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HomeMy WebLinkAbout042-1020-10-120 0 Q a> 0 O v kn It o I C~ r; N j Ci N O O N N ,C O a) C z N LL C C O ' ~ O I Q ~ i i 3 m r z a~o Z _ o v z d d N w a m W IN- z c 0 O Z d c (D z? I' O C O 0) F- a) z E a m (D M ~ v co CD uJ U) c •~Nl d L L O ~ O 12 Q w z F- Z o w Zs N E z ccoo N = c N E N 4) CD L ~ m w 4 .y + L m C O 0 0 ° N O D a E: m N Z N > "t F- E- H U N ` 333 ° 65 0 •ti 3IL IL CL 7 O N-0 N N N U) J L) 0 Oi Oi } O O WftV O N N N O au Q4 =3 CL L GLl O u, N Vri Q O N 'y^ N N I'. C LO O C C lp 0 an O O M 0 O. OQ 0 a 01 o N c6 F- a) c E E N O O CF (D m to C2 cn E E m v C.0 z 2 U) O ~ w 1 ~ w E \J `a CL /a W dt M E d CL • CL d 2 m A U a2 0 O U 481905 CER T I EI ED S UR VE Y IWA P Located in the NE I /4 of the SW 1/ 4 of; Section 5, T29N, R 18W , Town of Warren, St. Croix County, Wisconsin. Surveyed for: Myron Olson 1146 105th'St. NOTE: North Roberts,. Wi. 54023 ~ quarter corner falls in lake. U`JPLA9"-' I ED T~AND:S 2097.40' - - - - - - - - - N89°5.4'41"E N890 54'41"E ' _ (N89°54'23"E 510.00) 2608.85' T - a S 89'44'04"W 476.21' - I - - W 1/4 Corner 32.92' (477.00') I E1./4 Cor. Section 5 00 I I Sec:. 5 T29N, R 18W . a ~6 6'1 Bearings referenced to the East- West 1/4 Section line of Section 5, ry m assumed N899 54'4111 E. N n I i. I c~11 L ® T I n I 1 LEGEND ZI 434, 767 Sq. Ft. 1 1 1 M o (9.98 Ac.) t U') Section Corner monument. 1 , m Including R-O-W. I N r' 390, 770 Sq. Ft.. N ~I pl 0 1 "X24" Iron pipe weighing N (8.97 Ac.) v Co z1 1.68 lbs. Ain. ft, set. Excluding R -O -W . vl • 1" Iron pipe found. oy ~1 W 0 o LU = -T- Fenceline au o= Q i 'j i0 m° I to w ' Vol (47700') Previously recorded infor- ~i m N mation. a I N Q 1 0 °1 O o1 z N 89'56'07"E 509.25' z1 O H~ r- NOTE: This map has been done z 475.82' '-TJ (n ~I to evise and re lace that 33.44 1 I al Certified Survey Map recorded u--®~ 2 I 21 in Volume 8, page 2283. No 217, 878 Sq. Ft. DiGH new lots have been created. ated, (5.00 Ac I 1 DJ~' Town and County approvals w o Including R-O-W . are not required. 9 203, 605 Sq. Ft, 96 1 r AA (4.67 Ac';) v o v N I I Excluding R -O -W. `r1 I, i H-11 (47 AO') 1 01 ,0IIIIIIfHl1N 475 t 63 ' 33.26' !11 g%%!\ ~CC1VPD3 srz S 89' 56' 07"W 508.89'1 (S89°54'23"W 510.00') i<r ~I } UraPr..1• c~''a D 1 ANDS P' ' I T ~ - - - - % o v , N • o S1/4 Corner ~ss~Np FILED Section 5 11111 T29N, R 18W APR 141992+ ,1AMES O'CONNEII /This 9t Des instrument drafted by: Y "Coo., 492-2007 VOLUME 9 AGE 2471 ~ ~ 82-7 758 VOL 21 PAGE5225 KATOLM H. WA13g - REGISTER OF DEEDS ST. ROIX RECEIVED FOR~RECORD 4DER71FIRO SURVEY MAP 06/19/2006 11=30AM LOCATED IN PART OF THE NEI/4 OF THE SW1/4 CERTIFIED SURVEY MAP OF SECTION 5, T29N, R18W, TOWN OF WARREN, REC FEE: 13.00 COPY FEE : 3.00 ST. CROIX COUNTY, WISCONSIN; BEING PART PAGES: 2 OF LOT 1 OF CERTIFIE6 SURVEY MAP RECORDED IN VOLUME 9,` PAGE 2471 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. RECEIVED N OWNER SURVEYOR MYRON OLSON EDWIN C FLANUM 1146 105TH STREET NORTHLAND SURVEYING, INC. ]a Al Q6 ROBERTS, WI 54023 P.O. BOX 14 O7LCr i ROBERTS, WI 54023 8 LOT 4 OF THIS CEimFommge~qeQ~ DOES NOT REOy~Sj%%W IT IS A SURVEY 0 FF77 ND NO NEW LOTS WERE CREATED. wd N SUCTION 5 ER 1 15TH AVENUE d E1/4 CORNER U SECTION 5 S 89°23'04" E EAST - WEST 1/4 LINE N 89°54•1' E) N 89023'04"W 509.98' 93 S SW23'04" E 2097.28' 9 2110.93' N 89°33'41 • W 476.22' O SEPTIC 33' 33' Q i ^ CLEAN OUT I E"X IISTIN ~I ~I a ~ ~'I ~ y 1!! I QI o SHED F' I i 1 ~I LOT 4 S W W a 5.10 ACRES INC R/W, zO sn'' 2. Ali O 222,200 SQ. FT. L4 z J (1)i I a. Q; N 4.41 ACRES EXC R/W 192,195 SQ. FT. °~pa I Z I i~d e 6' O~o i' I V i 3.B9 N 89°23'04" W 509.61' I *WWII ~%SG.... N 9 VN W4 0 ED C. FLANUM LEGEND W 5-2487 ALUMINUM COUNTY SECTION CORNER AwY S m 49 MONUMENTFOUND p • 1 5/16 O.O. IRON PIPE FOUND SnM'M~ //aD~ 314"X 18" IRON REBAR SET WEIGHING 0 1.50 LBS. PER LINEAR FOOT SCALE IN FEET 1"= 100' u 1 OO' BUILDING SETBACK LINE 1 00 0 1 00 ¢ b ~ PREVIOUSLY RECORDED DATA Z SHEET 1 OF 2 SHEETS $ 1 Of 2 Vol 21 Page 5225 1 Parcel 042-1011-40-200 07/24/2006 03:03 PM PAGE IOF 1 Alt. Parcel 05.29.18.73B-20 042 - TOWN OF WARREN Current X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner RICHARD A OLSON O - OLSON, RICHARD A 1134 105TH ST ROBERTS WI 54023 i Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1134 105TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 5 T29N R18W PT NE SW FORMERLY LOT 2 Block/Condo Bldg: OF CSM 8/2283 N/K/A LOT 2 CSM 9/2471 5AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 10/13/2005 809306 2908/326 QC 07/23/1997 1069/267 QC 07/23/1997 945/261 07/23/1997 9451239 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/19/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 48,500 120,400 168,900 NO Totals for 2006: General Property 5.000 48,500 120,400 168,900 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 48,500 120,400 168,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~S 3 00,,j 4 /o.tm. v -F5 .7969 ngsDivision artmentofIndustry, O SOIL DESLKIPTION REPORT .O. BSafetyox 7969 1Mfisfonsin'brp P Labor and Human Relations Madison, WI 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) 2 4~le - [P 3,? 7 Page of - Customer Name i Evaluation Date Oce nt Lan Use or vegetative over Pareni Nlatena s AG-JIWQ r~/SoN ,r,1~~~ J/'1'P - A, - -I f^ ate a owest /roun water P ain E evatii %%yer (3~%2 7`s [ v/S s Yo 2 /OD ' ounty ts NoLoa Ong hate m a ons Per q. ft. Peay (s S fa,~ TP Lot Lega Deunptron eometry an Dept ope an Aspect ~I S-ee. S; T~-9ti /,1v 'uw,eEv E ,g'o~► o 1~ °7a s 4U Horizon DepColor Mottles Remarks: tlayskins Loading In. l u. Sz. Cont. Color Texture onsistence Roots ores H and other GPD/ .2 /rj_~' 1oYW 4/y z 3U /0 y.w~.e l f c S - G 1, fs , f 1~1 vfl l VF S /osf,, ziee4 70 AI /oye s 0 v . s 3 Structure Remarks: tlayskins Loading Horizon Depth Dominant Color Mottles In. Munstll u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores Hand other GPDlh.2 0 Yk 7/ Z- 2 9-12- 10Y 516 3 /s - y~ /a V ¢161 1, fs o,-f, ye Mt v f',e l of s /~s `r a - S '/oo ~4 R ~`~6 l~S , f, yR N►, v foe- ,51& Horizon Depth Dominant Color Mottles Structure Remarks: tlayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPDlft.2 / 0-I2 /oy/e ~/f S 0 1-2✓f I/OYX l~ 3 y Y2- /02"' S/Ce - S 2 l v S - 60 v . S o s _yG 16 ye U1 9e -F 2 9 S ~5 S f3 L~ /in-: VA % ,oN Horizon Depth Dominant Color Mottles Structure Remarks: tlayskins loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores Hand other GPDlh.2 / -12 !D yA 414- i, Orf em Vfk 2,.,~ cs -S 0 ft 2- 12 2-f 1/0 YA 514 s/ i , f4 44 v1r,e G S I`e'40E// 's -3 /0 Yje 5/6 lfS , f, f4 r>m v f2 / S - S- '7, 5 YR 416, 5), 74 s y~ o > io yk Y/y s 3 3- Horizon Depth Dominant Color