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HomeMy WebLinkAbout030-2048-90-000 �C o Q) ° o 0 f4 a ao No 0. 0 0 o mm I N Ly 3 v 0 o ye �no0o $ �a� � a CL O > Q1 LY�J O z 00 p n C _ t5 T c 3 o nE aE N O M A N O E a U lC � CL N � N OCO Z O ° o N a m O O_ Z :i U d Z z N M N N C •�NV •p In � O �i c p m p o z w N z o .. d N r L O N O a G r CD d > rr U ' N E a m t z o O 3 a 5 z 0 IL w ia c U) ° CO o o -i V rn Z Y c\ U') 70 p � LO v c` = N a N w E d > U) o 1� rn O = N y o 00 3 I ca w e E Cl) LO CD Q ce o ° ~ E u d rn °o o f r z< N N Q co I O v O Q M 7 N 04 H N M C N r.. N C s lC.l i0 L co p U Cc co •O Cl) N U) Y O Z =I z (n ^" II d Cc € a L: a CL i E 0 c r A U a 2 O N U Parcel #: 030-2048-90-000 02/18/2005 12:47 PAGE10F 1 Alt. Parcel#: 27.30.20.510U 030-TOWN OF SAINT JOSEPH Current j X_', ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): *=Current Owner *KHAN,A HAMID&HUMAIRA A HAMID&HUMAIRA KHAN 1390 HILLTOP RIDGE HOULTON WI 54082 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1390 HILLTOP RIDGE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.040 Plat: N/A-NOT AVAILABLE SEC 27 T30N R20W 1.04 AC IN GL 2 LOT 1 Block/Condo Bldg: OF CSM IN VOL I PAGE 135 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-20W Notes: Parcel History: Date Doc# Vol/Page Type 06/28/1977 341123 556/306 WD 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 6127 505,700 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.040 155,400 342,100 497,500 NO Totals for 2004: General Property 1.040 155,400 342,100 497,500 Woodland 0.000 0 0 Totals for 2003: General Property 1.040 95,000 260,200 355,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 135 Specials: User Special Code Category Amount Special Charges Delinquent Charges Special Assessments p 0 00 q 0.00 Total 0.00 W ••y� s �- L 0. t_u 0 N / 0 0:: U } ���111 �7 a. 01. X j z f i ST.CROIX COUNTY z o i ; St�1?t�FY W N . O p= z i ;327587 iIfRTIL IE S4VE1 MAP u � Description: l From the northeast corner of Gov. Lot 2, Section 27, T 30 N, R 20 W, St. Croix County, Wisconsin go 1275. 14 feet West and 605.86 feet South to point of beginning for parcel to be herein described; Thence S 70 04' W a distance of 76.30 feet; thence S 50 36' W a' distance of 75.00 feet; thence S 850 12' W a distance of 284.25 feet; thence N 180 19' W a distance of 12.00 feet; thence N 1c 45' W a distance of 111. 10 feat; thence N 70 22' E a distance of 33.70 feet; thence N 860 31 ' E a distance of 303.52 feet to point of beginning, the above described parcel containing 1.04 acres, more or less, and. subject to an easement for travel over a 66 foot wide road easement extending from the above described parcel eastward to S.T.H. ##64 right-of-way. Certification: I hereby certify that I have surveyed and divided, the lands shown hereon; that the above description is a true and correct description of said Lands; and that I have complied with all the provisions of Chap. 236.34 of Wisconsin Statutes in surveying, dividing and mappir)g said lands. l % James R. Grubb �f. Sou f47 4' /,275. /q P. West Registered Land Surveyor S-722 of NE. corner o f' Gov. Lo 4 Dated April 1 , 1975 2, Sec. 27. T3on/, Z0W. G6 I N 86° 3/ W 303.32 a� tl 3 ± 1. 