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HomeMy WebLinkAbout020-1323-00-000 i I I I I (n ~ Z I ~ ~. ~ o m r: I o n ~ ~ CD ~ ~ N C j (D 3 CD 7 ~ O N N N a. CD O O ~ ~ O I rn <'~ ~ m a o I ~ I ~ A w I ~ c °o c_ I N ~ '~` 0 I ° ~- ~ o W ~ .. I N I ~ I ~ a A_ O I ° ~ C N ~ ~ ~ I °o o ~ m ~ ~ I ~ fD N Q Z O_ '" I d _O O 3 ~ CD I ~ C I u, ~ I a ~ Z ~ I ° v, v o' I I I I I n 47. O Z O m I I I I I I I I I o `~ ~ p ~ °o •. C'1 f/! Q 3. ~ n o m f c ~ c ~ m c ~ 3 ', `D m I ci m v ~ ~ ~ ~ .o ' at c A ~ ~ m ~ m ~ ~ _c ~ ° ~ ~ C N I' O o w (~ ' w ~ O I ~ CO N _ W .N-. O O C ~ ~ 7 O p N y 7 O O O d ~ ~ ~ °° a o n o ° °- ', ~ i ~ ~ N N CD '~ = ~ O O ' ' O C 0 o n 3 :.. a' o .. ~ v ~ ~ ~ d ,.. fA fA fA p ', I ° ~ ~ v o ° , m co N rn D d ~p n m y N N A 7 Z 07 Z D o ~ O ~ C fD N N ~ C N O (D ~..' fl. 7 ~ (Q ~' Z D o c ' -' n ~ ~ n .`p .. Z O ~ ~ ~ N O ~ ~ ~ Z d ~ ~ ~ C '~ i ~ O 3 m ~ !~? Z ~ A A T C 7 a z 0 0 A a~' 0 b N O O ~~ Q v, a o ~ ;v ~A r ~ ti wisconsir=Department of Industry, SOIL AND SITE EVALUATION Labor and• Human Relations DivisiCR at'S'~Tgty and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~J, (' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # Page -~ of _~ APPLICANT INFORMATION -Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location .~G ~~ Govt. Lot !~ 1/4 - 1/4,S T j ,N,R E (or~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number Nearest Road ~~os~ I ~~r I ~ y~/~ I ~ ~/ ) /~G/ ^ City ^ Village [~ Town I rr~~~ ~~ ©New Construction Use: ~ Residential / Number of bedrooms ~,_ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~y gpd Recommended design loading rate bed, gpd/ftz • 8 trench, gpd/ft2 Absorption area required asp bed, ft2~trench; ft2 Maximum design loading rate ~_bed, gpd/ft2~_trench, gpd/ft2 Recommended infiltration surface elevation(s) •t ~ - d0~ r ft (as referred to site plan benchmark) Additional design/site considerations ~CW/~ i Parent material - Flood plain elevation, if applicable 9.20.3 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system [~ S ^ U ^ S ^ U ~ S ^ U ^ S ^ U ^ S ~ U ^ S ^ U S(]IL (7ESCRIPTION REPORT Boring # /o/ ~ Ground elev. /~~ft. Depth to limiting factor in. Horizon Depth Dominant Color Mottles Structure i C t B d Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary Bed ,Trench -7 v- 2 StG 1 L VF S '. O 2 -2~ /-~ 3 L ~ C S 3 3- ..s- .S S o G L - -- ~ . ~ Remarks: Boring # - ~ .zM VF ~. 2 ~' -z3 -6 ~ L . O ~ . ~ ~o . 3 -/ . --s a ~ -- - ' . Ground el v ~~ft. ~, V~ Depth to limiting g6 factor T CFtOIX - in. Remarks: CST Name (Please Print) Signature 1 Ie~tCING~~ OfE Tt /' ~ 1/ 7 ~ Address Date C ~ ,,, ~k /~~~. ~'v~cxr~ cvt syoi 3 7/may/y~ 3z33 PR@PERTY OWNER ~~j.1`~ COr1~FT SOIL DESCRIPTION REPORT PARCEL I.D.