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HomeMy WebLinkAbout030-1034-90-000 Cs Nr g 0 cn 3� n d r� C ; C n a �1 3 � 0 o 0 O ! O O A o N N CA O 0 N n I 1 4 N °w �• 7 'y. 7 c .+ . 7 co CD m c OD cc L Q MCI a j 7 �'. ? N N a W W N 3. -ONO CD N N a 3 CD U N Z m to N n! cb ° o ° o o o M CD � CD - m O m O 1 CA N c O N Cr O 7C O f0 3 NI O O 7 CA coo !, O C 0 co N N D. vi CD CCC O CD 7 N W .. 7 N 3 a I.: o OD 01 d IV O ° m sy m y c o co CD I N o co m! O R Q 2 C1 �� fl I C l. Z 0 0 0 0 o o o o l °: • 0 0 0 3 CO) ai to 3 3 CO) O cn m CD O D I 0� N o �? �' o_ M °—' n �+ I co N I o z z 0 Z o D I D 7 O o s o v cn cn 0 ti N c j CD C N C CL C1 t1 " N 7 (n Z CD n C6 p CD 0 a a A Z 0 Z - i Co m 0 (D m `2 m CL A O O O :7 O ''• Z Cp N C CD CD W -NO CD I c CD Q m m n o cD co—• m C _ RL z a c°°oa a 0 m N O co N I N 0 fi CD y 3 A. CD A i I CD O CD C7 N I I t I W N w I a I QD I O O� I I O O b 7 ti O CD Q CO ti I p 0 O 0 O CD O CD CD ti Parcel #: 030 - 1034 -90 -000 09/26/2006 08:43 AM PAGE 1 OF 1 Alt. Parcel #: 09.29.19.118E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner E NICK & KAREN J SCHMIT O - SCHMIT, E NICK & KAREN J 509 NELSON FARM LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 509 NELSON FARM LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.300 Plat: N/A -NOT AVAILABLE SEC 9 T29N R1 9W NW NW PARCEL #11 AS Block/Condo Bldg: SHOWN ON SURVEY & DESC IN 602/198 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.300 203,200 219,600 422,800 NO Totals for 2006: General Property 4.300 203,200 219,600 422,800 Woodland 0.000 0 0 Totals for 2005: General Property 4.300 203,200 219,600 422,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 117 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS = SANITARY SYSTEM REPORT 1.)I. ER /U / '� TOWNSHIP SEC.� TT N, R !�r . W ADDRES fc� , ST. CROIX COUN WISCONSIN. ".?DIVISION /�r�L� ,E '� f/ LOT // LOT SIZE PLAN VIEW -Distances S dimensions to meet requirements of H62.20 _ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I TT ° -- well T �s c- e m e i � l (� Iridi�cate o thl Afro SCAL s P E'TIC TANK(S) / 060a, MFGR. _ �„ S , Se r -� CONCRETE STEEL 140. df rings on cover Depth DRY WELL `INCHES NO. of width length area no. of lines ,.V, width length ,�� ` are depth to top of pipe 20 // SUT GATE / 'IV RATE elc Ss % AREA REQUIRED �o /S' AREA AS BUILT sciaimer: The inspection of this system by St. Croix County does not imply complete caoliance with State Administrative Codes. There are other areas that it is not possible I, inspect at this point of construction. St. Croix County assumes no liability for (stem operation. However, if failure is noted the County w 1 make every effort to ,.ermine cause of failure. 'EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST `INSPECTO DA= PLUMBER ON JOB LICENSE NUMBEi � V z . 4VORT OF INSPECTION_ INDIVIDUAL SEWAGE SYSTEM San.itany Penmit�� State Septic NAME �U rown.ahi S Cno.ix County Locatiox r eiv Sect.ion _ SEPTIC TANK - Size gattone. Numbers o6 Compattmente ` Viatance Fnam: Wett it. 12$ on gneatea 6tope it Bu.itd.ing it. Wettand.6 fit. Highwaten a it. DISPOSAL SYSTEM . D.eetanee Fnam: Wett /()L9 it. 12% on gneaten. .6tope_YD it. Bu•itd.ing 7 it. Wettand.a • H.ighwaten St. FIELD DIMENSIONS: Width o j then c Depth o S ta ck b etow t.ite / Z in . Length of each tine 0 V_ St. Depth o6 noek oven t.ite .i n. b Humbeh• of tin e.6 Depth o6 t.ite 6etaw gnad .in. Totat teng.th a t.ine.d it. Stope o6 tneneh y in pen 100 it. 3 D.i4 tanee between Una 4 — L t. Depth to b edno ek fit. Totat ab.6 oxbt.ion area � # Depth to gnoundwaten N it. Requited area �j�� it Type a6 Covet: P p n Str PIT DIMENSIONS: Numbers o6 pi Gn .it avet around pd yed no Out Aide d.i am a Depth b etow -i.ntet fit. 2 Totat abdonb a ea it A Aiiea equ�.hed �t2 INSPECTED BY E APPROVED , DATE 19C REJECTED ,DATE 197_. 