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HomeMy WebLinkAbout040-1211-40-000 4 o aai o N ~ O 60 y ry O 00 ~ I N I n I Q' 'ts I d w i a Z c C LL L O Q I ~ I, c I 3 Z y rn Ii E cn Ii O I' c z y y 00 ~C14w ILm i o c C7 a c o z v o I N H r'"O N Z N ~ M N a O O N U) N C • O L 0) 0 CL -C rl I C 0 V O Z F- Z N O .O-.. z m o c co a W A N N N ~ > i Id CL M o T) co 2V11 O m O G C E N ~w ~ ~ i'I ~ N N N ~ J o ~i 'S a o Z co O O O 0 W116 4.; 0 (L IL (L a ° (A J U ''.C.~ OOi OOi } N r - N O a 7 M m W L CL 'O N Q } U} N 06 O ClS Oi M O W 3 m rn 0 co a 0 0 O O O l a cn U d O W N N r C O CL C V O r0) O H o COMA OOi V! .a0+ N N N NI _ a r r r r F~ O' N • O I 1 m O O O O a~O y E O L U F- LL r 0 Z c U ~xt a Lam •2 •1 E L c C y A 0 a2 o) 0 s 1 . FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 7 rc, SECTION T N-R W ADDRESS ~j~~~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~JG~ r~ v LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yS` c '1S EE 4 to s 3 INDICATE NORTH ARROW BENCHMARK: Elevation and description: ~5,t. •~-e ~i S / l s Alternate benchmark A-1 e - SEPTIC TANK:Manufacturer: fi? v -v7'X-r~Liquid Cap. p y~ d Rings used: 6 Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft. 11z.' From nearest prop. line:Front , Side, Rear Ft. No. of feet from: Well ,,//ate ~.ll Building: / q ' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: 2 Seepage Pit: Width: Length / p y Number of Lines:_LArea Built /d a a Exist. Grade Elev. 4f-,G Proposed Final Grade Elev. 0 Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well:_,( a> No. feet from building 2.5 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE : PLUMBER ON JOB : GrJ,~aG=_ r ~ LICENSE NUMBER: 3 ~'Z 6/90:cj AA1 d Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor acidHurpanRelations INSPECTION REPORT West Grov St. Croix Safety and Buildings Division • (ATTACH TO PERMIT) Lot 4 Sanitary Permit No-: GENERAL INFORMATIONSE4,SW4,Sec. 7,T28-R19,Co. Rd. F 149196 Permit Holder's Name: ❑ City [I Village 1] Town of: State Plan ID No.: Todd Francis Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1003 040 1241 40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 03 ~W 101.2(", ` Dosing ji . Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Map. 11 Aeration NA Dist. Pipe B47 Holding Bot. System 9 3 y ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand C Model Number GPM LIO C rne~ , TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Ord Fi SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING 11 INFORMATION Type O _ CHAMBER Moe Number: P' System: OR UNIT < v 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) o' ~u 1 i b GL lL rl O G~~? `,4 414. Z95091 Plan n revision required? ❑ Yes ❑ No _ .f rev: n 9 Use other side for additional information. 11( ,n r[2~~ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: "./411 9T 97 / ~~.z~a r~ W# [SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNT// ~R STATE SANITAR PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than C/ / 4? 8% x 11 inches in size. El C eck if revision to prddvious 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 S 44-:'/a V '/4, S T ,4.?, N, R /Y E (or)(W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE * C o ❑ Public 01 or 2 Fam. Dwelling- # of bedrooms PARCEL X NUMBER(b) 111. BUILDING USE: (If building type is public, check all that apply) rL~~~ oC 416 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5.E] 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) 9'4.2-0 ELEVATION I a- s D d r 1 4'2 Q Feet ?r 7d Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New