# LET '~/O Boring # IPJ'2. ~ Ground elev. /d3~_ft. Depth to limiting factor -- in. Boring # y /OO. 3 Ground elev. /vim-ft. Depth to limiting factor in. Boring # 5 ~,• 5 Ground elev. ~d~ ~_ft. Page ,,~ d ~_ Horizon Depth Dominant Color Mottles Structure tenc i C nd B R t 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s e ou ary oo s Bed ,Trench l 1 r S Z 0 D ~- `-- G S O- _ 6- -S S os - ~ •~ Remarks~3.~ ~Ola ~~ Cod ~t'/~ l"~~'h~T ~_ _ L L-~ G S ~. ~- - 7 0- 3 '- L L - , Z.~ '~ o G s - - ' ~-y .~ -s' - o sG L s - ' s y7_ _s- 5 ©s G L -' Remarks: ~ 3 -~7D~ G/?, [D/T~i2/C - TT~h~T Horizon De th Dominant Color Mottles Structure R GPD/ft2 p in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary oots Bed ,Trench - z G z L '.D ~ L ~,~ Depth to limiting factor in. Boring # a i Ground elev. n. Depth to limiting factor In. Remarks: Remarks: -8330 ~~ Q,E .ayc DAVE FOGERTY PLUMBING Lkensed ~Test~~ Phimber ROBERTS~WI3CO~NS1 5iW23 Phone 7~9~3656 /~/~. ~ 7/3Y1Q6 /J~'G7`~ Co•K'7'• ffwG 9zo3 LoT +~ Q ~/ _--~~ iy ~ ~ _ ,` ~-~. zy` ' ~ X .~ : % *3 ~ ff ~Y /Sy . i3 ` ~. ~S C S`c LoT #/v /. z 6 ~e/%Es S4~G~ / "= Yo' d = J3iY(/ / " Gmiti~~it ~N~~ x = ~3oie.~vG ~ y~s-EC~.v . ~v. 3 ~mT ~j/ ~~ 1 1 1 i I 1 I I i I l~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safely arad Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (11fm11 Permit Holder's Name: ^ City ^ Village ^ T n of: Delta Construction, Hudson Township CST BMElev.:- Insp. BM Elev.: BM Description: CJ C/ h S r TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~'dQ Dosing -- --- AeratrOn Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic 7 ~s'r ~-~2, Zvi ~~' NA o _ _ .-- --...._._.. A Aeration ~ NA Holding PUMP /SIPHON INFORMATION an .____.___ mand __.-- Model Number GPM TDH Lift Lriction Syste H forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM ~ ,~/ _ / _, { ELEVATION DATA County: St. Croix Sanitary Permit No.: 363978 State Plan ID No.: Parcel Tax No.: 020-1323-00-000 STATION BS H1 FS ELEV. Benchmark j, 3 Z ~ 3. ?Z ~ Alt. BM Bldg. Sewer ..~ J `~ . 3 / Ht Inlet ~, (~ d ~ Z '~ Ht Outlet ~,'~ (Q. S Header/Man. ~.. ~3 9~ Dist. Pipe ~ ~,~3_ ~~ Bot. System ~- ~` : p ~ y Final Grade ~~ 3• ~ ~ ~` Z St cover ~ ~''~ t/ / f-l~o BED / EN Width Leng~ . No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM _ ` _ s'~ ~ DI EN 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LE Manufacturer: " SETBACK INFORMATION Type O ~ ~ ~~ ~ ~ ~ _ BE OR IT a um er: System: Z DISTRIBUTION SYSTEM Header /Manifold ~ Distribution Pigo(~) ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~_ Dia. ~~ Length y3-~s ~ Dia. ~ Spacing .S 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 BedlTrench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) q5 Inspection #1_/~ l' 24 /dU Inspection #2: / / Location: 666 Todd Lane, Hudson, WI 54016 (SW 1/4 SE 1/4 10 T29N R19W) - 1029191670 Scott Acres -Lot 10 1.) Alt BM Description = 2.) Bldg sewer length = Z~ ~ -amount of cover = ~- 2,Z" ~ ~ ~d/~o~oa 3.