 Vold Vo% 9 0 s iV HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "913" r* 30 4 5/8 a- 2 5 9 I 3 5/8 't 2 m 6 + Q -I- 15 4 3/16 ,l 4 9 10 1 1/2-11 1/2 NPT 2 5 0 U.S. GALLONS 10 20 310 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE a TOTAL DYNAMIC HEAD/FLOW PER MINUTE { EFFLUENT AND DEWATERING * CAPACITY 12 + HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 81 231 31 15 4.57 45 170 ! 20 6.10 25 95 - 3 5/16 Lock Valve 23' r r e CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. 1P Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. i Standard all models - Weiht 39 lbs. - /z H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak' i N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 _ duplex (3) or (4) float system. ' 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- "E88 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0002. 7. Two (2) hole °J-Pak", for watertight connection or splice. CAUTION }a For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quell- Piggyback Mercury Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, tied licensed electrician. All electrical and safety codes should be followed includ- 7;+ FMO495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487; and Simplex Control Box, Ing the most recent National Electric Code (NEC) and the Occupational Safely and rf FM0732. Health Act (OSHA). RESERVE POWE D DESIGN For'unusual conditions a reserve safety factor is dfigineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 Lwisvd+e KY 40256-0347 Manufacturers of... Z EZZI~ 01 SHIP T0: 3280 0++ PA'116 Lane Af 0 O Lowsvide., KY 40216 QUAI/TYAWYOS ' dNCE ~9a i,4 (502) 778-2731 0 FAX (502) 774-3624 1 SANITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY 7 D STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~y /902-7 8% x 11 inches in size. IJ 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. PROPERTY O ER PROPERTY LOCATION cR • F4V e-- A e, / E_ 11,, lt4 11., S / lP T 21?,N, R E (or) W PROPS TY OWNS GLLA~DDRESSellgC 1E_ LOT # 3 ? BLOCK # 1~dT5TI 2A~ WPi'T-- CI , , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER P Z ~loU So-~/ O~o,tr Gtr/, ~SS/O~<o 4106) 3 11. TYPE OF BUILDING: (Check one) CITY ~ NEAREST ROAD ❑ State Owned VILLAGE T~ V _G / E ❑ Public "7 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX =w W. I III. BUILDING USE: (If building type is public, check all that apply) V 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. 9 New 2.E1 Replacement 3.E1 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure I / 43 ❑ Vault Privy 14 El System-in-Fill W 3 ~,v,,4s x 69 3 VI. ABSORPTION SYSTEM INFORMATION: /OO' 2 67 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) EL(~EVACTION 73"0 x4f - Feet / ' / Feet CAPACITY VII. TANK in gallons Total # of ` Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel glass Plastic App' New Existing Gallons Tanks C Concrete structed Tanks Tanks SCI Septic Tank or Holding Tank C_ El El 1 0 El Lift Pump Tank/Si hon Chamber 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) rUMPRSW No.: Business Phone Number: POg&t T G~R~Gt, 30 7 pis -,?,es Plumber's Address (Street, City, State, Zip Code): .4=1Z V IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Issuing gent Signat Stam ) Approved ❑ Owner Given initial zfj,~ Surcharge Fee) Adverse Determination (J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber w 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. 