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HomeMy WebLinkAbout030-1023-80-200 o ■ o ■ - 0 n 2 E § § K § / J } ; $ k 0 ■ m e z ¥ 1 m§ S . $ 0 E ° e : \/( [\ /i � » / I § J R $ r CO § C', m :3. \ 0 U) o E § C, i ■ � @ * > E � : \ f � . %: a / $$o Q b b . « : n r ■ $ CD CO CL ■ o C 2 !T 7 \ ■ "IrA. 2 S § I: � CD 0 + CO) cn � e > § \ § 1 3E T o q CD �CA #� gd m � tj k # & ' ƒ / o } / / I / c CA ƒ D k a m _ j � A � ■� z R \ z a o 2 7 �_ § k ® � CD \ \ a> a CL , CD g k a 0 }2 �)CL f A CL CD z CD ° i(0 It � \%E � ��k / CL s = a CL §_ a � Mx[ k ° ■ ) / § /? §� ; � Parcel #: 030 - 1023 -95 -025 01/03/2006 11:06 AM PAGE 1 OF 1 Alt. Parcel M 06.29.19.98D -10 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner FREDERICK R & JENNIFER S HAUSER O - HAUSER, FREDERICK R & JENNIFER S 353 RIVER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 353 RIVER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 6 T29N R19W PT NE SW & PT NW SE COM Block/Condo Bldg: NW COR SE 1/4 SEC 6; TH E 8 RODS(132 FT); TH S 10 RODS(165 FT); TH W 16 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) RODS(264 FT); TH N 10 RODS(165 FT); TH E 06- 29N -19W 8 RODS(132 FT) TO POB; ALSO COM NW COR OF SW 1/4 SEC 6; TH S 89'E 2391.91 FT; more Notes: Parcel History: Date Doc # Vol /Page Type 04/21/2004 760221 2553/385 AFF 04/21/2004 760220 2553/382 LC 09/29/1999 611130 1459/357 WD 09/12/1984 396288 696/304 WD more 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 83307 164,500 Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.600 70,600 79,000 149,600 NO Totals for 2005: General Property 2.600 70,600 79,000 149,600 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 II ' Total 0.00 0.00 0.00 Parcel #: 030 - 1026 -10 -000 01/03/2006 11:05 AM PAGE 1 OF 1 Alt. Parcel #: 06.29.19.104B 030 - TOWN OF SAINT JOSEPH Current X I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area Application # Permit # Permit P PP Type 04/21/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RETIRED HAUSER O - HAUSER, RETIRED Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.550 Plat: N/A -NOT AVAILABLE SEC 6 T29N R19W PT NW SE AS IN 136/291 Block/Condo Bldg: LEGAL IS INCLUDED IN DESC OF 1459 -357 AS ONE PARCEL INCLUDED IN 030 - 1023 -95 -025 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 98D -10 06- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09/29/1999 611130 1459/357 WD 07/23/1997 696/304 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/21/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 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 Parcel #: 030 - 1023 -95 -000 01/03/2006 11:06 AM PAGE 1 OF 1 Alt. Parcel #: 06.29.19.98D 030 - TOWN OF SAINT JOSEPH Current IX, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/21/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RETIRED HAUSER O - HAUSER, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.500 Plat: N/A -NOT AVAILABLE SEC 6 T29N R1 9W NE SW AS IN 136/291 PT Block/Condo Bldg: OF ADJOINING LAND WAS ADDED TO THIS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09129/1999 611130 1459/357 WD 07/23/1997 696/304 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/21/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 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 ._ . .. _ 0 § M 0 k � CD g T U 0 f/ o ° m om R S - _ — CL - � \ } [ [ @ o 2k M 5 C �� X . 0 D R 222 m ? §/ § 3 E E 10 % 8 ., c E■ E� © E 2 � > E � \ D e..Z; . § \ > 2 S ƒ; (D ® \ \ CL § § 0 2 ° o § . 2 7 0 0 0 0 § % % I' z \ 0 g E ca to CO) o > § \ 2 7 ° ° . ° 7 2 ' \ [ z > / 0 / \ \ �. CD c \ ® / D \ _ � z � CD § � \ k � / § � 0 z ¥ o 17 k . § e 2 N m m \ � / n z $ ƒ � K � g ) � 7 � 2 i . � � ■ 0 CD % CD CL �\ 3 d �1 eD � o �n o� C N o c 3 " c i N 0 _ ,0 i X M A z 0 i � i Ii A N E A A O W O O a A w ti , o A � ti � A b a ST. CROIX COUNTY ZONING DEPARTMENT ' AS BUILT SANITARY REPORT r cl t Owner (:�4r s Property Address 353 City/State �� so .rJ �.