~ 3~ was a~~s{~ y~a-! Cs T ~s~ ~~s~ro/ en r ~ rc CG~a ,,yy~~ G / s Plan revir5ion re~~i rf~ct~? a ~f ~es ~y] No Use other side for additional infor ation. /6 3 60 ~. SBD-6710 (R.3/97) Dat Inspector Signature Cert. No. b ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: VV1fii rtsir Department of Industry, SOIL AND SITE EVALUATION {)~bor {*rfd ~ .. man Relations 'g~~ ' Division of Safety and Buildings in accordance Sv ;i'p.Fl~ 9, WIS. Attach complete site plan on paper not less than 8 1/2 x 11 inches i si~~f~('lan ust.~. ~~ ,,~ include, but not limited to: vertical and horizontal reference point ( ~'ldirection~~~;/~D ~ (- percent slope, scale or dimensions, north arrow, and location and bist~fice to neares o r a I I.D. # ,r, APPLICANT INFORMATION -Please print all inforl~fa>~ion, sr cRolx ' wed by Page _,,L_ of ~ Date Personal infom>atan you prowde maybe used for secondary purposes (Pnva~y to s. 1~ 4~~+tdjjl' ~ Property Owner ~ ` i , Properly L ,,y~n\~, ~L ~ jO r-'~~A / ..~-~ 1/4,S `~ T.~ /`a 'N'R Property Owners Mailing Address / l~ /(/ •• d. Name or CSM# 2mG ..~ "=' Sj• / X071` ~-e/zEt City State Zip Co ~.. L~/~ ~ Nearest Road .~/.~ACJrss I i .r I ~ t/. /~/'~~ '~" ~~ /~S ~ Town I ~~n l~~ ^ New Construction Use; m F ^ Replacement ^ f Code derived daily flow ~~v gpd Absorption area required ~.S'~ b Recommended infiltration surface elev~ Additional desigNsite considerations _ Parent material S = Suitable for system CO U = Unsuitable for system Q~ S U U Boring # 2 w Ground e v. ft. f~y.3 Depth to limiting `y,~47`C~f ~/~u/ ~~ r w Uo ,, ~- I SOIL DESCRIPTION REPORT Kisting building E (ory~ I ig rate ! gybed, gpd/fi2 •8 trench, gpd/ft2 ng rate _Zbed, gpd/fi2 trench, gpd/ftz as referred to site plan benchmark) plain elevation, if applicable 9.20..3 ft AT-Grade System in Fill Holding Tank ^S ^U ^S ^U ^S ^U Horizon Depth Dominant Color Mottles Structure i t C B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ence ons s oun ary oo s Bed ,Trench -7 v - ~ StG 1 L t/f S ' . D 2- -.2.~ io - ~ .~ L z C S 3 . s- s S © G C. -- - ~ . ~ , z (~ s ~ ou,.~'iac w ~ , Remarks: Z .t /YI F ' ~' -z3 -6 ~ L . d ~ • ~ 'L ' factor - in. Remarks: CST Name (Please Print) Signature Telephone No. ~--- O~'E TI l • - Address Date CST Number / ~ ~ c wt s o.L 7 ~ 3z33 PROPERTY OWNER /T~f.G-G j~ CO~,~j; SOIL DESCRIPTION REPORT PARCEL t.D.~ LIT ~/D ~^~ 3 2 3 '- f~ Boring # S Ground elev. eft. ~~: ~r Depth to limiting factor '-' in. ~~ 3. Boring # Ground elev. ft. Depth to limiting factor in. ,.