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HomeMy WebLinkAbout032-2105-40-000 r Parcel #: 032 - 2105 -40 -000 o 7r21r2oo5 02:00 PM PAGE 1 OF 1 Alt. Parcel #: 28.31.19.989 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BURTON, RODNEY G & ANN T RODNEY G & ANN T BURTON E116 1205TH AVE DOWNING WI 54734 Districts: SC = School SP = Special Property Address(es): P'rY Type Dist # Description * 434 190TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC / �J Legal Description: Acres: 3.110 Plat: 2005 - GRACIE ESTATES SEC 28 T31N R19W SE SW LOT 4 GRACIE Block/Condo Bldg: LOT 4 ESTATES Tract(s): (Sec- Twn -Rng 401!4 160 1/4) 28-31N-19W Notes: Parcel History: Date Doc # Vol /Page Type 11/07/1997 568220 1275/539 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.110 48,500 72,800 121,300 NO Totals for 2005: General Property 3.110 48,500 72,800 121,300 Woodland 0.000 0 0 Totals for 2004: General Property 3.110 48,500 72,800 121,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T Wiscondin Department of Commerce PRIVATE SEWAGE SYSTEM y Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 363840 Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Burton, Rodney Somerset Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1 r _ s -r �„� Oft-2105-40-000 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY ST Iq BS HI FS ELEV. Septic - Benc a _A) 2sd (o�,Z I po - p Dosing Alt. B � 3.7` o -�{ Aeration Bldg. Sew Holdin St/ Ht Inlet IF- TANK SETBACK INFORMATION St/ Ht Outlet g 90 -N , TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic 5D ' p / —� NA Dt Bottom �— Dosing NA Header / Man. 'S 91-20 r Aeration NA Dist. Pipe S C Zf Holding Bot. System 9 s' )v ' S _ �& q s. s' PUMP/ SIPHON INFORMATION Final Grade ' L , — 4 qS s a .to 4 o' Manu cturer errand St cover �• `f Model Numb GPM �' - [ T o D r H Li Fri ' n System TDH Ft (oq.4c, - cemain Length Loss Dia. Fi ist. To Well SOIL ABSORPTION SYSTEM Z SEZI�T Width r Length N . Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI E N DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING re : an a _ INFORMATION TypeO CHAMBER Moe Number System: QJ--.,O - -Z of OR UNIT DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Xir Intake Length Dia. 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: la/ 19/ 6OInspection #2:-- --1 - -i Location: 434 190th Avenue, Somerset WI 54025 (SE 114 SW 1/4 28 T3 IN RI 9W) - 28.31.19.989 Gracie Estates - Lot 4 1.) Alt BM Description = 1_sr+1(�ec�..� 2.) Bldg sewer length = 1 p I D - amount of cover Plan revision required? ❑ Yes ]�NO 4 7 l Use other side for additional information. 9 SBD -6710 (R.3/97) Date Inspector's Signature Cert . No I 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ` rL L g e r 1 t 3 I _ � d 1 d E �� f r Y Safety and Buildings Division ` i SCOL1S %n SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Cod Madison, WI 53707 -7302 n ^ • Attach complete plans (to the county copy only) for the system, `paper not less County than 8 v2 x 11 inches in size. �a� �rofX • See reverse side for instructions for completing this applicat' �� tl/ (� State S� nitary Permit Number 343AYa Personal information you provide may be used for secondary purposes _­ I C _ ❑ Check f revision to previous application [Privacy Law, s. 15.04 (1) (m)]. Uu p Pla I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL I 611MA r tate / t Property O ner Name � on 49 tz vd w, S T �/ , N, R E (or) 49 Property Own is Mailing Address t' N,umt+er Block Number ® ©S Cit State Zip Code Phone Number Subdivision Name or CSM Nu ber P,01u -1 L✓r 1 5!Y - 75 (his) 6y3 - 52as" G ae � 7/¢ S II. TYP F BUILDING: (check one) ❑ State Owned Li ` M !'