HomeMy WebLinkAbout032-2142-30-000 r— -
Safety and Buildings Division County�5 1
201 W. Washington Ave., P.O. Box 7162 • 4 /
iseonsin Madison, WI 53707 - 7162 Sanitary Permit Num (to be filled in by Co.)
(608) 266 -3151
Department of Commerce State Plan I.D. Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address)
may be used for secondary purposes Privacy Law, s15.04(1)(m) J
I. Application Information - Please Print All Information 2 3 7 S3 S+.
.
Lot # Block #
Property Owner's Na me Parcel #
i� �,� / i
Property Owner's M ailing Address Property Location
nQ� S� N t /.,Section —
City, State Zip Code Phone Number
(c ircl (on T N; R
II. Type of Building (check all that apply) Subdivision Name CSM Number
2 Family Dwelling - Number of Bedrooms F ice'
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City_I..iVilla.V; wnship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - 02 a - 06 Ll s o�
System El Replacement System ❑ Treatment/ Holding Tank Replacement Only [I Other Modification to Existing System
ist Previous Permit Number and Date Issued
B. ❑ Permit Renew mit Revision [J_ Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner Ll q(.,.�/ 31 /1 /02-
YP S
IV. Ty of POWTS stem: (Check all that apply) 6 �c�
Y
- Pressurized In- Ground ❑ Mound > 24 in. of suitable soil L1 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter a ching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) ersal re equired (sf) Dispersal Area Proposed (st) System Elev
J i
Capacity in Total Number Manufacturer Prefab Site S-_
VI. Tank Info eel Fiber
Plastic
Gallons Gallons of Units Concrete Cons vtcted Glass
New Existing
"ranks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersign tune responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's rure MPiMPRS Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zip e) t
JI SAD
VIII. County /Department Use Onl V Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu" g Agent Signatur No Stamps)
Surcharge Fee) 1 p ?A3
❑ Owner Given Reason for Denial I�
IX. Conditions of Approval /Reqons for Disapproval
Attach complete plans (to the County only) for the system on paper not less than SV2 x 11 inches in size
l
Soil Test and System PLOT PLAN
PROJECT P.C. Collova Builders Inc. ADDRESS P.O. Box 489 Someset Wi 54025
SW 1/4 NW 1/4s 3 /T 31 N/ 9 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/24/03 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRE URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL H. R. P. Same as Benchmark
SYSTEM ELEVATION 91.4/91.3 5' below qrade
53rd ST. �.
Vent
ALong "
Standard Biodiffuser
Leaching Chamber
3 4" Grade at System Elevation
Alternate Benchmark is Top of nail in Small
Pro 3 elm @ 98.9'
Bedroom
House
i
200' Plans Designed Using
30' Conventional Powts
Manual Version 2.0
T
25' 2 -3' X 69' Cells with >3' Spacing
35' B -3
20'
50' M. * 5' Vents
Alt 70' B -2 Tested area has <1%
Slope and thus no
a M. B -1
contours
a
0
0
M
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re ewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Prbperty Location J
Govt. Lot t, j 1/4 /Vl.� /4 S T / N R E( r) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number City ❑ Village own N est Roa�
New Construction Use: AlResidential /Number of bedrooms 3 Code derived design flow rate y S GPD
opt
❑ Replacement ❑ Public or mmerclal - Describe:
Parent material i�� Flood Plain elevation if applicable �/� ft.
General continents
and recommendations, , 5C 2
Ong # Boring
l g
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. �j 'Eff#1 •Eff#2
Boring # � ❑rr11 Boring
!C7 ft. Depth to limiting factor /1 D +n.
pit Ground surface eleyl� Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 o - d r3 / z- , S '
o� s — ,a
3 r - O s / 77 tiA4 4// 1 / I - 2
' Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 m9Y ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 nVL
CST Name (Please Print) S' CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date E alug'on Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 '' � 3 715- 246 -4516
- 1
Property Owner ` of
/ Parcel ID # Page
a Boring # Boring b
Pit Ground surface elev. ft. Depth to limiting factor �0 in. _ §o � IlApplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I n- ,-3/
o
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil licetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (RAM)
isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
safety and building Di &ion
INSPECTION REPORT Sanitary Permit No:
404946 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan I N _
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:
P.C. Collova Builders, Inc. Somerset Township 032 - 2142 - 30-000
CST BM Elev: llnsp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark U i
Dosing Alt. M ? r
'15a W
Aeration Bldg. Sewer �.
Holding SUHt Inlet
St/Ht Outlet d ,
TANK SETBACK INFORMATION lat. S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f `� Dt Bottom
J
Dosing Header /Man.