~ . -. A Page r:+~ N, '~ . , Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ~. r S z 0 0 - ~' S 0- ~- ~ er L CS - . O • O . - S v.s - ..d' (~(. O i Remarks~,jl3 -~ ~O ~a ~,~~ CoB r /~ ,,_ j~~'h~T p- - Z ~ L S ' ~- o - 3 - ~ L z•~ - o G s -- ~ y . ,i- S - o s~ ~ S - ' s S ©sG L - Remarks: ~ 3 ^- 70 ~ ~rR' t o/~~ i7~ - 7~h<T Horizon Depth Dominant Color Mottles T Structure C i t B d R t GPD/flz in. ~ Munsell • Du. Sz. Cont. Color - exture Gr. Sz. Sh. ons s ence oun ary s oo Bed ,Trench - z G t L '.O 3 - •s ,~x c s~ L y s -- - ; . ~ Remarks: Remarks: SBDW-8330 (R. 08/95) ~. LaT # Q ~~~ ~~ DAVE FOGERTY PLUMBING Uc~eased~ T ~~ Plumber F arty Hai~hts Road. ROBE~o WI yN~ 5023 ~/ay/Q6 /JEGJ"~ CGZvs'T. zy` ~y t ~, ~~s- -C ~c SE ~ LoT ~/v /. z 6 ~~,ES y' 1 d(. _ /~/Y(~ / " LmiCN6'it ~iVty~ ~.z/~~^ ~ ~,,r1H~'/~ /e7U.p ~ x = ~oR~^iv~ ~ e : Fnu~r,~ LoT cmiziv~R. ~ ~~. 8~ _ slAs~ ~ s ; ~ ~- - y ~p1'G ~ z - y Z/qQ• 3 a_ ~ -- y 9/p~~ I{wG pzo.3 __ _~ ~~ ,~ ~,S `/SOD ~ ~~~.,~ I a ~mT '~/, !o. ~. r9. lG7d Sanitarti' Permit Application safety rk ttwlomgs urvtsta ' In accord ++ith Comm 83.2 L 41'is. Adm. Cbdr . Washington Avg 201 V1 PO Box 73C nsin e `~ tier rc+rru sicfr fir instructions fi+r completing this application Madison, WI 53707-73C a s Department of Commerce Personal intbrmation ynu proridr may br used tier secondary purposes (Submit completed form to county if n~ ~ Privacy l.a++. ~. I5.0•I(I)(m)J state owned Attach coin lets sans lug the count+ cc. 1 for the s+strm. nn a er not less than 8-I/2 x ! 1 inches in size. County Su+[c S;uutar+ 1'cn , yn e ~ ~ •I. it revision to previous appGcauon 8 \ State Plan I I) Number . 363 I. A lication Information - I'leasc Prins JI Informal' Location: Property Owner Name .,, fP[, LII~.GG Property Location L N, R 0 1 I/4 I/4,S T L~Y~ , , Property Owner's Mailing Address t U ~ 2 $ +~ / Lot Number Block umber k ~~ J ~ $T CROIX O City, Sta e - %ip C'ode d' Zt~Nt": ~'ho ~ bee Subdivision Name or CSM Number ~ on/ o i sc~rr p.cie~r II Type of Building: (check one) L '' ~ ~'ty ^ Village ,,{ 1 or 2 Family Dwelling - No. of Bedrooms: Z.. Town of O Public/Commercial (describe use): ^ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. (~ Ne+v System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) System 'l'ank Onl+ Existin S -stem 3 ~~ -Ong B) Permu Number Uate Issued ^ A Sanitary Permit was reyioush issued IV. Type of POWT System: (Check all that apply- Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized !n-ground ^ Holding "tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersal/Treatment Area Information: ' ' - I. Design Flow (gpd) 2 DisprrsalArea 3 Uisprrsal Area 4. Soil Application ~. Percol~t~n'Rate• 6. System Elevation 7. Final Grade Required Proposed Ra[r (Gals./day/sy. ti) (Min./inch) ~^ Elevation VI Tank Capacity in 'Total ~ of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons "Ranks Con- Con- glass New Existing Crete structed Tanks 'I•anks ~"!