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HomeMy WebLinkAbout026-1053-95-025 o NOl o cnO 3 m c rs d C K 1 M n e Q! !tp p. I fA N z O A fn Z Z of Z N Cn X (1 O = Cl O O N O W O O w O O tb O < < C �-r O CD C .. v Cn 7 0 W ICI drl A O p_ ,�.' 7 7 m y ID N N m M V N 4 A c O O m m C ao L" O ^ m M N D7 y -I rn a w O. N N 7 fS Q o C N CO O 0 C t c c ,mC'•, 7 7 (m7 f0 � M o N 0) m m r l O oo b 3 O y H O d d O N y L 7 O M 0 ° m? uDi a s(2 l to D y a s in c CL °° IW o q cx IW o o ° N O ^" O t0 m O to to p m + O a � � -3Z A W Z A A S I, O m .Zl ° o °o 2 o n fn W W A A 3 O .•'.' Q C • � 0 Z 0 0 0 0 0 0 0 C a C O �ti��l ? titi.3 0 j o �D 'D v o o or v v v r. v CD a L o K3 o m _ m _ m CD y v °' j cn 1. m .. CD .. N OD I I � zCD z z zc o D o D D O O m c m m m �• y N to �T1 m to m � m m a m a Oro 3 > CD_ 0) �_ fx d 7 W 9 W M m o 0 ) a m 0 m Z C C �1 CD m � A ' A y W f m D 3 CL m m o c o v n CO o c m c O v c o a 0 x o a =r- m CD w CL .0 vmi 0 f]D I I m � .z o o CD M m a r. c e a a�� fi I I s fn w =r =U N m= g qb O N O m a O O C m (D Al ft 69 O EA O c„ O CD O 0 L O 8 3 3 1 9 VOL PAG E_5278 KAT� H. REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR j?fiCORD CERTIFIED SURVEY MAP 09/25/2006 02.30PM CERTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE SE 1/4, OF SEC. 18, T30N, R18W, TOWN REC FEE: 13.00 OF RICHMOND, ST. CROIX COUNTY. WISCONSIN. COPY FEE: 3.00 PREPARED FOR: SURVEYOR: PAGES-- 2 SIENNA CORPORATION DOUGLAS J. ZAHLER 4940 VIKING DRIVE S do N LAND SURVEYING. INC. SUITE 608 2920 ENLOE STREET EDINA. MN 55435 HUDSON, NA 54016 OWNER: E1 /4 COR.. RECiV SEC 18, SEAN & DANIELLE STEPHENS T30N. R18W 1520 100TH STREET NEW RICHMOND, WI 54017 N _ K016 LEGEND UNPL ATYED LANDS FOUND ALUMINUM COUNTY — — — — — — — — — — 4 SECTION CORNER MONUMENT N88- O-O- 146.03' N85'12'19»W ST. CROIX COUNTY 113.93 SURVEYOR'S RECORD SET 1-1/4 DIAMETER BY 18" 9 Q LONG REBAR WEIGHING 4.30 I I LBS. PER LINEAR FOOT 6' BUILDINGS 3 jj DRI A SET 1" OUTSIDE DIAMETER 0 BY 18 LONG IRON PIPE, WEIGHING 1.13 LBS. PER 1 33• I LINEAR FOOT FOUND 601) NAIL. I Of wis = LOT 1 ' 'tom ` ` AREAS. I ZAHLER 1 Z TO MEANDER INC. R/W _fI ` 4.081 ACRES 177.781 SO. FT. *14s i m TO MEANDER EXC. R/W 3.648 ACRES 158,910 SO. FT. TO THREAD INC. R/W m �a l 'v I i ao . �Y i t 516* ACRES ^ 1 W I � 3U TO THREAD EXC. R/W i 4.73* ACRES W 3 171 J us i J � j ° a w l •3f T1iREAD i r-+OF WILLOW I I ;RIVER % to \ S 'r 1 33- � - 21s.17 \��� 33.00't 183.17' ��� •. N89'36 '46-E SE COR.. —► SOUTH LINE OF THE SE 1/4 SEC 18, U IN LQTTED LANDS T30N. R18W SCALE IN FEET 1" = 100' ' mod 100 O 100 THIS INSTRUMENT DRAFTED BY WILLIAM KANE JOB NO. 6524 -02 DATE: 09/21/2006 SHEET 1 ❑F 2 O IOf2 Vol 21 Page 5278 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county. St. Croix Safety and Building,Division INSPECTION REPORT Sanitary Permit No: 430361 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID _ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Sheffel, Tom I Richmond Township 026 - 1053 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range/Map No: 930 •/Z 9X • /Z- C ST g►N` '� ("p Swtl VIQi� 18.30.18.278B TANK INFORMATION ELEVATIOIT DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � Benchmark !? •� • p�[2 • q� • Dosing Alt. BM o 1 77.7 Aeration Bldg. Sewer %-.4 A - !oa h,o�- x•30 `� 3s �� Holding St/Ht Inlet 1 TANK SETBACK INFORMATION St/Ht Outlet •�3 93s,08• TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > r Dt Bottom Dosing Header /Man. Aeration DW- " n W+µ 1�• (a 3Z • 91 Holding Bot. Syst G � 1.20 931• . 