9 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEAL Z � P.O. BOX 309 MADISON, WISCONSIN 53701 Ott REPORT ON SOIL BORINGS AND PERCOLATION T I�V r A LOCATION: � /a, , Section — _?_�, WN, R /f ® (or(o�ownship or Municipality Lot No. —IL Block No I' N u Count Subdivision Name C� Owner's Name: C Mailing Address: /" 1 a ailing Add TYPE OF OCCUPANCY: Residence No. of Bedrooms —3 Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS / L7- 7 7 PERCOLATI N TE TS C 7 7/2 - 7 2 7 2 SOIL MAP SHEET .2F�-6"� SOIL TYPE 07 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- / Y6 S-e e— A 10— 44P: X C� / .2 2- P 3 S `v s�. z-. Z 3 I V o SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 7 G B- '746 " _ �ar� > � 6 �, y „ ,2 S`' 67 I• +C 7Q6' /� S �C I � �G� /, PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square f et ofV'table areas. Indicate num_be o �uare eet of absorption area needed for building type and occupancy. O °1 <O L' In 'sate scale or distances. Give horizontal and vertical reference points. 9,46 / p 3 R M ' 000 all 1 i F ] a IW l i z' I, the undersigned, hereby certify that the soil tests reported on phis form were made by me in accord y it h the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) _*Z A 1 Certification No. Address Name of installer if known CST Signat iY A — LOCAL AUTHORITY J PLB --67 State and County State Permit # Permit Application County Per t # for Private Domestic Sewage Systems County I *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 53(, TQ A, I k ; Rct A6'L4 2-n B. LOCATION: W j W ' /,, Section T _ N, R � E (or) W Lot# _City Subdivision Name _ nearest road, lake or landmark Blk# BR WIGS lage CL&t Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family X Duplex No. of Bedrooms No. of Person D. SEPTIC TANK CAPACITY 1 000 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rat Total Absorb Area sq. ft. New ✓ Replacement Alternate (Specify) Seepage Trench: � No. of Ft. YllidthDepth "_Tile depth (top) No. of Trenches Seepage Bed: Lengt Width 19 Depth J-1 Tile depth (top i1 No. of Line 'a Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private t& Joint ❑ Community ❑ Municipal ❑ Owne n ame as li o E H 115 if other than present owner: 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Cer ified Soil Teste / p NAME �x � � C L�i�_„�,c�.��C # J �j �/ and other information obtained from (owner /builder). q _ Plumber's Sign <Q ' MP /MPRSW# MA0( Phone # � - ,5 1 7d Plumber's Addr 804 Pr\QWQ0e- ST ©, k�- a.%oVn . W isC PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on.the property or neighbors property. If well has not been drilled please indicate. 3 Q i j , . o 1 6 P e, , a.�2E , } .. ea... . . m �... e pgc ec c E 3 'v m .�....'.� d .-. _ :• __ a �. .. J 3 , 5 Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application A -,�44-7y Fees Paid: State 5, ) ? C u ty 6'e DatQ l Permit Issued/ (date) Issuing Agent Na ` Inspection ' ;7Nco State Valid# Date Recd ' 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 J J ST. CROIX COUNTY ZONING DEPARTMENT = AS BUILT SANITARY REPORT Owner; Property ddress kA9,1 2',ze City /State - : ti• Legal Description: Lot Block Subdivision/CSM # ' /4, Sec. _, T 9 N RAW, Town of PIN # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Z SeJe Size ST/P /,�vo / Setback from: House 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 99 Well /z P/L -3>0_ Vent to fresh air intake t 1 ELEVATIONS Description of benchmark ,c� ,� �' r , e �= Elevation Description of alternate benchmark !kfQ Elevation Building Sewer ST/HT Inlet ST Outlet - 90. 