Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-1031-50-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515125 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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: Mangine, Frederick P. & Jennie I Somerset, Town of 032 - 1031 -50 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /6U G M t C 5 11.31.19.150A TANK INFORMATION 2 ELEVATION DATA TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV. Septic k �' d �� Benchmark Q • 7 /Op • 7 /O Bet 99 Alt. BM ,/ 3 Z �� • S Fro r' t o ` Aeration V Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ( - I i J !� i 3 � Dt Bottom Dosing , Co (' Header /Man. Qe� Aeration Dist. Pipe Holding Bot. System O .' 3L PUMP /SIPHON INFORMATION Final Grade z , � •�I Manufacturer Demand St Cover P 3 74 Model Number t- TDH 1 1-if Friction Loss Syste ead J TDH Ft Forcemain ia. r7777vell SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length / No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /_/` "2 �, 1 ` �• SETBACK SYSTEM TO `i,l., P/L U BLDG W LAKE /STREAM LEACHING Manufactur INFORMATION CHA �F —�6 yJ Type Of System: lb5 CHAMBER OR Model Number: DISTRIBUTION SYSTEM G.� �— k to W%C k � Header/Manifold Of IDistribution x Hole Size Pipes) I x Hole Spacing it Intake � �` (� Length l Dia Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ez to Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � es 0 No es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 605 Lakeside Lane Somerset, WI 54025 (SW 1/4 NW 1/4 11 T31 R1 9W) NA Lot 1 Parcel No: 11.31.19.150A F' 1.) Alt BM Description = ' , '�'� �•L-1 el. VL �� � ✓\, 2.) Bldg sewer length = - amount of cover M Oc.✓ :ys 4 - - -- Plan revision Required? ❑ Yes No r Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's S' ature Cert. No. C 1111worce.W1.90V Safety and Buildings Division County c 201 W. Washington Ave., P.O. Box 7162 S ( 2- ro i • is qn C Madison, Wl 5370 1k2 Sanitary Permit Number (to be filled in by Co.) DOW A X15 Z S Sanitary Permit Applicatio State Transaction Number In accordance with s. Comm 8321(2), Wis. Adm. Code, submission of this form to the appropriate governmental PIV A unit is required prior to obtaining a sanitary permit Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purpo in accordance with the Privacy Law, s. 15.04 1 m , Stats. L Application Information - Please Print All Information Property OWDF 's Name V ED Pared # ` In 31 _ 1 Property Owner's Mailing Address Property Location O S Lu s IG 2 0 2009 Govt Lot • /� �� City, State Zip Code Phone Number S w 'l., N . 'b, Section ' ' s O / lP a � NIN itviA GOO ICE (circle one) , " & ZOG IL Type of Building (check all that apply) Lot # T I N, R Q L §al or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name 1 Block ❑ Public/Commercial - Describe Use El City of ❑ State Owned - Describe Use CSM Number C s S 7r3 ❑Village of I Vo l - Mown of S (` IGII Ste �r9n5 �Z d I �� GL III. Type of Permit: (Check only #6e boa on line A. Complete line B if applicab ) A. New System VNJ Replacement Treatment/Holding Tank Replacement Only F1 Other Modification to Existing System (explain) B. F1 Permit n Permit Revision Change of Permit Transfer to List Previous Permit Number and Date issued Renewal Before Plumber New Owner 2 G �fn (j q 2 y E iration [ aV l / qj itV. T ype of POWTS S stem/Com nent/Device: Check all that a Non- Pressurized In- Ground Pressurized In- Ground 0 At -Grade Lj Mound > 24 in. of suitable soil ElMound < 24 in. of suitable soil LD Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) i V. Dis rsal/1'reatment Area Information: nflyro Design Flow (gpd) Design Soil Application Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation Sa 1 S V qC0 I ( q CC) VL Tank Info Capacity in Total # of Manufacturer , Gallons Gallons Units U 0 y i New Tanks Existing Tanks z0 .1okiing Tank Dosing Chamber - - VII. Responsibility Statement - 1, the undersigned, assum res 'bility for installation of a POWTS s e attached plans. PVm bqr's Name P 's Si /14lPRS her Business Phone Number Plumber's Address (S City. State, Zip Code) 7�/ 575 1 fh Q Coun tDe artment use only Approved _ Disapproved Permit Fce Date Issued Issu' g Ag S' _ Owner Given Reason for Denial DL Conditions of Approval/Reasons for Disapproval SYSTEM OWNER:, 1 Septic tank, effluent filter and 40 0 )d dispersal cell must all be serviced I mai�utmber. ���� /n �v as per management plan p ust be maintained al- oir a "T "fa l icablt�� for the system and snbmit� Conaty o on pa of less than 8 W x 1 inches in size as per app L� atl " SBD -6398 (R. 01/07) Valid thru 01 /10 P[oT R fNk ay. h w Iv ' w Yq Sec, < ( 31 ti jq Iq t�a� � ; cs rIN 5959 vo (, t f �a � ro ;X 0 � LOT 0.,1 oC �o �C was P , JL 030 -t o3 So -- orD a .3 rN , (, — � go, 13 n` 41- dos m — $after. ct r-X-- ! I 4L 3 x c Cam P�o�r R. - �r.e.