�'Se Nearest Road p Village J Public 1 or 2 Family Dwelling - No. of bedrooms Town of d 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 0 3 Z- 07 /0 S-y 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ 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 2 New 2, E] Replacement 3_ E3 Replacementof 4. E3 Reconnection bf 5 s E] Repair of an ---- -- _ystem -- - ___ -- System Tank Only Existing System Existing 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 W-Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit Z ' Lax S 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTI 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.) P oposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) ✓ Elevation © d O Feet l c9e, 0 Feet Capacit VII. TANK in Ca g ga llons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks e n ptic Ta oH�eid+fFanir �p ❑ ❑ ❑ ❑ ❑ i hon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si ature: ( MP /MPRSW No.: Business Phone Number: A-s Vs v 9 /f a 3 s - 11-f 2- Plum ber4 Add ress (Street, City, Stat , Zip Code): �ry O 77 a m L� 5 ' X 7_5' - 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D a t ssue Issuing Agent Signature (No Stamps) Approved [:]Owner Given Initial Surcharge Fee) q61 Adverse Determination OU X . CONDITIONS OF APPROVALL / REA FOR DISAPPROVAL 44'.,7 �� kt'.c q��or,Ca. o.� +`u(,5 °t �tl,( J �rare`�t It CC SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS.?; T, 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 septictank(s) must be pumped by a licertisecd 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: - A To be complete and accurate this sanitary permit application must include: I. 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 repla(ement, 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 aid specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the foltbwing: A) plot plan, drawn to sC or with complete dirhensions, location bf 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 practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. �o r�a�nP►/ Duy�d SEA Sway A �l � �' 3/ ,� /11 �/SG � 32o S �ova.., � ► n , s � 3 y �. /�r�o�onit w1 6 75*1 his S - /i 3 z e5�rACle lvZ2 z�y � P A r �mrtr- c ( 4 � t Sfe�. i�. f �n / �ri.+.a / J d Are CA ed by 4e CSI. C /.S low 7 5 A40 al aTr.suY. 7S �oP / • �o � � 00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of Lat3nd Hpman Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less r��14 x:11 1n1pheslh size. Plan must include, but not limited to vertical and horizontal ref re t (BM direction and" of slope, scale or PACE I.. # dimensioned, north arrow, and location Q`d tan oAa t road. \ /r ��- ��Q - ,3j ��IY APPLICANT INFORMATION -PLE PRIN ORMA7O REVIEWS BY DATE PROP OWNER PROPERTY LOCATION ST CRCyIX I - GOVT. LOT - 1/4.:S 114A2,& T3,/ N,R ,g E (or�li PRQRERTY OWNER':S MAILING ADDRESS couLOT BLO # SUBD M OR CSM # ZONINGOFFICE C ITY STATE ZIP COD \ ❑CITY ❑VILLAGE WOWN NEARES RO A New Construction Use 1x1 Residential / Number of bedrooms [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow �_ gpd Recommended design loading rate �7 ed, gpd/ft 0 - 0 — trench, gpd/ft Absorption area required bed, _ft2 trench, ft Maximum design loading rate I _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) ,g Y,� ft (as referred