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HomeMy WebLinkAbout038-1083-80-000 C O N O O y 0 O i, -D: O O 3 O O a Cy O es EA O va M O d q 0 C C, to 0) m 0) ~ C Y C N OO .y ~ •N 'N' tV (0 ? w6 W 0 0 N 0 0 m? M. co 0 y 0 CD O > yc0 O cn.nZO > yCO O 0.0z0 O 0 N - O. OI N L - O 00 N _ g Tp. r OL Oy O Tp. OL 0 00 ap 3~ O y anw .0 0 Sao N N n._ y C M N C N fl• co a C M C N O• co _0 04 y 00 0 C fo y C C N 0 C) C _O N C C cc a) V- CL > Co c f0 - co U ao C m o c c6 (o U O. a - o a C U - C j5 U) a) CL c: ~c d L co m a C _ to C c Q U w- - '0 d U L- C N C O_ N a) 0 C y co O c U)i o a N p Q) y o u N p y Co `6 > O N cu E O V1 N to l0 c0 co L O L 0) a 4? O. c co t > L O a~ a 0) Q) O m CO c- " >1 M Q O C L O a N N CL y Z f90xM EV' N 3c Z camxam E`n 3 c ao~a~ sacic~o v °p~2 a~ .0acica?o LL c L a aD00 n E co m E c 0 a doaoo y EE '0 Y U O d. N N w N y U 0'It N y 1 l 12 a o c $o aa> a o o `m ao r aa> a °a C) moo U) U) 0 Q mO cn2 co i aiN f i v 3 `r o Z H Z Y O Z d d rn cq a. m N F- Z c O o O Z c w w 2 115 aoi 2 ? c o 2 to F- o E E a a 2 Cl) 2 Cl) l-.]~fVl i ' O 0 C U) 4) • I. O O O O ! 6 U O O N Q _ Z m z p p N z z a 16 a c C i E E N E N 0 N- i Y 7 O Y m C O a m m c o p (D L O Q a a c U) 6 N a c w N .2 0 N LO U) U) ~ E0 wN E c~N 1 U 0 0 0 d 0 m Z o n O co Z o • ~.a a a a f a N O N y N J V rn rn Z } Z CD a CO F\V N 0 0 - O O N O _ E - E L m d a, m r orn O m N O a> O 1 9 m 'f+~ Q Z Q Z s o U O C N y E O N C C V 0) '8 C a 1 co ~ 0 O R O O ~ C N C N N C t~5 0 d m p y C H C U a QOj p E 0c) C7 M a' E cx- w cn 0 CL c E E > co 0 c.. p a c o L CJ a) -°0 m C a N a H 0 a c o cwr N M chi , o y o E m o o m o E m o • yam„' o N cn j o Z N z=3 a z U) Z N Z L5 a z cn v~ . ~ a d to L E Q a w `IV E i 'E 2 4) c A vat' 0 nv s " r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER gal ~g1,0. gtta TOWNSHIP L SEC. T YLN-R1_W ADDRESS 4 A~ j ST. CROIX COUNTY, WISCONSIN 4L SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM W Pit"KSr/Giro ± 4 4o` 86 /,F'cr'as~o 38 - r a~ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: - SEPTIC TANK: Manufacturer: 1~~5 Liquid Capacity: ad/ Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation:" Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,© Rear, O 4T22 feet .From nearest property line : Front 10 Side 10 Rear, O _ feet Number of feet from: well building: 3 ` (Include this information of the above plot plan)( 2 reference dimensions to septic tank) ' I PUMP CHAMBER 3 Manufacturer: Liquid Capacity: , Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:_ Length: Number of Lines; Area Built:. 91,10 Fill depth to top of pipe: j~ Number of feet from nearest property line: Front, O Side, Rear, Pt Number of feet from well: y~ Number of feet from building (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK ;R Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: , License Number: 3/84:mj I Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: l,abor and Human Relations INSPECTION REPORT St. Croix Safet fetyand Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION NW NW Sec. 29,T31-R18, Co. Rd. C 149234 Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: Don McVitty Star Prairie S91-40879 CST BM Elev.: Insp. BM Elev.: r BM Description: Parcel Tax No.: 488J 0t~ ~.C CJ 6Lt ~ ~yr~"6 038 1146 89 TANK INFORMATION ELEVATION DATA 11 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic )j Benchmark D001-9- Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet v0 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic '>-5r >60 NA Dt Bottom Do ' NA Header / Man. Aeration NA Dist. Pipe 'gam/ ~,Yv r , .3/ Holding Bot. System 10' PUMP/ SIPHON INFORMATION Final Grade :3 r~ ,63 