��l4lC' S cc :. T COUNT`r ZONING OF-Fl Legal Description: t . Lot Block Subdivision/CSM # w 1 /a sE 1 /a, Sec. (P . TAN -RI W, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC A-tr-o4/ Setback from: House 5 Well (ofl P/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: 7c <A°= Width -5 Length 41L— Number of Trenches �- Setback from: House Well * 8b P/L tr- S Vent to fresh air intake = 70 ELEVATIONS Description of benchmark �6"'l 4",6 Elevation Z/ f° Description of alternate benchmark Elevation Building Sewer ST/HT Inlet v.3 ST Outlet �>, R ;�,, PC Inlet PC Bottom Header/Manifold �7 �~ Top of ST/PC Manhole Cover k?, Sir Distribution Lines O 7 O ( ) Bottom of System Final Grade Date of installation / bR 7 - Y Permit number 3 5 11 0 State plan number Plumber's signature ��e- -� L icense number 2 Y9Q Date 1.2�1q Inspector 1pa-d Complete plot plan Or X i 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 ,j .�i 5 � INDICATE NORTH ARROW i • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division 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)]. 353110 Permit Holder's Name: ❑ City ❑ Village $I Town of: State Plan ID No.: BERTELSON Chris I St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 030-1026-10-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e i M: �lw�r crr. �c I UUO B ch Ik `(Ot> ( 0 07 Dosing Aerati n Bldg. Sewer Holding S Inlet /j j TANK SETBACK INFORMATION St Outlet ►f• 36 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake I NA Dt Bottom Dosing Header/ Man. IZ•7S Aer ' n NA Dist. Pipe Zir- van Hol I Bot. System G- 4G SrJ y 3.8� �' 3 6 PUMP/ SIPHON INFORMATION Final Grade .7� 90 Manufacturer D and ST C ocled2 Model Number GPM TDH Lift f riction S st TDH Ft Forcemain Length Did. Dist. To Well SOIL ABS TION SYSTEM BE R Width Length No.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �0 ..� DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: uv CL INFORMATION Type O A +�/ -1 _� OR UNIT CHAMBER Model Number: Syste T OA' I J DISTRIBUTION SYSTEM Header / Manifold „ Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length I Z , Dia. 7 Length W. Dia. � Spacing k 57 � Z Z 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.) _t ST. JOSEPH 6.29.19.104B 353 River Road �`T.li w k Of fTYl2 ��� Q� S df r t„-G 1 ' - 6 � G v Lt Gt•..0� ��1.�ilc�E?/' . PoTn� f tech I /L7_11t o D Plan revision required. Yes No Use other side for additional information. f 5 SBD -6710 (R.3/97) Date Inspector's Si ature Cert. No i ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: m �P b i S r f e t = E 3 � t � ..... . E S 1 € X ! d _ � t E a I � w 55 I e w 1 # . _3_. z .... ...e.._ ..,..,, .. .. ,.,. ... . p... ,_. I E E £ _ v` m. .o.w c ...q. ....e..m.P ..mme .°,.;. [ 5 } � 3 = a r '4 { � i � f I .. °.. a.. I p °gym .... ._...... .. L ...w .. m E .,.. s ,,,,. � £ 6 .mow ...... , . ...... .-.. . s ...,.... �.. .......,,... . ... ... .. . .. ..,... .., k 4 = k ? 3 t i III I 3 3 ee. _ E s � 2 m . ®m�m mm e. j a I E � � 5 , ...e.mmm t m. r s- € E 4 } �® I _ e ®me a '. -- tee, --""' -.e.. a. ma..�.... .. -..... € ,.ye. ..... _ �.. ....... .....,... ... .I ....... ., , _., ,.,. .., . � .. ...... �,. 5 i G 3 3 f � � E ate 3 P4 iva ®mme, ( i R g 1 € a . _w.. ,w _ .m.�mm_.,, ., ., > ._..,�.,.. a......�.,.... ... °».mme._,..,..._._. e...° ..%,.�,� .... . ....... .. ._,_.....�. ,..... _..,.,,. .. .__m_ ... m...._.. ..._.�_.. _ �-.� . ,. __ ......._.._....