to site plan benchmark) Additional design / site considerations Parent material 2 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑S ❑U ❑S ❑U I ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cpnt Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench s'tr✓ Ground elev. - Depth to S limiting factor 311 r Remarks: Boring # :::• :t::::' vZ l / 1 Ground elev. ft. Depth to limiting factor ,, Ll Remarks: CST Name:— Please Print Phone: ` A ddress: - f,-' ,c7 ZE s Signature: Date: CST CST Number: PROPERTY OWNER I` SOIL DESCRIPT REPORT Page,'of % J PARCEL I.D. # j Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cpnt Color Gr. Sz. Sh. Bed jTrench :.. ^ •. ............ . ..... Ll -� r Ground elev. Depth to f> limiting factor Remarks: Boring # l :.:. Ground elev. _ 8 t. I Depth to limiting Q factor �y > ge,_ Remarks: Boring # ` Ground elev. lo X��Jzv i / ft. Depth to limiting factor � i 5_1 Remarks: Boring # 4:.... . �. Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) it t S�¢/r� 1 f - 11 169 /wel ' I , I 7r" I I I i : I I ` F I I I I i I I � I � � 1 � � � � I � I I � � � I � � �� I f ; � ; f � I y � i � � � � ; � � � - i { - i � I i ; � ! � i y . � � �''�, ' � f r r f? r t� f t t 1 1 � � I i i i � � � I � I f� f'� � �_ -- I C 1 ! r t r _ t� f i I l l_ I I � I � � � � t I �' r � � � � � � r I y r j � r r} I -1 i i 1 I } f i _. i � I i j i i �� - f r � � i � ; � i � - � -� � r � � � t I I l �- _ t � � C � � I � t - ; � - r- � - -- � I � I � ; I - � � � I � � � f } � � �: � - -� -� � � i - - �- -- I i i � I i � � � ; ; ; f I , _ -± � � -a - , '� i � � � i ! i i ; I � � I � '�. '� � I I ' _.. _ .. r � i � � �, t __- , � , ; , � y ,- - I 1 � 1 � i r - - i � � I_ fi l � t � � ' �_ � I �_ � � t t ! � f� � � � � � � 1 ! ( - _ � � ► fi- -' i 4 � � ;, i j I �, �- I 1 r f f � - I .I i I i � � � � � ' � 1 � � � � '; i � i - - i - � � I - - -a .. r I i , .r � � � , 1 � i � � � i - - -- i � � �� i i i i ' - ' i � . , i � , � i E � � I i i � k i � i , t +i � � � � tift� }� _ I ; i f �I If r i �, � � I ��� t; tjI1 � t - - � �� 1 � f ± � i � �� I i � I I L f y; i j j i j i f� II � f I I ' ( f � � ( I � i � i � ; � i I t i� � � I 4� - _- r l � t , f � t � � ! � � ( � i j � ! i � I �_ � i - -� - � � � {. _ � i - I L � � � I - f t f ? t � - -.....� - � r i � 1 l � I t . ' + i I ` , � ' I- ' � � i I 1 I i ,. ._ t , � I i I � � it � j �� �,s � ��li! �� I CI r i f f i -- I ► �� ' 1 I i I I ', i FR0m FRK No. Rpr. 18 290 11.3%#1 P1 ST CROLK COUNTY SEPTIC 'LANK MAWMMANCE AGIUZbMW AND OWNERSHIP CBRT1'FYCATION FORM OwaerBuyer �„ Q.An a 'Y1� 1,�� �Li'�, Aftw 34 a 1 Pwperty D v (Verttkation roqubcd trap ft ad* V"smueat for aewr eonslruc atyatate „L)k's _ Parcel Identif ation Number Lagueue ON Pmpaty► Low" �� 'fi, S w Y,, Sec. � �_, T � �T - ly W, Town of SabdWoa 4 �9 / M r 0 - 1 O w k 31 A V.1 4L 15 Lot it Carddled SUVV ay Map # Volume Page # R►dt mty peed g Volumc _ For # Spec Bowe 0 ywAp no Lot linos identifiable 0 yes U no Imprapa ne and m howameof yamr septic system could result to its prematare titihw to bandle snares. Proper mainteottace oaa w dpwnpNet wA the sap* tank evmy titres yeess or soesm, if we&d by a Hoensedpun4w W1d0 you pros into the system e ft amedt taw amadm of the sepdc tank as a treatmoat stage is the waste disposal aye0etn. 'YU popetiy cwm :;teas to mbmh to St. cmix Tanied Depumant a omtiCisatiaa fo= signed by lino vwaw and by a tasslb nhtaDbRx. 