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. 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 investigations and establishment of standards. SBD-6398 (R.11/88) EL~~//tTiD.u S , /O/. Oe ' HOMESITE SEPTIC PLUMBING CO. 2 03 - o 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT C$T "X 1 ~~2_ n WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 3 /O~ • lct~o MINN. INSTALLER $ DESIGNER LIC. NO.00663 13 X07 01~? wat~ 135 Sc.4G,E- . / 30 ti°EC~viiPED For 5- 4 = E,~ r s T/N G y'/'f9E c /E "W-X us -1;r4v 4e.- s s 'x 3 .4 ysf4vt /00.2-6, SyST~~► 10,9.2- a ysT~'~ • rol /OD.2~ ~ ~ I t 1 I ~ I C I ~ I ~ , z I MI I ~ I ( I j 1 1 ~ I I p M I ~ 1' ( h l 1 ~ y r I I I i 1 B3 \ /0010 I3M~yS~r: ~i ii ~ i 2 1 ~ I I y 'V /wc io~ P--6f- 1 0-29 Bi /oy 2~ 135 gno Cyst-~ KS 44 T /01 Su G-G eS T%el) T peN c fti~ -6- 0 AED~t'.ti f I ~ T r0 J3 S - /,feE,,, 7-- //o-YF -/0&A -.s T 7AE.u GIB - 7 O Po s7 ov 6of fl W6, 99 O ivE~ i Ti~E,c~ /00.0 !/i yA-.,si lkeua, /O/. O /oG • hioasE vs r~ L~~- F LESS T ~S of '4r0,eE T~sT 13G0~ SF.-lv~il° 604-44 ~i ~E~ei-Yf/V T 44 (/S T Lim ~T -Fovwo A4,J-7 d ~tT~ov a~ /o ~!S FT ©.e /i•~ s. E. Cdr •r , r . Fresh Air Inlets And Observation Pipe Approved Vent Cap iy Minimum 12"Above .v i S h ' Final Grade _ 4" Cast iron 3(r Above Pipe Vent 'Pipe 'to Final Grade Marsh Hay Or Synthetic Covering Min. 2" Aggregate ' Over Pipe 7 Distribution Tee Pipp 0 0 0 0 0 a " Aggregate v PerfOroted Pipe Below Beneath Pipe o Coupling Terminating At Bottom Of System x: III : ~~~~-v Gyp S REPT131 TROY ST. CROIX COUNTY ZONING PAGE 1 11/13/92 10:05 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/13/92 AREA: TN Activity:•A920d353 11/13/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 16.28.19.1032,NE,NW,LOT #39,GLOVER STATION,S.PACIFIC Parcel: 040-1214-80-000 Occ: Use: Description: 180274 Applicant: MC GINNIS, PAUL Phone: 386-3882 Owner: MC GINNIS, PAUL Phone: 386-3882 Contractor: ULBRECHT, BOB Phone: Inspection Request Information..... Requestor: ULBRICHT, ROBERT Phone: Req Time: 15:11 Comments: X06 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item;-00012 FINAL INSPECTION 21 ~Er ,t:~ ~yyyyy~~ ,,r Y v 4 6 A DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION ~.0. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: SW, NE , 16 , 2 8 , 19W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town Of Troy Atolding Tank ❑ In-Ground Pressure ❑ Mound O R IT 4R~Te 2t ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Douglas Geissler 1119 S. State St.Apt.263 River Falls BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST PER PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas Wang 3231 St. Croix 119537 