Aeration 'v Dist. Pipe
Holding Bot. System
Final Grade 9s
PUMP /SIPHON INFORMATION /
Manufacturer Demand St Cover
GPM �J /
Model tuber
TDH Lift Friction Loss Sys ead TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Tches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufactu"S 10 V) (V VLLS
INFORMATION CHAMBER OR
Type Of System: / i tNy UNIT Model Number:
- mvt DISTRIBUTION SYSTEM
Header /Manifold IDistribution x Hole Size x Hale Spacing Vent to Air Intake
/ Pipe s)
Lengt Dia 44 d 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 [lf/ i s Topsoil Yes I gl No Yes ; No
`l l( �j I �� _�
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / / L Inspection /
Location: 2377 53rd St. Somerset, WI 54025 (SW 1/4 NW 1/4 3 T,31N R19W) Deertrail Estates Lot 18 Parcel No: 03.31.19.1243
1.) Alt BM Description =
1
2.) Bldg sewer length IT it
- amount of cover = t rA L 19 rf r
Plan revision Required ? Yes 2n. o (�jj
Use other side for additional inform -
-- - — - - -'
Dat I pctor's gnature Cart . No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
1 * & � :o�s i n
201 W. Washington Ave., P.O. Box 7162
Madison, WI 53707 - 7162 Site Address
Department of Commerce �� a3 ,�, a� //� 23 �� �•
Sanitary Permit App 'cation Sanitar P N u � �1&
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number 3, V -C � W
C, � G. , ECENED O3z - zr Z-
Property Owner's Mailing Address Property Location
L f I MAR 13 2 - T3 N, R
City, State Zip Codd Phone Number COUNTY Lot N ber Block Number
ST. CROIX FFICE
ZONING 0 Subdivisio ame CSM N ber
H. Type of Building (check t apply) as or 5 ►�; ksua� estS .
1(i or 2 Family Dwelling - Number ms illage
❑ Public/Commercial - Describe Use wnship,-�c
11 State Owned Nearest Roa
2 3 1 x Us IT r
III. Type of Permit: (Check only one box on HAV (numbering scheme for internal e). Complete 14 p cable)
A. County use
1 w 2 ❑ Replacement System 3 ❑ NOnl ein of 6 ❑Addition to
stem Tank Exis ' ste fir
B. ❑ Check if Sanitary Permit Previously Issued
Permit r Da Issued
IV. Type of Permit: (Check all that apply)(numbering sch for int use) I
44 ❑ Non - Pressurized In- Ground 210 Mound ❑ Filter 50 onstructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 Single Pass 51 ❑ 'p
45 ❑ At -Grade t 46 ❑ Aerobic Treatment nit ircula ' ❑ O
V. DispersaVrreatment Area Information:
Design Flow 40) Dispersal Area Dispersal Area S ' pplicadon Percolation Rate Syste F' rade
Required Proposed (Gals./Days/Sq. (Min./Inch) f 5 ation
3
VI. Tank Info Capacity in Total Nump Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons N # 1 Concrete Constructed Glass
New Existing
Tacks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement - L, the underj assume responsibility for installation of the POWTS shown kthe attached plans.
PI tier's Name (Print) Plum MP/MPRS Number 'WB usiness Phone Number
Plumber's Address (Street, City, State, ZQJV6de
VIII. Count /Department Use
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Age nature (No Stamps)
Surcharge Fee)
El Owner Giv Initial Adverse ZZS 1 1
Determinatio 1 X1.1
.Cgnditio of As I
proeasons fo Dis PP n 0 n 1 ��
11 y M r J -,,Lc— fp,(.1(nX1 COS-1.6 ( L iu r xa�+u�g3 uv�O tM�=t' ^^`�` -�
Attach complete plans (to the County only) for the system on paper not lea than 81/2 x 11 Inches in she
SBD -6398 (R. 05101)
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PLOT PLAN
PROJECT P.G. Collova Builders Inc. DD SS P.O. Box 489 Someset Wi 54025
SW 1/4 NW 1/4s 3 /T 31 N/ TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/11/02 /TANK 3
CONVENTIONAL )00( IN -GROU ESSURE CONVENTIONAL LIFT HOL
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # o ,BENCHMARK V.R.P. To of Nail in Maple Tree � ASSUME ELEVATION 100'
❑ BOREHOLE O WELL : R. P. Same as Benchmark
17 SYSTEM ELEVATION 92.5/92.0
Plans Design sing
Convention owts
0 7i 1 Manual V ion 2.0
��.
