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HomeMy WebLinkAbout012-1010-10-000 o C m ° C `o1 CD > ° 3 r* ~ m ?k A3 z op j wog co a+ N O N O 41 _ O N O CO (1 r. 7 A N tT1 O O CD O C 0 O ~'S N C O M' v C 1 N N-0 3 CS <D - D p COIi N CD C y O O p N O -e sv (n ~ D a o j N y N Q -0 W (n M~ N 3 O V I N ` ? C ley < co m f n r N y co cw W O !1 I ~ 3 ~ l~V T T V o • O rn o 00 o p ca 009 a aQ Co' ~ B~ V 0 -3 cy O O 0 CD CD O .~Di. O W 7 W CD rr N n ~ N za)z Q a D a j ro CD CD 0 y C 7 C COD N Ca ~ d CL = cp -i to O a N A Z C~'1 c a d A C 7 0 -1 w CD V 0 m o 33 z p 3 A A o mm N z CD N I N -~na3_(17~ ~O O CD S OOy T p v, 3 O NCO o v C O -7 Ol 0 7 y OZ a N ' 0 CD t~J Q N A`~1 OD CD _y 7 Cp C N O Q Cp O ^y' y O N n N 7 N LU CD 7 0 a CD 0)n N W x m 0 7 y y= F y°O 0 7 OC~D SO 3 N W y A X100 xO 3.y 3 $ -4 CD =r° m a N O=r D a_~a N I Qag°-' o N~ i v N 3 N o 7m, N z yi. a, '-0 fD CD ?5 a M y Q o p O CD Parcel 012-1010-10-000 06/27/2005 09:55 AM PAGE 1 OF 1 Alt. Parcel 03.30.17.36A 012 - TOWN OF ERIN PRAIRIE 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 OLSON TRUST, BERNARD D & JUDITH C BERNARD D & JUDITH C OLSON TRUST 491 LAKEVIEW LAND OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 18.200 Plat: NIA-NOT AVAILABLE SEC 03 T30N RI 7W SE NE THAT PART OF SE Block/Condo Bldg: NE EXC CSM VOL 4 PAGE 1187 AND THAT PART LY- ING SOUTH OF RR R/W AS DESC IN VOL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 692/208 EZ-U-1437/451 03-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 06/20/2001 648841 1664/216 WD 05/2411999 603646 1428/357 LC 07123/1997 884/565 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 8,000 96,900 104,900 NO AGRICULTURAL G4 8.200 700 0 700 NO PRODUCTIVE FORST LANC G6 8.000 8,800 0 8,800 NO Totals for 2005: General Property 18.200 17,500 96,900 114,400 Woodland 0.000 0 0 Totals for 2004: General Property 18.200 17,500 96,900 114,400 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 i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT n / Owner - - Property Address City/State F Legal Description: Lot Block Subdivision/C_SM #°v~, r`' ~~1c ZW, Town of PIN # J 1/4 W_ '/4, Sec. 3 , TE:tN-R) ~ E sr r SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer 12 s Size ST/PC .0 / Setback from: House Well L Pump manufacturer Model Alarm location HOLDING TANKS ONLY Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width Length- Number of Trenches Setback from: House s'i r Well ,.3d P/L~~~ Vent to fresh air intake ,f s ELEVATIONS: Description of benchmark Elevation 1- r Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 29 9/ ST Outlet 02/-Z) PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover -IA- Z Distribution Lines O 9X O ( ) Bottom of System 7, ( ) Final Grade O Z2 7--2 O ( ) Date of installation f1 /Q~ P mit number State plan number ~--23/57& y Plumber's signature ! License number c~~ Date --f--t" Inspector Complete plot plan or v NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW r S~ J7 tr 7V INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety rind Buildings Division CountY > 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.1 s.o4 (i gm)J. 3 4 4 6 5 5 Permit Holder's Name: ❑ City ❑ Village 0 Town of: State Plan ID No.: OLSON TRUST (Bernard Olson) ERIN PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: va,r~ 00,D, 012-1010-10-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark lot(. 