�.._.,...,..,.t _5 i Safety and Buildings Division SANITARY PERMIT APP C 201 W. Washington Avenue 14 swns i n j _, t - P O Box 7302 Department of Commerce In accord with Comm 83.05, ��� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst pa s r than 8112 x 11 inches in size. • See reverse side for instructions for completing this applica to Sta _S itary Permit Number SEP 17 X53 l l o Personal information you provide may be used for secondary purposes S !>IT W�� ' ❑ it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. Sta I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL IN N `, an Property Owner Name ion Taq N, R E (ora Property Owner's Mailin Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 1 ( ?4� ),38G ass II. TYPE F BUILDING: (check one) ❑ State Owned o it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ji Tow OF o v w® III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number ( s ) ;p. 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. ❑ New 2, W Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _S tem ________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 0Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit , i 43 E] Vault Privy 14 [] System -In -Fill )(��— 5}O 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. /inch) Elevation 6 S7d IF 1 ,4)0- ? Feet QO Feet Cap acit y VII. TANK in Ca allons g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank QQQ l 4Je e y.✓ FQ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: N Stamps) MPRSW No.: Business Phone Number: y _?2 lumber's Address (Street, City, State, Zip Code f. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (include' Groundwater ate Issuin Agent Signat re (No Stamps) A roved Surcharge Fee) o pp ❑Owner Given Initial Adverse Determination �. >�o ` TA - 1 X. CQ TION APP�tOVAL / REASONS F,OR D�SAP = "rrat-, G n - - �� � 1 �.�.�a.(9M,� a,6..L,�sJp�.a�( " rat-, am '°� J SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber f INSTRUCTIONS 1. A sanitary permit is valid for two (2) yea 2. Your sanitary permit may be renew fore the ex; iration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will p9cibl -.T 3. All revisions to this permit must be appr yy the permit issuing authority. Mallo - AWW , 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 51icensed 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: 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 8 112 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. J e a hh1 V-' `1 �a 0 IL Ll 5E,4', 6 Sap> �G�nm jp �z �absu��o f�t� Ccd� Wisgonsin Department of Commerce SOIL AND SITE EVALUATION ` Division of Safety and Buildings Page I of 3 - 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 SA If P percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # (l ot, 6 o APPLICANT INFORMATION - Please print all " i r.WVrffMtjqn , 1 Reviewed by Date Personal information you provide may be used for secondary p os s �P6va -y Law, s. 15.04 1) (m)). Q _ Property Owner Prop Location t l Govt: L t 1/4 5 1 /4,S T N,R E (or1 j Property Owners ailing AbTress n G` Lot # a Block# Subd. Name or CSM# City State Zip Code ne Nu �^ N ❑City ❑ yillage [54 Town Nearest Road Nr El New Construction Use: Residential / Nu Y q Herbols Addition to existing building Replacement El Public or commercial e Code derived daily flow _ gpd Recommended design loading rate i 7 bed, gpd /ft ! _ trench, gpd/ft Absorption area required bed, ft � � 3 trench, ft 2 Maximum design loading rate 7 bed, gpd /f1 gp trench, d /ft Recommended infiltration surface elevation(s) t �� ft (as referred to site plan benchmark) Additional design/site considerations O // e e c Q Parent material �� f`GC. �r� Ur J?ZcIG S!'/ 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 IRS 1:1 U 5f S ❑ U LPS ❑ U ❑ S 1:9 U ❑ S 0 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench U -5 1 Ground \ elev. Depth to 5`� limiting factor ((J-Y —in. Remarks: Boring # r. 3 / 5 j IJIJr I all Q �n C Ground elev. Depth to limiting factor / 6_7_1� in. Remarks: CST Name (Please Print) Si re Telephone No. U.