0 7 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () g z -z/ () ( ) Bottom of System () g ,g 9 Final Grade () If s l -- / () ( ) Date of installation elf t99 P rmit number State plan number Plumber's signature J License number ��1 Date Inspector ,„%y Complete plot plan a 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 i 0 u'kl� INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermi IX 3446 2 Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)]. Perngt 4q ft j,Nan4I ❑ City Vill b( ffn of: State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: 1 Parcel Tad NcQ _1034 90 - 000 a0 0� gAVA4 s 900 V. TANK INFORMATION - ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic d p Q Benchmark � 0 a d Do . Z Aeration Bldg. Sewer - Ing �/ Ht Inlet TANK SETBACK INFORMATION Ht Outlet f Q TANK TO P/ L WELL BLDG. Ventto ROAD �e� Air Intake Septic 7( NA tom D ing Header/ Man. Aeration A Dist. Pipe Ti / .b .S Holding Bot. System t 7"/ /f 2 t, Z . Z�s PUMP/ SIPHON INFORMATION Final Grade YZ �9 J Manufacturer De nd M N er G M Lift L os ction System 'TDH t Forcemain Length Dia. H ,well SOIL ABSORPTION SYSTEM BEDtf Width / Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N j ' DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu %r r: SETBACK CHAMBER INFORMATION Type 0 ode Number: System: J 30 7�0 ; I's C1f - - OR UNIT DISTRIBUTION SYSTEM Header/Manifold n Distribution Pipe(s) x Hole Size x Hole S acing Vent To Air Intake Length Dia. Length ' ?Dia. Spacing � � AJ / 7� U0 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.) LOCATION: ST. JOSEPH 9.29.19.118E,NW,NW 509 NELSON FARM ROAD O aO �W1 = d d -r ��lciS�i �f SyS'�Gh�- W i l� rOc ul� UcA.. va�tX° Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date nspector's Si ure Cert. No. � 4 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ^ s ° } E a d 3 I 3 E 4 } 4 3 � e S S I ^ ° a { i »n m a - 'a a, r _ E f e .,mow...... = =.....� ...... », m =e °.,.... =.a = «.. mew....,.. . .... .a.. _ . ... ,. em= m.. ... _ 3 a a t t ` c a _ 4 a =� E i � t � a E i � me «. £ m P ^ .�..: ..�. .. « ..,..�. , ., «. _ s i _._,�. _.. .. . ,. ,� .. g 4 4 E 4 { � 4 p Safety and Buildings Division Visconsin SANITARY PERMIT I ; N 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83. Vk�s: {fsd ;, Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the , o rret less; unty than 81/2 x 11 inches In size. CtJ • See reverse side for instructions for completing this a I ion 1 a Sanitary Permit Number p g p r ' 0 ? 6B2 Personal information you provide may be used for secondary purposes ST CRCYX heck if r evision to previous application [Privacy Law, s. 15.04 (1) (m)]. rOUNTv ;; �$ ate Plan I.D. Number ZONINGOPRCE I. APPLICATION INFORMATION - PLEASE PRIN AL RMATIO Propert Owner Nam S �i preperty,Ll' n r /a1 1 /a, S T , N, R ore Property Owner's Maili ddress Lot Number Block Number City, St a Zip Co Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned it Near st oad Villae Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF ,vp III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) c� - l °E . 118E' 1 ❑ Apartment/ Condo .3 — 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. g Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an - - - - -- System -- r - - - -- System - Tank Only Ex 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 N Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Va t rivy 14 ❑ System -In -Fill f -� 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 S Feet Feet VII. TANK Capacity gal Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank o ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El ❑ 1-1 E3 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans. Plumber' ame: rintJ Plum is na r (No ps MP /MPRSW No.: Business Phone Number: Plumber's ddress (St t, Ci State, Zi Code): IX. COUNTY/ DEPARTMENT USE ONLY [] Disapproved S nitary Permit Fee (Includes Groundwater ate I ssued Issuing A nt Si ature (No Stamps) Approved E] Owner Given Initial 00 Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber P , INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at atime 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: 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 