61 .tom .0: Dosing A4-i g9l 3. ft) 10 r. 2- Aeratio Bldg. Sewer 41., Z4 o© ~ Holding &6_ St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet qS'-qqj.t TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic NA Dosing NA Header /Man. (O - 2 7$ `f0 t h -t Aeration NA Dist. Pipe Holding Bot. System - 7-0 PUMP/ SIPHON INFORMATION Final Grade c481 q, 07 Ma facturer m nd 3.34 C pt+299- 'it Model Number GPM L ction System H Ft TDH Lift ' For In Length I I Dia. H Dist. To Well SOIL ABSORPTION SYSTEM W BED TRINM Width Lengt / No Of r ri-hes PIT No. Of Pits Inside Di squid De th I N 12-1 1 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manufacturer: SETBACK INFORMATION Type O CHAMBER tuber: System: 1, 7 s~ S CIO OR UNIT DISTRIBUTION SYSTEM Headerr anifold u Distribution Pipe(s) a x Hole Size x Hole Spacing Vent To Air Into e Length Dia. T 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.) RIN PRAIRIE 3.30 17.36 1772 190th Street Plan revision required? ❑ Yes *9 No Use other side for additional information. 03 02 -1 S 2 K SBD-6710 (R.3/97) Date Inspector's Signature Cert No. l ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t i z « a ,r..., s { x f p i ~t l t i use ~ e J a s P g s ~ r i x k a z - • Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Asconsin i P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Ad - of h 3`J Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system per ng less Qi;<rrt , than 8 vi x 11 inches in size. • See reverse side for instructions for completing this applicati rL State 5anf ary Permi umber Personal information you provide may be used for secondary purposes AU 5 2 7 Chglck,if evision to previous application [Privacy Law, s. 15.04 (1) (m)]. t- ST CROIx Stag P►a I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL IN A F 37 Property Owner Name 9 operty Locatio 1 l - ,LS ` T , N, R E (ors Property Owner's Mailing Address Lot gtter,' Block Number Cit , tate Zip Code Phone Number Subdivision Name or CSM Number I. T P IL I (check one) ❑ State Owned ❑ City Nearest Road D village Public 1 or 2 Family Dwelling - No. of bedrooms fil Town OF 194 III, BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0/ - 3• % . 11 • -36 "or 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Rec eational 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. M New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only ExistingSystem 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 W Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit Il ~I 43 ❑ Vault Privy 14E] System-in-Fill Z )cot 5 ks ) VI. ABSORPTION SY TEM INFORMATION: 1-11 _ 1. Gallons Per Day 2. bsorp. 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./ nch) Elevation 97, 4A5- Feet / Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing strutted T nks Tanks Septic Tank or Holding Tank 21 ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta tion of th nsite sewage system shown on the attached plans. Plumbe , Nam Pluu St MP/MPRSW No.: Business Phone Number: Plumber's Address (SIreet, CV, State, Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Is ui Agent St nat re (No Stamps) C Ppproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination / X. CONDITIONS OF AP ROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber f - 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: 1. 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. 111. 