- Addre Date CST Number a So azs - e� - ff SOIL DESCRIPTION REPORT IC ' PROPERTY OWNER �� r`t" � �� Page � of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench o r . /Z, S I fit oA-C, r �- C v r q1-1 Zwvj hk C Ground i ( elev. q 1L , Depth to limiting �O factor m in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor 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 # ; (3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # E3 Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PAGE Z OF N AME h e4 LOT # D 14 k LEGAL DESCRIPTION q f SCALE 1 "= O BM1 ELEV. /, d DESCRIPTION- � BM2 ELEV. , O DESCRIPTI'ON- + SYSTEM ELEV. 's ALT. ELEV. U CONTOUR ELEV. . VA V A Or c� w . 'Y i n Sro(Je Z 63 ell Gambe- i � 8Z SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems Permit Number 9/20/99 Date X "X ° Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil 1 6 in Aggregate Depth 2 4 in Nominal Pipe Diameter 450 gpd Estimated Daily Peak Flow 0.80 gpd / Wastewater Infiltration Rate 562.5 ft Minimum SAS Size 86.50 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 89.00 90.83 1 91.00 104 85.33 89.50 Yes Cut required 2 91.00 109 84.92 89.50 Yes Cut required 3 91.00 110 84.83 89.50 Yes Cut required 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM X Owner/Buyer X Mailing Addresses � y Property Address - u l (Yuificatioa required from Planning Dgwtmmt for new coasttuctioa) CiVIState 4a%f-VX Parcel Identification Number D c "/ Q; (o -/ 0 - Oy LEGAL DESCRIP'X'ION Pmpaty Location iV %, ac- y SM. Le-, T 2� N -R` _W, Town of S - f Subdivision _ Lot # - Certified Survey Map # Volume . Page # ~- Warranty Deed °I 6o a Volume 6o 9 . Page # �. Spot house 0 yes no Lot lines idmOmble P-'yes ❑. no �YST�VL�Id�4:NANCE - ta m q*mooaldnmkfiL its pz asatut+cfaiTm�ctobandle�ras s.Proper c earleaa cond a 1 p t one U* cWy &W Yc= 0 r if ncc d by t U=scdpamp= Wbat yom pat.iato du_; system re pttiCtaati• as.: �+ Catmcattt zgeia�uvrastcal�eysbcm. .. _ _ T Y owe agrocs to sabmit to St Ccvat Zoning Dcgacbmcat won foam. signed by 6c vwncc and by a P 7 ya>aaplambcrr sewtodphamberora hoeasedpmmpervci6* ff lit(1)Sheoaaitcw*--z-sL-Wat�rdisposdsystcru- ts m PmP= cPcMtiQg conMM and/or (2) after i g=fioa and pMMpmc cif may), the septic twk-is 1=.d= W fia of •sludge. Uwe. 1he gdodbave .read the abort requiccorats and jC to maiatzin Sue pdvate sewage disposal system with the standards Oct fork h=kln set by tdre DVactmont of omn ace and the Dot of Ill pxw=cs, State of Wrsconua.. ccrecazioa 601 tioS that Your scpfio system has bocce maintained must be completed and rct um od to Ste St. Qoix.County Zoning Office widda 30 da three year Wicatioa date. X SIGNAZURE OF APPLICANT DATE / OWNER• CERZTRICAITON I (we) certify that all stag on this form are tm to the best of my (our) knowledge. I (we) am (are) the owacr(s) of des nibcd above„ by virwe of a wamaty deed r coi W in Register of Deeds Office. SIM A1UI - OF APPUCANT DATE s « « « «s Any information that is nihA preseatedmay m v* is the sanitary pc mit being revolted by the Zoning Department. 0EE000 Indnde with this applicatfoa: a cumpod warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATIC 8AR OF WISCONSIN FORM 1- 190 TH"s aAcs nesenvse Goa neon'" *A • WARRMTY DEFED 39 j :SS " VOL- rAff 31 4 RiG1iTM OWE D d, made betwev, Na rj. iv...I. ... .............. ' .ST. C"X GO., WUL #prmerlyrjorie I. Schorn A w�da�t•- and•.a..aia,gle.. 'd Reooi�! 12th e son, 00. Lwh.iis 7. gerfels Eh ................... .... .................... G and.... rantor, day of P� /L 14 • - - -• ............--• .............................. .... •-- ••............•--- -....- ---. 