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 mainstwater 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. s 3 k'XI. y , \ lot( s ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certi y that I have inspected the septic tank presently serving the residence located at: Section T N, R _ZO Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes _Z No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known) : Age of nk ( I f known) (Sign ure) (Name) lease print (Title) (License Number) -99 Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspectio opening over outlet baffle). Name Signatur �,MP/MPRS � Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings 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 --i-/ I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. R vieio by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner Property Location Govt. Lot 1/4 1/4,S T N,R -(or�7 _'S�_LJ - Pr perty Owner's Mailing Address Lot # Block Subd. Name or CSM# City Stat Zip Code Phone Number El City Village R3 Town Nea Road (7 ) ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow L gpd Recommended design loading rate 1 Z _ bed, gpd/ft2 gpd/ft Absorption area required ��2 bed, ft trench ft2 Maximum design loading rate _,_ _ bed, gpd/ft trench, gpd /ft Recommended infiltration surface elevation(s) 6 94 d ft (as referred to site plan benchmark) Additional design /site considerations Parent material d%4L &SW Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound r In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 10S ❑ U I ®S ❑ U 10S S ❑ U 14 S❑ U ❑ S 0 U [Is O U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 • in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Gr. Sz. Sh. Bed ,Trench Ground elev. ft' - s Depth to limiting factor X `l I[O—in. Remarks: Boring # Nil /I 11 1A) 3 / Ground elev. 3 A 'q !o Depth to limiting factor 1 1 1 ' Zn in. Remarks: CST Name (Please P nt) t� Signature Telephone No. 4 j' r Z/�- 7 Address Date CST Number s ✓, _ SOIL DESCRIPTION REPORT PROPERTY OWNER Page v 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 10--21 ' 11 Ground e 2�11j - ft• � — ' Depth to limiting b factor Remarks: Boring # .. Ground elev. 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 # E3 Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: / SBD -8330 (R.9/98) ,�� S - �� %� �Y % ✓ -.��:� 9 -7.�y -,rips Z 1 4",w .4 /v w- �eAaw, d��•a•� aN (a�t�iN. "�'-/�C/Q0O �® 3 � a G�ca " f CROIX COUNTY SEPTIC T�'.NK MAINTENAI'vCE AGREEMENT AND OWNEkSHIP CERTIFI(. "ATION FORM OwnerBuyer L , > Mailing Address z!s� Z&f. � i?SeJ /Aw — Property Address (Verification required from Planning Department i'cr new construction) _ City /State Parcel Identified ion Number 19-&0 -• gog LEGAL DESCRIPTION Property Location ' / *, ,_ Sec. T N -Rlq Town of ' �L- -• Subdivision _ , Lot It Certified Survey Map # , Volume , Page It Warranty Deed # ,�1� , Volume ,Page It Spec house ❑ yes ® no Lot lines identifiable ® yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Prope: maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put in;;) 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 c aer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site was tewaterdv posal 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 undersi -ned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of C'ommet,:e and the Department of' Natural Resources, State of W isconsin. Certification stating that your septic system h s been maintained must be completed and returned to the St. Croix County "Zoning Office within 30 days of the thr e y expir date. SIGNATUI E 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) ti:e owner(s) of the property descri d a e, bpi of a warranty deed recorded in Register of Deeds Office. _3C 5;v SIGNATURE 6r APPLICANT DA L * * * * ** 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 fr,,m the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VGS I t T NO. l l7 �. Si'ft"� ?t.i � ef� ads " S � s.e --�� � t , : Nl R w"Pt DI r ti !