~ - 81~D oD ~ ~^ ^ ^ ^ ^ VII. Responsibility Statement I, the undersi ned, assume res onsihility for installation of the PO shown on the attached sans. Plu er' ame int Plumber's Signature (n ps): .h4R/MPRS No. Business Phone Number ~ & Perk Tes in err~ ~um~n g g y > „?Z ~ - S'- Plumbe s Ad ress trees, ity, .'fate, !ip Code) Spooner, WI 54L~i VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Uate Issued Issuing Agent Signature (No stamps) ..Approved ^ Owner Given Initial Adverse Surcq;~tiarge Fee) a~ ~• ~D -3 !' ~~ Determination <K .- IX. Conditions ~o~f~A~ppr~oval /Keasons for tsapprovat: ~ ~ ~ ~~~ ~ ~ ~ ~ ~ g ~ r t ow ~~. ,~~y w~~~ z fl syrT~~, . fl~ ~ /• ~ !7.7 r~c~ SBD-6398 (R. 07/00) ~~~t+~`Z ~ ? ---y3.7~ ~~ ,- ~~a# l ~1 i~~i 288 NkKe~e Rd. ~~15j 635-96091 . .~i~~ i~~' ~i~4 ~~~ ~. X20.3 ~T ~'/d ., /~ "'1- '- X ~' ~~ v~I /ALT ~/ ~1 (, I~ i~ 1~ t~ ~~ 1 i~ ~~r~= ~ , ,` \` s+~ x 1 1 t ' ~ (so ' s~.~~~ ~ ~ = sn /d ~i ~~ o~ ~ ,-~etu~L = ,6r~- ~ ~~, ~~° 1~ = BoRru~ 0 = wt~ , ~ ~° r ~)te r~ ~aN y ~~? o~ S'S/sT,EI+n. ~ = foruwP ~dT' col~,rv~7U p ~a GK~ ~'.~-. f- ( ~ TiCc',vc~' ~ S'~ ' LoaJt T i .= r`ic~'NcN, y3.7~r ' Laves l`ie~.v~~rs ~ cC~ r sfs. i . ,,m d,,f z ~s ~o~tdtF', Wiscons' apartment of Industry, SOIL AND SITE EVALUATION t:abor.d n Relations Division of Sa ety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertlcal and horizontal reference point (BM), direction and fj~ ~' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # d APPLICANT INFORMATION -Please print all information. Reviewed by Personal information you provide may be used for secgndary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ~L < Govt. Lot W 1/4 - 1/4,S Property Owner's Mailing Address Lot # Block# Subd. Name or CI City State Zip Code Phone Number ~L1/~fhs~ I ~.r I ~ c/n/~ I ~ z1P/ ) /i`/ ^ City ^ Village [~ Town Page _~ of v Date Tl ,N,R E (or~ ES Nearest Road Q New Construction Use: ^ Residential / Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow .~~ gpd Recommended design loading rate bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required asp .bed, ft2 ~ trench, ftz Maximum design loading rate ~_bed, gpd/fl~~_trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ •2. ~ /U/. 8 ~ 3, ~,/.S - >d0~ 3 ~ ft (as referred to site plan benchmark) Additional design/site considerations .C,C~/~° i Parent material - Flood plain elevation, if applicable 9.Z 0.3 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for system ^ s ^ u ^ S ^ u ^ s ^ u ^ s ^ u ^ S ^ u ^ s ^ u SAII I'fFCCRIPTIAN REPORT Boring # /o/ ~ Ground elev. /~_ft. Depth to limiting factor in. Boring # ~2 ~p . Ground e v /D~ft. Depth to limiting factor - in. Horizon Depth Dominant Color Mottles Structure i C t nda B Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons ence s ry ou Bed ,Trench -7 v- 2 StG 2 L f/f S '. D 2 -L~ /o c ,3 G z c S ". 3 ..s - .s S © ~ [. - - ~ . ~ !)~• ~~ - Z ~ 5' 6`,u''J1~ `'`' ` , Remarks: 2 2 M /~ ~ . ~' -z3 -6 ~ L . d ~ ~ ~ 3 -~ -s © ~ - - ' . '2.. Remarks: :ST Name (Please Print) Signature Telephone No. 0~'E Tf /' ~ - Address Date CST Number / /~ c w.~ S aZ ~ 3233 PROPERTY OWNER ~EGhSz COr~~T; SOIL DESCRIPTION REPORT PARCELLD.# 4r ~/o aZO /32 3~~ Boring # 3~ p2• s Ground elev. /d3_~tt. Depth to limiting factor ~- in. ~,2 Boring # y /OO. 3 Ground elev. /0~.3 ft. Depth to limiting factor - in. ~~ Boring # 5 /~' S i Ground elev. /fj.~ S ft. Page ~~i:~- Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench / ~ r S ' Z 0 D ^ r_ ~' S O- r- ~ ~= L CS - . O • D (e(. O Remarks~3 .~ ~O j6 ~~°. CoB _ ~C'/ T f"~~'h~T p- Z ~ L S ' ~ 7 D_ 3 _ L L z.~ o G s - ~ ' ~ Y .~ -s - os~ ~ s - e ' . S Y7- S ©sG L - Remarks: ~. ,3 -`- 70 ~ lr/Zr~3,/c. - TT~iS<T' Horizon Depth Dominant Color Mottles T t Structure ist n C B d Ro t GPD/ft2 in. Munsell Qu. Sz. Cont. Color ~ ex ure Gr. Sz. Sh. ons e ce oun ary o s Bed ,Trench z G z L .o 3 - . s _ ~~ S~ L L s '- - . F Depth to limiting factor - in. ~~ Boring # Ground elev. ft. Depth to limiting factor Remarks: 'n' Remarks: SBDW-8330 (R. 08/95) ~~ a1YE FOGERTY PI.UMBNrG tioaged !'eric Tester m Phxnber p /~32y33 ROSE ~,-WI 5023 ~/a y~Q6 ~I~GT•s~ Co•~57. NwG y'zo.,3 ~r #Q --__ '~' '--~~ zy ` 1 --~ i ~, X-~ ~ ~~, , ~~ 23 ~ Xis ~~ c SE LBT ~/v /. 2 6 ~e/%~s t ~ d = /3iY(~ / " ,cmtiv6x ~it~rv) ~.r~,~ ~ i~,rJ~iri~ imvo ~ y x = ldoR~.~v~ l /,~, ~ REV ~ ~a~ ~ ~ 1 ,~ y~SFG~7/ = ~~' 3 1 I ~mT 'iii ,. ST CROIX COUNTY SEPTIC TAI~IC MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~.~ (t~vS? - Mailing Address ,?~Q~ .Z ~-~1'~`• Gr/~l'o,~ w.L^ SYd/G Property Address fri~, % oDD L (Verification required from Planning Department for new City/State ~ f~SD.t~ G~ .~~®13 Parcel Identification Number DAD -/~1.3 ~f~ LEGAL DESCRIPTION Property Location ~_ '/,, ~_ '/,, Sec. /o , T~?~N-R~~~i~, Town of _ Subdivision ~oT?' ~CYY~S ,Lot # /4 Certified Survey Map # !- ,Volume ~- ,Page # ~- Warranty Deed # ~'Y 3 S' 68 Volume // 77 ,Page # .~~d Spec house O yes O no Lot lines identifiable O yes O no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three y r ex 'ration data r / ~ ~ . ~/ / / (~ SIG A O APPLICANT DATE OWNER CERTIFICATION ,; I (we) certify that all statements on this Corm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty descri above, by virtue of a•warranty deed recorded in Register of Deeds Office. l l b-t~ SIGNATURE F PLICANT DATE ****«* Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** i- ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~• 5~~:~ ~fy Document N.•mbrr Return Address Parcel LD. Numter: 020- I U t 1-UG WARRANTY DEED .