P-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank sQ d I [A Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, 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) P MPRSW No.: A Business Phone Number: w (.cJr,'a /?y .Se~'IGCIhakeY' G 31''x,! Plumber's Address (Street, City, State, Zip Code): ~l S "-17"" 'Pet IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issu g Agem: Sign ure (N Stamps) ILJ~ Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination 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 .f e T s v-~ '7e z./r d r, rip f~ 1 ` x ,5 0 ' z~r°~~s'x S d ls~ r T , 'y;2 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~C)G^ ADDRESS : t v t yCc i• FIRE NO : 3 J LOCATION: 1/4, 1/4, SEC. '7 T~~N-R W, TOWN OF: r Q ST. CROIX COUNTY SUBDIVISION: C. (2F 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 : ~ki/ St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 '~P0,04 T -OF Safety I Buhurngs Division Department of Industry, SOIL DESCKIPTION REPORT Po. Box 7969 labor and Human Relations Madison, WI 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Sc S HMEPE 7' 'S Page / of L ~l - SS z- ustomer Name i va uatron Date urrent Lan Use or vegetative over Paren 10 11 t j na s ,P~i.Pi~ G~P~S'~s rT're/' ovtwRSff- S~4tiDs flow PlainC anon u tourer ress sumate She west roun water N ounty ax ara No. /sj f c~ ystem Los mg~te m a ons Per q. t. Per Day ST G~p~'IC r~s ~,Po vE I q 5 S 4• f f Lot Lega Description ystem eometry an Dept , L04J oW an Asye t t/ sw,,S7>^ AJ rR(gw Wo °F ;T~E~ -94.0 X20, sow Structure Remarks: clayskins Loading Horizon Depth Dominant Color Mottles In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bounda ores H and other GPD/ft.2 y /o yR W /o?r 0 C~ /oo,zoi • 41A 7-1o,-) A6 vjro,v Structure Remarks: clayskins Loading Horizon Depth Dominant Cola Mottles In. Munsell u. S:. Cont. Color Tenure Gr. Sz. Sh. Consistence Roots Boundary ores Hand other GPD= C, S ~l /f ccv i 1-~o R 2- n-30" /o le366, ~a- S R nr -e 0 Structure Remarks: clayskins Loading Horizon Depth Dominant Cola Mottles in. Munsell u. Sx. Cont. Color Tenure Gr. Sz. Sh. Consistence jtoots Boundary ores Hand other GPD/ft.2 • is of septic cyst for Horizon Depth Dominant Cola Mottles Structure Remarks: clays ins loading In. Munsell u. Sz. Cont. Color Tenure Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.J 7-1a A-1 yl Horizon Depth Dominant Cola Mottles Structure Remarks: clayskins_ Loading In. Munsell u. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Boundary ores H and other GPD/ft.= HOMESITE SEPTIC PLUMBING CO. 85,; O'NEIL RO., HUDSON, WIS. 54016 # y~'Z ROBERT ULBRIGHT - /►S. MASTER PLUMBER LIC. NO. 3307 M.P.R.8, i ,•!N. fW3TALLE i & DESIGNER LIC. 1-10.. GM ~ Qfl~~ Additional Remarks: /~v~trid, S of Nt /sow/:vyS ~9~~a^y/J a-k j ✓ ~ ~ .S I,!)~ ~p ~(J/ /I ~f Q F' ;ti ~ffi/~if T/O•eJ OF D.~4~ ~ D 1( 7'%l°E~U GGt ~t 47Ze7CO-1I1V 1,VS7*11--4W 0,0 /S Pa Slp,4e s . oer~o.•.,.~s E-~ Lz-ti2 Z Ce,,, e Sao p Roxe s co fA 4 T~PR M640 S ,Qar.G~, 5 ' X so ' , Other Site features: Limiting Factors/Depth: CST Signature Date Signed Telephone No. CST y SOD-e310(N 01x0) SSE ~o T p ~77~f a-a Sc~SSE5^r ep 5~V 1)M,7SI-E SEPTIC PLUMBING CO. 665 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 'IS. MASTER PLUMBER LIC. NO. 3307 KIP.R.S. INSTALLER. & DESIGNER LIC. 140.00563 GEES T G-~'o v ~ k'.G~ - HT n pp Ro X N U) L-Ot C okJA.)t Q otriAj Tod o f P- (f o x 7, ASSu~c O HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 WEST— 1-01' L-;" E- ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. %AHNN.:INSTALLER & DESIGNER LIC. NO- 00663 i g test ,~It a1 Septic Y {Ora convenbOn r mor µ I Sthku T f~oMesrt~ OAJ M I No-IE : ~o~ MOST- LiE sir IRo~ nta~~- f}c{4~2 yS -FM 1 WEST- I (5 f3 D pm.5 ) ! RP RoY~iH~7t i DoT Zr lEv~tTtoJ = 1000 B~ z- , Top OF 99 yo' i~ ' ZD 670 - i~ 10 - - s -----s xV3---- --5v1 - - sysr• FiIfu.