Mottles Structure Remarks: tlayskins Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.2 2 ,m t ~ CS / 0-ly lo ye 5/Z- S 0,M, 2 covp S . L y 30 1/0 Y2 10 / L9 C, ew'E If rp g 0 - ~Q l6 yR sly G /00 y /~S rf . ~,e e"1 I 'A r HOMESITE SEPTI ING CO. y. 655 O'NEIL RD., HUD 54016" ORIGINAL ROBERT ULBRIu s L 8Z AS. MASTER PLUMBER LIC. NO. r N. fFlSTALLE'I & DESIGNER LIC. N0.00663 w~~ \ ( f Additional Remarks: ~N Si7`e7 Ut ~ f 7i D,c) 14I,JW 44-- 40 e2 i J I' ,4t OM ~So v S/. poi f( DiSr~C •i3o T:d,l.) TO ?,f' ~►7.yf~U ,-feteV P T► /s Aso. f.f . APAP/'A-7 6- It TJF-- Other Site Features: ` y 14 ,f,2 -71f) 344ZP5 Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST y i AP~eR OX . S~ U K~ L 0 r L . AD•e330IN 01,901 A OA • _ 13,46~ yo' ~ 292 i % 3 y X° o~ s %%A Aell" W i "3 s~ 2 h~vr , ~~o a 3 30 1,~40,eo r, All . Go 7- c S,y Sti`l / StT % STEEL ROD (arISEL) /~J~t-Tio v = /D O • D D ~ ~ />c1/~ jro,V ! SySTF.. y ~/~vfiT~o-vS 13 Z04t..eS7- 77-6-0 63 'IFS 7 Z& A,) e4 y = ~l, ~Z " rf' L r HOVESiTE SEPTIC PLUMBING CO. ~s E55 `?'F!L!L RD., HUDSON, WIS 54016 2 Z ROBERT ULBRIGHT ST y~ NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INS FALLER & DESIGNER LIC.-NO. 00663 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN&USTRY, c DIVISION P.O. BOX 7969 LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SEY CTION: OWNSHIP OT NO. ILK. NO.: SUBDIVISION NAME: NE sw'/ /T N/Rle E (or Gti/tg REiv ~s", PsNo LU- is COUNTY: MAILING ADDRESS: 511 /,~ol G M~IFIZ /d5 ST ~o ,STS 4~/s 3 USE DATES OBSERVATIONS MADE NO.BEDRMS,: COMMERCIAL DESRIPTION: 7ROFIL : Residence N 2QNew ❑Replace (CCQ JF- T 1'7- , 90 L3G~JtJE 5 L ! RATING: S= Site suitable for system U= Site unsuitable for system SC -5 1 ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: rEJS YSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) CJs Nu 14S ou aS ©u ®u DS EA If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: CGgS S -"F- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTORE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HI H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) p' S ~P/ocw.ral2 , S ~Ly•R,a • ✓`y B- l 4 S 9 3. 72 It-o 3 3 C"O!VA(Is `Y /-5*) G .Rio C, <-X , e f3 o . s l . 0 ' R.q'Q Aoi&k=2 I.va.L 5Y w/ f.f f- 13- oR^6Y• "y of- Is 2, 1& 0 cwt w C WAv-,4 AwL 6 B- r q . , ,g3 8,v.PtOWAQ s •S' B,,-Sy• w••e s (.6.6' f-{• N. 010cK B- Z ,Q / 3• J~ 3. 5 511 S1 W( f; OR-fly. Hots 2,74' f,.4 APA-,>t R,,.1 I B-3 7,(0' /~.1~L PucEcQ 36 p r -7.5 sy s , 1.2 s ' ~I (,N -17"A loo(~t s , . 67 ' Coe- ate, {tom c► Q 3. 8 s( s l B- CP.d r 1 1. y01.6, 3.5 • 75' (3N-Sy_ lS l• S8 ' RN. )S I-IG' 2 $ W114 e tom. L w f C?t~ $ , w OR PERCOLATION TESTS `'OG 7a.~SvEs } EST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTER SWELLING INTERVAL-MIN. Rt D t P RI PER INCH P. Z /0 P. Z a 3 a 115 , L 2 I P• 2 ISO-- / * Z 2 2 P- P- p_ /.v 0?,V1fit /,J S S T P-- T"15 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are 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 percent of land slope. 