~~ r Pa-~._;3~C s F •_.,r-. MAX 10 -'_ >' 11:00 ~A? ' .:., ~~ a • t' ~_. ~9 Joseph A. Klewicki, a singe person, cnmeys and warranty to Uelta Constructi~m, Inc., a Wisconsin Corporation, the following described. real estate in St. Croix County, State of Wisconsin: Pzrt of SWl/4 of SE1/4 of Section 10, "township ?9 North, t2ange 19 V4'est. St. ('roix C~unry, Vr'isconsin, described as tbllows: Lot 1 of Certified Survey Map tiled April 24. 199t;, in ti ol. 11. page 308?, Doc. No. ~426ti4. T 1"S R This is not homestead property. ..~~ Excep~ion to warranties: Easements, restrictions and rights-of--way of recard. ~f any. ~~ Dated this ~ day of May, .Q96. (S%AL.) _~_- _ - --(SEAL.) ___ seph A. Klewicki ACKNOWLEDGMENT STATE OF WISCONSIN ) 1 ~ )~ ~_~;~,~ COUNTY ) Personally came before me this .~-~- day of X 1996, the above named Joseph A. Klewicki, a single person, to me known to be the fpe son •, who executed [he foregoing instrument and acknowledge the same. ~~ ~~~ Notary Public ~ County, WI My commission expires ~- ~ ~ ~' ~ _ Ctrs Amt tatY p~lic THIS INSTRUMENT WAS DRAFTED BY: StQ ~ of Wisc~~tn Attorney Kristina Ogland Hudson, WI 54016 '~ ,y ~'t> Y .~ .. . :. .. ~,« . SLjRVBYOR'S C$RTIFICATB I, Allen C. Nyhagen, registered Wisconsin Land Surv that in full compliance with the provisions of Chapter Statutes, and under the direction of Delta Constructio land described on this plat, I have surveyed, divic ACRES; that such plat correctly represents the exteric subdivision of the land surveyed; and that this plat the SW1/4 of the SE1/4, in Section 10, T29N, R19W, Croix County, Wisconsin; being Lot 1 of Certified Su Volume 11, Page 3083 at the St. Croix County Regisl further described as follows: Beginni g at the S1/4 Corner of. Section 10; thence S; south line of the SBl/4 of said section, 1318.21 feet the SWi/4 of the Sgi/4; thence NOOo25'39"B, along sa: feet to the north line of the of above said lot 1; along said north line, 1318.23 feet to the north - sc section; thence SOOo25'34"W, along said north - south the point of beginning. Above described parcel c (1,382,279 Sq. Ft.). ~~~ 3 --- - I I+~. ~/~i.... ~ (~ FJ. ~~8~ I" IRON PIPE FOUND 33' 1 --- -- -- -- - N87°0532"E, 12.61' FROM COMPUTED °41' 39'~W 1318.23 LOT CORNER 235.13' G : ' ~ ' ` , . 2#A 299.00' 48.71' ~ I 1269.52' ~ H L = 20. I ~~ l^J ~ I _~ ~ ( i i ~ 2. ~ ACRES `~ 2.09 ACRES ~ 97, 650 S0. F~. ,~ 91,052 S0. FT. I N 9 ~_ JQ 1.85 AC. EXC. ESMT. 3.06 ACRES ` -ice 80,552 S0. FT. 133,167 S0. FT. ~ .~ ~ 1 w ~ ~ ~ I O m 2.98 AC. EXC. ESMT. 1.26 AC. EXC. ESMT. ~ >~ ~O 129,671 S0. FT. ~` 54, 942 S0. FT. ~ 0 rt ~ - iO P L ~ ` ~ ~ N HWL = 914.80 ~, ~ _ ~ M 20~ . - ® S89 52 57 E 150.00 1d M s _ ~r ~~~r~ _ I M / / ~ ' i M ~ N89°52'57 °W 150.00 o ,LPN =- ®--I '~ ~" ' HWL ' ' ~\ / ~~ " G ~ ' ~ ~ ~ ~•., 914.80 ,~ ~~ ~' ~ / , I U ~ ~ II ~ . ' ~ ~' / 2.30 ACRES I = /~ 2 ~ / 100,000 S0. FT. ~ \N ~