anu ac Demand P "7_° (a f9 Model Number GPM TDH Lift Friction DH Ft Loss ea Forcemain Length Dia Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Len., No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS d EN I N 't? LEAC Manu acturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM CHAMBER el Number: INFORMATION Type O c7z r/. OR UNIT y System: DISTRIBUTION SYSTEM Header /-AAe~ Distribution Pi e(s) r7 ix Hole Size x He Spacing Vent To Air Intake Length ALL ~ Dia. Length f Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over q Depth Over rf xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ~V 3/ Bed /Trench Edges Topsoil C] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) f > f ! e 3 Plan revision required? ❑ YesP P/Vy Us e other side for additional information. SBD-6710 (R 05/91) Date Inspector's ignature Cert. No. ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: I [Z7Pj&-HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than l U~1-4prevlous 8% x 11 inches in size. ❑ application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - PRO ERTY OWN PROPERTY LOCATION '/a 4+/ '/a, TS1 , N, R /8 E (oro 7 PROPERTY OWNER'S MV NG ADDRESS LOT # BLOCK # /~~i CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME R CSM NUMBER / A)-r z~q- I 'n - 2e II. TYPE OF BUILDING: (Check one) CITY NEAREST R AD ❑ State Owned VILLAGE 4014 OF: 91*e 1.0AeX ~7 ❑ Public 91 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX NUMBER( 111. BUILDING USE: (If building type is public, check all that apply) - ( o 88 1 ❑ Apt/Condo 7 c^► 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 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3.E] Replacement of 4.0 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 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 ® 9110 91'.17) S ;q, -el 9/ Feet Feet CAPACITY VII. TANK 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 Holding Tank Lift Pump Tank/Si hon Chamber F-I El I El F] I F1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installat n of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plumbe s S' natur : (N tam MP/MPRSW No.: Business Phone Number: 1.ar 1 7 1 P_F16hi- Addre (Street, City, State de): 6ev IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signatu e o Stamps) Approved ❑ Owner Given Initial Surcharge Fee) lllllh~~~~ Adverse Determination ~ yyo X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y 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 prio► to installation. 5. Onsite sewage systems must be properly rhaintaihed. 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 tarks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; -eplacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 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) 17 ,9-a-.7 -9i revleW of ,~l%f~PSt✓ ;mss 9 include does not Septiclholdin8 of the Wis. Ad,M%n is tapPraval stream 82. This Submittal and - any plumbin secti©n 1 tlett er plan tank see v4 that dete d for C that Plum ode require I' PC°val is f/G0~ F~ IQ~, / ~ `J~/t~C•t ~iJ~ J[~~~` ~ / 1,2 -1 s'o' 1 SEW ~ c WOKS St:,:P'`iC ZWJK B0R UMAN R+ A E IN~~~ByA~ A OltAGs p~PA- ivtslOfy ~f ~~~CE A.PPF-.CmMA:F6 N MTb VCt's-f FC Krtef-~ cF THC C0'~ A$SCKKtliON Ap- A tAus He C;, T A MttJEM JM O'C- t.Ob Ft » Tb eJ&,-,.?IZE THAT -Tt ERS 0- hZ" of GC'vER ogek TUC-- D1S i Ri&r, lc0 L,&-MeAL-$ r T'1+CAE1-6KEi A Suf~T-Ace WA`tbt RuntilFF UWERSoctl MOST BE kC'Ji Q AS P'ER IL-.KK f33 ,10(7#1) 7`/~Gcoldl 5 1 ~na. ~s,_ l ✓X~ S"/WS' S~: ! e /.mot! 14 yJn V/dl5 ,"b ,cL o Sir2 E ' ~<j~ •Y~'O z l ~0 C/ n / i~0~.~-S',Eo -S/'~°J~~ J.