��' ` Q' A•f ^ t
o 3 n
�`� B oom > 12„ Sidewinder High
House of Cov Capacity Leaching
�( Chamber
(� ong
16"
34" Grade at System Elevation
B.M. #2 AL
25' 25'
2 V
B
M 5�% 5' B. #1
�' Slope 15'
75' B -3
� -3' X 69' Cells h >3' Spacing
0'
100'
Od
-1 25' Vents �
100'
PI as Note. dimensions on this plot
1 based upon the soil test. The
for the soil test used a scale of
— 100'. Using a scale based on this
mension makes measure the scale
extremely difficult and thus the
dimension may not be exact.
350' Property Line
x �
�.
� . -
_ �
. : ��
PLOT PLAN
PROJECT P -6. Collova Builders Inc. DD SS P.O. Box 489 Someset Wi 54025
SW 1/4 NW 1/4s 3 /T 31 N/ 9 TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/11/02 BEDROOM 3
CONVENTIONAL XXX IN -GROU ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
IL BENCHMARK V.R.P. To of Nail in Maple Tree _� ASSUME ELEVATION 100' ter Zabel A -100
❑ BOREHOLE O WELL * R. P. Same as Benchmark
SYSTEM ELEVATION 92.5/92.
Plans D ned Using
.
0 Conve nal Powts
�p ? Man Version 2.0
Pro 3 Vent
Bedroom
>
Sidewinder High
House Capacity Leaching
o ver Chamber
16"
1
20' 6' Long ff Grade at System Elevation
B.M.
25' 25' 34
25' ents
M 15' B.M. #1
" Slope 1 4111 75' B -3 `
-- 2 -3' 'Cells with >3' lee,
0'
100'
B-1 25 Vents
100'
Please note: dimensions on this plot
plan are based upon the soil test. The
plot plan for the soil test used a scale of
1" = 100'. Using a scale based on this
dimension makes measure the scale
extremely difficult and thus the
IL dimension may not be exact.
350' Property Line
I
I
.00 y.
i
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County -� • � r01 X
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, an� S on end _distance to nearest road.
` � i
Please print all Reviewed by Date
,•ii�arrpa?tiaFn:
Personal information you provide may be used fseSprdary purps (Privacy Law, s. 15.04 (1) (m)). I Zbrl Z
Property Owner `/ ,.�U Pr perty Location
Got. Lot 5 E 1/4 /l /WI/4 S ?> T 3 N R t E (or�
Property Owners Mail' Address ' `' Lo # Block # Subd. Name or CSM#
(_ -f- • ST CPO!x Le r- I l I E -5 +C' C
City State Zip Code on2 > F!CE City [I Village [.Town Nearest Road
et�A I r �S
� , .)Z94 - 3%L& So w r 5 e--�' � 54 .
New Construction Use: CW Residential / Numl er �J _ — `J� Code derived design flow rate 6a 0 Q GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material C> U-(-C JC -.S A Flood Plain elevation if applicable ft.
General comments S y w e-( - e - V „ f Z • Yo
and recommendations:
5 Boring # r] Boring G
Q pit Ground surface elev. _7 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff
1 0- l0 Z — sit I rrxa Z
Z `f- t S 2 c5 -- • 5
3 g r �tl 2 -F; cs — 5 •S
LIS 1 f•Z
0
F2-] Boring # Boring
® Pit Ground surface elev. �G. �9 o ft. Depth to limiting factor ! CSLo in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
z- S -z4o 1 5 �5 — • 5 • 8
3 z - �t I 4 - 5i Z -
Ib L S m5 . - t 1. Z.
4-- R2,v�
uf-4z,
.Z 41 Z `1•Z ,2
* Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ature CST Number
a er 25 3 30q
Address Date Evaluation Conducted Telephone Number
22 5 W S. Sc me-c-- s s-4 11 L01 5 q-1 3 C - 1 ► ) 2 1- H Q
f �
i
Property Owner u r kywS1i. Parcel ID # Page Z of 3
Boring # [] Boring
® Ground surface elev. bd . Depth limiting factor 0_ in.