� W� � h�- Sc�,., �4, Sec, !� T 3 ( � ✓�?(qw t�os �0.kQ � cs► Ss $373 v If 3 P� So t t LA , WT_ Sy O a, io vv\ ors -R`� / S 1'� Opp ;X ' : ► all o� �o Sas ; ;� �; mil- 0 40 so - orD a .3 7'� ,�4•� (ao @ q./ 8 i� $© Ors x (44)�y l I T i ti 6rrM wQ( POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FILE lIiFORMATlON SYSTEM SPEC(RCATtO11iS owner r Septic tank Capacity 1 000 0 NA ga Permit it �j Septic Tank Manufacturer W Q S ❑ NA DAN PARAMETERS Effluent River Manufacturer 0 NA Number of Bedrooms 0 NA Effluent fitter Mode! L <r 0 NA Nub of Public Facility Units 0 NA.- Pump Tank Capacity ga l U*A Estimated flow (averagel O gaVd pump Tank Manufacturer 92 Design flow (peak), (Estimated x 1.5) C7 g aVday gip. Manufacturer N SON Application Rate Q Wday JW PUM Model A Stendatd tnfluer►tlEffluent Quality Monthly average* Pretreatment Unit 0 NA Fats, ON & Grease (FOG) 530 mg/L - 0 Send /Gravel Filter 0 Peat Rites . Moc3>ernical Oxygen Demand (BOO 5220 mg/L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Sods (M) 6150 uMOL, 0 Disinfection O Other: 0 NA Biochemical Oxygen Demand (130 0 8 ) 530 mg/L M- Ground (gravity) 0 1*4round (t ized) Total Suspended Solids (TSS) S30 mg/L ".. 'Q At -Grade - z f�6-�J 0 Moused Fecal Collform (geometric mean) chal00ad 0 Drip - Line r vel - le - is - 0 Other: Maximum Effluent Particle Size Y. In dla 0 NA b NA Others D NA Other , 0 NA ' typical for domestic wastavvaw end effluent. Odwr: 0 NA MAINTENANCE SCHEDULE Service • Errant Service Ftequenay Inspect c:onditim of tank(s) At least or every: Z 4) (a) (Mm&n n 3 years) 0 NA Pump cast contents of tank(a) When combined sludge end scum equals one .thkd (Y of tank volume 0 NA O months) Inspect dispersal cell(s) At least once every: earls?.. (Nddodrntun R Yom) 0 NA Clean efffiuer>t f S At least once. every: •. 'E3 NA inspect p mv. pump controls & alarm At least once every: usronthisl u 0 NA Flush laterals and pressure test At least once every: tttornth(sl O NA 0 yr3ar(sl - Odwr Ax. (east onus every:. Q monrl �(s) NA - 0 NA MAOIITENANCE WSfRUCiIONS Inns of tanks and dispersal cells shalt be nude by an kKovkkW carrying one of the following flcensms or verWilcadow Master Plumber; Master _Plumber^.Restricted Sewer. POWTS for, PoWTS.MaIntainar; Septage Servicing Operator. 'Tarok inspections must Inclurde a visual inspection of the tanks) to identify any miming or broken hardware idet"v any cracks or - Make, measure the volume of combined stodge and scum and to c hw* for any back. up or ponift g of effluent. ground surface. The disgmvW ceKs) shall be visually inspocted deck Ucr effluent levels In the obese vatku pipes and to duerdc for any 1ondin9 of effluent on the ground surface, "The priding of effluent an the ground surface may indicate afang.00ndMon and - regukee tine bionediats notirication of the local regulatory aud>Rnity. When the combined aeration of sludge and scum In any tank equals ocwdtird (V or more of the tank vahxna, dw entire contents of the tank she# be removed by a SAS Servi&V Operator and disposed of in accordance wilt• chapter NR - 113, WftoOnso Administrative Cade. _. AM other services, ir>cpid'tng but not Inted to #0 aervang of effluent f kws, medtical or presatuized convenents. pmet reaunent units, and any senvi at intervals of 512 rnorrths, - strati be performed by a certified POWTS Main. A servI a report be Pminded'to the lain smeary audxwiW wi tdn 10 days of cmWk tion of any service - event. Page �of START UP ARID OPERATION , For new cOnSM do n, prow to use of the POWTS dock traeet n W tank(s) for the presence of .Panth9 products 'or odw.clurnkmis that may impede the treatment process ardor damage the dispersal call(s). If (nigh ccuumdraticins are detected have the comtamts of the tank(s) removed by a septege servicing _operator price to use. Svotem start up dud not occur when - oil conditions are frozen at the infiltrative surface. During Rower outages pump ttanke may ftl