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST---* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER PIT INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES L] NO NEAREST-~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator SBD-6710 (R. 06/88) Thomas C. Nelson ®It.HR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code TWYPERMITA STATE 7V637 -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. PROPE OWNER PROPERTY LOCATION ~ Tdv, N, R E (or 0 CL_ ~ t55 ~t'i/' o l !1 % N S /Z PROPERTY OWNE 'S MAILING ADDRESS LOT # BLOCK # ~cl~ s7~te sr, Qf~ ~6 1 TY, STATE I, ZIP CODE PHONE NUMBER SUBDIVI/S~014 NAME OR CS UMB.,E,(R II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned '2 ❑ VILLAGE (3 19014. Pd' PAC 'I I < ❑ Public N1 or 2 Fam. Dwelling-# of bedrooms PA EL Ax UMBER III. BUILDING USE: (If building type is public, check all that apply) G~ D 1 /D 3 .1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 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. fKJ 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 9 Seepage Bed / aX 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 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 1 Div 99 F Jb3. V eet VIN. 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 D V e sr P C 5 . I . Aj 1 0 L1 0 0-- Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Pium~r's Name (Print): Plu s Signature: (No tamps) MP/MPRSW No.: Business Phone Number: LI/k Plum is ddress (Street, City, Stat Zip Code): X L) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Lga nits Permit Fee (Includes Groundwater ate Issued Iss g gent Signature (No Stamps) n Approved ❑ owner Given Initial Surcharge Fee) L" Adverse D t rmin tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 approvedby 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. - II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check alil 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; close 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 investigations and establishment of standards. SBD-6(198 (R.11/88) 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 ! l Location of property J- 1/9 19 1/4, Section 16 , T d t N-R la Township Wm Mailing addres PIG 5 6)Z Address of site Subdivision name C16 U -ei- Lot number Previous owner of property S S 0 IA' Total size of parcel/ l~ Date parcel was created Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes No ell Volume c~and Page Number as recorded with the Register of Deeds. 4 (,r t 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 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. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has du recorded in the Office of the County Regis er of eds, as Document No a-~.~_). 141) 11 J-4- Al' gnature o Owner Signature of Co-Owner (If Applicable) V Date 94 ig ture Date of Signature a ' `wry I. 1111 ~A~l ipecu"Ma .s no. rrr AM* Dennis R. Schultz and C. 3~[. lye -at r eii oven rijit, JUL 0 S r I E sgD Sail Qnafi p..Built Howes. a partnership . CORfi9tof Lawrence N. Johnson,-_ inc Kruger and Eugene O. Larson . Grantee, # 'Witneilgeth, That the said Grantor, for a valuable consideration . - 1i at{TUR" C. III. e _ ' "eveya to Grantee the following described real estate in . St a CroiX P.0 . Box 167. River ral County, State of Wisconsin: WI 54022 Tax Parcel No:........ Let f39, Glover Station Second Addition Land Only. TLANSM } 'T i 1. This A W. not homestead property. Tugdb a with all and singular the hereditament, and appurtenance thereunto belonging; Asa ...A►i~~. R. Schultz and. C. M. Bye a wutrYpt that the title is good, indefeasible in fee simple and frcc and clear of encumbrance except a mieipal and zoning ordinances, easements for public utilitiesr and building restrictions, if any, i' eutd-=will warrant and defend the same. Y"i • DOW this . 22nd. day of June , lsi . Dennis R. Schultz z- j` (SEAL) is" • C. M. Bye `i ADTa=IITICATION ACYNOWLEDGYSNT" ' >jyaaRlter(s) _ STATE OF WISCONSIN - . St. Croix County. 22nd n.° asfhsatksW this ........diy of.. . Personally came before ms this + Of` i June 9. a above wa d b6hnis 1~....9chU11 z ahe • C, M• Bye. TTPLE: MEMBER STATE BAR OF WISCONSIN (If not, . I.-I....' . authorised by 706.06. Wis. State.) to me known to he the person S......... wilt 40WOW forezoing instrument aly~,ars1111u1~ed tha same S THIS INSTRUMENT WAS 0RAFTF0 BY ~....r<.. BYS._~ Sandra _ Attorney, of _.Law \nc: r fl, r C~Ox~t• , . , 4 nt.%•. W W, i" fftnature+ may he authenticated or arknnwled ed. Rr•th }f: nmrnie irnyi},p~p:tn~nt°Ilf Iipt, > :alp 3 are<aot nece-zsary.) datr: Atlg'.La att ra• .r... a •t~ r e~Cl. M .~1 ~ 1 ' i7: ~ - •Ker of ►rrgnm tuewiaa In an, rM •.?d be t>t»^f •,r W, f•r.r.!.•1 • 96-T a'rATr sws e, 1902 st:v - /rRlt si. 4 use f STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER a0z f f~ ~ G ROUTE/BOX NUMBER /C IA FIRE NO. CITY/STATE CI/Ar l u ZIP PROPERTY LOCATION: 501/4 1/4, Section , T 6-9y N, R__~f_W, Town of 71,0, St. Croix County, Subdivision6 %U 544 1111 , 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. y SIGNED Y", DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address PARTMENTOF .REPORT ON SOLL BORINGS AND INDUSTRY, SAFETY & BUILDINGS LAQOR AND PERCOLATION TESTS (115 DIVISION ' HUMAN RELATIONS ~ P.O. BOX 7969 (ILHR 83.09(1) & Chapter 145) MADISON, WI 53707 ° L CATI N: SE T N: OWNSHI UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: sW ,4 tJE % ~ 6 /T~8 N/R ~9E (o ~~Y 39 ~LUUext s~~cvu Z "~ea. COUNTY: OWNER S B YER' NAME: MAIL p ST•c-R-C~1X ~ouGLRS GEt ss X11 q S . s~-~ S P)'pT. Z63 USE i U~-~ k! l S V u 2Z NO. BEDR COMM AL D RIPTION: DATES OBSERVATIONS MADE Residence N • A, New ❑ReplacerJ . L$_ 8 9 ~v . a . RATING: S~ Site suitable for system U=Site unsuitable for system • ONVEN I NAL: MOUND• IN-GROUND- S M-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ~I S DU ®'S ❑U ~S DU ~ ~S DU ❑ S ~U ~Z 9'Cou V~~►Jltf.. 13~ If Percolation Tests are NOT required DESIGN RATE: under s. ILHR 83.09(5)(b), indicate: GL~s $ Z If any portion of the tested area is in the s, , Floodplain, indicate Floodplain elevation: r V A . PROFILE DESCRIPTIONS NUMBER DEPTH IN, ELEVATION OBSERV D BORING TOTAL PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH • TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B- \ 66 10.4' Nor.)E. 7 66 Sf?