~ 5y i s sT 91,0 N y ~ 6,iev s c1.. i PLACf_~ e.,~ T AP-.EA ~ 4t n c, iz SUS 7 2-0 V . = 13r}C~~~ l~oe~NGS X = C, S iT~S v r. PLOT l AAA) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION H -LABOR AND P.O. BOX 76 HUMAN RE PIE.LATIONS PERCOLATION TESTS (115) MADISON W153707 HUMA (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: WEST I ~ NAME: s~ 4 W 1/ 7 /TZ? N/Rl E (or) W ?'R D Y - COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: s+,G,orX ~'ooo d xvpw y bee uciS Z~'~ R~ur`~ 1~~~CrE ~D• ~~~so•~ wis 54or4 USE 1, 3 loco - Co s 2-- DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I 1 STS: Residence 13-1-4- , /f , M New ❑ Replace RATING: S= Site suitable for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: ISO YSTEMIN+I_L_ HOLDING TANK: RECOMMENDED SYSTEM:(optional) CD S EA ❑ S ©U ' E S ❑U S RIU ❑ S IKU - 7~e,- s w, excess'/vE' Tlove- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: ez-, f Ss. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ;r..+ 13rGr-14L 'f L-C-_r- d'l BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH. NUMBER DEPTH IN. ELEVATION OBSERVED EST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK d B- / O • ' 7. > All" may. 3.-1 S 1-1, LW G. o v~~t l t w 2 ~ s-Z > s ' _"Pe.. 13s ._sy s I. J - a s I 7. ex y c w die . o 8,.3 9.0/00, 3 > (v vE,~ c 5 ' t fit.-Gy-Qa. S~ I•S' S~ (,•o' T~„> B-Y O > %,4:9 10 v& cs' ,e B-s 1.0 ` 55. yo' %o 15 2;0 , a B- o PERCOLATION TESTS IV (I6:QY Cs STS i} S TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES N j NUMBER t 44LS AFTERSWELLING INTERVAL-MIN. PERIOD P RI D2 PERIOD 3 PER INCH P- 3. ' -e Y3 Y P- 2. iL 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. ,rQ,vGsj, ~G . O ' e SYSTEM ELEVATION ~ I I L S S ~ T i i1~►~- i ; 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 print : TESTS.WERE COMPLETED ON: _ Q Q SEPTIC PLUMBING CO. P-12 SON WI& 54016 ! ' ADDRESS: ROBERT ULBRIGHT CERTIFICA ION NUMBER: PHONE NUBE (o tional►: MASTER PLUMBER LIC. N0.3307 MRA& 2 y L 3 ~D " M~~ S ^ ' •:JSTALLER i3 DESIGNER CST SIGNATURE- uee _ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD.6395 (R. 10/83) - OVER - G~ovE ,21~ . 4045- 7- pQ # t, z 3 S - G fT- p~.pp 9,O )t • N w ~ofi coQN~~ fl SS W+r D HOMESITE SEPTIC PLUMBING CO- W O'NEIL RD., HUDSON, WIS. 54016 WEST' "r Lime ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. MINN. 'INSTALLER & DESIGNER LIC. N0.00563 o I1~ * 'I i I S+hk~n COT Ho~'►ESitE I t a I ND-tt : I~d~+t H o S r `it- Q•M • v,R Pr ` i Rr L,CAST_ 2$ ` fleon , SET „ I pAl hLv.J (r I f}C-f t ca.~ S Y S -l a M t PrP P M&I' Al WEST 5`OT 04E~- 6leWlT100 t iv . 3 3 S, • x sv - Tor F 3/y" Puy ni . F(y„ h7lo) - 91. y0 P1 p s ~L pp _O ~ -t- Lo Sys ~ x Q'3 5yI ~ t~ ~epLgc~r{eaT' hQErt c° o • = Bf}G~l~-~- ~o~iNGS S i TES ~ X DER c. c W I _ PLOT I TAIJ SAFETY & BUILDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND, INDUSTRY, C DIVISION LA13OR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 537069 7 i ' HUMAN RELATIONS 11 LH R 83.0911) & Chapter 145) LOCATION: ON: , SE TI N: TOWNSHIP LOT NO.: BLK. NO.: WEST I ~ NAME: -cf sw 7 /T N/R! E (or) W _rp 40 Y I I- COUNTY: OWNER'S BUYER'S NAME: MAI IN ADDRESS: s+,G,o/ JC 7oDO d flvi2jeey fAucl 'R,'UER R jaGE ~D• uPSaA3 , w iS S4o~Co USE - Co S t_ DATES OBSERVATIONS MADE TION r~ NO.BEDRMS.: COMMER IAL DESCRIPTION: X PROFILE DESCRIPTIONS: New STS: Ic~Residence 34v¢ !alNew ❑Replace I 41-14er- sc 5 -7 3 '15;4 RATING: S= Site suitable for system U= Site unsuitable for system 1 ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) o S ❑u ❑ S ®u a S ❑u ❑ S ou ❑ S au CXGESS/OE O O V O K 0% S v/O"J If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~ under s. ILHR 83.09(5)(b), indicate: ~iG~ ss Floodplain, indicate Floodplain elevation: i PROFILE DESCRIPTIONS Dt-Giat.