above normal highwafer levels. When power is restored the excaaap vvaWawmar will be 0 god too the dispersal cell(s) in one bqp dose, overt ading. the call 'and may result in the bac p or ur surfia6li, disdtar" Of of cent. To avoid this situation have the corrterds of dw.pump tank removed - by a Septage Servicing Operator prior too restoring. power to the effluent pump or contact . a Plurnb�er or POWTS •Mal aaeiner to assist In mwntally operating the pump c orntrals to restore normal levee within the pump tank. Do not drive or park vehkAss over tanks and dispersal cabs. Do not drive or park over, or odrerwise disturb or compact, the area within 15 fleet down slope of any mound or at -grade sot absorption area Reduction or of the following fnxn due wastowetar: may improve the perlionnance and prolong The Me of the POWT& entibiotiM baby wipes; cigarMGe butts: cardoms; totter swffisy degreaears; derrtal floss: diapers; fat; foundation drain (sump plump) water, fruit and vagefabis pw&W. gasobhe; grease; hides; meat scraps; metes; oil; ping products: pestk&lea: aanftWyr napkins; tampons; and water softener brine. ABANDONMEIWT When the POWTS fails and/or is pemun an* i91oBn out, of service the following slasps shall be taken to insure that the system is pnuperly and safely abandoned In cormpbar>Ics wish dtap r Comm 83.33: Wisconsin Cade: • At piping to tanks -and pits shall be diSoanneeted and the abandoned pipe openings Wiled.. + The contents of all tanks and pits shah In removed and ply disposed of by a Septa" Se:viciig Operator. + Alter pUmpiug, all tanks and pits shah be excavated ` and removed or their covers removed and the void space ftid with sob, gravel or another inert solid material. COUTIPSGEMM PLAN N the POWTS falls - and cannot be revoked the fobwiug measures hwim been, or tntat`be taken, for provile a coda m Wilant Ig A suitable replacement area has been evaluated and may be utilized for the location of a replacement 96'0 absorption systan• the t sho*,be woLeo<ed froin dkmxbarnc@ and conwattion wW s - houid not be'inf kigsd -upon toy r eetbarks.fram akiftfrig and proposed sfluoture. lot- bnse.and wells. Fallure t3o praceat'die'tep xt.area vet result in the need for a new sob and alto evaluation ta: a.suitable replacement area• teepaacement_ systems must Comply with the rules in effaot at that tine. © A suitable replacement area is not evallable due to WdxN3 c ardor sob bmitatImm. SWCbV advarWes in POWTS - teclandogy a ; tank ►they' ba instated as a last r±ssort so replace the farad POWTS. 13 The site has not been evaluated to idea ffY a suitable repboament are.. upon - failure of the POWTS a sort and site evaluation must be performed to locate a suit" movement area. if no replacement awes is avallable a hddmg tank may be installed as a last resort to replecd the fated POWTS. 13 Mound and atgrade a* -abpxpmn systems may be reconstructed In place following removal of ha. bionaat at the :' xufttstive- surface. _ tiuirls. =.of- su���;a y� the u vias.in- effisct _ «WARIRN(f> > S6"ilC, WW AND OTHER TWA'TMEW TAM M NAY CONrtAW LETHAL 01"t301. DO NOT MTER A SEPTIC, PUMP OR OTHER TREA'TMEI T TANK UMER ANY CIFICUIWAINIM. DEATH MAY I IM&T. N SLUE -OF A :.PEWON FAOW THE WTINIOR -F A TANK MAYBE DNHCMT OR YHb'OSSIBLE.. ADoTIONAL TS PQVYi'$`WS'fAI.LES POINTS NAWA Name U Name fhorke Plioiis CS S13 SEPTAt3E SERWCWW OMUTOR ) LOCAi. R6lDILATORY AUTHORITY blame ; . ` r< Phone . « i Phone Ttalis doau mt was drafted in coww0ance with ctwpw Conran 83.22(7i(bXI)kQ&M and 83.540). (2) & (3 vyhcor do Ado *'hW'M a Code. t { ST. CROIX COUNTY ZONING OFFICE .� CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Y>7 4 v% residence located at: . C5 W 1 /4, NIAJ 1 /4,S tion Town 3 / N, Range-- /-q Town of Sd r� ' , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 002 Did flow back occur from absorption system? Yes-4 No (if no, skip next line.) Approximate volume or length of time: ,/�' gallons minutes Capacity: /� 0 Construction: Prefa Concrete_ Steel Other Manufacturer (if known): Age of Tank (if known): 01 0. (Licensed Plumber Signature) (Print Name) 7 (Title) (License Number pRS (Date) ' Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) f � - ST. CROIX COUNTY SEPTIC TANK MA NT'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address L.