--3] Pit � ft Dth t liiti ft ! Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Z ifi - ; ► m-C c 5 - 5
3 2 - `iq l - S i l Z rna rrTC-, IC .5
4t 4q coq y 1co -- Lj t • Z
q Z, SV
� d
F-1 Boring #
❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F i i
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
SBD -8330 (8.07/00)
t
PAGE OF_�S_
NAME � J f IGOWS . ( LOT# R LEGAL DESCRIPTION SF- '�4 .--'�4,S T31 ,N,R 1 E (or)
SCALE: 1 "= (OCR`
BM 1 ELEVATION
BM 1 DESCRIPTION
K
BM 2 ELEVATION 10C) • C-
BM 2 DESCRIPTION ylu,* l
SYSTEM ELEVATION Q Z, gD
ALTERNATE ELEVATION q3. Z0
CONTOUR ELEVATION it/g4
1
,
I
1
I
, 3^
•
t ,
. O
c c
0 a
o
SIGNATURE DATE
I
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be p ,jmped once every 3 years.
2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, aalis are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to stave this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower eevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
Shaun Bird #226900
f��
FROM P C COLLOVA BURS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07:33AM PI
ST CROIX C OUN'T'Y
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Own _ P, Cb I10VA B W lr _ =NVQ
Mailing Address rr y, 4 S SpM I� J5T lu j r
Property Address
(Ve required from Planning Department for new construction) ki
City/Statt� \OAS- l J�� Parcel Identification Number
LEGAL DESCRIPTIQN
Property Location ( A )
; �"" %,, Sec. . T.2dN -R Iq N, Town of
Subdivision &SA0 a, Lot €€ -
Certified Survey Man It V0Its<mc Page f zz
Warranty Deed 0 _ 7 7 - 3 . Volume J
Spec Douse C3 yes ❑ no Lot liu� identifablc ® yet ❑ no
SYSTEM MA ENANCC
Improper use and mainteuwec of your semis- system could result is its prrsnatsrafidure to landlc wastes. Proper Maintenance
consists of pumping out the septic task every thr= years or sooner, if needed by a licensed putter. What you put into the system
can a$sd the finnction of the septic tank as a treatment stage in tha waste disposal system.
Tlta property owner agrees to submit to St. Croix Zoning Department a certifkatioc form, signed by d3z owner. and by a
taasterplumber, joumeymutphtmber ,=trictcdpltunber or a licensedpumperverifying dint(i) the on - site wastewaterdisposal system
is in proper operating condition sad/or (Z) after inspection and pumping (if accessarj), the septic tank is less than 1/3 full of sludge.
,Uwe, the uadcrsirned have read the above requirements and agree to maintain the pri-eat . sewage disposal system with the standards
set forth. herein, as set by the Department of Commerce and the Depattment of Natural Resources, State of Wisconsin. Cefificatioa
stating that your septic system has been maintained roust be completed and returned to the St. Croix county Zoning Office within 30
des car expitatioc ata. *f ,/�
Sf
9TUM .j►PPLICANT DATE
OWNER CERTIFICATION
I
we certify that all statcm=u on this forest are true to the best of my (cur) knowledge, I (we) ant (are) flit owmt(s) of
the p desc ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
o z
N DATE
•'�4•a Any information thtt Is mis- represented may resuit in the sanitary permit being revoked by We Zoning Department. •'• "'
•» include with this appllealtan; a staa,ped warranty dccd from the Register of Deeds otrtee
a copy of the cattified survey map if reference is made in the warranty dccd
UV 11! US .Uvl\ UJ.Vo r.-. t.LV JOU 4jQj z.GV1.71 V 1,zzvz) WJUUJ
34 3.5
ACKNOWLEDGME_N'TS
STATE OF MARYT.AND )
COGTITY OF
Personally came before me the above named Bradley Schipfalbe;n, to
me known. to be one of the persons who who executed the foregoing and acknowledged
the same.
DATED March, 1997
Notary Public,
I _ County, gat! land,,. . w
j My C b mmissi n Expires `
STATE OF ILLINOIS
ss F
COUNTY OF COOK ) My Comm ion f�ira - kugvat 2. Z00�
Personally came befere me the above named Dwayne Schiefelbein, to me
known to be one of the persons who who executed the foregoing and acknowledged
the same.
DATED March 194',
Notary Publiic r
Cook County, Illinois 3 f i i Z d�t7
My Commission Expire
"OFFICIAL SEAL"
STATE OF WISCONSIN ) ELAINE SCHIEFELBEIN
ss N�COMNtISJON STATE pES1 F ILLI
COUNTY OF ) �'
Personally came before me the above named Gerald Shanahan. to me known
to be one of the persons who who executed the foregoing and acknowledg- ed;�h8'••.._
same.
r
T � y
DATED March 2 0 1997
Nota7 B bl: c/
Coun W scgn{8;in
My, C,,gnissior. Expires
STATE OF WISCONSIN 1
ss •
co,RirY of
Personally came before me the above named Patricia Morris, to me known
to be one of the persons who who executed the foregoing and acknowledged the
same.