3attrnaymsmplttsnber ,sasesW%6phtmber or r lieemedyWmpr raeWaS OW (t)the on - sin westewaterdmowl systm b is pt!opa op ifs ooaditian asd/ar (3) after WSPectioa W pampia; tit Y)► dW tek . yak is Ions titian 113 fish of dttdae, Vwe, dw mdouipM have sand Im above ftquhmo me and &Wee to mstntain the pivate WnftV dispwai systeia wrifh 6W 20*%24 set ► ltertia, at set by tba Qep�mamtof Comtersme and the Depsctmeat of Natural RwtsaNrces, �m of WteCOasbl. Ce�atioa imft Cut yow septic system bu bees malhbdasd must be ootRpteted sad retarded W the SL Cmix County Zwtag Wi a 30 4n of dw 6M year awtMdon date. IR/agl5Z KMA'YM OF APPUC:ANT DATE QHMM.r I (Ww) eM%* flat all stateamts on this form are true to the best of my (sec) kwwicdfc. I (sea) to (am) to owoee(s) of peopasty desvti60 d above, by vhlue of a warranty deed rmrdad in Regluee of Deady OtFice. -T r' l8 lagoo M tiA'R3it8OF APPIACANT DATyI 0040+ «• tmked b the Zo �'�' Any iadwatian tbst is itys-sepaoseolod taA9 esetstt is tbt: siaaitaty lrseanit being y naig 1]epsmnen •• Include wick this &poked= n dunped wounty deed *= to &#&WWof Deeds afticc a dopy of dw oesiitled MOM Wisp if mterence is wide in the Warmly dead vot r�Na 519 WARRANTY DEED s���tiv Io L� Document Number ST. CROIX CO.. W Qw'd W Rsead Return Address KRISTINA OGLAND NOV 0 7 1991 ` Zilz, Estreen & Ogland P.O. Box 354 1:50 P M F Iludson, WI 54016''- '144, Parcel I. D. Number: Hartman Homes. Inc. conveys and warrants to wv G Burton and Ann T. Burton, husband and w& as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: Lot 4, Gracie Estates in the Town of Somerset, St. Croix County, Wisconsin. TOGETHER WITH AND SUBJECT TO a joint drive %2y with Lot 3, Gracie Estates, as the same is depicted on the Plat of Gracie Estates. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this _ day of November, 1997. TRA SFER E M chae Ha an AUTHENYTICATION Signature(s) Michael Hartman, a single person. authenticated this 4 41- day of November. 199.. f� Kristin O land TITLE: MEMBER STATE BAR OF WISCONvSLN r THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 0) LOT 6 W 100 ACRES (D tb 130,854 SO. FT. 0 W tD •s 3 °43'30 "E 328.30' ��• o , S89 43 30 E 656.�656.66 377.89' 49.59 214.02 392.99' Z LOT 5 g CD LOT 3 3.12 ACRES ~ 3.18 ACRES INC. ESMT. 135,756 SQ. FT. LOT 4 138, 677 SQ. FT. 3.00 ACRES EXC. ESMT ��. 130,700 SO. FT. a ` 3.11 ACRES 3.11 ACRES EXC. ESMT. 135,683 SO. FT. w 135,471 SO. FT. ' 3 N �I (A M� 0 0) C JOINT DRIVEWAY , ` LOT 2 O \ U 3p p0 X06 D, E I 3.18 ACRES INC. ESMT. '` •� 9 �� g 138,636 SO. FT. 3.09 ACRES EXC. ESMT. 134, 416 SO. FT. 0 CUL -DE -SAC 1 S89 0 57'52 "E 275.00' I 3Y )IUS TO BE 191.50' ��� UPON ROAD ' ,` \ '(E N ? Z O p i0 1 o � � � �9•� LOT 3.02 ACRES INC. ESMT. I 131, 560 SQ. FT. ©I 2.90 ACRES EXC. ESMT. � 2ES INC. ESMT. \ 3 126,256 SO. FT. / SO. FT \ — — — — -- ---- -- �- -/ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Cont' r ` Safety and Buildings Division u ST . CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3P (51wi1g.: Personal information you provice may be used for secondary purposes [Privacy Lkw, s.15.04 (1)(m)]. BU m R i�Flgl�ler's.L�rpe: fZCitu�ljl ❑ Town of: State Plan ID No.: ��11..