-) J ScU.3(� (Verification required from Planning & Zoning Department for new construction.) City /State...5amQ r Parcel Identification Number 30 -103 LEGAL DESCRIPTION Property Location .S 0 '/4 , N W '/4 , Sec. , T jLN R_L� W, Town of So rr 4- r S¢J Subdivision L' - ry l U o l // �, , 3� tom- , Lot # / Certified Survey Map # S-5 3 3 23 , Volume / / , Page # Warranty Deed # S S , Volume Page # Spec house yes �d Lot lines identifiable Les) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pining 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department witbin 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the Property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLI (S) DATE * "Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departnoent. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) II 1 'rIP—L (,Q Y\ h to D S Utk S, [,CL r - q. S D ���s �et" O fo FF EZ1203H Ovv OV Va �~.• ♦040000 Ovv 0004 •t•~ i j 't'� ":••• � .•1Q QQVVO - Ovv4v00 OaOV evO vOV - VO VV000• 11 sva .r' i;a �'. 24t' OQb t' K• • 4 y Y,O a c v v 0 0 vav vov 4.625 11 vbv t! b n O a 4 P V 1 J2 Circ. 18.84 vev sv• � vos sav vvv vvv vaevv P vv ♦. rvv- v v vvvabvo v. Tvv�avTVVVV� vvvvvvv V VVOV ♦OTVVVOVVVVVVV VVVOTV* a vO VT00 VV VVVV VVV'VVVVO WOTT *V V- _241 g Boa m 36 12-1/2" DIA. (typ.) Void Votumr Soil interface Area 11 jg EL 51 Void coefficient in Aggregate given at 57.4'/x. Sidewan (2 Sidewalls) 2+ 18.84in = 3.14 O.D. of 12in 4" pipe = 4.625 inches _ !ft 2s12s;n Void volume per linear ft. = 3.14 • tfr = 0.117 ft' Bottom 2.00 k 12in)ft Total Son Interface Area 5.14 SQ. . O.D. of mssiercy ;index a T2.5 inches Void volume in aggregate of cenwrcylinder =(3.14 • tin ft) - 3.14`[ -311 }, ` t l It ll ! -.574 --427- ii' O.D. of outside cylinders- 12 incises ) Projected Trench Area Void volume in outside cylinders = 2.3.t 6m 574 -.901 ft' Sidewall Height - 12 in. '2 a 2.00 Sq.Ft. t2in J ft,_ Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders = [( 24,n • 6in }_�; i .( 6i" � 1 n. f fr 12in t ft W l t2iul f: i ' 0 245 t3' Projected Trench Area a SAO Sq.Ft. Void volume at outside bottom comas ( 112 of void volume between cylinders) 0215 / 2 = 0.108 fY Total void volume - 0.1 17 + 0.422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft ) ft Gallons per ft = 1.763 X 7.48 - 132 gallons ner linear ft. 31, X ' EPA Aggregate Trench System EZ1203H �Z�ZU•W Ring -InduStrial Group 68 indusVcial Park Rd. _> Oakland, 1W .18060 semi FU NAM& EZ120314-rat 5HEE1 tat t t1 -27-01 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 i 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 distan rsltoa Please print all Information. ► j"' J I ( evieW&d b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. Property Owner Property Location Ven Govt Lot S w 1/4 Nw 114 S T I N R 1 E Property Own sting ress AU 2 Q 20 Lot # B� subd. IVar►e cSM# c C Sitat -ems Zip Cade ��NM/VG'��'�C�UMTy ❑ City ❑ Village T Near t Road �.zl G { ) 2p N/NG 0 0 New Construction Use: jKI Residential / Number of bedrooms Code derived design flow rate GPD Replacement (] Pub{(c,or commercial - Describe: Parent material _ �k Flood Plain elevation if applicable ft General comments and ations: j� �� Sysril f r�tssaJ 01Z;1 �l r� y.3 D Boring # Bori 1/ [� pit Ground surface slay. 7 � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure F h, sistence Boundary Roots GPD/ft2 M. MunseO Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 rEff#2 _d L S Gk D 3 _ 6 ® Boring # Boring NJ pit Ground surface elev. �' 3-5 R Depth to limiting factor b� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 j M 5A th V f I 7 1, z • Effluent #1 = BOO. > 30 < 220 mg/L and TSS >30 < 150 mg(L ' Effluent #2 BOD < 30 mg/L and TSS _< 30 mg/L Name Printj Signature CST Number D Address Date Evaluation Conducted Telephone Number [ / - / 3 - 7 / Y &,S1,3 I Property Owner Parcel ID # p d G Page o Boring # Boring ® Pit Ground surface eiev. ft. Depth to limiting factor _ j V in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 '2 -.1 V tg H S � k m� r o (l to s M t.1 , C) ❑ Ong # ❑ Boring ❑ Pit Ground surface elev. ft Depth to thrilling factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 i Boring ❑ F-I Boting E pit Ground elev. ft Depth to Ong tactdr _� in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN1 In. Munsell Qu. Sz. Co nt. color Gr. Sz. Sh. 'Eff#1 '0102 I ' Effluent #1 = BOD > 30 220 and TSS >30 150 ' s < _ � < _ rtrg/L Effluent #2 - BOD < 30 ngiL and TSS < 30 mgA. 