~ PhGE Z of Z H ~r B- 95 1o1-Z' ►I ~ qg B- S X02.. 103. It 02, PERCOLATION TESTS NUMBER INCHES AFTERSWELOLING INTERVALAMIN. A RA P- PER INCH P- B~ T h ►ti6t~ s r P- 'w ` o . "T~fE S s'T~-j ~'P~/ T >S t~oiar~- wi EK C.~ 5 E~ G LASS g ~ P E )iti! E CODE t S r~ P- t9 A•n~ Iv p c -g DN'~. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what sre the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and of land slope. ~rJ tZl Pc L p~ranY - EL. 99.0' ~GE 82 Q~'RktM'RDT- SkTTR6~ SYSTEM ELEV TION R~~~E~r-- ct_ ge.a' ~ ..P S~'8f/• ; I i '8~#f _ 100' o' ou z't Q - - - _ ~ fi t _ ~ I ~ - , Z{. ( _ ~ ~ I ' ; . ~ - i . , i ; r_ Sit ~ ~ ~ C~~ "'~►~T~ I ~ .w i i ~ - f - _ - o ._._~f~L N t $ _ ~ ~ ~ T ----r--j s°~ s% , _ ~ _ of ~tz~ F ~A 5 ~A~ ~S~!~~r ~n $,s ~ 3 i T _.~'nus. _j ~ - 1~3Z11►1J1.LF . 1_~~ ' ' ' _ i . I ~i S l1 s•y~ r 1,~0 t 1}t~~E w+thXlh_U!`1^ E~l.oul~lA ~ a.► ~ bF yZ cp~~ ova ,-tt~a-r - . , a 8~ ~ ~ I S 6E SuR Fx1C~ . " 'j I (~~AtN _ =~4~ to , I _ u . ~ ~ ~ , . . , _ ~ _ ~ g qF( ~ ~ i j SCq~I ~tlt~ ...D~ . - ~ ' So ~N~ ~ ~ I _ _ _ t - z" . ~ A~IFfc gO ~ Bh *2 1, the undersigned, hereby certify that~the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wi Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, sconsin NAME print I'~2'T--y.) l.1 ~ L ~ w~ G TESTS WERE COMPLETED ON: ADDRESS:. O . L30K '7~ y Z1 JU. 5 ' ~ 8 - 9 ~ ~ ST, CERTIFICATION NUMBER: PHONE NUMBER (optional): R) u ~~R ~s~ LLs W/ Sao 22 CST o0o S7 6 ! S-ytS-d6 S _ _ CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ILHR-SBD$395 (R, 10/83) ~~6 E ~ ~F 2 -OVER - J -f- laS G c fsS~2r Ain J4~~~odel`toPvar l~.ak .Yg H 3' 3 ,I 0 P.U ih (O nark la► S ~Sfer~. ~ t. 9~, D /a`x 99 ~ l3 ~e~ a ~o ~g~ laX ` gad B3ti IS°1o G 63 S J~ a cc ke ptG 4 & d fv 1yv. $`9 g~Y P 1 oc. v a,a. go 6 uhV d /0.x•'7 e~~ fio e w"n ~ o' from Q rain~I C 4A flee . 66 x j U l U V C r-1 1 /-1 1 1 LOCATED IN THE SE 1/4 OF THE NE 114, THE NW 114 OF SECTION 16, T28N, R19 w CURVE LOT RADIUS ARC CHORD CHORD CENTRAL FIRST SECOND NO. NO. LENGTH LENGTH LENGTH BEARING ANGLE TANGENT TANGENT SURVEYOR'S CERTIFICATE BEARING BEARING 1-2 533.00' 316.29' 311.67' SOO-43'30'W 34.00'00' S63.43'30'W N82.16'30'W I JAMES T. SWANSON. REGISTERED LAND SUAVE SURVEYED. DIVIDED ANO NAPPED GLOVER STATION 3-4 533.00' 327.60' 316.74' N64'59'23'W 34-34'14' N82.16'30"W N47.42'16-W SE 1/4 OF THE NE 1/4, THE SW 1/4 OF THE ME SECTION 16, • T28N, R19W, TOWN OF TROY, ST. C 5-6 200.00' 96.79' 95.85' S28.25'52'W 27.43.44• S42.17'44'W S14-34'00"W FOLLOWS: COMMENCING AT THE E 114 CORNER OF 724.53' ALONG THE EAST-WEST 114 SECTION LINE 7-8 266.00' 114,13' 113.26' S26.51'30'W 24.35'00' S14-34'00'W S39.09'00-W 512.78' TO THE POINT OF BEGINNING; THENCE S 316.29' ALONG A 533.00' RADIUS CURVE CONCAVE 9-10 200.00' 197.21' 189.32' SIO-54'05"W 56.29'50" S39•C9'00"W S17-20'50'E S 80.43'30" W 311.67'; THENCE N 82.16'30' W 321.60' ALONG A 533.00' RADIUS CURVE CONCAVE 11-12 265.00' 240.91' 232.76' N13-12'14'E 51.53'32' H12.44-32-W