04 Acres �-- � .Trrdicgfes 1'ron pipe sfcrke \5 6G egse�r Z 241- /. %3 ,) tr 61 Af 0 284. ZS / 1 / 3 � s 8s°�z•�✓ / 4* a FILED �--- ~' 9 o' AJUAN ES 1O'i CO1NNOL I Scq/e: /" CR Repkier of Deeds Survey for Anna LaVenture $1. Croix County, March, 1975 Wten 8 � Vol. 1 page 135 , ff S�y• Certified Survey Maps St. Croix County, Wisconsin "r a • Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A��� TOWNSHIP S `; !' SEC. 2 T �� N-R W ADDRESS k7 'l 4 OX 7Lfo ST. CROIX COUNTY, WISCONSIN �{ hS� his. SUBDIVISION r_. LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G� 9 110, 9S� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /'/JD ' O Proposed slope at site: 7 �0 /N/ES J2 �DAv G SEPTIC TANK: Manufacturer: CD" ,QO- 7AA-)/A'_ Liquid Capacity: i A � Number of rings used: Tank manhole cover elevation: �• !0 �J , .a ' Tank Inlet Elevation: /2 �2 Tank Outlet Elevation: ! Number of feet from nearest Road: Front,O Side,O Rear, O > feet NO- From nearest property line : Front,0 Side,O Rear,O Z 0 feet Number of feet from: well > °Q 5 building: -//0 (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE • t PUMP CHAMBER 40 ' Manufacturer: CAM /3 0' T't''�� Liquid Capacity: Pump Model:��l� Pump/Siphon Manufacturer: "(JpUG� Pump Size ' (Ito' 9� P� �6 30 Elevation of inlet: � Bottom of tank elevation: ' /�, , y Pump off switch elevation: �/ Gallons per cycle: ?- Alarm Manufacturer: Alarm Switch Type: � ca N . � v Number of feet from nearest property line: Front, O Side, O Rear, Ft. r Number of feet from well: > S Number of feet from building: �5 (Include distances on plot plan). SOIL ABSORPTION SYSTEM M b U,v WS v is I d Bed: Trench: Width: 0 Lenith: �—O Number of Lines: Area Built: Fill depth to top of pipe: 02— NO . Number of feet from nearest property line: Front, 9 Side, © Rear,0 Ft . z Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elev on: Area Built: Has either a drop box O or distribution box been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANk ..+ Manufcter: Capacity: 0' Number of rings use Elevation of bottom of tank: Elevation of ' et: Number o feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector- Dated: / Plumber on j ob: License Number: HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGHT 3/84:mj WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. .a INSTALLER R DESIGNER LIC.NO.00663 E�rsf a`0y. r9 r 0 AP� �� L fS V r w r1 20 0 /0/ i � t h 1 1 � i r o i ► I ±, Hh�%/IA X00.`Y 1 _ �Oo � 3y 1 30 �. N O 104- - ,O _ 4 r 6(o Pn► T� ;1;L 6EpTic PLUMBING CO. 0'401-RD.,HUDSON,WIS.544016 /� A013ERTULBRIGNT /T VIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. T Ai,LER&DESIGNER LIC-N0.p00663 bEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SW%,NW4,S27,T30N—R20W CONVENTIONAL ❑ALTERNATIVE Slate Plan I.D.Nu be,: Town of St. Joseph ❑Holding Tank ❑In-Ground Pressure MMound "999d-101.446 HWY 35 NAME OF PERMIT HOLDER: ADDR INSPECTION ESS OF PERMIT HOLDER: A Dr. Hamid Khan Route 1, Box 700, St. Joseph, WI 54082 BENCH MARK(Permanent reference poml)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber MP/MPRSW No.: County Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 106123 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED [:]YES ❑NO OYES ONO BEDDING. VENT DIA.: VENT MATE.. HIGH WATER NUMBER OF ROAD', PROPERTY