}L 'F~tT a BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTU E, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK) e- 9'.Or I G ' A) > 9 p id Ar 61y. 3A) s, z. o s, G.o 'T-•>F..~ / y vEx es w iz '0 B~3 9.D~ /00#3(o .?S' 4--cy.~ ~f.aa, S, .?s emVF,e cs w t' r r B- . O ~JZ rDy ? A5''Dt.-6y-Qa. S I.$' L S~ (0.0' T•}„~ ,C Utz 4 'r 5* l .2v ' B-s I.o ` qs. Yo' B. o PERCOLATION TESTS //.1 ' UE.Qy CS S7~_it'/f7°4 S ~ TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INCHES RATE MINUTES h i NUMBER IUGUISS AFTERSWELLING INTERVAL-MIN. PERIOD E 1 D2 PERI PER INCH P_ 3 -r Y3 P- 2 2 -e .2_ Y P- Y 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. 2 O ' / SYSTEM ELEVATION LI °w 9'2'0 ~I I I _ S.1~ w1 A j E A Pk I T I ' ! 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 (print : E SEPTIC PLUMBING CO. TESTS.WERE COMPLETED ON: Args, HUDSON, WIS. 54018 ADDRESS: f108ERTULBRIGHT CERTIFICA ION NUMBER: JPHONENUMBU(iona1): S. MASTER PLUMBER LIC. NO. 3307 MRAS. )"V 3 <o - /p S ' •:dSTALLER 8 DESIGNER CST SIGNATURE: t _ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. , DILHRSBD-6395 (R. 10/83) - OVER - r' was ; ~ -rPoV E' ,Q1~ . j ; 97 `2.35-G OT- h-pp R0 X • N w Lot C.0~2NE-k flSSWrcp HOMESITE SEPTIC PLUMBING CO. w e S T' to T LiN F 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 4lNN. INSTALLER & DESIGNER LIC. NO. 00663 lid I Sfiht!En DuT I I N-n~+E sitE , M S r Li F ~ I R r L-E~1 S T' ~.S ` -F~on SET it, IRa'j rtc~w RP P ROY.~HA'tt WEST— 1 ~4 ~-f c<u.e $ Y $ M , DoT Line - ~lEv.~T~oa~ /OO•d /I 20 3 {3~ / 1~ `~,l'1. SET • - ~ 5' XQ2 S~ x ` S ' Tor ° F 3Iy~PUG ~3i 1'Le . LFILU /VO,) = /t7 ~U This r o test site A.ppRo ® for a con Ventionai septic s *stem. Sys ~ x ~'3 Syl ~ pe ~S • TePLALeMCA 7r ft P-EAr I Q~ I O ~ z ~ .v SCA/~ ; / ZO J( PE R C. S i TE-5 I~ L 0 n~ P T r. { 't X" MIMS 0ld~laa W=wi'r1 VgWWi........ ; ~ a~i.~'~{'./S~td~d/..~.... ~nG~t~.l.~. _ dt...Attd~ie~t..F.~19Rt~lA.♦..bo~taha~ld... ~ ;1~ - % r . a Id li ! /itrY'rw, ~T Witnesseth, That the sold Granter, for a valuable com"Gratioa...... - - 5t..... roiz RaTutw TO eeevs to Gsesfts the following described real estate in !t ormty, State of Whiesasin: Lot 49 Plat of West Grove Estates in the Town Of Troy, St. Croix County, Wisconsin Tax Pwa" and running therewith, an undivided one- twelth (1/12th) interest in Outlots One (1) and Five (5) of said Plat. n This e not homestead piroperty. (is) (is no SE Toptbec with all and singular the bereditaseents and appurtenances thereunto belonging; And ~.;;j warraeb that the title' is good, indefeasible in fee simple and free and clear of enenmbranas eaoept ` ' r - say easements., covenants., reservations and restrictions of recbrd. and will warrant and defend the same. A' Dated this I~ day of All $ t 21... . ..(SEAL) _.....(SUL) Kevin A. Maple y t 3~ Carolyn J. Man1eY _...e 4 AUTHENTICATION ACHNOWLEDGKNKT' f sigssto:e(s) STATE OF WISCONSIN r. ss. St. Croix _ . County. N authenticated this day of...... 19.._ Personally came before me this ..Sp....4W et . Nivj st 1989... the above. anesed Kev A r-anley.. 