N34-09.00-E N 64.59'23• W 316.74'; THENCE N 47-42'16" W THENCE SOUTHWESTERLY 96.79' ALONG A 200.00' 45 265.00' 140.49' 138.86' N02.23'17'E 30.15'38" N12•44'32'W N17.31'06'E WHOSE CHORD BEARS S 28-25'52" N 95.85': THE SOUTHWESTERLY 114.13' ALONG A 266.07' RADIO 44 266.00' 68.29' 68.10' N24-52'24'E 14.42'36" N17-31'06'E N32-13'42'E CHORD BEARS 5 26.51'30' W 113.26'; THENCE S SOUTHERLY 197,21' ALONG A 200.00' RADIUS CU 43 266.00' 32.13' 32.17' N35-41'21-E 6.55'18' N32-13'42'E N39-09'00'E BEARS S 10-54'05' N 189.32': THENCE N 89-11- /4 SECTION LINE: THENCE N 01.35'061 E BOO. 13-14 42 200.00' 95.Bi' 85.16' N25-51-30-E 24.35'00' M39-09.00-E N14-34.00-E 1/4 OF THE NW 1/4: THCNCE S 88.24'54' E 500. I STATION: THENCE N 42.17.44• E 240.00' ALONG 15-16 42 266.00' 128.73' 127.46' N28.25'52-E 27.43'44' H14-34'00'E N42-17'44'E STATION: THENCE S 47.42'16' E 200.00' ALONG STATION AND THE SOUTHWESTERN RIGHT-OF-NAY 17-18 467.00' 281.77' 277.52' N64.59'23'E 34.34'14' S47142'16'E SS2-16'30': N 42.17'44' E 66.00' ALONG A SOUTHEASTERLY 5 47.42'16 E 125.00': THENCE N 22.38'30' E 40 467.00' 140.88. 140.35' S56.20'49'E 17.17'06- S47.42'16'E SSA-59'22'E 185.00' ALONG A SOUTHWESTERLY LINE OF GLOVE 169.58' ALONG A SOUTHWESTERLY LINE OF GLOVE 39 467.00' 140.89' 140.36' S73.37'56"E 17.17'08' S64.59'22'E S82•t6'30"E 480.00' ALONG A SOUTHERLY LINE OF GLOVER ST ALONG A SOUTHERLY LINE OF GLOVER STATION; 7 19-20 467.00' 277,12' 273.08' NBO•43'30•E 34.00'00' S82'16'30'E N53.43'30'E SOUTHEASTERLY LINE OF GLOVER STATION; THENCE THE SOUTHWESTERLY RIGHT-OF-WAY LINE OF GLOVE 34 467.00' 161.91' 180.77' NOS-33'56'E 22.19'08' S82.16'30'E N75.24'22'E THIS PLAT CONTAINS 1,856,575 SQUARE FEET, Y. OR LESS'. 33 467,00' 95.21' 95.04' N69'33'56'E 11.40'52' N75.24'22'E N53-43'30'E THAT SUCH IS A CORRECT REPRESENTATION OF LAND SURVEYED AND THE SUBDIVISION THEREOF M . LAND DIVISION AND PLAT BY THE DIRECTION OF FULLY COMPLIED WITH THE PROVISIONS OF CHAPT THE SUBDIVISION REGULATIONS OF THE TOWN Of SURVEYING, DIVIDING AND MAPPING TH.E SAME. GLOVER STATION / JAMES T. JAME f GLOVER STATION SWANS=N AEGIS OGOE 113 \ / V \ L RIV[R FALLS, WIS. RIVE b" s \ r~ m n °j •J6. Inv UCI~JSI Ae~<' DATE Sup" . r C.. Tt \ r~ po / nti.~ sy Jd-47Coaaaaa C'rA%\`~F rbb / 1AF'p = S ':JB GLOVER STATION 40 ~I . 02., C 460.00' ~O~O iP 203.322 S.F. _ N, 6 b . 0 2.372 AC. 20.03' !qT do \ v° S' ~ ° ICI 41 39 o `'j ~•OJ• ,V 509, 417 S.F. W n 42 •YF.\ r s°/s` \ - 17 a 2.512 Ac. 38 °o.0'. bb v 91. ceo S.F. 0 37 ~ /6'. JO \ on • 2.009 AC. 102.659 3.0 'r °J• \ - 2.357 AC. jbp• , ~O.y i6 i rj \ \ ~ 222.Bp• SOUTHERN 260.0o, b b UNPLATTED LANOS ! 273.2- LOCATION SKETCH 1 NW-NW NE-NW NW-NE. WE-NE UNPLATTE GLOVER GLOVER STATION ROAD ~:•T:!Lr° are no o5jecCom 10 IMs plat kith rc=ee1 f0 Sees. 230.15. .1 C. 26.20 and 236.21 11) and 121. WI3. Stda. and IL! III 8: of Sf-NW 4.3 'i..;. ZWn.7CoG3 u povid~OJ 1(q' r°:. 230.1= Mr. Kis. WIS. Ccr6"Ml-+...Y,9. ,aa- d.. J. iB CA Y. SW-NW Caro ADDITION 0' 100 CLOVER SIATION J SW -NE /lia/-~ 1 f' C j SE_NE 1 X/U I J ...1 1 DEPARTMENT OF DEVELOPMENT SCALE 1' - 1000' N 1/2 OF SECTION 16, 72811, RI9W