0 26 • 3' n PUMP SIPHON INFORMATION Final Grade c ,� - 'fie Manufac rer errand St Cover M Model Numbe n nn • ee,Q .e�(!w • c, Sw � ° •b 932.33 TDH Lift n Loss System Head TDH Ft �l� of d��. 5 -19 933�SZ Fo main Length Dia. Dist. to well SOIL . A ORPTION SYSTEM ��� 42 4= BENCH Width r Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIM Of 97 • (21 SETBACK SYSTE P/L BLD IWELL LAKE /STREAM LEACHING Manufpcturer INFORMATION CHAMBER OR ksl F F�SC•K- Type Of System: f t UNIT Model Number: �V • >� �•� (f DISTRIBUTION SYSTEM Header /Manifold f H Distribution x Hole Siz x Hol S acing Vent to Air Intake Al ipe(s) so I Length 0 • Dia L pacing •` 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 N Yes R No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:1 inspection #2: Location: 1520 100th Street New Richmond, WI 54017 (SE 1/4 SE 1/4 18 T30N R1 8W) 35 acres Lot Parcel No: 18.30.18. 78B 1.) Alt BM Description = J S ) A(k n Q � - �4 �- 2.) Bldg sewer length = ��7) •a•Ic• "S / `� '1C _ �o'iaru� V t", 2 S "" - amount of cover = ! sc 3,4 n r.. � - 1 i t PI n revision Required? � Yes No Use other side for additional information. SBD -6710 (R.3/97) Date sepctors Signature Cert. No. WvtC&Wtc-nrr sW`3 Safety and Buildings Division County .S T ' X 201 W. Washington Ave., P.O. Box 7162 Nl fisconsin Madison, WI '53707 - 7162 Site Address Department of Commerce IS20 look 57 Sanitary Permit Application Sanitary Pe"Pit Nunft in accord with Comm 83.21, Wis. Adm. Code, personal info on you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, sl 1 I. Application Information - Please Print All Information j ED late Plan I.D. Number Property Owner's Name arcel Number T TDM ? G %� -f L -SEP 12 2003 02.(P - /053 - l - 0 0 99 ) Property Owner's Mailing Address F. CR01 Property Location f� 15r2, 0 / 0� v ��' ZONING O � �E y . . SG , �j iI. S /� T X N, R � City, State Zip Code Phone Number Lot Number Block Number L11 ��/y,� Subdivision Name o oV A CSM Number II. Type of Building (check all that apply) ❑City I or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use &.hip M•Q A-) F_,> ❑ State Owned Nearest Road �60 'tk sr'. III. Type of Permit: one box on line A (numbering scheme for internal use). Complete line B If applicable) A. 1 ❑ w 2 Replacement Sys 3 11 Replacement of 6 ❑ Addition to For County use S s Tank Orgy Existin System B. 171 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In- Ground 2111 Mound 47 11 Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation ,7 s RNs P VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Tanks Tanks g Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, some responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S'gnature IdPWRS Number Business Phone Number 'R. l�ix 1 z1,4" S F )/ I - 77a -3 1 / Plumber's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use Onl ppr o ve- 11 Disapproved S Y Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) - ❑ Owner Given Initial Adverse. Determination IX. Conditions of Approval/Reasons for Disapproval 3 o (e'- SYSTEM OWNER: c n 1 Septic tank, effluent filter and dis ftersal cell must all t10 §grviped / maintained as per management plan provided by plumber.` 5 yS 2. All setback requirements must be maintained a s per applicaDl CQfiW0A9jg" (t the comfy only) for the system oo paper not Idd than SW x 11 Inches In size SBD -6398 (R. 05101) ? _ W o cc: 0 co CC N p. _ 4 M mo w , \' Z O ` � �. - � � M oQ `n -' cc Ul u' M \ A Q�-CD �r O a0 C` r•c\ 'U r cl ` •1 ^�•^ I I I i � 1� '0 O I I w c A „-.