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 81/2 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; Q oints• 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. Safety and Buildings 15837 USH 63 HAYWARD WI 54843-8107 TDD (608) 264-8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 20, 1999 CUST ID No.224263 ATTN.- POWTS INSPECTOR ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08!2012001 Identification Numbers Transaction ID No. 236587 Site ID No. 177024 Please refer to both` identification numbers, SITE: above, in all correspondence with the agency, Site ID: 177024 ST CROIX County, Town of ERIN PRAIRIE; 190TH ST, NEW RICHMOND 54017 SETA, NEIA, S3, T30N, R1W Facility. OLSON TRUST 190TH ST, NEW RICHMOND 54017 ; FOR: CONVENTIONAL SYSTEM, 450 GPD C01" Object Type: POWT System Regulated Object ID No.: 481050 I ~-T , ■ This approval is for a conventional septic system to serve a 3 bedroom residence and a horse stable that is no~ A I "'.!';J pr:F intended for public use. ~oN of t,FF The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in C chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. s`- The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic tank that is required for project. See section Comm.82.20, Wis. Adm. Code. 3. The additional soil boring that was submitted to me for this review must be submitted to the county. 4. The replacement area shall not be disturbed per COMM 83.09(1)(c). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 07/13/1999 FEE REQUIRED $ 110.00 ~z -~~LL~ FEE RECEIVED $ 110.00 PATRICIA L SHANDORF, POWT9 PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634-7810, FAX: (715) 634-5150, M-F 7:45 AM - 4:30 PM PSHANDORF@COMMERCE.STATE.WLUS WiSMART code: 7633 f (~sGx o~ GJ.,Z' SS~~b?O Atally . 3 T 3c`~✓ 7~J V~~*-S c Q~N`CE Jv NGS '4('~ Oa4 D CE _SPONDEN rjx~ s~6-;70 ~.JA,C1~ S/~i~,Ef sxd 7:,041- 74,) /well j✓~r~~ ~{/.•5t~1~~~1- fi~/~0:0 a d ~z s r~•~K I • ~accc ~osa.~ „ /dOo I I / .1? V • d ~4 0 40 Ai I/ Ftdoh Alt IAIdI► And 066eivallon Pipe ~ApP/or°d Vonl Cap 11 Clods llno;'A C°,I Iron lilnlmw lb.__C V,nl Plp• 0, "In pa iao GPo__lA9 •d plp. O.pln 1«nln ulny AI 8ouom 0/ 3,644 no n PI'UP05CD Fin, I DISTRI BUY IOI.I PIP[ SOIL FILL 2~of= 11GGR~GAIE , - APPROVCO Syu C71C MATERim- oR 9 + ca OR MARSH OF S7R; El-EV, p FM~ OFFUT- ,aGG►lCGATE DIS'rR15IJTI,') 1,I PIP LEAST AIJU AT LCAS7 7U INC AT LO I ►JGNCL aUT 110 MORC 1'HA '►JU C. H C S E3Cl OW ORIGMA L `+R `12 IUCIICS OELOW AO FIrJAL GRADE /'WtmuM DWH OF CXCAVATioo C1JNId1Ul•~ m~ r;{o~ dItIGW~11 69AK WILL BE P ~}t of EXCAviSTIoN U~ ~ ► qL `~1--- luefl e S IoM 1 I GLADE WILL 6C_ IIJCH[ S SIGUCO: LlcctJSC tJUMB[12: DATE , 1.~ Ila WiscoEsiri Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of S Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 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. Parcel I.D. # d /';7 - /O ' 44O APPLICANT INFORMATION - Please print all information. Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot S- 1/4AIZ 1/4,S T N,R 17 f~(o g Property Owner's Marling Address Lot # Bloc Subd. Name or CSM# r City Stat Zip Code Phone Number El City El vil a Town Nearest Road New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate a~ bed, gpd/ft2__,_j~_'trench, gird/ft2 Absorption area required J_bed, ft2trench, ft2 Maximum design loading rate bed, gpd/ft2-, z'e_trench, gpdt112 Recommended infiltration surface elevation(s) it (as referred to site plan benchmark) Additional design/site considerations Parent material ~f Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S El U S ❑ U ® S El U ®S ❑ U ❑ S [i~U ❑ S 9 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench /s ~ /irrs & 1-7 Al/, L:,L '-_2 JA~ _/e -5- Ground 1 - elev. f ft' r- -4e Depth to limiting pg, ,~(~(o factor -1-7 in. Remarks: Boring # 4.16 7 - f I-ILL) Le Ground elev. 1S Depth to limiting factor Lin. Remarks: CST Name (PI as rint) \ Signature r Telephone No. Address Date CST Number D S l S 1- 1 SOIL DESCRIPTION REPORT PROPERTY OWNER ~A~J'~157 Page '~Zof 3 PARCEL l.D.# /I0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~pjft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench /5 /mss AZ Id I Ground ~o elev. 5ft. , Depth to limiting factor Z-F in. Remarks: Boring # l y 1 s s / - 14-11 Ground elev. Depth to limiting factor Z_in. 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 # D l- , Ground elev. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) ~STfy! l~oetSiov i9s, f~Grrt~fe~{~!R s y~ G+764~'S ~ a'Cjr~Cl'nk..f' ~,Z~jr ©©0 } /D~ • .;`n of Department Commerce Division of Safety and Buildings SOIL AND SITE EVALUATION Page of Bureau of integrated Services in accordance with Comm 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 S~ percent slope, scale or dimensions, north arrow, 7," ocation and distance to nearest road. Parcef t.D. # 0I :5r' a'd Q /'~7 /Dl0 - /O D00 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)). Property Owner Property Location _ Govt. Lot S 1/4'1~/Z 1/4,S T N,R ,Le (o6 Property Owner's Mailing Address Lot # Bloc Subd. Name or CSM# G ' City Stat.7 Zip Code Phone Number ❑ City._ ❑ Vil e Town Nearest Road 1 L C i ) 171- New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow. - gpd Recommended design loading rate .S' bed, gpd1ft2 trench, gpd/ft2 Absorption area required _YpQ_ bed, ft2~trench, ft 2 Maximum design loading rate 5' bed, gpd/ft2_'_,:~_trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/site considerations - - Parent material Flood plain elevation, if applicable ft -414 S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system p s❑ U 0S ❑ U Cos ❑ u ®S ❑ u ❑ s ®u ❑ s 21 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench s kJ el /~xs 12 /A) Ground _ elev. Depth to limiting factor min. Remarks: Boring # ~S h1 lin 5li I .r d - Ground elev. j ft. Depth to limiting factor -:rLln. Remarks: CST Name (PI as tint) Signature Telephone No. Address Date CST Number PROPERTY OWNER C ' gad SOIL DESCRIPTION REPORT Page of _..S PARCEL I.D.# Z9'1~ /(Z/i116 Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ~S AJ ~/f a 5 IVZ Ground elev. Depth to limiting , factor in. Remarks: Boring # 1 s s _ Ground elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ur ~ r .1c hV" Ground elev. Depth to limiting factor ,T'7 In, Remarks: Boring # 3 Ground elev. Depth to limiting factor .'~fT in. Remarks: SBD-8330 (R.9/98) A f :I~al~a~ ADJEO ;l r~ 9/r 474 9/1 ~o 10°0 /a~ 05/24-'99 31ON 09:49 FAY 715 246 5660 BERNARD'S NJRTHTOWN Q002 ST CROIX (COUNTY SEPTIC Tj'LNK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ow-ner/Buyer Wf Vr Mailing Address &Vii" ~2 iI ~ W) 1_".49,_,~ +~5 ~ , ~•~i_c ~ D a ~ Property Address /-:Z7,--? Z2 (Verification raquired from Planning Department fOr liew construction) City/State Parcel Idzntificnlian Number OA: LEGAL DESCRIPTION Property Location Sec. T 3e ) 1d-R _j;LW, Town