��OO11VV , KK ll _T CST BM Elev.: Insp. BM Elev.: BM Description: Parcel b5tx-:2105-40-000 TANK INFORMATION ELEVA ION PA TA A9800025 TYPE MANUFACTURER CAPACITY " STAT)I BS HI FS ELEV. Septic Benchmark Dosi ng 1� Aeration d Sewer Holding SN Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Aiirinta a Dt Inlet Septic NA Dt Bottom Dosing NA Header/ n Aeration NA Dist. i e Holding Bot. stem PUMP / SIPHON F MATT Final G de Manufacturer Dema d Model Number GPM TDH Lift Fri ion System T Ft H ead Forcemain Length Dia. Dist. To eu SOIL ABSORPTIONS STEM BED/TRENCH Width length No. Of Trenches PIT No. Of I de Dia. Liquid Depth t DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG LAKE / STREA V Manu acturer: INFORMATION Type O ER Mo el Number. System : T DISTRIBUTION SYSTEM Header! Manifold Distribution Pi } ole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia Spaci SOIL COVER x Pressu stems Only xx nd Or At -Grade Systems Only Depth Over Depth er xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes C] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 28.31.19, SE,SW 434 190TH AVENUE Plan revision required? ❑ Yes []No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No. i i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER; I r wrecw•w • „ a�a.� , Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County /� _ than 8 112 x 11 inches in size. Sf e�OZ;r • See reverse side for instructions for completing this application State Sanitary Permit Number J 0 - 7& a5r The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop Owner Na Propert Lo ation r/43 1/4, Sera T 3 , N, R E (o W Property Owner's Mailing Address Lot Number Block Number r:3 42 109 t5 L Ci State . Zip Code Phone Number Subdivi 'n Name or CSM Number y ❑ II. TYPE OF BUILDING: (check one) E] State Owned it Nearest Road ❑ Village Public gl or 2 Family Dwelling - No. of bedrooms 5 Faown OF e- sZSv /go e III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo — D 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station if 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 E,New 2 E] Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5_ E] Repair of an _____System __`_____System _____________ Tank Only________,_____ Existing System - --------- Existing 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 12J: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. Sy tem Elev. 17. Final Grade (�C�`� Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch)'6r Elevation Z5;!:) 75-0 e7 . Feet / ©C7• Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank avlil t9p (j,(„{ t�3L 72 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber IA.) e­ ❑ ❑ 1 ❑ I ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plum is Na e: (Print) Plumb 's Sign re: ( o Stam s) P MLSI o.: Bu siness Phone Number: l Plumber' Address (Street, City, Sta , Zip Co IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issu Agent Signature (No Stamps) Do Fee) a Approved ❑ Owner Given Initial 1 � Surchar 9 01-17-7-.06 0 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: - k eoi;&faef �'w�• a/ b�� �� ii �erkcr�- S8D -6398 (R. 05/94) DISTRIBUTION: Original to county. One cupy To: Safety & Buildings Divoion, Owner, Plumber INSTRUCTIONS • '` , 1 . A s a nitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 a�+ministrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. 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. Ill. 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 8 112 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. 7&o 3,4 mrz o t j �,�2 1 q c� 13% Q -1M A j G Do t('i s V7- us rJs i� n ti Sd.�►- � c.�►2s G -r �-j l� •� . /yl Y J 7 fir.� yn � ,O 2s, Y `drs� i 2d M S.t" p� 1 Au �•��X3�NX�d 4 L r ALA5� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page l of . +. Labob!tnd Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less r`tiyf , x ii fnehes.'h.size. Plan must include, but not limited to vertical and horizontal refere t (BM� direction and.