`- _ ' \A o rn •z, o VIN 138 # 1300W U3111d a3dOdd V ��Z)tib'E8 •WWOO aid 3- LV8OddO3NI llt/HS W31S'lS .LMOd SIH . ULDRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg..Veslgners of Fngineering sy sten 715 -386 2 8 M ` Private Sewage Consultants PROJECT INDEX PLAN ID # DATE r �I r�11 OWNER 1" A L /S*j- _511eFA - PHONE ADDRESS /S�?,o / ST .-V&cl ���1 �I�itl v 01. Syo, 7 LEGAL DESCRIPTION g's — /r►,P�fS ? pv,u't�S P/A) oi G • 1453 • y's - OVV 5 s"�. - mac . 1 7 o /e i&' cJ TOWN OF /C / e4 A t 0AJ-F,> COUNTY CSTM �` • Z/�,dit'iG� �'' ZZ G 3 LOCAL AUTHORITY/ SUPERVISION 5 - 1-401y- G) X, PROJECT DESCRIPTION: / A) A F1 o at7 �I ac t.,,% • � l�(l ,S;q TLGc�t � So i' /S' /tit .tf' � • o' �lj' �. S . Gvi // �' �i T�� t�'�D U� 6 ? / / f i / 1j,� j THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL &0 fiorv 116el `/S FILTER MODEL # "Ro BP_RT Uhl?ir,4 �-- Uibricht & Associates Private Sewage Consultants 2812 1 0th Ave. Spring Valle , Wl 54767 � P9-1 I"! GrRWTOR SIZING WORKSHEET G P9_2 SYSTEM PLOT PLAN / O� P9.3 - CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9 .4 of „ it of to P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9•6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /01. OQ LA w THIS POW SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # b ' ie I Q N�a w w s o z 4�, N — *, c,- � t 0 : c� O► O .,� i 01 a e i z— w O czp w � m it VN QN. _ 0 rn o Z a 0 �C -n OHO cp 3 Z i I C lcvuhTE P 4PI' 04 q y . U �ti 1, Iff i "Z... ��iu� Sh`ED 9 g 'IRV -- Y _ 6rP0 SS SEC T IoA) 0/ Tlflf s It 4,4A i 1'Y • �j�fJElUf tl i 2° �� /tlDj� 3 "aC C` s ' Iff i / M - Y OVER, See Backside For Inspection Pipe/ Vent Details 3 Wisconsin f � SOIL EVALUATION REPORT � of Division ofety and Buildings in accordance with Comm 85, {Ks. Aim. code Attach to site Co w' 57'• CRV /, X- oonlple plan on paper not less than 8112 x 11 inches in size. Plan must inducts, txrt not limited to: vertical and horizontal reference point (BM), direction and Parod I.D.0 2C. 10 . FS da Percent slope. scale or dimensions, north arTpr2arrd;4ocq* #t distance to nearest road. Please print 811,110fiormation. r R by Date Persond fnformatlon you Provide a" be dem ndery purposed (W" 9Aw. 8.15.04 (1) (m)). ` • 'Z i 1 Property Owner Z003 Property Location l ! 0 /K ? G i5,4 `� � � GaA Lot 3 9 114s f- 114 S I6 p T30 N R/ (or) w Property Owners Malting Address Lot # Block # Subd. Name or CSW / 5 2,0 /UO fL�- S` r� a'I be NIA 14 �S t 13 ou NDS ) l State Zip Code Hhdne'"J"1tidr ? S O City C1 Village 5Z Town Nearest Road AID R el k) j . 5 o c z y(o • 7 0 Ric �-t o,v oo 1, - ST. New Construction Use:pd Residential 1 Number of bedrooms Code derived design flow rate GPD KReplacemnent [I Public or commercial - Describe: � Parent material o U s D O V Gcl� Flood Plain elevation If applicable - - � . 3 �'- ft. c>eneral i rom data : �P 7rs7��v 5• if l3 D o� and PWIV � SU/ 7, F' �o� �I /.0 (r/�6 U•vp Cd f>(J� -rJ L / Bor1rQ D q� / 9 P ft Ground surface elev. ! 3L • ft. Depth to fador v In. Sol Appficadon Rate Horfxon Depth Dom*wrt Color Redox Description Texture Structure Consistence Boundary Roots GPM in. Munsell Qu Sz. Corti. Color Gr. Sz. Sh. 'Efr#1 'Effit2 / o•Zz /oYR33 — Ls /f R 4 w 3-F •7 / S O, ►. Z Pit ✓ Ground surface elev. �3Q ft. Depth to limiting fakir in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF IM Musell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 '011#2 1 00' 1 2, /o R t A3 GS /.w► /p S w 3 . 