of Subdivision. Lot Certified Survey MAp # - , Volume , Page # Warranty Deed # 9 , Volume , Page # Spec house ❑ yes M no Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper us-, and maitltenance-of your septic system could result in its premature failure to handle walitcs. Propel' tuaintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the eysteim can affect the function of the sepric 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 c -nor and by a master plumber, journeyman plumber, restricted pli iher or a licensed r unrpcr vCrifying that (1) the on-site wasieweterdisposal 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 pave read the above requirements and a6rec to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Deparunent of Natural Resources, State of Wisconsin. Certification Stalin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 s of a three xpjx n date_ iiNATUP.E 1 AP CANT DATA OWNER CERTIFICATION (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of prope y described abov+s, by uirlue cf a warranty deed recorded in Regi;tcr of Deeds Office. S ATURE OF APPLICANT I3AT'i Any infomtation that is this-represcnred may result in the sanitary permit being revoked by the Zoning Department. •w Include with t9ils application: a stamped warranty deed from the Register of Deeds office a copy of tlic certified survey map if reference: is made in flu warranty deed l 05/24/99 HON 09:51 PAX 715 246 5666 BERNARD'S NORTHTOWN Q0(16 ~Y. pp Y~MOY 6Y,..~LL.. w1.C Oh~_•i STATE OF~WISCONSIN, CIRCUIT COURT, COUNTY IN PROLATE IN, THE MATTER OF THE ESTATE: of LATON M. HENDERSON ~ty.~1 r'j i♦ bOMICILiAfiY ~r 4- J PAI In 4 `l bermed ~ 1 ! . 6_. REGISTER'S OFFICE S7, CROIX CO., WI Reed for Record {T _ y . J at Q CT29 1990 11:45 AA Repftter of D a e d a r i l e No. ""0. g THE STATE OF WISCONSIN, to Laton N. Henderson WHEREAS, Laton M. lenderson died domiciled in St. Croix January 3, X994 County, iNisconsin, On January WHEREAS, you have teen appointed personal representative and have fully qualified; NOW THEIRiEFORE<, these letters are issued to you, and you are ordered to dminister this estate according-to law. 1 i0 of Wkwons!n County Of St. Croix I her®by certify that 6oi;1M- 1 00f"Pared by me, the R"I~_ I, IIt ~ f correct COPY Of thk d I record In m O e of , .L 10rce and R le uE, eft, Aftea `QgWlin `ECG ~ ' ,rtr~ h ~ a{C r~ IN T EST I M Y` V4 ~`I t: O F t __Nw have signed these letters and affixed the seal of the Court or. June , ~99Q RE NaRMAN SCHUMACHER, SKINNER C. A, aicharti & WALTER ► S . C, Attorney Dreuit Judg• P- O. Box 50 Address Neer Richmond, W1 54017 Adare6 No. I&A 119941 DOMICILIARY LETTERS 05!24,'99 HON 09:50 FAX 715 246 .-606 BERRINA.RU' S NORTHTOWN 005 !2 a (~t+Towneh'i'O-Thirty (30) 'North r Range sevenr_eenc (~7:~azW~~i,ti'm~~ireBerved in'Otha't-ldeed recorded ir: the s T,.. , t, 4 Croix county s Xbt Dedda'- Q~,.,,e++~ 1990 in Volume 860 &;O'I ~T?Pc I~ t7t~tNo. x456904. Q ~a•Reco 5 fPB~R; 23S r~r,.w_ti7u,v'- q'. Y 17 r , ~ r i,µµ ~ -71 ' -4 . ~ ~-•1""T~~ 4~~~,-~} a'ty Gti ••~F.': J . ~ , I .-e.^,~tw ~,..t ,.i~~i ~ ~SR , y{{ tZ~ v 0 -4 "II +•t,.~y. r~~~ - ~ ~ _ ~,,;-w it I{ d t y R1[F7;'i: i ~ t Kr, t• ~..,+'r.~:' 1.SI1~ i1t,~d cfiy: ftJ Cox IR`` A' _ :row A If ft" , 1 0"•°4°1orlVQr '~14 a1~ wed Auger (s), tQIY, + . ' zJ It Q0 # 30, 1,9* -Bag 1 u~~. ~~~,Q ~ ~ i~r? •7,,11.•11 I i. 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