$ THIS SPAU RES €FIVED FOR RECIDON010 QATA 6! REGISTERS CfFF3CL r on L. Ac'.c4 d d CirnstaAce J. 9ItIS DERV, made between _?. O ?E C w1 ST. CR04 ;? - . �AG. slat!., litlr7lllslid_STld_7111 ifs Rec'd, for Record thfs__ # _ day of.ta .. �E►. 1939 and _.1. Nick Schmit_ -and Zaren._,L._ _Lusband_and__w ft_8s�_ of 011 A M. Grantee, :? T Witnesseth, That the said Grantuflfor a valuable cnnsiderst Ion — of s convey Grenteesthe fc ?lowing described realcstate?n —_$t ix__.__ —County, AN To It state of Wisconsin: A parcel of land known as Parcel #11 located in the NW 1/4 of NW 1/4 of Section 9, Township 29 North, il Aange 19 West, Town of St. Joseph, St. Croix County, Wisconsiny — described as follows: Colmnencing at the Northwest .corner of said Tax Key r° ---_,. J Section 9; thence SO *36'W (true bearing) 972.29 feet; thence This is _ not homestead props ty. N89 "E 333.00 feet to the point of beginning; thence NO °36 LAND MY j1625.88 feet; thence S71 ° 17'50"E 27.42 feet along the Southerly right-of-way line of e ;;proposed town road; thence Easterly 26.15 feet along said Southerly right- of-"Y lina" "hose chord bears S80 ° 39'40 "E 26.04 feet; thence 939 530.09 feet; thence S0 ° 36 1 W'200.00 feet; thence S89 ° 36'10 "W 392.00 feet to the point of beginning. 'Subject to a permanent roadway easement located in the NW 1/4 of the NW 1/4 of Section 9, +:Township 29 North, Range 19 West, Town of St. Joseph, St. Croix Co., WI, described as follo Beginning at the above described point of beginning; thence NO3VE 40.00 feet; > thence iN89 ° 36'lO "E 392.00 feet; thence SO ° 36 "W 40.00 feet; thence 389 ° 36'10 "W 392.04 feet tq`the po :t' l ,of beginning. Also easements and rights of ewnerahip as spe:ified in Affidavit Establishing Easements recorded in the Office of the Register of Deeds for St. Croix County, .V1,.'i& 'Vol. 497, Pages 410 -412, Doc. 315988. Subject to recorded easements and restrictive cove s. t *SEE oge er with all and singular the here d its me nt sand appurtenances thereunto heloni;mg or in any wise appertaining) And- grantars i warrantXthat the title is good, indefeasible in fee simple and fre, and clear of enc umbr,..c �'ffi� �� @ as except _eMi$&t�1ai e c oy an a t}£_SH _Qrd_ n an tmdPry� mangy fpL_�1�CLL ;f! _ tom+ to that 3t Lint'' nttrty V� Cna k_497 °n S PA' e✓!xeeat enant9 4'Yl - OII 413 a e p, � W C_ . � eX e and wi I warrant and efen t e same, entS } txr i" �f, 1n oL. 7, et. s e . Y Executed at Sr Pat'1 Minnesota this _ day of ^ . 391Q_ s SIGNED AND SEALED IN PRESENCE OF - (SEAL) i nn AnklanA _ EX _ (SEAL) _ (SEAL) h f *This deed is given in fulfillment .)i a Land Contract e i_tto between the parties on t. t 10/22/77, said Land Contract having been recorded in the Office of the Register of Deeds fo St. WI , on 10/31/77 in Io 563 p. 385., Doc. No. 3 44273. " _- - -� authenticated thi3 - day of Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.Of viz. j QUA STATE OF t4YS rr @"" RAMS RV _— _.COJnty. Ss. Personatiy came before me, this ` day of 19 -., the above named— _ grantors - r _( sordart_ L_-.", c k_1and_... and- _CoII,4�dttCe_ -,�. Ay ,�G1gAt� huSb3Ad_g:5�_Y i 11 to me known to be .he person___g -_ who executed ti a e foregoing n_rrumeni and acYnow rd the ) a fhis instrument was drafted by Owen L. Sorenson of F Stringer, Courtney & Rohleder, Ltd. _— Vil-;: see- 1200 North..e -.; ter -n Natl. -- Fs?nk. ts:idg. ='s : St. Paul, MN 55101 Phone: (612) 22/- "1784 , L is i rhea witne;,_s is +i. r _ 1 Vam, f per Sons - „r;n ing in any Spa , , - ivy shouid bo .yped or pr i,tt o.. ,:- tha. + RR. \QTY PEED STATE BAR OF R NCO V Fir ;_ 1 W i i a \ OD ,bl'LEI ,611EZ ' ppZ a � 90'081 O i ' I N N OD (X) w N w ro ooZ i OD O 1 m In �. W M ao — OD U J ' 88 9 R LL z Q m in ,