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HomeMy WebLinkAbout032-2017-95-000 (3) i F 3 °' c m �1 ID I n C �• �� (D N fT m o ° 0NO o 0 C" w H• co . Cfl A O N Q1 Cfl W CD '� `z ` (D N (N71 D N WO r '7 N j N N j N j c j 3 N (D O O N N N N N N N Q F y W (O O 0 0 0 0 0 0 00 o N N S ! 0 O O W W 3 CD `< M SM 7 �1 N Q O lV m Cn CD D CD 0 (o A O N 0) Cn (Q y c Q � O N K3 N N� N 3 � C O O O O O W O 0 0 0 3 W n -+ O O O O (D (D a !, n r to y (vD - < N ^ S ' < 3 v O O O m I � r3 O O O j m 1 (D rr ID CS C/) C m 3 ! a CD Z z CD N N 0 0 o ua l D ! 0 O ° H • O O_ O CD d _N N N O C fD CD a !I CD 1 y o ? Z CD c _ A 2 C Q C 7 C N C Ln co -0 G O CL 3 Z I � �' I m p N Z O I f•0 moo a p n 'COD O 3 - n -� C1 (D C O 1 Co �' Z Q 0 o v, 0 FD' oN m Z j rn O CD N O ?0 Q tJi p p � > (r O n N (� A p CD (n < FD � � Er < c O ° 5 o CQ y Q V. U) - ti CD T Q - O (D CD N O N . � V N A N 00 V O L I III Q � 3 0 a a y N a O n I ~ "O ~ w O O C6 N N O) Iii a O) N > R @ 3 0 o tl N O U co E N O a O o 7 M N O w u 3 CO LO M L - - o O U O a O S— c n as co ° °' ° ao U € N @ 'O Y co 'C Z CD @ N 7 @ N w LL C (V C (n C Q) O)co O M O F - O@ C_ O O a) N - �O O OO O ON E Q N0 @ N=IA U @ O a � y rn W O Z Z d d a m n I- U) Ln I N C C9 a O Z L O c M r :3 w m z a 3 2 y d a E m N O ` y CY (mil N ? C 1� O O O • (O a L m N O M o O Q O N Z co ozo I ts @ `T a E 5 zz E m > m @ o CL 0 od u O a �v ;333 FL U) I •N c ° a a a @ E ° _d E y ~ N N yr ° ° d U) J U I! O O O U N N O (D c0 2� O �1 Z w U o O N _ O _ c m c d rn y U d D O O y) N C O O O Q O @ U O d O LO O M •V @ a U 0 0 0 1 i+ � @ N N W M C9 y 7 C N o E of y y> E c L o co rn l N cZj O @ • W ' o o U) !. W v 0 Z N Y a U) c� v� ) M € a CL • a y - Z5 i y a c E ` c :: r A U a. O N U I I _ Parcel #: 032 - 2017 -95 -000 03/13/2007 08:42 AM PAGE 1 OF 1 Alt. Parcel #: 5.30.19.536E 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): 0 = Current Owner, C = Current Co -Owner O - DOVE, TIMOTHY & JUDITH A TIMOTHY & JUDITH A DOVE 1422 MAIN ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 466 CTY RD V V SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 8.000 Plat: N/A -NOT AVAILABLE SEC 5 T30N R19W PT SW NE COM INT N LN Block/Condo Bldg: HWYS 35 & 64 WITH W LN NE 1/4 TH NELY ON HWY TO PT 515'E OF W LN & POB; N TO N Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) LN SW NE; E TO NE COR S TO N LN HWY SWLY 05- 30N -19W SW NE TO POB EZ -UT- 1206/61 INC (537A) 032 - 2018 -10 -000 Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1088/091 WD 07/23/1997 836/96 07/23/1997 833/406 07/23/1997 742/710 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 15.000 120,000 414,700 534,700 NO Totals for 2007: General Property 15.000 120,000 414,700 534,700 Woodland 0.000 0 0 Totals for 2006: General Property 15.000 120,000 414,700 534,700 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 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER�rV L ADDRESS SUBDIVISION / CSM # - -537 LOT # c ' 7q SECTION T N -R_j C _W, Town of SCgyNStsL ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 T�c 3 L13 L INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building ewer ST Inlet: ST . g outlet: PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR• 3/93 / J Wisconsin Department of Industry, Lab " an Relations PRIVATE SEWAGE SYSTEM County Safetytand +ngsDivision I NSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284252 Permit Holder's Name: ❑ City ❑ Village rD Town of: State Plan ID No.: ACTION BATTERY INC /TIM DOVE SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032- 2017 -95 -000 /0,0, 7 /,Oo. 4 TANK INFORMATION LEVATION DATA 70 025 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,, Benchmark i S � 4 Ad Dosing v Aeration Bldg. Sewer , �� ?9,g3 ' Holding St /Ht Inlet Zj� 66 TANK SETBACK INFORMATION St/ Ht Outlet �,0 9" 31 TANKTO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet ir Septic ,. '3OU' NA Dt Bottom Dosing NA Header / Man. - S 9 17 , 15' Aeration NA Dist. Pipe Holding Bot. System 9 PUMP/ SIPHON INFORMATION Final Grade 1 4 &0 Manufacturer Demand Model Number GPM TDH Lift L oss riction System TDH Ft Forcemain Length J Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length s No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO > Model Number: System: 4 �yj rj > OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air 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 3 y — .V/ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 5.30.19.536E SW, NE HWY 35 -64 y Plan revision required? ❑ Yes [No Use other side for additional information. . , 1- 1? 