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 or TTY 608 - 264 - 8777. sruna3ao �uroal I it CD o T"A ►��;n.Q I _ s u , �I�/ w y� s T 3 1 IV R tg W LOOS � �S e CL La fl.k � !� `Qd / �� � {�Q �� (D,3 loaf -SO- o© cD A 6 M4r 8c*f's ►rL t JOlb SCru I "_ klpt 3 p T J l rya i ys � f r VOL PA 1 WARRANTY DEED 559/05) Document 'Number- r hA�pv !r► X41. 4 Rerum Address 1 :45 , first National tank of New Ric,htnond rat 7 r A I� Per Box - r = , W= 54017 M New.RiChmo nd, Par`ce - I.D:'Numb0:. ,032 10 51: -5 & ° 90 • -f i Joseph " - P'Iaurde;' -a single_fperson,:.conveys and : ', warrants to Frederick ri described reale st "atz S2: hip m _.. llowt g e husband ,aril wife, as survidorsarital pro perty,'the, o Croix county, State of Wisconsin: Part of ttte SW1 /4 of NVV''1 /4 artd pari of the SEl /4••qf h1W 1/4 of Section 11, Township 3 3 North, Range 1 ,9 R'est,. St. Croix County, VJiscorisin,•described�'as; follows: ' 'Loi 1`of Certified Survey M<<p filed April 23', 1:997.: is Vol. 1 I ,Page 3242, Doc_ N o. 558373. This is`not horneste4di property.' ' Exception to, warranties: Easements,, restr.cttons an rights -of - way of record, - d -u Dated this � day of May, 1997. ;�,.... ER �,..� (SEAL)' Ios h • Plourde a /k /a Joseph E Plourde AUTHENTICATION r Signature(s) Joseph F, Plourde, a single person, authenticated this �; _ day of May, 1997. Kristina C)gland TITI..L: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 s aY` • rte. _ 1237 PACf 45 559055 WARRANTY DEED Document Number - y { Return Address M AY t.-) 97 j First National Bank of New Richmond r PO BOx C 11:45 A New Ricnrnond ; WI 54017 } J Parcel I.D. Number: 032 - 1031 - & 90 r Joseph IF. Plourde, a single person, conveys and warrants to Frederick P. Mangine and Jennie S. Mangine, husband and wife, as survivorship marital propert;, thre following described real estate in St. Croix County, State of Wisconsin: Part of the SW 1/4 of NW 1/4 and part of the SE 1/4 of NW 1/4 of Sec 11, Township 31 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot I of Certified Survey Map filed April 23, , 1997, in Vol. "11 ", Page 3242, Doc. No. 558373. This is not homestead ro e P P rty- Exception to warranties: Easements, restrictions and rights- of -way of record, if any. Dated this — � ,a " ` day of May. 1997. �L�! –lam (SEAL) Jo h F. Plourde a/k /a Joseph E Plourde AUTHENTICATION Signature(s) Joseph 1, Plourde, a single person, authenticated this Ste' day of May, 1997. Krtstina IDgland TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 i ,y 0 0 Co << FILED C�b 77 lu —.� :�7 �i � o •r 1 PR 2 3 1997 KA THLEEN H. WAL&I MOC 558373 0 a i ED LAUDS WEST LINE OF THE NW 1/4 N N 0, - C. _T. H . I (D Qj N00 0 35 1 00 "E — N N00 0 35 1 00 11 E 578.71' ��- - rt ro 1 N 545.62' y g m H (t O - 2 V O ' pF• W .F 0 ot) W Fh 1w•a N W A N A r N W rh O _ T �O to L N 01� ...0 O fD 01 rsj r M c n tt Z or N m A z 33 33 O rt I A f f rOn IZ 3300'- ~ 17 N00 0 35 1 00 "E 577.60' n :::r . 544.60' ti ti � 0 (D O N V1 N o Co 00 G N o0 C N. O O In z O O N N .� 10 00 00 c> o C) > m m w on •F 0 o U) P) F ° o .o EA � N m o o m CJ7 f'1 IZ C7 Ir w m _ --I o o I Tl 1> E v, Ct as fin N mm IG o - -W �--� M W u ro -n 3E ZE V to m r 11 M in N - C) & d ^- . 33.00' — —1 O C/) 543.58 U) rh C N � N00 ° 35'00 "E 576.58' ( rn G N Ct 0 0 If t1j n wV w I T. fi O a , V V7 V lD p c, N � IM o (n 1 rh A c 3 i9 " -3 C, O O �1T�1 Ct —I W N IM N 0 C • m , W 0 0�0 T x 7 - - C. - tf n rF n 3 0, '9 K 0 CA ID C y C z � o Cp rn "' M Star (D � 3 2 . 0 COP C1 0 a 0 i0 C 'n to Ct 4.3'! 33.01'- C O T 542.06' Cr a, 0 S00 0 25'22 "W 575.07' ` �y z H n o CA V j H ' PARGCL IN V.590 PG. 531 w NM OM 5 0- Z W O�0 lT _ 0, O W Ma C • - f � r1 Un C M Bearings are'referenced to the west E line of the'.NWk of Section 11, assumed c 0 to bear N00 °35'00 "E. >> O c� tfi Vol. 11 Page 3242 - r (D o 3 m m 3 3 rT O �7 N Z O Z N Z O c - 0 ee • ;' O w N p O C D N O� p Vt w N m p. z c � o p 3 m co 3 w r " oo cn _ m �_ CD m R N 0. � N m _ A= (D p= N C7� CD N O O O O C'r = m j' = m -1 O N ( O G .. N n a CD CL O D 3 o m a o C o U) M. O G C 0 a a W (Jt ro "o O N 2 co ED w m O ° co 2. O O (9 N(D --•„ Z N (D 1, � (0 O �" �_ j o) .: O N O (o (D U Z O 0 ! o r to co O C p N -4~ N O d 'O�' S X C x .. CD CD I L a a '0 a O O O m O O O (D ! o C z �Q N y y N y N '�i O D CD CD 1 cr O 17 Vi y `Cr _G N ! I O (p (D = M, (D 4) CD - M N (p N O •• N y < N ci 3 m m 3 3 ?! m N CD m A °o a z -� z �, A N ZG) D 4 A �1 N '' ? O I = N !