~..,1K • ~O~p,~ ~ °J //~~C~caGjN%~ ~2W i ~2- / GE SYSTEM t' ` o ~F~'''n" t~'~F.N VlS~ON OF AF NICE SEE OR Cs~-,F" C'r'oss ~<'~~o,~) ~ ' PAGE OF -S CroSS ~~C }1UI, p Y /1 Vr1) J, 15 ~en-1 fresh All Inlet& And Obisivallon pipe ~C~c7 ^ _ (~l Appror's/ Vonl Cap 411nlmww 12 Abora I'l-01 Clod. 20. 42' Above Pipe _ 4' Coal Iron To final Gra,• V*A1 Pipe Malik Itoy Of SynrMrlc Co.ulny urn Y Ayprapola O../ Pipe ' Ot.blbrllon Pipa o 0 o -Tao t ~AOOr,yalo o Parlorola, PIP, B.n.ale, pipe 6.lor o ~Capllnp TormlMUnp At Balloon OI Sy.lam ~ir g5!9~► {,.ICJ~~ 1 O!1 < 1" 891 ® 7 SOIL FILL DISTRIBUTIOM PIPE • APPROVED tj)j {ETIC COVE ` /iATF_RIg4• OR 1" OF STRAW 2"OFAGGREWE OK tAARSN uAy ~ feOFlt-21/Z AGGREGATE LLEV.OFQ~FEET DISTRlfjtJTI0Q PIPE -TO BE AT LEAST 1,/ IIJCHES BELOW ORIGIIJAL GRADE AUU AT LLNSTLO IIJCHLS BUT KIO MORE THAW 42 IWCNES BELOW FINAL GRADE, MAXIMUM DEPTH OF EXCAVATI00 rXOM OR16NAL 6f(AK_ WILL BE _ II.1CHEs INNIr1UM IDCF71A of EACAvATICIN rAOM, C ►16I}JAL GRAPE WILL 5C S' IN,~ucs ONSITE SEWAGE SYSTEM slGUCO: - ~ ~ ~ LAPPR""""'WED IGC►JSC LJUMpEIi. DEPARTMIENT OF INDUSTRY. LABOR-AND HUMAN RELATIONS • DAT E -,Z _ cl/ IV'ISION S AN BUIISDINGS now SEE . C PONDENCE ` SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 KIM A OCONNELL Owner: DON MCVITTY RR1 BOX 105 2001 90TH ST STAR PRAIRIE WI 54026 SOMERSET WI 54025 RE: Plan Number: S91-40879 Date Approved: October 16, 1991 Gallons Per Day: 470 Date Received: October 7, 1991 Project Name: MCVITTY, DON Location: NW,NW,28,31,18W PROPERTY Town of STAR PRAIRIE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW CONVENTIONAL. Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, G Z~~4 leU GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/38 silo 8®tH. DON MCVITTY X Private Sewage Consultant DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INQUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 3707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ TY: OT O.:BLK. O.:SUBDIV ION NAME: T N/R i (or 1!31 4 COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS USE DATES OBSERVATIONS MADE 1=:1 COMMERC11 DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ®New ❑Replace - -p 2G- 2Z RATING: S= Site suitable for system U= Site unsuitable for system Ros NVENTIONAL: MOUNROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDE SYSTEM:(optional) ou a s ❑u ©s ❑u E s ®'u o s IS e0WAa1 If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.1463.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: A/Z PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND EPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- i i - - s - i - A/& Ale 4 - j4z B- > - B- G - - B- B- ,J s PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t -PERIOD P R PER INCH 3 ~ P_ 3 ' ),o J EPL P-- P- P- 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. SYSTEM ELEVATION f ! - [ E I I i A~sus✓ 3 . E 77~ E I 7 1 90 ___11 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. I NAME (pr. t : ' TESTS WERE COMPLETED ON: - J317 19 AD DR CERTIFICATIgN NUMBER: PHONE NUMBER (optional): 3 / S- 8- CS IGE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - a v INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred, A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion; if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N,A. in the appropriate box; 1 1 . Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Sail Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock colt Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate coed s - Medium Sand W - Well fs Fine Sand Bldg - Building Is Loamy Sand > - Greater Than *sl Sandy Loam < Less Than *1 Loam Bn - Brown *sil - Silt Loarn BI Black si - Silt: Gy - Gray *cl - Clay Loam Y Yellow scl Sandy Clay Loam R - Red sicl Silty Clay Loam mot - Mottles sc Sandy Clay wf - with sic - Sil y Clay fff f Tine, faint Y c - cc t ion, coarse pt: - Mrn - I- medium m - "I ck d - c' ct p - p!iinent HWL - I't water level, Six general soil textures irface we"-r for liquid waste disposal BM - E- ich Mark VRP ~.tical R TO THE OWNER: TW- is t``^ -`-.p in securin- y permit. Th , E.tunty or the Departm ent may request rif, i I 1 in he field prior to mil issuance. A fleto set of pt-,)3- - the private i t application must be abruitted to 1( : " . r in order to )rrni ary permit must be obtained and posted p. cc .~;truction. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 4 OWNER/BUYER dU lWe & ADDRESS:. Q Q I 90 v ~T.. FIRE NO:- a 00/ LOCATION: /lrzv 1/4, X1/4, SEC. _T&/ N-R_,L 9 w, TOWN OF: S7,Yw jo'e ~t6~ ST. CROIX COUNTY SUBDIVISION: LOT NO. - Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the 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 the 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 from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 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 2)0 y 1¢ /e'PS& zyc 4 fjVZI Location of property &W1/4 NW114, Section ;29, T_3L_N-R S W Township S7,*,,re AR'm /4~;; Mailing address _200,/ 5'0 S'Oln 6WLSC-7 - GvL' . A- yo a S' Address of site 199-5- 90 ST, S01,94WS&7' 40-t Yo r subdivision name /V0/V4F Lot no. iyD.vs Other homes on property? yes No Previous owner bf property ! C f7 eAM S o Z- Total size of parcel 3 /7 C"8 as Date parcel was created 7"x Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes )C_No Volume !VSO and Page Number 19s-- 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 the office of the County Register of Deeds as Document No. 3 L $ _5-/ , 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 apolic nt Co-applicant S'-mss-9/ Date of Signature Date of Signature ro 1 y , i DOCUMENT NO. w S'rATB BAR OF WWONSIN-F•ORU 2 VOL 370 WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA - - - - REGISTERS OFFICE Richard _F.,__golarz And Lilliannl,._ clarZ, ST. C*013( CO. WI& huEDand and w1fB~~S _joint tPn~ni u liw'd for ' Record Mrit; dGY Sf A. D. 19 eo 9 convoys and warrants to Donald W. MCVittyL and Rose E_ at8:30 % - V-i tty, husband and tai f as io i n t tPnan tjS_-_ - RETURN TO 1 Donald & Rose McVitty the following described real estate in St. Croix County, State of Wisconstn. Rt. 1 Somerset, Wl. 54625 i 1'ax Key No. All that part of the Northwest Quarter of the Northwest. i Quarter (NWT of NWh) lying North and West of CTH "C" and North and East of the 'town Road, Section Twenty-nine (29), Township Thirty-one (31) North, Range Eighteen (18) West, containing 3.5 kcres more or less. N TRA IS, FIE E 1 a This is not homeatead property. (is) (is not) y Exception to warrudies: Dated this lot _ day of__Sf~ptember r 5 (SEAL) (SEAL) chard F. 1 (SEAL) (SEAL) Lillian L. Solaro r #AkTHSHTICATIOM ACKNOWLEwi.;MENT 11 Sig tur suPwntimmad this 4th day of S'T'ATE OF WISCONSIN { Nov er County. Personally came before me, this 10th - day of INg lac Deee"beri1n~,, C•: e above named TITLE: MEMBER STATE BAR OF WISCONSIN 149-h--94- F_ S 1 - ( (If aw, Li 11ian L, authorised by 1706.06, Wis. Slats.) 5olarz This instrument was drafted by Reins tra i Van k S t.. - _ - . _ , to me known to be the pcrson$ who rxece.:rd the turn - Attorneys at w going instrument and acknowledged the same i~ New Richmond, Wisconsin 54017 ~ S14",atules may be authenticated or acknowledged. Both < ( ? r t_ _b-sr_• ,.11! riot n-cssary.) 0) l iimnue stow IS , :aee•wewrana~,,.ury'■.a,.s+v'y+*- -v.-_ x^ae ANTt psltA.,,,~ MIA's p R*rr _