401 4;00 AIL .............. ... ............... ..........•- - - -• ............- - -• - -. . •--•---- •••........................... .... .... . ..... ... ...................................................... .......................... Grantee, Witnesseth That the said Grantor, for a valuable consideration..... - ............ .................. ........ . . . .. ..........--- ..... - - - -- ---•--- •-- • - - -•. S f...- -Cro - ix asrrua� re i conveys to Grantee the following described real estate in ------ ! ......................... I County, State of Wisconsin: Commencing at the Northwest corner of the -- Southeast Quarter of Section 6, Township 29, Tax Pared No: . ....... _ -------- i North of Range 19 West; thence East 8 rods; -- �� thence South 10 rods; thence West 16 rods; thence North 10 rods; thence East8 rods to the place of beginning, being a part of the Northeast Zuarter of the Southwest Quarter and a part of the Northwest Quarter of the Southeast Quarter all in Section 6 Township 29, North of Range 19 West and containing 1 acre more or less. I ` ... homestead property. (lt) (i9 not) Together wi!': all and singulai` the hereditaments and appurten$nces the n belonging; And 1 I. Marjorie I Olson formerl Mar orie I. c�iorn i ` ... .. ........ -- -• - -. - . -- -- -- - - --- -- Y. ........ J _ ..... -- ---- ---- - -- - -• - -•- - 9 warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except existing highways and utility easements of record, if arty. i 1 and will warrant and defend the same. 12th Se tember 19 84 Dated this ... - . .. ...............• --- __ day of ......... - -- ....... ...... - ...... -• . ............ •... - -- -----._(SEAL) f.lL - -- -J_- ! - -_.- (SEAL) . _.. _ ... • MARJO IE I. OLSON formerly supli'�SRIE r: SC CkN ................ .• - -- ---- -- -- --- --- - •--......._... SEAL) - - (SEAL? . ..... - -... - --- - - - -- •-- -- - ---- -- -- -- -- ----- -- -- -- - --- -- --- - - - - -- AUTSBNTICATION ACKNOWLEDGMENT Signatures) Of MaTj�rie I. 01SOn, STATE OF WISCONSIN formerly Marjorie I. Schorn .....................•----------......--------•-- ........._••------------- - - - - -- St. Croix ......•••....... - ---- ------ ---County. authenticated this ........ day of .....:..................... 19.84 Personally came before me this - _...nth..._. day of September _ --------- , 19 '34 --- the above named ...................... ........................................................ M_ sr 6 _ r_J e I 61eon for•ntrl ; D. • - E1EYW001 Mar„orie I. Schorn - - ----- -....._ - -- ----- - - - - -- ------------ -------------------------.-----------••---------------------------- TITLE: MEMBER STATE BAR OF WISCOI;3IN (If not . ............. • - -_....... ................... . O authorized by § 706.06, Wis. State.) *a V known to be the pe or. -------- who e.i.ecuted U.e trument and,inc o -ledge the same. TMIS INSTRUMENT WF.° JN +FTE0.3Y M e ,(/ Et WO�, CARI � MURRAY Y ��i..��; "__ � � -_ a_ y ------- - - ---- - - e cho=ner o n Eteywooc� r , E -UdSOn _a..- W1SC E OnSln 54016 �' iatacy Pub `i � t ...... County, Geis. _..------ s ... . •-- -- -._..... --..._ . 6 . C roix (Signatures may b- authenticated or ucknowle Bot '.'� ^ Spermanent. (If not, state expiraticv: are not n essarq.) ! !ly;q± 1 A� date- -- -- -- -- - - - - -- -- ---- t......... _. ............, 19= ......) ch Name of persons *iRnm` in any caparity 0, .A be typed or pr :^ M below their airr.t.7— WARR.NTY -WED STATE BAR OF WISCONSIN Wice in Lora: Blank Co. IT. PORE! . °a. 1 -1982 Mil... .. e, Wis. , 1101 CamMctwd Road. Hudson. WI (715) 3864680 St. Croi)c County (715) 3864686 - fax Zoning Office Fc A ix To: From: Fax: Pag es: ] 4 Phone: Dat Re: CC: ❑ Ucgent ❑ For Review ❑ Please Comment ❑ Please RePly ❑ Please ReCyCle • Comments: III