WELL. BUILDING. IVINI TO FRESH ALARM. FEET FROM LINE: AIR INLET OYES DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: OYES ONO ❑YES FIND DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FR E SH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES 0 N NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIDE DIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTH PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO F HE511 BELOW PIPES ABOVE COVER ELEV.INLE7 ELEV.END. PIPES FEET FROM LINE. AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES El NO ❑YES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. 1:1 YES 0 N 1-1 YES 1-1 NO OYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATE R I AL NO OISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKIN(, E LE V.. ELE V.. DIA.. E ELEVATION AND LE V.'. PIPES 1111A DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ❑NO 1:1 YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE OYES 1:1 NO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator L DILHR SANITARY PERMIT APPLICATION C�' Y,C,�p�' In accord with ILHR 83.05,Wis.Adm.Code STAT SAN TARY PERMIT# . �. �o pia —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/s x 11 inches in size. S�� — d ¢¢ —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES P<NO PROPERTY OWNER �/Lt A PROPERTY LOCATION 4. "^) ,J W % A)" li, S �? T 76�N, R LO E (O� PRA rTY OWNER'S MAILING ADDRESS R LOT C �tJJ/l11`` I I Y, TAT / /_ ZIP CODE PHONE NUMBER CITY NEAREST R AD,LAKE R LANDMARK CITY, . V "� 154-bYl—I S O VILLAGE: s�a II. TYPE OF BUILDING OR USE SERVED: 99-4" Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System KS,, ystem Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ❑Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy (e.XvIound ❑ IGP In-Fill Tank V. ABSORP ON SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ❑Seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes pei h):S REQUIRED(Square Feet): PROPOSED(Square Feet): 106 ^ f O 11 60 V V Feet Oprivate ❑Joint ❑ Public CAPACITY VI. TANK in allons Total ##of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank or Holding Tank "o Lift Pump Tank/Siphon Chamber f ❑ ❑ TH-1 ❑ VII. RESPONSIBILITY STATEMENT 60LOOV6— 1 i✓1C.—, I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No• Business Phone Number: , 209A yo Plum er's Address(Street,City,State,Zip C d ). Name of Designer: s ©- rid- - We 9A fc r VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name EPhone 655 O'NEIL RD.,HUDSON,WIS.54016 CST's ADDRESS(Street,City,State,Zip Code) WIS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. r: MINN_INSTALLER&DESIGNER LIC.NO.00663 IX. C OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sitary Permit Fee Groundwater ate Issuing Agent Signature(No Stam s) Approved ❑ Owner Given Initial c�e� ,� c arge Fee /_& Adverse Determination . 6 2, X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- . rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever ne'Oessary, usually-every 2 fo 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete $#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; Vl. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 81/2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground 1ter included the creation of surcharges (fees) for a number of regulated practices which Wisco CiR`S e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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 �� /ZM ` Location of propertyS�1/4 1/4, Section '� , T 30 N-R2-0 W Township Mailing address Address of site Subdivision name Lot number L6t C.S/yl Ud, Previous owner of property _�A:ALf Total size of parcel Date parcel was created 1 � 7 Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house)? Yes o Volume �S`r and Page Number 1� b ms recorded with the Register of Deeds. ------------------------------------------------------------------------------- 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 rded in the Office of the County Register of Deeds as Document No. 3 Y c/� ; 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 been duly recorded in the Office of the Coun Re ter of Deeds, as Document No. ) . Signatu?V '70iwnei 6P Signature of Co-Owner (If Applicable) Date o V Sig ature Date of Signature L G � YS 2S5 N � / v ......................... a vot , #A !boveM» MAIN AbOWK and LAIMU" Aw m _ ..... ...._hu..tld..and...� _.. w..+....—.-«« ......----...----»---.....-_»..»----—------------------«------------------------ Grantee. 'That the said Grantor for a valuable cousiderstion..One..do lar 'tstd other.-- ... omidera iau _............. P ., It pf Gsssttee the following described real estate in....St....Croix.......... County. 46*of wisosesin: scrum ro ps toot 1, as shown on Certified Survey Map recorded June 1975, in the office of the Register of Deeds for r° ; hKt Croix County, Wisconsin, in Volume 1 of Certified Survefal!(Aps - -•._ •a Pass 135, document 327587. This is . non_ .` A*Veber with a non-exclusive easement for access road described as follorat r the Northeast corner of said Government Lot 2, go North 89°15' West aloP the Ni ". line of said Government Lot 2 a distance of 1198.2 feet; thence South 704' Ylat ' fast to the POINT OF BEGINNING of easement, thence South 5 036' West 87.0 feet; �Alauth 46' West 56.0 feet; thence South 85° 4 14' East 66.0 feet; thence North A�� �RSt-90.3 feet; thence South 89015' East 524.2 f. • t more or less to STN 64 risite . wY- line; thence Northerly along said highway 77. E feet; thence North 89015' Wei . fi .7: feet more or less to the POINT OF BEGINNING. AND a further easement for ' ',4oscribed 89 follows: Also beginning at above mentioned POINT OF DWINNIiRi; outb-.89 15' East 66.4 eet; thence North 7°4' West 71.1 feet; thence N{trtd too �R"tv'b6.4 feet; thence South 5 36' West 71.1 feet to the POINT OF BEGINNING. i TIONB TO WARRANTIES: Existing easements of record, Affidavit of Covenants s 1� r85 se 29 �o�tions�njej6p'gions in deed from City of Stillwater,s 7igedter withPSH and singular the hereditaments and appurtenants thtreunt,, beron6ir.g or in any wise appertaining: A"_. AW!"..Maaaaur---and..LaVonne..M_...Francia- both...s•i lo.-• j lb s:the title is good, indefeasible in fee simple and frc< and dear � f c-:uinhrancts ex.ept.._ . .. ................... tay.........»..... ........._._«..._........_...__.....__............-..............---..... .............. -_...-.._-......... ..-...... ..-- ......