1• 2 is • /o W Ls /� s ti cw �,� . '•7 �• Z 3 �s Zs /�► �• Z - 9 35% z Effluernt #1 = BOD > 30 < 220 n4l. and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 nnglL and TSS 130 nv& CST Name (Please Print) Signature MNUITiber $` _ - 3 Address Date LuaW�n��� Number 4 960 7 /5 • 77 • 3 Y 5/•L... Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ��j ,r�,E - � 13Y NO /e 14AJP C! C! N A >�4- �3 d • y/P�90E �T U�"ti % . sy s 7 �z • o , PmpedyOwner Parcel ID # Page of o Bo,tv# ❑ ❑ Irt Ground surface elev. ft. Depth to Nmiting factor in. SoN Rate Horizon Depth Dc mrvt Cokm Redox Description Texture Structure Consistence Boundary Roots GPDW In. MunseN Ou. Sz. Cont. Color Gr. Sz. Sh. '001 'Eff#2 Q� Pmp-My Owner Pamal ID # Page of .x X Pst +Ground surface etev, _ €t. Perth to Hmmty factas Soli ication hate _ Depth Dominant Redox Description Texture StmIctupe Gonsistarce Boundary Roots GPo _ in. mlinsetf Ou. Sz. Cont. Color � Gr. Sz. Sh. # `Eft'#1 GS i t 0 Sip / 11 J, 0 0 J — Fit Ground surface elev. -a/. ,0 f. Depth to Iftniting factor � s: � } Soix atrn Ra Horizon Depth Dominant Color Redox Description Texture SbWure � Consistence f3otrrxiary Root GPM 3rf. munsett Qu. Sz. Cont. Coto C -r. Sz. Sh. i `Eff #1 `EtFf#2 2. o • e lU�- E ? S �DJi � 21 ""'t Hors Sj� L Bori ng # loyin Pit Ground surface elev. _ ft. E'°Pth to !` iting factor T^ in. Stai7 'eatsan gate Horizon depth Dominant Color Redox Description- Texture S e Consisteanoe Boundary Roots GPt?ff Ia. Ou. Sz. Cont. Co lor Sz. Sit. "'E4 i *Ef€#2 ' a x_ <ST'i.� G- -SYS T'''� [J E ._._ ..____a ""ring # flit G curod sur ace etev. � R. Depth to Orriftirsg factor WL SW Application elate i Horizon Depth Dominant Col Redox tiara_ Texture Structure Consistence Soundmy Roots GPD f� im Munsetl u. Sz. Clor ; Cr. �z. Sty. 'Eff# `Eff##2 a _ — a 4__ s 3 � i *Effluent lent #1 - BOD, > t 220 faxitt. anti TSS >?R < t 50 mg/t. ` Effluent Q. W [100 30 mgft. mid TSS < 30 mWL The Department of Com erce is an Nuai opportunity service provider and employer. if you creed assistance to access services or need €mater in an a'teraate forrnat, please contact the depatiment at 608-266-315) or 'l= 609- 264- 1:777. setx.sIM(R_ W) J S'1' CROIX COUNTY ` S,E,Itp 'TANK MAINTENANCE AGREEMENT' — . AND OWNERSITIP CERTIi'ICATION DORM Owner /Buyer d 4 G S Mailing Address !s�'O /(�d ST /V-V 4 ��0�1� Property Address �r (Verification required front Planning Department for new construction) City /St<<tr' Parcel Identification Nutnber d -'& - / 3 LEGAL llESCRIPTION Ptopetly Locution SiE ' S� 14, Sec. `13 , 1' N -R W, Town of �� A -l 0 *u r Srtbdivision ins (jUwQS , Lot # Cetffffed Sill IlIap # , Volume � rage # Wt,rrnnfy Deed # SO 87�� ,Volume Page # 3S �--- . Spec house U yes no Lot lines identifiable lX yes U no f SYS'li;' MAIRI improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consisur, of putuping 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 lank as a treatment stage in the waste disposal system. •l he property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by it ►naslel plumber, ioutneymnn plumber, restricledplumber or a licensed pumper verifying that (1) the ou - site waslewaterdisposal system` Is in proper operating condition and/or (2) after inspection and pumping (if necessary), file septic lank is less than 1/3 full of sludge. ihve, the undersigned have read life above requirements