1 SBD -6710 (R 05/91) Date J I sp or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s e e SANITARY PERMIT APPLICATION safety of Buildin W Bureau of Building Water S stems 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 77 f than 8 112 x 11 inches in size. S /, • See reverse side for instructions for completing this application State Sanitary Permit plumber The information you provide may be used by other governor t a rograms [:]Check it revison to previous application (Privacy Law, s. 15.04 (1) (m)j._ Y State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PFUNT ALL INFORMATION _ PropiWy Ow er Name T'1 y 4,b !!'t Property Location ' 50#& N f1i4, S S' T 30, N, R/ E (orlo Propert Owner's Mailing Address — Lot Number. Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 5 4 tj2 Y (74S) 11. YPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public ❑ 1 or 2 Family Dwelling - No. of bedroom Town of J c0 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �f 1 ❑ Apartment/ Condo `� e . 3 o ' /? r 536 03 o� _ R Q 17 ` 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. New 2. ❑ Replacement 3. I] Replacement of 4_ ❑ 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 IN Seepage Bed /a X y(� 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ 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/day /sq. ft.) (Min. /in h) 7 Elevation © N l /, Feet / . Feet Capacit VII. TANK in silo 5 Total # of prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel . glass Plastic App New Existin strutted Tanksl Tanks Septic Tank or Holding Tank I E ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe 's Name: (Pant) Plumber' gnature: o S r47MPRSW No.: Business Phone Number: P b r'S,p.dd ess (S et,�y, State, Zip ode): , a� IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sa{� Surcharge fee) tary Permit Fee (Includes Groundwater ate Issued Issui g Agent Signature (No Stamps) X Approved F1 Owner Given Initial Adverse Determination /0 -�119&2 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD -6398 (R. 05/94) DISTRIBUTION: Original to county. One u,py To: Safety & Ruiidings Div, ion, Owner, Plumber 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 - 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. 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. a `� B FL®MNINN a NEATINN P.O. BOX 221 1073 35TH AVE. AMERY, W 54001 Phone (715)268995 ACTION BATTERY INC. 484 HWY 35-64 ST. CROIX COUNTY SYSTEM SIZING 100GPD 1 -CATCH BASIN 140GPD 7— EMPLOYEES ONE SHIFT PER DAY. 240GPD TANK SIZING 240 GALLON 750+ GALLON 990 GALLON PERPOSED SIZING 400 SQ. FT. BED REQUIRED 480 SQ. FT. BED PERPOSED � t 0 990 GALLON SEPTIC TANK REQUIRED C � 1000 GALLON PERPOSED BRADY UTGARD MP7456 PRIVATE SEWAGE SYSTEM Conditionally APPROVE DEPT. OF INDIJfiTRY, LABOR A MI JW RM 71011 DiV OF SAFETY MI) RUILOIN®S r 0 2 SEE CO E ONDENCE s l � ►�,�� � � � Tom, �� � 3 6 6 N 7 o5 ow�(2, P j a yn 6-PO { yao flip Q \ r 3 b SL a L•Qn.. � 0 4 1 I '/y /00 R i 1 I .. 7 n r, T C7 1 .. Q mow Fn �---, Ln T In •c C� � Q Y M Ln a D r ' 1 � u n A p O Z g r b Z i % rl D 7U •7 r-+ � � d :�11 �a D +C C D A AM r_ y � � SAFETY FL"':r�.. -� Z Fri. -� b M N Z op ;c 2 7D .q► _ a a�o 04 r — X p D rq d� )U r - 0% )Pb C� D N 0 Vo i y * C G Q G L � Z n a W M � Z � d � - p rn �O n - n R, �Tii Z CO N -3 �< ; < ' 1 Z o ^' - ' Nye .A. O O 2 Vf -c r P PA— r z � I Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Humav Relations Page of Divisidt o( Saf1ty and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. rcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i Property ner Property Location G Govt. Lot 1/4 V,1�1 /4,S 5� T 3® E (oCWW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Zip Code Phone Number [] City El Village ® Town Nearest Road Son, u r ( 7iS) d y 71 s o*' "S� T` y ® New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building _ ❑ Replacement ^�9`0 ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate -Z�_bed, gpd /ft r - � ' y trench, gpd /ft Absorption area required bed, ft 3 �� trench, ft Maximum design loading rate _4-2 —bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site ZT rations Parent material 400 _ —A 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 R5 s ❑ u R4-S ❑ U BS ❑ U ❑ S 0. U ❑ s a U ❑ s e U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ct S - s _ SL ail v�� - Ground elev. — /6 y) ft. Depth to limiting 77 in. Remarks: 1 /��C,4� /r' y �" '7 s wt x Boring # �/ c l 7 57 /C Z 3YI -- S - M G q S as SL 2AA 6C '011,44 Ground � elev. - - - -- - - -- - - �lN�ft. Depth to -? , C . .,° u -- - -- limiting .. f , a o c , �tor / in. Remarks: CST Nam (Please Print) Signature Telephone No. Address )4 Date CST Number 2 / =/o S'T ,�rr -e� !,*%�; S � /ao I I /•ii Sc 3 yv °! SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of , PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s �1 SC irj u'�'(� `T S S te: Ground elev. , Depth to limiting 7� fac or in. Remarks: ---- -- ,Boring # 3 S r Ground elev.� /L1 0•t.3 It Depth to — -- limiting fa for "��in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # O. /,ZS 4 &6( Gi 1 • RS`'/ S - -cis Ground elev. — T Depth to - -- — limiting factor in. �` Remarks: � �s °�— �• ; y /0 �` � J'Y�t: Boring # Ground elev. ft. Depth to i� {tlltL limiting `�A �¢�� factor in. 8'+ Remarks: SBDW -8330 (R. 08/95) f c S Tin 3 Yo rri r, m i 5 C- 1 Pt r r, 715 -2" -6999, ' 1$,-2 M ;ZS' ;lo 3s' fo r r /17 Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor an7 Humdn Relations Page of Division of Sa;4 y and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ST " percent slope, scalee or dime nsions, north arrow, and location and distance to nearest road. Parcel I.D. # ca AF LICANT IN RMATION - Please print aN information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Oyner Property Location rJ Govt. Lot 1/4 N`1 /4,S 5' T 3 © ,� E (oW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City 6tate Zip Code Phone Number Nearest Road r UU Q (? /vim) �/ ❑City ❑villa Town -� S Ofh New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement / ❑ Public or commercial - Describe: Code derived daily flow a T V gpd Recommended design loading rate bed, gpdA I trench, gpd/ft Absorption area required 42 bed, ft 3 .3 trench, ft Maximum design loading rate j _ bed, gpd /fl2 trench, gpd /ft Q � Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material . VG( // 1� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system S ❑ U ® - S El ®-S El ❑ S _U ❑ S a U ❑ S U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed , Trench • / - s .54 Bid v,�,� as — S' , p- /o y f ft. Depth to limiting -Ar, in. Remarks: Boring # 1 f u 7 rY R2. Y/1 —' Sz. e 11 L 7 (9134 An Ground elev. lft. R0 2� me1y v 540 Depth to limiting factor � _in. Remarks: CST Name (Please Print) Signature Telephone No. 0 Fh i'! i S :f Address )�C Date CST Number 2 /"/0 ST 44-'..� Sc /00 y0 01 r SOIL DESCRIPTION. REPORT ' PROPERTY OWNER Page. of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 l g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots F � Bed ; Trench Ground elev. /d NJ ft. Depth to limiting ffactor 7 Remarks: Boring # 3 s SL ,4.Gf` & je cis v ' Ground elev.,/ Depth to limiting factor 77- Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 0• /Z svc cis Ground Depth to limiting \ factor 7 Z4PD in. Remarks �g ' Boring # Ground elev. ft. ' Depth to UMAHL 1 ti , limiting factor - in. Remarks: Amery►, WI 54001 SBDW -8330 (R. 08/95) T At, z c8 /in �Yog UTGARD PLUMBING & HEATING 5 Z,7, �'' P.O. Box 221 Amery, WI 54001 M 70 2 " /G'e JDa Phone 715- 268 -6995 j e-,677 zl'pol"Y T Sy �9 ` �r fo r /17 I L S T C - loo r is 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 (•UZ Al 'e5 114, Section , T ON -R Township Mailing address :35 - fl-�/J D �� Address of site a Subdivision name _ N //4 Lot no. Other homes on property? Yes - _ No Previous owner of property <:� Total size of property Total size of parcel / Ae Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _ - No Volume and Page Number as recorded with the Register of Deeds. _ aq-f -j - - - -, l � _ 1 2.� 7 - - -- ---- -F- T�---- - - - - -- lf Q-cr� 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. _.