01 5~f~~ SYSTEM ELEVATION. I ' f ps k SEA PLOT- i tN old ' N SUCT~ R((- rY for2 44ou-,~ sy sT~`~-r s~:// /;P.Q C? k;of ?die P,17r' AV IA Z4N.L0 G- D e P 7 . y r 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 Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (printl: HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: p 655 O'NEIL RD., HUDSON, WIS. 54016 S -'z d - I'T t 0 ADDRESS: ERTULER- H- CERTIFIC TION NUMBER: PHONE NUMBER (optional): NIS, MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Z y~ 3 d ~o S ' CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHA-SBD-6395 (R, 10/83) - OVER PLC 7- ,S Ass - G~~ y t = t9p-AG IOC, } Ti'O,JS i i Y I ~ scr~E: / 3 0 j3o . HOpAESITE SEPTIC PLUMBING CO. 655 UNEIL RO., HUDSON, WIS. ~16 # y Y~ L o ROBERT ULBRIGHT AS. MASTER PLUMBER LIC. N0.3~7 lA.P.R.S. N. INSTALLER & DESIGNER L C. NO. W663 Li 3 J I ~ I B~ - - 'o ~3 W 38 ; 0 523 5 3 I I SE T 7o~b ~ of wooer STlf Aw E' /~-vtTio~ , boa, o coRNE, 4,o00 -{QAACA- noSt w/ (~A~ Pi6Ro.j rY o a) 3 0 y p 4 o~ ti o o y N c N ti r> N O N C ~ I N N C O N ~ ~ O N O j z C V .O IL c D MD _ O Y E Q g a~ r z CO Z O O I z d m 0) w co FN- Z a m O o z 75 r 1- 16 U) H r W Z E -o i O) ~ M a d 0 c ~N L r o w N z~z Z w 04 _0 M m E N N W N d m ~ d ~ O w Y C In O y dl N f0 O O C. c c a E - N Q O U) U) U) E L U r Z N> N S L U) O d d 0 ~N In O y IL Z.; 04 U) J C) O ;2-- z N _ N co E O \ Y o t m c a Na .21 2 'p of Q Z cn m O o o w `~o (4 c ~ .r N 0 c ID d m ° o c v n W O_ C n d 7 h CF (D U) 00 N j 0 .d. d C N N f0 N O N O O U 0 0~ I O ~ O Z c Z rL CO v a a a 0 S: a r A 0 m23 Il u,ci I,~CATIN• WA)N 08.29.18.113A,NE,t NE, 110TH ST. , LOT 2 isconsi epartmen o n ustry, PRIVATt SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safejy and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 171507 Permit Holde,% Name: ❑ City ❑ Village (X Town of: State Plan ID No.: 1 LSON JEFF WARREN CST BM Elev.: Insp. BM Elev.: BM `Description: n Parcel Tax No.: ry s 1'/id GCi' c_. a+~1 Q, ,,S 042-1020-10-000 TANK INFORMATION ELEVATION DATA A9200275 I 2 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic1 ~e,r G ~Q Benchmark Q& " Dosing r/ l ` cr 1't• 7/ O',i/ , -7 ~5 OA, Z Aera Bldg. Sewer Holding St/ Ht Inlet 0041-3 11 TANK SETBACK INFORMATION St / Ht Outlet 06 001 TANK TO P/ L WELL BLDG. Ventto Air Intake ROAD Dt Inlet Oz Septic My ` >58~ c ' NA Dt Bottom • 36 Dosing NA Header / Man. Aer teIr NA Dist. Pipe Holding Bot. Syste ` PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 4~;q P ° s' ~ I ~ 19i e AModel Number GPM u TDH Lift Friction e System TDH )Ft Forcemai n Length 30Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S •S MEN I N LEACHI Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM M um er. INFORMATION Type O CHAMBER System: Coiv. X30 r~o~ ' OR UNIT DISTRIBUTION SYSTEM Header l lern*feld Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length} Dia- Length52 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over „Z` 1 11 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ZG Bed/ Trench Edges ~D `t Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) r70 0 C. ' ekea-XA_ A-4- Plan revision required) yes ❑ No 9 I q Use other side for additional information. J/ Z SBD-6710 (R 05/91) Date Inspector's Signature JI w Cert. No. ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: r ; SANITARY PERMIT APPLICATION CILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANIT Y PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 6 7 / 56-7 8% x 11 inches in size. heck 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 OWNER PROPERTY LOCATION '/4, S TirBLOCK N, R E (oPROPERTY OWNER'S MAILING ADDRESS LOT # # r-- C TY, S ATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER lG i D CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : Ila ❑ Public K.1 or 2 Fam. Dwelling- # of bedrooms PARCEL x . u ( ) III. BUILDING USE: (If building type is public, check all that apply) Q y - ~p d /Q / ~-Q 1 ❑ Apt/Condo 20 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 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 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 El Seepage Bed 21 El Mound 30 ❑ Specify Type 41 El Holdin9Tank 12 M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Z g~ v E~EV TION s~ gals- Spa r /Q `jQ Feet 5• ~ Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank OQU ~`dWG Lift Pump Tank/Si hon Chamber r'clwe VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): .dc IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Is ue Issuing Agent Si re No to urc Approved E] Owner Given Initial ~ harge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S Buildings Division, Owner, Plumber INSTRUCTIONS o r . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership o- plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 639fi) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic fank(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 locarcode"adrriinistre..tor 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 nstalled. 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'/z 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 th=se surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) S b S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property K-2 on D~.I0 Location of property/t/C-1/4 1~5114, Section U T N-R_LtW Township _ Vl/Gt'V rzr\ Mailing address ~oX Address of site __nn Subdivision name__ Lot no. Other homes on property? yes No Previous owner of property Ono( /~y 4 U-J-1tr Total size of parcel -Co, Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec? * Yes No .L)&L&4 `V Volume 9Srand Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in he office of the County Register of Deeds as Document No. A-t~ V- , 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. S a re of applicant 4o-apapl#ican't -7-1-72 -7-t- qQ Date of Signature Date of Signature I • DOCUMENT NO. !STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 4sss22 - ~l 958 FACE 15 _ - REGISTER'S OFFICE This Deed, made between John A. Kurkowski aka ST. CROIX CO. WI John Kurkowski and Anne T. Kurkowski aka Anne Recd for Record Kurkowski, husband and wie JUl.O G 1992 - p - Grantor, and._------Jeffrey A. Olson and Jeanette M. Olson at $:30 A. P/1 l rop e rty survivo r ship mari -t-'a, - Grantee, Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration....-. St. Croix RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsin: BANK OF NEW RICHMOND Tax Parcel No: ~P-- Part of Northeast Quarter of Northeast Quarter of Section 8-29-18 described as follows: Lot 2 of Certified Survey Map filed July 24, 1991 in Volume W, page 2382, Document No. 471816 and right of ingress and egress as shown on said Certified Survey Map. This is not - homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And------------------------------------- - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this ----15 t----------- day of ~U]~!