DATED March 1997
IN
a Public. -'
county, wiscq'pW&'.' • .
My Co=iasion Expires $ 'y),,�t�•� I,,bA ' aSSD
5TA"E BAR OF WISUNSiN ORM 1-198-
557389 WARRANTY DECD. rrIt
00CUWNT ^40. w1?3_0w33 #
1 1- 71 1.1 773 CrF:�
Gerald Shanahan, Patricia Morris, S cn:x pjj
This Deed, Mil hxtw 1 . w�av
Dwayne 9- 5n , V
K fi 571 Be . n
f APR I
nr__,. -q
W i ccnsi .. CP5�90t!tiCn 411 11:30 A. aj
and other g2od j�q4 valuable considerations_.__
cor%q, to Urarnix 0w t,)L d-Mbed real ItItate in 4t. Croix Nis SPACE " Hb"
comno Sure of witworiiin: NALOIC AND q�_- UA14 �WAA - A
The East One-half of the Northwest Quart. CEO of NW:) /3
J �
. e
the Southwest Quarter of the Northwest Quarter SW 4 I SS
of NWL), and the Northwest Quartet Of the Southwest
Quarter ( o f S all in Section 3, T31N, N19W;
3.11.19.3 •
PAACZ!L 0kNT1VCAT'QN
3.31-19.39 SL 3.31.
TRA�PF
$.Ssas
7hi.% —, iz not hQmovad properi.y
with alimd itaguiar the liercditarneritt _nd appuncratIcts
And _&ranr_C1r,,
warrants illit t title 1 5 food, indded"' bit in fre %it-.,pie and rree 2r.0 :tear of crwambran.ti xci:pt
easements, restrictions and reservations of record; there is a boundary line dispute
and there i no war ranty of title as to the portion of land shown by the survey stakes
that are placed on the PrOPGIrt
anti %H arvint and defend flit same.
zZled % is —March 97
(SEAL
D,4yr.e Schief4belv
Gerald Shanahan
A (SUL'
Patricia Morris dle ga ei
(SEAL)
r7 "jcxiA-r "V'V1ft7.--%
AurHENT11CA00N
State of *ns A4141NGTONI-
Benron
lacalcd this do, M
utth'.. Personally rarni: before me this __'_12:Z dak of
'
March 1997
be
"a
G Schlefelbein
OTARY
1►111; STATF Q
or. VyASHINGTQK-
C
4'(IT
___
PAT ft GOIA
- 4"
'1(1t1lonzt:d by 4706.:`6, %Vit� Yals) My APPOLnTrwn; E-Vm JULY 17 % IL be jhr person who cm:-.4itd t ft
111st tint and d ' knowledff the Same.
Hl!', JN5jj1VMFwrNAS J)AAMU BY 01,
LLMVtGSON & GAUWVRICK.S.C.,Attorneys at L a 'w
Osceola, Wisconsin 54020 N,KSn Pubite, BQ"tofl Wash.
Lpiiiiatwo data:
'Al IS VerMAAtrl Of nut. state b... atittielltic.1tLd tic •cknowltdged. are trot My
WARRANTY M VU
_( 1 -•
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OD
LOT P o
139,184 SO. FT
3.20 ACRES
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562.OSi - • I — _ 2
4LS i� 94 ?S H.W.L. .I i 1 I - N89'15'42 "W N
10 59 . . ! I 345.16' (�
183.82' „� 8 y�19 O
390 76 • 5 21 I I SOUTH LINE OF THE FRAC7)ONAL
09 .E I I N£1 /4 OF7HENW1 /4 — - - —_
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SE 1/4 OF 1HE NW 114 I I 1 0 I N O
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w ° o co
co LOT 6
pp
131,162 SO. FT. O I
L O T ff _ _ ..01 ACRES (.n
130, 757 SO. FT , ' O 1
N I '
3.00 ACRES I I
M /N. F.F.E.: 986.2
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N89'50'27 "W � I • —\
380.29' I _% T RO _ _ 9
rn
° j TO B£ CONS7RUC7ED BY OMER OF LANDS
I
TO 7H£ £AST NN£N D£wLOlPmENT OCCURS.
Sh
/ — N89'15'42 "W 345.16' — —
LOTV I ��
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3 00 ACRES I I
MIN. FF.E.: 978.7 N I .................................
1
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w LOT 19 OD
o
„ ?. 131,162 SO. FT.
1
a `t��o' 54' I 3.01 ACRES
DiRAWAGiE EASEMENT : � ��
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: '
.89'50'27 "E 381.21' I
b . 207.6 b� I i I
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