4 •...r..... < r'anley _ TITLE: MEMBER STATE BAR OF WISCONSIN i. (If not, . _ to aphorised by § 706.06, Wis. 5tata.) me noWfi•o be the personr....... who esstnltsd file forecoin :instrument and`#ahs0lrledge the pass, THIS INSTRUMENT WAS DRAFTED AV ` TA - i.,. 1 • ~.ct~. -:4 (Signatures may he authenticated or acknowledged. Roth (`oA'~)1„peGadi~K Mt its" are not necessary.) date : ,.r) •Nare. ed DQ11IIe. Wales la .ay etpecity should he typed or printed belors their .ienccuM. - 11rl4lg wig ~ 11 U R MtM . . 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 A ~dlac, Location of property 1/4 1/4, Section T a N-R_Z2-_W Township v'a y Mailing address Address of site 3 L..1 Subdivision name f-J~-- G Stu Lot no. Other homes on property? yes No Previous owner of property e,; , \ Total size of parcel _ I A cc 5 Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number /D 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. y S0 -7a 7 , 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. Sign re of applicant Co-applicant Dat of Signature Date of Signature ~L 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 Location of property 1/4 _1/4, Section _ 7 Ta K N-R_LJ1 W Township a Mailing address Address of site Subdivision name_E-J -5 4tz Lot no. Other homes on property? yes_ No Previous owner of property e-v h ~cL r-c~ Total size of parcel I A ex-o--c, Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes 2( No Volume Wand Page Number /D -7k 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. y Sp ? , 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. 'gn re of applicant Co-applicant V Dat of Signature Date of Signature I I( "M 01001 VOW aseawb"w 4" DOCUMENT NO.. STATE BAR OF POW 1--IMI w , sr. tone tx:, an This Deed, made between eV ri.. Aa.:. e¢114.x $t feed ior lk re >ti Caroly ...J ..MpAjg .s huband and. K fe of AUG1809 ae-eurvivoreMp• r..el-"property; . , Grantor, and. TodA..Ma..-Frain-ia...&...Audrey..F.rmcia.,...hushand----- s~. vre ; ~e~,~,~ert Percy AybN►sro Grantee, Witnesseth, That the said Grantor, for a valuable consideration. conveys to Grantee the following described real estate in . St. CTOX asruaN TO . County, State of Wisconsin: - 5 Lot 4, Plat of West Grove Estates in the Town Of Troy, St. Croix County, Wisconsin Ta= Pared and running therewith, an undivided one twelth (1/12th) interest in Outlots One (1) and Five (5) of said Plat. yq1 This iS.. nOt_........ homestead property. (is) (is not) s 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 any easements, covenants., reservations and restrictions.of record. and will warrant and defend the same. ~rh d Dated this _ I" day of AU uSt. 19--89. (SEAL) ' (SEAL) Kevin A. anley - - (SEAL) ..7... .(SEAL) i Carolyn J. Manley - AUTHENTICATION ACKNOWLEDGMENT . Signature(s) _ STATE OF WISCONSIN ss. ` - - St. Croix - - :-.County. authenticated this day of 1P Personally came before me this i s day of 1u-gUSt. 1989.-. the above named YevinA. I:anle .-.CarolY?? - --J~--------- ' . - .ley . TITLE: MEMBER STATE BAR OF. WISCONSIN . - (If not. authorized by , 70111A6, Wis. Stets.) to me lowti,t0 be the )rerson. who executed the fomroin>.in.trument and adkncwledge the same. THIS IN,TRUMENT WAS URAr1F1 nY - T A/? C- .oly?? J. anley- Nota- [~f1C _'County, Wis. (Si),nature:s may he authenticated or acktmwlcdvcd. Brit! NT` i , inis~terf q p(roulpPft 1f not, state expiration C; are not necessary.) data: *Names of perwna signing in any caParity ?h-c,l ho t,- o,,i .r ormut i 1 d0- th, it wAAMNTY DEkD STATE 11" OF WISCONSIN yp Dsrtt .Awnss