------------- 19--....... - ----------------------------------------(SEAL) -----vG e44 _ {~`t------ ------(SEAL) * Jo Kurkowski i • ----(SEAL) (SEAL) * * Anne T. Kurkowski AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. St. Croix Count- County. authenticated this day of 19-•---. Personally came before me this 0-1 day of -----Jay------------------------------- 19__92.. the above named -----------------------------------------•--------------------------------------John--A-t KuxkQw,ki__&.a__j4hC1_.KLT QWak7...and----- * 4 D.Me-_-T,..KuxX.owj3ki__aka-,AMe__CurkQW&ki.,-..... TITLE: MEMBER STATE BAR OF WISCONSIN 11 ' husband.-and- wife t , ` (If not, - authorized by § 706.06, Wis. Stats.) w to me known to be the person ek %ute~the foregoing i ent and knowleheAe•'same.'' THIS INSTRUMENT WAS DRAFTED BY - , V p Bakke Norman, S.C. 1--- -rte:; @ • C7 * enneth L. Za a ca - - - s Baldwin, Wisconsin - - Notary Public St. --Croix--- ~ sue. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (Tf1%, . ; are not necessary.) 5/9/93 date: *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE. BAR OF WISCONSIN Wiseon,in Leval Blank Co. Inc. S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER r4e 14 n5o Qn a~ D fph ADDRESS L50 ,y c~3 FIRE NUMBER CITY/STATE#Q1niy)0Ad ltl-T ZIP '5 S PROPERTY LOCATION:E1/4,1/4, SECTION U , T N-R-LLW TOWN OF yvarre-rl , St. Croix County, SUBDIVISION , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED! DATE St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF -REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, C P.O. BOX 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUMVtPAtt;FY: OT NO.: LK NO.: SUBDIVI ION NAME: ti~ /4 A),5 /4 /T ZY N/RIr E (c ► w,41~ 2 cs.~r PENS%~ G-- 000NTY: MAILING ADDRESS: ST. GQoi 1< kuk, 6w6-K"' /0 20 Sir- 'PoCieeT S USE DATES OBSERVATIONS MADE INOL B DBMS: OMM R CIA S RIPT ON: TESTS: PAOFILE DESCRIPTIONS: PERCOLATION DoResidence 3 New ❑Repl SvLy I l(? I I ToLy I - I e [ I ~3'vu/il~t4RATING: S- Site suitable for system U- Site unsuitable for system • ONVENTI NAL: JMOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:lo%, ional)7I?CAJr t5 z S E]u EIS ❑U EIS ❑U 0S EA ❑ S ®U 6"Ly- Wilk DIP-°P ox al'sTR; e~'r(o.~ If js.ILHR Testa are N~?T required ]DESIGN RATE: I If any portion of the tested area is in the un83.0915)(b), indicate: Floodplain, indicate Floodplain elevation: S Zff 1~fOW PROFILE DESCRIPTIONS BOTAL DEPTH T R UNDWATER•INCHES CHARA TER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 9 /0 3 z 5 ~P owEO' 9-z / y i .wt5 S!, 73-36 '~tci > /0 3G' io R 4/4 S/~ /m y,e~ ds 96 "-/00' /o re G/Sc ~ 5. o S ~r 0-9" ,ore 3/Z s%wEO - 8 . iy^•c~Y ¢ J,-/' 7- P 'e) s4, B-Z ~Zb~./G 'ycU > (2O ;'-lzo" /i o.}M, io Wd- 4 e,q~r 1 s ,r, tlfR,tw iz-zz' /o yR S ,Y, I,w~Sb t,nm'C I'; i2_ j ¢Z B-3 /old 97 9y Ito ?/DO /oYR oA",gie 0-F i2 • z''- l00 "Mi)(, OF io V 5!4 PS, WIX, IMnS J dAY-0- /o yQG/Q , , /f SR, ANv , B- q 0-/Z " io f 2 o r-•, p owcv - 3 SOY B- l 2r66 zn- 11& AafiF f S/G RvDf`~ S p /0 yk 312 /0 A. •q , P/o - rc j 9 l ~O y ¢ S' B- S 90 /•~l~ ~`U > ~d z,w.SbK) AvNfR') ICs-36-I0YR 416 S/ IA"5-R, CQS; ASV IC ICI rfO.tJS PERCOLATION TESTS ' 70 11 /0 yk G14- S' > o~ .3-J, aQ / EST DEPTH WATER IN HOLE TEST TIME D 1 WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES- AF ERSWELLING INTERVAL-MIN. p RI D 1 P R D PER INCH P. ! 