------ a 0"M watraa t and defend the same. St Paul Minnesota th.s 2.Q-th-, 7 t. �°,ii�C111/d at...«.......«...._..'.«._.«_._..t................. 1 dap nf.._ �l1IIH_........__.___�........., 1� � AND eir►bIOD IN PRZCaSNCE OF x� ° eSO Patiling_ '4116Qur `r 7(�a �. LaVonne M. Francis ¶ x tl r ......... ........... ....................... ........................_«...«.»�Ji;{L, r} >ng .-._. ...«............................................... day ..f... .... __...... ..... ............__........... 19......... Al Title: Member State Hu of Wisconsin or Other Pared , Mimesota Authorized under Sec. 706 06 viz. ....... STATE OF 9190001=K " as. Ramie.Y-_...........___»...._County. ,. j 116:8004y came before me, this.......................Nt.1.1.---............... . dal of...........Ju..,llt-......................... _....._..- •�Ite�6ose snood.._«..�lF�l.�..l'44�$our...and-..LaVonne.M.,...Frat}cirs.a..l�pth...$ �g,�,e..Perp41A�__ «............................................ ....................................................... ............. ....................__.. Ire,me hsawa to be the person....N.. who executed the f:ueg,�ing instrument and acknowledged the same. a r ya C. X96 Nimison Road s ...............-............. we ed witneaei,is optiabd. Notary Public, commission iiR sf r WOW id*W:C*Kdtir shottid be typed or printed below their signatures. or wwoawa sc Y.'3 SI kr ~ ST C - 105 SEPTIC TANK MAINTENANCE AGREEMENT ►'''' St . Croix County : '' j OWNER/BUYER !��' ?A t@SS Y . Y. /� //�//✓ �"`, � �T ° 110 A ?o- Fire Number ROUTE/BOX NUMBER CITY/STATE GU�-s• ZIP PROPERTY LOCATION : Section Z7, T ?09 N, R fi 4 Town of_J� St . Croix County, Subdivision Lot number_. Improper use and maintenance of your septic system could result in xf its premature failure to handle wastes . Proper maintenance con- + sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you ptit into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal 14_a,�_em. 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 t owners of all new systems agree to keep their systems properly maintained. = The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o I/WE, the undersigned, have read the above requirements and agree (A to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St . Croix County Zoning Off:Lpe within 30 days of the three ear expiration date. . y P SIGNED X It, �n q •I` .. t DATE �i.-.►� � , f �,�„ ` wi St . Croix County Zoning Office P.O. Box 98 >'I Hammond, WI 54015 i 715-796-2239 or 715-425-8363 Sign , date and return to above address . ' i P - 1;o f Z. ( teL UEje pt "DEPARTMENTQF REPORT ON SOIL BORIACS AND SAFETY& BUILDINGS INDUSTRY, c DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (11�) MADISON WBOX I 3707 (1-163.090)& Chapter 145.045)fA LOCATION: SECTION: 7� TOWNSHIP - LOT NO.:BLK.NO.: SUBDIVISION NAME: S w t� t4 -? /T 30 NIR 24E(or S7 7 x E 10 t — COUrT W S NAME: MAILINGADDR F SS: S4.kac( HAMI'D k( A J p-4. 