� O �• Ln ' Q) �-✓ m N m N N CD R CD N c N N C D C CD CD m N ' cn ( C N C C7 O A z o CL `Z d (D M (D m j CL -� Z 0 3 0 3 A p o co N � N g p A W Lo N N d fD N a S X Q fD co N C C O p N C 3 N o mvsCD m (D O N N a (D 'O -(On N N O p (D N N (D C N C) p O a En N fi I �No d ti Q — o y w m = a oa o N A CL = D ( bq N N fA O tD O ((D a f I STC - 104 rb AS BUILT SANITARY SYSTEM REPORT ��CEtVED t' /Cd /'�c�n DEFY' OWNER 1 997 f ST CROIX ADDRESS �e7� L . ,3e Le..►� F co IJNTY`.r''j ZO NINGOFFICE SUBDIVISION / CSMJ ?.2 "'Z. LOT SECTION L T - '?/ N -R /q W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ie 1{ 3 1; • Lai INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I - ,t BEN 'HMARK: Gt/ Lo �GGesctr a o ' / i /art ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: &)- tek5' f, Liquid Capacity: /oao Setback from: Wel House �' Other Pump: Manufacturer 4 Modell Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 3' Length Number of trenches 2 1� �j� ,�� ,• Distance & Direction to nearest prop. line: a 'f Setback from: well: /a8 ' House 6 3 ' - Other ELEVATIONS Building Sewer /D2.Sfe ST Inlet: / -"'/ ST outlet: 14? - 11, PC inlet PC bottom Pump Off Header /Manifold /,o /, Bottom of system / ,0 4, Z Existing Grade Final grade 6 5/,:!5P5; DATE OF INSTALLATION: PLUMBER ON JOB: . LICENSE NUMBER: 1 ZZ INSPECTOR: 3/93:jt • PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitar 99064 GENERAL INFORMATION Permit Holder's Name: E Cit p Villa a Town of: State Plan ID No.: MANGINE, FRED SOI�I&SE'I� CST BM Elev.: Insp. BM Elev.: BM Description:SQ,,,, a r ST 5 Parcel 65 / 100 � 1 t r v y1 rjw 5 rod t*I r or✓Irr TANK INFORMATION ELEVATION DATA AOb0382 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Wf_,:K - , Benchmark j�7 " , lo `� / 00 o Dosing �. d A/I ;,1,:., ; ��'1 2.3 Aeration Bldg. Sewer ," G 1 p y Holding St /Ht Inlet 'S3�d �/p 1r�Z TANK SETBACK INFORMATION St/ Ht Outlet ( % (p. hp' ?6Z TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic +. ��� {' 32 +3 t 9 / NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System g 3/ �,1 %' pD Z) too.? PUMP/ SIPHON INFORMATION Final Grade j. /0 $ Manufacturer Demand 5 2 " / g 32 1 , /0,5 y3 Model Number GPM TDH Lift Friction stem 'TDH Ft Forcemain Length ia. ist. To Well SOIL ABSORPTION SY TEM BED / T Width Length No. Of Trenches PIT No. Of Pits Inside a. Liquid Depth DIM EN I N 3 5-q Z DIMENSION SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufac rer: SETBACK CHAMBER INFORMATION Type Of ,�/ _ Mod Numb : System:C +70 _ 1p(' OR UNIT DISTRIBUTION SYSTEM Header / Manifold " Disttri Pipes) W i � �/ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. — Ce�igth �(�ZSBia. Spacing � — ��5 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only xx Seeded/ Sodded xx Mulched Depth Over (� 5 r Depth Over xx De t Of Bed/ Trench Center I • Bed /Trench Edges Tops []Yes [] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, a c.) LOCATION: SOMERSET 11.31.19.150,SW,NW 605 LAKESIDE LANE LOT 1 ff Plan re vision requiFel ?��❑ Yes No Use other side for additional information. I 1( 1 7,1 1 C17 1 SBD -6710 (R 05/91) Date Inspector's SiWnature C rt No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f e • n e �— t s e 4 s w a 3 7 uildings SANITARY PERMIT APPLICATION 2 01 e E.W and sBn Vi scons i n In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County (', n than 8 1/2 x 11 inches in size. 9 . (irk 1 • See reverse side for instructions for completing this application State Sanitary Permit Number o?qq 0 &4 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 1 5.04 (1) (m)]. r /y t/l�l f , State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE I h./YI PRINT ALL INF RMATION Property Owner Name P rope rt Location 5Lj U4 t�t�u) 1/4,5 { T 3j , N, R ff �(o W Property Owner's Mailing Addr (As, /may Lot Number Block Number AW City, State / Zip Code P Number Subdivision Name or CSM Number Z Z i' ) �/ II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road Public 1 or 2 Family Dwelling - No. of bed rooms 3 Town OF C/' III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) / o3a - /D3 / 5 o -ioo 1 ❑ Apartment/ Condo //. • 31. 