�S"_ /j , and that I (we ) r own the proposed site for the sewage disposal system or I 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. ,,,/ J Signature of Applicant Co- Applicant f J y i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAn.uvc ADDRESS `f 8 y -Z le PROPERTY ADDRESS '5 (location of septic system) Please obtain from the Planning Dept. CITY /STATE PROPERTY LOCATION 11, - - - a J L X11_ 1/4, Section _ T - R �r TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ��- -, VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic 4Fteircould result to 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. I 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. V%Vc, 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 Count Zoning Officer within 30 a Y da of the three year expiration date 6 Y Y F SIGNED: DATL St. Croix County Zoning Office Govemmew Center 1 101 Carmichael !toad l iudson. Wl 5,1016 ji STATE BAR OF WISCONSIN FORM 2 — 1982 II WARRANTY DEED DOCUMENT NO. VOL 1207PACf .9 R7 i LR 3 CrriCE J effrey C. Lauck ST. CROIX CTY., %q i i p� to It�t7ff! — — I Nov _ e 1996 conveys and warrants to Ti mnthy Dnve and Tn(ii th A- !i 1:30 P. M -- Dove. husband And wife ��! Re; crer of Car's ii THIS SPACE RESERVED FOR RECORDIN D ATA i j NAME AND RETURN ADDRESS the following described real estate it. $ t _ Cr n i x County, 11 v State of Wisconsin: -7V 032 - 2017 -9 032- 2018 -10 ELIDE UMBER (See Attached Exhibit "A ") 1 531/ 5 �'�' g 3 3T A S ER i $ I vg /v9 / FEE i I �i This is not homestead property. XXXX (is riot) Exception to warranties: Easements, restrictions and rights -of -way of record, { if any. Dated this day of Q6-1:6 A.D., 19 96 % I (SEAL) X (SEAL) li q (SEAL) (SEAL) ;I �i ' I AUTHENTICATION ACKNOWLEDGMENT #` I Signature(,) Jeffrey C. Lauck State of Wisconsin, ss. s County authenticated this "� of 19 9 Persona came before me this da � Y Y Y of 19 , the above named I I Kristina 6gland TITLE: MEMBER STATE BAR OF WISCONSIN ` (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. �. THIS INSTRUMENT WAS DRAFTED BY r Attorney Kristina Ogland _ Hudson WI 54016 Notary Public, Count: Wis_ 4 ° (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 19 J Names of persons signing in .ny capacity should by typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Woom" legal Back Co_ Inc. Form No. 2 — 1962 MiMazlcee. we. F t ' •<o�±i',ti ,�`�iF"�if ,�" �i�" 1�.. '�i'�tlfi - �, "'""�4'I!1«`4t'?�' ''l�. e'"-K:�"�r�"�.;�lt "_ 'I��:.K43lfr�r�,i 'r VOL 1207PACE497 y EXHIBIT "A" A ?arcel of land located in part of the sw, of the NEh and the SEh of the "E. of Section 5, Township 30 North, Range 19 WORt, Town of Somerset, St. Croix County, Wisconsin further described as follows: a 7 corner of said Section 5; thence sol °31'06 " Commencing at the E, al lino of said 6eCLiOn, 22d0.4C along the north ; feet; thence N ° 28'54 "E, along the north line of that parcel of land recorded and described in Vol. the St. Croix Count t Re Deeds "49611, page 260 at Of o 5 th S01 °31.06 "E, along the east line ofsaidparcel, L39.0 f eet; 76 fast to northwesterly right -of -way of state Trunk Highway 11 35•• i "64•• and the point r. of beginning; thence HOl °]1'06 "W, along the east line of said parcel being a ling 515 feet distant from and parallel to the north -south � line of sai section, 693.30 teat to the north line of the SN of the NEk of aid section; thence N "E, along said north line, 1800.87 feet to the west line o! Lot 1 of Certified Survey Map recorded in Vol. "6'•, page 1716 at said y; thence S ° 30'02 "W, along said right 4' office; thence 50 1 ° 17'49 "E, along said west line, 13.51 northwesterly o[ way to 2 276 -77 feet; thence S20 029.58 "E, 5 feet; thence along said right -of -way, 41 -7 569.30'02•'W, along said right -of -way, 790.73 feat to the east line of the SNP of the NE; of said section; thence SO1•24%27 along said east line and said right- of -•,ay, 8.73 feet; thence S alon s 636.13 g feet to the point of curvature of a 2910.62 foot radius right concave southeasterl bears s 0 20 . 01.5 "W and measures n220.09 an et; alon whos chord arc of said curve and said right -of -way, 220.15 feet to the point of r -•:, beginning. �= e r 1 _ J M X