% of slope, scale or PA)�CE dimensioned, north arrow, and location aTd to o a t road. \ /`� , Q - Q- APPLICANT INFORMATION - PLE PRINT'�]YORMA7101 REVIEWS BY DATE PROP OWNER _ S ., PROPERTY LOCATION ST CROIX GOVT. LOT - 1/4 5�,� 1/4,S y T y l ,N,R E (or� PR ERTY OWNER':S MAILING ADDRESS S' Z(IH(;OFFICE LOT BL # SUBD M OR CSM # `- CITY STATE ZIP COD S � ❑CITY VILLAGE OWN NEARES �� New Construction Use jA R /Number of bedrooms [ ] Addition to existing building j ] Replacement ( ] Public or commercial describe Code derived daily flow _� gpd Recommended design loading rate �Z_ bed, gpd/ft trench, gpd/ft Absorption area required 9!q bed, it Q trench, ft Maximum design loading rate 7 bed, gpo1ft Ztrench, gpddt Recommended infiltration surface elevations) ft (as referred to site plan benchmark) Additional design / site considera 'ons Parent material Flood plain elevation, if applicable It $ = Suitable for System CONVENTIONAL MOUND 71N-G PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= UnsuitableI stem ❑S ❑U ❑S ❑U ❑U ❑ S S ❑U ❑S ❑U ❑S 0 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Opi Color Gr. Sz. Sh. Bed Trench -7 h- Ground elev. Depth to limiting factor > 91 --- Remarks: Boring # by A 9 1192 - / S� Le Ground � ,S elev. s zxz /F ft. Depth to limiting fac� Remarks: T Name: — Please Print Phone: Td Signature: r Date: i _ CST Number PROPERTYOWNER SOIL DES RIPTJON REPORT Page�pf ' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD /ft in. Munsell Qu. Sz. Cqnt Color Gr. Sz. Sh. Bed Trench [ ? (/ rr � Ground _ g '✓ Q elev. — ' Depth to limiting factor Remarks: Boring # 4 V Ground elev. _ 8 Depth to limiti factor Remarks: Boring # I / a - s 7 Ground elev. e wo _ Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to Hmiting factor Remarks: SBD- 8330(R.05/92) f ! i , 1 t 1 fi , 1 S r y I � tt. � i i 1,41 A i y � } p i y y y Y a l T f � � I -- f I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �'` ����, a z Mailing Address 3 D Ia�S�� y Property Address Z 1 1 13 C7 /y'p " eti t, 11 (Verification required from Planning Department for new construction) City/State Nu n S, J �� Parcel Identification Number 1 LEGAL DESCRIPTION Property Location 1/4, 5W '/4, Sec.�_�, T ]Z N -R__aW, Town of Subdivision 0 2 /zt+ r, Lot # Certified Survey Map # , Volume , Page # Warranty Deed # - S� ez — o , Volume L2 j . Page # �3 Spec house 0 yes ❑ no Lot lines identifiable 9f yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards q gre P g sP Y 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 Zoning Office within 30 s of the three year a iration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th roperty described abov , by virtue of a warranty deed recorded in Register of Deeds Office. "' /i &// 0 SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed A A. WARRA*% i"Y DEED sfi8�v L° Document Number .. Lip :� Or i ST. CROIX CO., W► ibc'd for Reeerd Return Address KRISTINA OGLAND NOV 0 7 1991 ` Zi1z, Estreen & Ogland P.O. Box 3.59 1:50 P M Hudson, WI 54016 ' `°' .4k ���"'` l . r Parcel I.D. Number: Hartman Homes. Inc. conveys and warrants to Rodney G Burton and Ann T Burton, husband and wife . as survivorship marital property the following described real estate in St. Croix County, State of Wisconsin: Lot 4, Gracie Estates in the Town of Somerset, St. Croix County, Wisconsin. TOGETHER WITH AND SUBJECT TO a joint driveway with Lot 3, Gracie Estates, as the same is depicted on the Plat of Gracie Estates. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of November, 1997. TRAj#1SFER $ S� !� YEE (SEAL) M chae Ha an AUTHENTICATION Signature(s) Michael Hartman, a single person. authenticated this day of November, 1997- Kristin O land TITLE: MEMBER STATE BAR OF WISCONSLN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristin Ogland Hudson, WI 54016 r*i LOT 6 1 0) 3.00 ACRES 130, 854 SO. FT. w w y 43 "E 328.30' S89 °43'30 "E 656.60' 377.89' 49.59' 214.02' 392.99' �0i 5 Z LOT 5 s LOT 3 3.12 ACRES U 3.18 ACRES INC. ESMT. 35,756 SO. FT. a 0 L O T f 138,677 SQ. FT. `5 ACRES EXC. ESMT �� 30,700 SO. FT. a ' 3. 11 ACRES 3.11 ACRES EXC. ESMT. 135,683 SQ. FT. 135,471 SQ. FT. w 3 c� N 0 N M� 0 ` O1 6 JOINT DRIVEWAY �yy9 LOT 2 u 00 -jQ6 Oc 'E I 3.18 ACRES INC. ESMT. 138,636 SO. FT. 3.09 ACRES EXC. ESMT. 134,416 SO. FT. 0 ` Y CUL S89 ° 57'52 "E 275.00' I -DE -SAC 1 \. !US TO BE 191.50' JPON ROAD 2 "I I If Ln LOT ? a� i � to v � N6 0 g3 \9 3.02 ACRES INC. ESMT. I I r . `8i cn 131, 560 SQ. FT. I `Z 2.90 ACRES EXC. ESMT. ©� Q• I FT ESMT• _ — — 126,256 SQ. FT. / �� I des INC. 1 GRACIE ESTATES IM Irr LOCATED IN PART OF THE SEI 14 OF THE SWI /4 OF SECTION 28 AND IN PART 4� &D.19 — OF THE NEI14 OF THE NWI 14 OF SECTION 33, ALL IN T31N, R19W, TOWN OF "' SOAVRSET, ST. CROIX COUNTY, WISCONSIN, BEING LOT 5 AND PART OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 11, PAGE 3101 AT THE c11<<rsr, ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. ow N No pole or buried cables are to be placed such that the installation would f i e� any survey stake, or obstruct vision along any lot line or street The distu:bsace of a survey stake by anyone is a violation of Section E: 236.32 of Wisconsin Statutes Utility Basements as herein set forth are for LOCATION SKETCH L the use of public bodies and private public utilities having the right to serve the area. SECTIONS 28 9 33 i ^ T31N R19W� P 0 I" I f w " I � + UNPL ATTED L ANDS �- 192ND &U >, '� AY ' - - - - -- r -NpRT LIM OF TH E KIM Of THE swVa, 36CTION 2e w g DEDICATED TO THE — PUBLIC w r -- -- 7 ` ALUM NN COUNTY !< N CORIRR MONUMENT M B 0 w1:04111 P Rrt - - LINEAR TOOT tot copra" MO� INT LOT 6 " r. 2+" 1110" "ff WEN I.M IBS. 901 Loop 3.00 ACRES cI' p • r IRON rIIR FwMNo q $ 1S0,904 90. FT $ A loo' 1qA %w SET6AC11 a' wtof uTILITT EASI LOT 4 10T - - - - -- roIr w.oR oRu I V1 rl .f -- fR0►OSEO DRIVE N 1 I - s i ni axAtrloN I� TH[ TOWNSHIP O �. G $69•+3'30 ^E 328.30' it SSSr43'30'E 656.66 1 Of 377.89' 49.09' 214.02' 392.99' 7 I Jr `� Of IIIj 9 Mf IIflIP;,.� Y L NO IN ' N t LOT 5 LOT J A A1111111111 IS* 4 IS*,i77 ft I NC low 118,714 E0, FT ,Y 3,OC' ACRES EXC. Cow. 7 •• ATM!! fxt. fSMT. �\l7. R 130,700 60, FT. 3.11 ACRES 130,471 so. 'IT. \; 130,68! SO.FT. u LP g ak "we CORNER r $fCTlal r JOINT DRIVEWAY 1� LOT 2 (� 1 3.16 ACRE$ INC. EfMT. C V N610 *, 63'40 "E \ ` �� b 136, 636 $O. FT. 140 L ' 3.09 ACRES EXC. ESMT N .� .• ,(. 13441 ,6 S0. FT, ' » 110.910' . ; 9 61097'92 "E� • ` 191.60 9 It'se H O W= LOT 1 --I 10' 3.02 ACRES INC. E$MT. iy Y 1► 131.060 S0. FT 1(11 I m S LOT 7 , t O - - _ 2 ACR EXC ESMT. ,3 � 1266,, s 296 S0. FT. /`!Y I q 3.12 ACRES INC. E$MT. ` - _ +� / /r— 33 136.083 90. FT / / • , 3.00 ACRES EXC. ESNT. \ 0// / A 130.696 94 FT. `\ ® /` ® SW WE 242 432W sr 26 t' a :39.' — N+ 73. 3 " E J � � � I • t 4M!'97' 'YN LOUTH LINE OF THE BWIM 4 \S 26 l .TO �w THE SW Cavell SctTCN 26 V 131 NORTH LINE OF .0 THE MUM A \ 9EG !3 T -`� NW Cd7/4R 4FC71O:1 T1