1 15 O)q ' 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Q Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. pg New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System System ____ _________TankOnly______________ Existing System ________ Existinq System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 5§ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da}; /sq. ft.) (Min. /inch) Elevation �� -6 7,R L� X1 Feet /Oy, 3 Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION 9 Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /gyp GAD f 4 kj C, /l ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name: (Print) Plumber's Signature: (No tamps) rP /MPRSW NO .: Business Phone Number: l� Plumbe s Ac dress (Street, City, State, Zip Code): � l /�' lx,/. r i IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) X Approved (c[)[ Surcharge Fee) ❑Owner Given initial � Adverse Determination A I&" . CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -6398 (R.11196) . DISTRIBUTION: Original to county, one copy To: Safety & Buildings Division, Owner, Plumber Ad i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: L Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 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; pump or siphon tanks; 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; and F) all sizing information_ ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY t.`.1l ✓ /+t s' DATE 2 7 (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE I ..........> ............. ............................... ........... ........ .... .... .... .... ..... ..... ..... .... ... .... .... .... ..... ..... ..... ..... .... .... ..... -- .... ... f f .... a a . . .. ......... ....... .. t�.L� ... .. ... ... .... .. . ..................... .... .... .... ..... .... ... ........... ; ._ ........... .. ........... ... ..... .... .... .. .. ........ .. .. ..;. .. ........ ` .. .. .... ... ... r ... ..... ........ �;.. ... . . fit.. ...... ... .... ;. a .. .... ...... ..... ... l lL .. ;..__... �, �� ,�� ... !�, �,✓' � GE ��.J / , �+ P ._ �: � " err . .. d6.t �C.p.P dSt.�.... u k. �`� / :!.v C�':✓_ %% , <. t � � .., .... .. , .. i, ...... a „* w .... .. . , ... I _ ;._... _....;.. PRODUCT 2*1 � Inc., Groton, Mass. 01471 . To Order PHONE TOLL FREE 1- 8*225 -M 1 f r C�/ /lt ' JOB TIMM EXCAVATING SHEET NO. Of Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772 -3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ..... .... .... .... ..... ..... ..... .... .... .... .... .... ..... ..... ... ... .... .. ..... .. ... ... .... ... ............ ........ .. .. .... ..... ... ... ......................... .... ............. . ... ....... t . .... . ........ .....i.. .... ......... { 4 . .. . ... ... ,.. ....... .... .. ;... f ..... ... ,..... .... .......... ............. .. 1 ......... .. .... ..... ... 00. z r a� Cr .- 3 b _. , ....... i_... PRODUCT 205-1 Inc., Groton, Mass. 01471 . To Order PHONE TOLL FREE 1- 800.2256780 �Q `� ��` ,�` � �O f - �_- �5�3 • roc' .� 1Rlisconsin' Dr3partment of Industry, $ O SITE EVALUATION Labor and Human Relations l ; qq -�CC��EE,t Page of Division of Safety and Buildings c _ 7 �eltAklCt dance lt� s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper dss th. ' )/2' a .11 in �es , in size )Plan must County / include, but not limited to: vertical a d horizontal reiilrenb int (BM); diriction and percent slope, scale or dimensions, ,Arrow, and disc ftA to nearest road. Parcel I.D. # APPLICANT INFORMATION - P/ 6'p_ 6if6rt►ation. Reviewed by Date Personal information you provide may be used for seco rivacy Law, s. 15.04 (1) (m)). Prope owner Property Location Govt. Lot �-�- = 1/4 1/4,S T N,R l i(or& Property Owner's "�A Mailing Address Lot # 1 Block Su . Name or (;,9m# - % .1 City Statel Zip Code Phone Number ❑ City El Village r 21 Town Nearest Road 1 14 � r I I - (/ - ® New Construction Use: JZ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _ Zna gpd Recommended design loading rate _,_ �_bed, gpd/ft2 gpd /ft Absorption area required 8 bed, ft 5 trench, ft2 Maximum design loading rate g g ,Z bed, gpd/ft trench, gpd Recommended infiltration surface elevation(s) , /zq/ ft (as referred to site plan benchmark) Additional design /site considerations Parent material 4,,/ 42 Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ZS ❑ U HIS ❑ U 29 S ❑ U 1 0" ❑ U EIS O U I ❑ S ® U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft � g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench - 9 / L/ Ground 3 / elev. 1� S s I — , Depth to limiting factor in. Remarks: Boring # {CiJ N . 