1 (3o)( 700 �4- .io46p If 60 S- S4o.Pj USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMM DESCRIPTIO I PR FI D IONS: N T STS: Residence ¢ A 1* ❑New Replace I M 4,V f 1_ 8 M4 V 11 12-- �V ov S, E w� ill-wry M h y 12- 1 G �j RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: I IN-GROUND-PRESSURE:IS STEM-IN-FILLHOLDING TANK:RECO �U SYST`ESM:(os11 S ®u 0S ❑u oS ®u oS ®u El Sau � If Percolation Tests are NOT required RATE:4 ]DESIGN If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C//fS S =7 Floodplain, indicate Floodplain elevation: $C S q S a�Se Ft HuMUD 15 PROFILE DESCRIPTIONS f4 !3.g S'f 14 10A," S U 6 S 7 /pt?f,*5 BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / S' De, go S TS I,33 9Y S S,/& D:1—� B- 7 /b 13 -3' 3 2 13�F�u aP4L y - Q,� ) S w Q u p 1" w D E o f N, 15 . -Pf-P op'-5y, Hof-S hr .2, 6 ' , B- P V o 0 1 sd� w� f 3.3 (4, Dr r• Hof s j2 3.6 t / /, r7' De BN ,5 y 5 TS S 3 ' 'be�� g.Z �O,D f�,5� S, O �, 3 8N_S1 w I'' i34A.)05 C f- X3,3. 1 f ff. oie -1y. /44D 1,67' 2>AAVe e Vt -gy 61' wt cem.,o,�j 1J. 01'Stwc B- op, mof-S uOt.01 WL F 5, O B- 7�� ��. 7� �' 2, '(v 7' :De IS _'St Lo ' B>J�IS S3� o� 3 B� s� W.n I Al 0 S o ate. s Sup-' R . 0EVitT10N5 of- 'PEP C5 9 PERCOLATION TESTS TEST DEPTH WATER INHOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER OD t —PERIOD 2 PER10131 PER INCH P_ 10 177,o 30 /G 20 P- P- 2, 1-0 P-_ P- 2 4 Z , 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. S 7 S•1•e_-i SYSTEM ELEVATION Ev'}ri'�S S^ �o�R-ve-e� w��f� /o o ��= , o 0 T� l I 1v _ tN s.. ! 11 (I I _ t _..... ........_ ._...__. _ __._. Lt:�1 +� ,,0T �cO Nor This �i _ ticrlai septic _ys em. See explanation. fi- 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 test§are correct to the best of my knowledge and belief, NAME(print): TESTS WERE COMPLETED ON HOMESITE SEPTIC PLUMBING CO.� L �Z— y f P� ADDRESS: ROBERT ULBRIGWT CERTIF�flCACT�ON NUMBER: PHONE j NUMB (o tiona0: WIS.MASTER PLUMBER LIC.NO,3307 M.P.R.S. y 7 d L— d `d MINN.INSTALLER&DESIGNER LIC.NO.00663 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) -OVER - v J -- • M , W ' 4 �9 i � Q i I � ' � M �~ +c Zl- Ln 1 0 _ F4 J x 4 � 4 Z 4 0 0- O � 2 � O � Z u o a Q Ln o 4 cc r NP jr- A4 V- cL \ cr a. P , d S88 - 01,446 PROJECT IND"X SHEET u . ss 11,4141.9 k44ti OWJ • r ; ADDRESs: 70 o S-{ D s,e-( °d' Z- " SITE LOCATION: fGv 1/� Vlo y� � c •Z'7 -r,?0 A, lP ?� [.� -10 S �'o S E PROJECT DESCRIPTION: 54, G-o � X C4 V� T"/ r `DR. K�44'5 Ex,ST456r- SYS''tt-t I'S FAiLlX1 , ��i'S PESiAENCe T/6 Soil (As utwFieo oa 54,1- wI'�,. Z0A.) G- gnnr�IS-t ��. M Q • T o (S E R P E-Rrli A 8LC= R u-1— S E A S"A 1/ � i e v' C L c.e , S � Q �� o i2 (� � E t'L O � PAGE 1 . PLOT PLAN VIEWS PAGE 2. MOUND CROSS SECTION 8, SYST7M PT,AN VIEWS PAG7 3. PIPr LATTM!?T, TjhYOUT PAGE 4. DOSING OR SIPHON CHAP•lB7R CROSS SECTIONS PAGE 5 . PUMP PER F OR!-.!AN(' SP-'�CS OR SIPHON SPECS PLUMBER: SIT{, EV_1LUAT"!M or DESIGNER HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD.,HUDSON,WIS.54016 ROBERT ULBRIGNT HOMESITE SEPTIC PL: ,nnS.MASTER PLUMBER LIC.NO.3307 M.P.R.S. E55 O'NEIL RD.,HUDSON, INSTALLER&DESIGNER LIC.NO.00663 ROBERT ULBRIG.. �.MASTER PLUMBER LIC. 