and agree to maintain the private sewage disposal system with the standards set fords, herein, As set by life Department of Commerce and life Department of Natural Resources, State of Wisconsin. Certification ' 4lnting that your septic system has been nlninlnined must be completed and returned to fire St. Croix County Zoning Office within 30 days of the three year expitaliom date. S _ A"TURR O APPLiCA DATE UWN C I (we) certify that All stalements on this form are true to the best of my (our) knowledge. I (we) Am (ate) the ownet(s) of flue pm .rty Iles 'bed Above, bv v' tue of a warranty deed recorded in Register of Deeds Office. 1(INA'TURLt Or APPLIC T DATE * * * * *• Any information that is nlis- teprescnledntay result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include 11 lids Applicntlon: A sinnlped wnrtnnly deed from life Register of Deeds office ' a copy of the certified survey map if reference is made in the warranty deed L.00UMENT NO. jSTATE BAIT OF WISCONSIN FORM 1- -19811 THIS arACS A[s[RV[o eoe RacORDINO DATA iI I WARRANTY DEED i y/ �� V :- - - - - 35? IN • S OFFICE i ij IX CO., WI I j This Deed made V—:ftn .......................... ............................... '' R if OI Rec . ... .. .. ........................... . ....... .. .. LIN. I..ONNENBERG, a ain�le person �{ ... l .......... NOV i 0 O 4199 3 .., Grantor, !! 1:30 P. M °._ and ...... THOMAS .. Joi..... SHEE�FIt_. A�II?_. LZ, S. Pa .- �e.+....�Q�QTa..,5E1F+F'�E.G_ ( j: Husband and wife V jj ............................... .............................................. 1' 1 .................................................................................. ............................... ; i - ............................ ............... --•- ................................................... , Grantee, I� Witnesseth That the said Grantor, for a valuable consideration...... ; I( 7 i+ ....... .......... ............................... ............................... ............................... �i - � conveys to Grantee the following described real estate in ....��...__�S.Q�.X..._.... 11i TO j County, State of Wisconsin: j i Tax Parcel No: ................................... ' ' i t 1 !! Part of SE 1/4 of SE 1/4 of Section 18 -30 -18 described as follows: a^ �I Commencing 650 feet S of NE corner of said SE 1/4 of SE 1/4; thence sc ( W 266 .feet; thence S at right angles to Ely bank of Willow River; thence SEly on River to point where Ely bank of River intersects the j S line of said SE 1/4 of SE 1/4; thence E on said S line of SE 1/4 of i( SE 1 /4, -to the SE corner of said SE 1/4 of SE 1/4; thence N on the E. line of said SE 1/4 of SE 1/4 to the point of beginning. f I I' Thin ..... Is .. ............ homestead property. (is) (is not) `. Together with all and singular the hereditaments and appurtenances thereunto belonging; p And.----- Lor_ aizls• A • .HRnll.!�.nheKg_.. c i warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights -of -way of record, if any. I' and will warrant and defend the same. m' Datedt this ............... .................. day of ...... .October 93 7 .. . .... .. ................. .............................. 19_..... . J Loraine A. Rolihenberg i � • � -----• ............. ............................... -------•----•......••--••--...---•------ ..__................... - -• V+CK1E ) A13Rt)NET .........(SEAL) ._..(SEAL - tFoTd�iRIDGC= �f11ev'sldi•' _ •--• ...................... •----•-- •--- --•-•-••-•---•• ---• • ---•- 1fYAPpAt "'�+£14 °f 3'Allf3i;111k ............ ' ••--•---•------••---...---• ...........................••-•-----•-- AUTHENTICATION ACENOWLEDGMBNT I Signature(s) ....... . ............. ... .. .......... .. ............................ STATE OR Wiffeel� J 4d ----------------- * ----------------- ---------------------------- •--------- (V�"-PIK ....... County. , authenticated this -------- day of ........................... 19 ------ P Wally came before me this .. ...... _....... day of Octo�er 93 ' ......... ..........•--•-•--- --•- -- --..., 19...._... the above named _..... _ . _ - ---- - - - - -- n A - ••ltoririenbe - rg Lora e "'° ................................................. -----........-----......_..----------•--•--------- •....------ •-- •-- ....._ TITLE: MEMBER STATE BAR OF WISCONSIN •...... - - --• • .. ............... . (If not, ....................... ' -- authorized by 4 70$.08, Wis. --•-- --•- -- .................. ...................................................... Stats.l to me known to be the person ._5_?._ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY V ....................................... �i. • r U/LI/ Kristina Ogland .... ................ . ........ . . . ... AA • .- ----...._ tt . or ney a V. .... ............................ e -------------••-•---°--•__.........__........._. ........._....._............... Notary Public ....................._._ ........ C , Wis. i (SignaY -urea may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration _ I are not necessary.) date: -$. _.7. I-•--•-•-••--• ........ ..... •........- -- 1 9 ......... — -- - - -- - - - - - - -- — — — ... - -- - I I *Names of pomm sisnlns in any capeeity should be typed or printed below their si =natures. - �! STATE BA 8 OF WISCONSIN ,- Wise. Wain Lssl Blank Co- In- n . r� �. 3-a Cov i o� y � � �► s Y57 - 4t, -_ � SC. CROIX COUN'T'Y ZONING DEPARTMENT AS DUILT SANITARY REPORT Owner ��/"L �G /' 2-y • 7 d SE. ECEIVED city/Stal �tl�Z() i f 0� OCT 3 1 2003 Legal Description: 144A S 0 U u � ST. S Lot _ _ Block Subdivision /CSM # / J ww COUNTY oFFICE 'A Sec. M, T30 N -RLJW, Town of I' 14 ou PIN # - S 000 SEP' TANK -- DOSE CHAMBER -- BOLDING TANK INTOItMA'IION 401 0 s-&X . > y- .' >7s Tmlk manufacturer Size ST/PC / Setback from: House Well P/L 37 Ptinip manufacturer 411 A Model Alarm location (HOLDING 'TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line _ Meter location Alarm location SOIL_ ABSOIZI' I'ION SYSTEM �3f00iFrusarR5 3 ' 9-7 " 2 Type of system: Width Length Number of Trenches Setback froth: House Well W P/ /L L 7 SCE Vent to fresh air intake 7 $d 1 4 1C VAT10N8 : S F /00 0 /-t v • ��`'S Description of benchmark 7 Or �Z �t-S Elevation y3 z' 1 Description of alternate benchmark 5v 12ye--/o 4 s - ro p .VA r L f,t yA. L,¢t4,p Elevation t 2- g� t�,3 . 70/9 or 6i�D Afw; j C.t. P"1--k- —731 Building Sewer, _N11Ar S'I' /li'T Inlet ST Outlet PC Inlet PC Bottom Header /Manifold Top of ST /PC Manhole Cover Distribution Lines ( ) () () �'� 7 jo/ AN Bottom of System( ) ( ) ( ) Dina! Grade ( ) ( ) ( ) o / ° Date of Installation / / Permit number - State plan number i. 0C'� Plumber's signature License number 1 C 3-15 Date Inspector ( A) 6-A in 3 Complete plot plan w No 0(,�t , VJV - 6 ekj� lilv 7 M e `o w F16 D 1 W+5 ) 00,A � Y �'s Ts�GI�S,�'� �f ©ov l v\ ZZ 'r z 4 U —Z Vow Ar— ` m40cn x o D Z fl a, cn :0 K N nCD - W l' r a oq► ° i i ° _ I � i vo CO C l� >m �„ _ G o ® 5P ov a y vi