1!-+ / Ground — — — elev. lift• ' Depth to limiting factor ? in. Remarks: CST Name (Pleas Print) ` Signature Telephone No. - ZZ Address �� Date CST Number © C zl)z n PROPERTY OWNER SOIL DESCRIPTION REPORT ? l Page of J PARCEL I.D. # Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Con Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench / n r Ground elev 1 — Depth to limiting factor Remarks: � Boring # Ground elev. — � �ft , Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench Boring # f 3 -mod H Ground s. t elev. Depth to limiting factor, in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) sr, A4 3&4 y W O 3u0015£o00N reoq o4 pownsse 'ti, uolpaS 40 IMN 0 44 10 au}i. O z 4seM aye o4 pa0uara }ar ere 96u}rea8 N 4J o in +, no. ;0% 0 . PJI �1— 5 j rn H .^ 1'1 I n of r-1 C ^ Z 1L0'515 Mull1SZp00S 'o `�. Ii '- -0 0 ,to's� 190'Zh5 0 g' 4r U vi c 0 U o ZI ,.°• o •!f QI N d V j • • • IL q Kl Cl�i X4�. c 0 >+ 41 m a LLI o i0 n Lli 0I .0 CD O v o+ c 1. a +' w 1{.I / AI I � ^ N 10 O W � CO w N w I X V 011- In N 7 S CL •d'f YI 1� M M Q •" e- -• Q W to QI o L > tv 4 y W .[ c 4 O 18S'9LS 3110015£o00N (n r _ 00.££ A +-) W N J Ln LL a o cn� .., M 14 UI W r4 r- r� 1n `� N c 1n Z GPI LZ M� Q b O N C O 7 fO � C.� G to L N ... •a• �..... .. ....... • ID w C� o o O 00 O UI .tn ( D cc G 1f1 N $ N �I O h y N 4 U I 109'hh5 �� n 4J .0 - 109' LLS 3A S£ �� = w3 ,or7 Z ° .a >, A , y � a N •�'i U L� t t I'— dN 00 O L L 01 r 4j x L O M (h .J -C M < C M M O U .n � N 1A N O 1 Z9' ShS 3u001 M OON _ 3u001S£ S 1LL 8 3 4J u ._. WIMN 3NlJ0 31111 1SU 11 T 11 .H I r3 `^ I S 14 W e ^ J C30 -N 71" FILED " `� PR 2 3 1997 ? rr�b o ?� ;..a :.r ,r: _ R*ft of Q. o z �' ° n St Cn* Co., wl 5 58,373 �� T a o 0 0 U�P.9 a i EU L,ArsYs ,y 11 II WEST LINE Of THE NW 1/4 n (t O _ C. _T. H. I (D `D m a N00 0 35 1 00 11 E 578.71' N00 a I' 7,QZ1. � N00 ° 35'00 "E 545.62' :* W o T �e �v+.�'�. O O O V o° o - v i Ct c N. � CD Q M W; N; O t0 N W rl' W tO O �m �v+ �^� �o O (D rn �J m c�h A r CD N (D f .Z7 M 33' 33 U/•' rt 31E :4 IOn Iz 33A0- p• N00 0 35'00 "E 577.60' n IL 1.1' 544.60' O (D a o "!A w to 1n OD -- - O 1n z - C -' zo °p° °O° G r ' y N N tJ .� A►+ I� ° o o a ° a °' °' CI � U) P) �� a Co N N 0 N ' N 1'1 Ir t° w m - —I M O O M C7 a' m G to n fin N �� w to IV) o io P Vf N to 6 ft d N 543.58' 33.00' — V) 0 C/) N00 0 35 1 00 "E 576.58' M m -< 0 0 Ir 3 ID tz a � O - � trif � N . 1 � Ct ° x B .i N `i w IM 0 O ••h m j O� y t1 �y r h O -P C p V n t0 n O 01 01 I TQ ►�+ Ct rh 9 VI N N A -� W N II 1 Q, - 1 — n .0 N .G N O t0 (D 0 = c 4 t x -n O n W OD -U . . . . �r Ct n 'O N M .'a aw- S C ID Cry z O CD Cr o �rn s M 0 ka c o c'D d t In ,c Ct 4.3'+_ 542.06' 33.01'- 2 0 o ' Cr 0 S00 0 25 1 22 11 W 575.07' y N c 1 � ash H PARCEL IN V.593 Pte. 531 CAN w W "' 00 tr! o w 00 t ° c '� Ct 4 S y N •- ~ >E d W N F II I o = rf C Bearings are referenced to the west line of theAW% of Section 11, assumed o to bear N00 ° 35 1 00 "E. 0 1 Vol. 11 Page 3242 l S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Location of property /4 1/ , Section _�_ N- R Township Mailing address Address of site Subdivision name $/' �p I / / 3�y Lot no. Other homes on property? Yes No Previous owner of property J� e to 1 yurde Total size of property 7 y Q,e3 Total size of parcel Date parcel was created Are all corners and lot lines identifiable ? Yes No Is this property being developed for (spec house) ? Yes � No Volume j� 7 and Page Number y d'3 as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER 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 recorded in the office of the County Register of Deeds as Document No. �f1c) ,15 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signat of Applicant Co- Applicant Date of Signature Date of Signature STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER ' Cf mac% r � r MAILING ADDRESS / ©� �'4 dal PROPERTY ADDRESS i &L 41, Y,6 (location of septic system) Please obtain from the Planning Dept. CITY /STATE N -R �� PROPERTY LOCATION �' G� T 1/4, �t� 1/4, Section �_ , � W _ TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ,VOLUME /I __ , PAGE gZ � LOT NUMBE 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant 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 owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiratio n date. SIGNED: DATE: St. Croix County Zon Office h' g Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r