'MSTALLER&DE!" DATE: SIGNATURE ..y C�INJ R� MAY 13198 �IGE OF r OF S F,yp CODE r '_J M \ �OMPN REAP � N pp,R 0� n I 11 EE \ I a. �J ku ill r— QC— Z h,a t SAS `'`� o �, % a-� Flo o aSv3 C71 of Cw _Zr " k 8 v � W a � e41 - ' SV o% GPI F (, G AGE O P P F a� F N row `' oo � nLo o LLJ 0 � � p Qo k yj W ,kn g C6 _ \ cm Ft ct - N oc J 'n- C/S w W LL! �.. OL Q Z f 888 = 01446 A Sy�� SSJAr �i;� Page _ Of _ 0 AN P -C ove r i n g Distribution Pipe c •, 4 \J`1111 teand s y SrEH AbIh. G FIFVArt00 MIR 0 G�� opsoll -= J Of Page , ._._ S�T��rcw,rra"' oR S 8 8✓'�[MME i� • O r J9 tora p,4 446 AIN r� Perforated Pipe Detail r 0 End View )Perforated End Cap) �\E�� PVC Pipe ' ,y• 0�6 Holes Located On Bottom, v� s Are Equally Spaced 7C S Q *� PVC Force Main w PVC Manifold Pipe a� 1319�a tS�GNr Distribution Gw �� Pipe or*()'N© Lost Hole Should Be GOOFS Next To End Cop End Cop J Distribution Pipe Layout P 2 / Ft• R / s 3 C� x 30 Inches 1\0 Y 9 Inches Signed: ��� vPS Hole Diameter Inch AC e���,o Lateral Inches) ` License Numb '�" �0 Manifold Z Inches � �Pc� �'� 3 Inches Date: ti� Force Main © # of holes/pipe /O G Invert Elevation of Laterals/00 SR. .S,!N D/cock 5'y_ T7r ti f/4V4;r/D,j 16 6 . D Fr. fr, 3 /'�c �o��� �i•�iv = SD .d""s. 11 147CPAIS �I 1/� l) �, a It / 7 P J t llE� D /,i 1-fR,4 S) -7 . (6 11f Tal f 15 r1 / n S88 - 01446 . - - SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 8 "WEATHER PROOF 2: 25 ' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE )GAS- SOIL TH CONDUIT MANHOLE COVE] I` W1 PADLOCK 6 FINISHED GRADE 4" CI RISER ��. 6" MIN . WARNING LABEL ABOVE G ADE �f._-4" MIN. 18" IN. 6" MAX. INLET I TIGHT SEALS TIGHT i 4" _ A SEAL APPROVED $AFF LE CI -f— �i , ALM JOINTS 4J/ CI 3 ' B 5 � i PIPE 3 ' ONTO pN SOLp� C SOLID SOIL MP OFF ELEV . b 0 FT. — RI SER EXI D .,�, OFF PERMITTED ONI IF TANK op 4 r MANUFACTURER -� � 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS G6 0 '7- SEPTIC / DOSE ,N�ivE,u ,Poch TANK MANUFACTURER : 401S . NUMBER DOSES PER DAY : �p TANK SIZES : SEPTIC /2-0-0 GAL. DOSE VOLUME INCLUDING /� I DOSE O GAL. C FLOWBACK: GAL. ALARM MANUFACTURER: LIFyEL 41VM CAPACITIES: A = 2 1, L = Zl � INCHES ' GAL., MODEL NUMBER: 19, V,L r SWITCH TYPE: M.E12wp- Fhok 7— B = 2 INCHES = 30 GAL.Ii PUMP MANUFACTURER: C = / 3-2- INCHES = Ly GAL. MODEL NUMBER : 2-2,o U SWITCH TYPE: ���� Qhccc M��� �IoATs D = O • INCHES = 1Z C.P GAL. REQUIRED DISCHARGE RATE 7 v GPM PUMP 6 ALARM WIRING AS PER ILHR 16 . 23 WAC i VERTICAL DIFFERENCE BETWEEN PLIMrE FF AND DISTRIBUTION PIPE 13, 5 FEET + MINIMUM NETWORK SUPPLY-R . . . . . . . . . . . . 2 . 5 FEET + /3_,� FEET FORjrgo* /, IFT/100 FT. FRICTION FACTOR . /, FEET pR�V P sF� if TOTAL DYNAMIC HEAD = �� FEET its INTERNAL DIMENSIOC° PU NGTHH WIDTH / Pti\-P�\�' � D I> R A, r a R Pp10 N ID P .S SIGNED: _ O` t�10 OF NUMBER: DATE: Dw 1/88 p SEE G y 70 S Op olVlstO" OFFICE App`ICA-SIGN ' ' CODES S8 g - 01446 HFADI ~ IL 115 CAPACITY 32 105 CU'R' VE' 30 100 - 95 28 so- 26 85 t EFFLUENT 24 B0 I MoDELi .# and Q 75 MODEL 189 5 DEWATERING = 18 V 20 85- Q z 18 G 55 _ Q 18 ODEL H 50-0 183 MODEL F 14 45 188 12 �- 35 10 MODEL 30 MODEL 137,139 IBS SEWAGE and 9 25 DEWATERING 5 20 MODEL 15 -MODEL 181 4 7 10 �/ MODEL W W 2 5 53,55, 57,59 0 GALLONS 10 20 30 40 50 80 70 80 90 100 110 1 24 75 LITERS 0 80 180 240 320 400 22 FLOW PER MINUTE 70 20 ICI 18 �- - MODEL 295 W 55 = 18 RE C V' V 50 nn 14 4S M ODE L z 12 40_ Q 35 MODEL F� 10 293 U 0 MODEL 8 25 I 284 { GOO�� I'�1 MODEL B 20- 282 �^ __ _ _. �• 15 4 10 MODEL ZAO���` Oi - 2 5 267.268 0 3280 Old UPI"La w GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 180 1y0 180 190 PO.BOX 18347 ,± Louavift K.nhxky 40218: LITERS 0 80 150 240 320 400 480 580 840 720 (502) 77 8-2731 f. FLOW PER MINUTE