93.0 ' 2 3 P. 2 96' D /0 1-5/1 C, d, O I /Cv I /G P. P- P- 5_ N p- tj PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or L*0 Cet(i ~ibcoghatiAthe zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at a"lly" s aQ1 dir-on nd per of land slope. k t+ TR 6,0 C,& 92 . r A4/', / /C e u c til 3 , Q ~i ti" SYSTEM ELEVATION. <ocvESr ~.P - ~ ~ I 1 I i ~ I t< ! i5 v s J.- _414MY E + vEL a fta Ai i N r 7- I _ I _ T' - T ~ 5 a ~ I . AP ~9 8 _ ~vo o,14 + c ,u o ~t S 4 V I. __Htorr o lop I 01 S ! ?Q i _ !l=0 1J. o L_. Fz e__ ~ v 'r Mou.~AS Ah~~S~l~ F~~47' ~ w~%2t= E~cess:vc~y oRG~a~c , I, the undersigned, hereby certify that the soil tests reported on t is-form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON: q 655 HO 'N IL D. HU NN WIS. 16 _ TL)Ly 3 1 ADDRESS: ROBERT ULBRIGHT CERTIFICATIONNUMBER: IPHOrJf NUMBER (optional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. Z y8 2 -3 ele MINN. INSTALL R DESIGNER LIC. NO. 00M & CST SIGNATURE: SoiG SVff~ 61 S' s/cv~-e v.P.tr~/-y~ fi s wi l-, i ARD 7 _ Soy/S _ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. nil NRAW11A.,19s_(A tnrctil n~,ara _ \3,0 11 god G ~ SueveyoR S Fova D, ~I~v~T~Q~ ~ in0.4 i iz 3 41 cE W 3y • 5?RAT ~ Si UN I I S ~o ~K~ 10 o ~ ,r $ ti 1(n 5 HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT WRIGHT CS T MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ppw IN51'ALLER & DESIGNER LIC. NO.00883 t;- 0 J }SLOT P`,A k) 3 L 0 T- ~ Z I scAte : 30 l p~ p Lo b o0 Cc C' 1All ! j s G 1 r 2XI IMF- PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS „ VEtJT CAP -4" C. I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUWCTIOIJ BOX ~MAWHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12"MiJ. 1 AIR INTAKE GRADE I I `4° MIN. 18"MIN. i CONDUIT-- I®°MIN, J^JI PROVIDE ( AIRTIGHT SEAL I I i I V I I APPROVED JOINT A I III APPROVED ,JOINTS W/C.I, PIPE. I III W/C.I. PIPE EXTENDINC. 3' I II ALARM EXTEWDING 3' ONTO SOLID SC 1. B I I ONTO SOLID SOIL ( I I ou C I I I Pump-1 '1I y OFF 0 CONCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TAKJK !,IZE : ~sd nGALLOIJS DOSE VOLUME ALARM MANUFACTURER: Al'e y'w INCLUDING BACKFLOW: .7`0r GALLONS MODEL AIUMBER: oal, CAPACITIES: A= ~IWCHES OR -?#4a GALLONS SWITCH TYPE: e/ uY /~~+a O-~ B c o~ INCHES OR 3 GA'-LOUS PUMP MANUFACTURER: C. = ! ~ ~ p NCHES OR GAI_LOIJS MODEL NUMBER: -4e- % D- le INCHES OR L~ GALLONS SWITCH TYPE: - JJ?e~~urx NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARGE RATE 234 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKENCIE BEEN PUMP OFF AMC) DrSTRIBUTION PIPE.. l FEET + MIUIMUM NETWORK SUPPLY PRESSURE , . . . . , . . , ...FEET + Ile FEET OF FORCE MAIN X F 0oFT.FRICTION FACTOR. 4r,4S FEET = TOTAL. DyJWAMIL HEAD = 17 FEET INTERNAL DIMEWSIOWS OF TANK: LENGTH i8~• ;WIDTH li r ~r ;LIQUID DEPTH cro 51GK)ED: c u-- LICENSE KIUMBER: F:_2 ATE: -117- REPT131 WARREN ST. CROIX COUNTY ZONING PAGE 1 11/11,/92 13:52 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/12/92 AREA: JT TActivity: A9200275 11/12/92 Type: CONVSEPT Status: PENDING Constr: Address: WARREN 08.29.18.113A,NE,NE, 110TH ST., LOT 2 Parcel: 042-1020-10-000 Occ: Use: Description: 171507 Applicant: OLSON, JEFF Phone: Owner: OLSON, JEFF Phone: Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121 Inspection Request Information..... Requestor: SCHUMAKER, WM. Phone: Req Time: 09:11 Comments: 9110 Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION