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HomeMy WebLinkAbout032-1008-40-000 rr__ oc# 0 CO) 0 13- o d v1 0 0 f c eo c l c ID n �? c �• (n 3! T. v, Z o w Z 2 5 2 o a r (n o o 0 D) (D 0 0 0 0 N O N ur O M! O A N • CD c o N °• m ' o �' in �D a 0 m m m c C (O N C O '� > > 0 (D W= N (O 0 N N N 0. Cr N 0 3 N y _ ' co 0 0 00 00 C N c 0) n N CD N A (D O W (D O) N 3 (D p a O 7 O r l\ 4i fD y ( O• O O cn Z D a s� (n 0 D ° o O N O. n (O ° W O. C (D O co 07 7 w N C a C Q. C O O r tj 0) w ! j (D w_ N ( ( A° v A Q CA O c ! (O co W 0 0 0 3 fT Q lei 0 ° 000= 0 0 0 O e� l G N - �f s c yNy� v c t�naiai� m �// CD (D (D _ N Q X N (D O p ° m a ° _ y m 3 O m °) °- D �, o f D ( o 0 o — ° a ° tr o' 0 O � O lV N . w; O N (n N o w > ° (a N m (" 0 (D = (D N Nye O N• co N O r o m n CL m n ° 3 7 G CD CL CL 7 m Z I c 3 II c A �1 :i (n A 0 F A A 0 CD w -w (00)moy3,< a CD oc a CD 01 N (D ° (D (D 3 >• T - 0 . a 0 T A y m V Q U N C N j ( A7 C 7 - 7 (D ° M n OZ Q d 3 0 OZ d m3 CD M 0 CD fD E N O Q• N a o x + m 3 CD .p » O' 7 ► N 3 O N n C a Z - ;z S O ... N m y s3 0 F a m° yc N O Ir y 0 (0) CD II I fi O tZi ( p N 0 w 3 CL �n oNo N O 0 0 a CNO C„ N °) O Er ~o •', C O to ry O p_ v 00 II O O ~ cz f 0) N DO N 69 0 69 0 ti a O ti n (4 o o y o S a o G O d O f _ ;' O CD 5 r. M; CD m CD � V m h T n 4t c CD CD m m m m m r. O 0 x z cn z o w- l z 2 m z o A r cn A o "� • (� (D O O O O ro O w N € w '.I 0 N .0 a < c w (D O c ro N co I.r N (D N CL 3 j N N d N itd tD t0 (D N c ' (D O j (D Q7 3 ( f� CA N N N Q Ys3 N t/� ¢ w N _ �0 0 O O O ri w T CD < �' n C O W O c tD C CD O w CD _. to (O m N d O O. O — O r 7 H (p 7 N p O Q p w (D O d m w O w to ZD m a l o zD m ao CD (C: O N O. n 0S ' O r 7 N O � �; co C rC C: `G o o N N 3 CJ r. N C. O w` -m N O 7 w �1 (D O (O O to O O O a i N .,0+, Q lV co O 0. O : CA N O o 0 0 0 0 0 0 �• O a (n 17 G G* O_ m �_ * L * * N t s N ti N w v c f�A N f�/1 ro No 3 0- O M D O cn i N wo m m o (n N %° d a o 3 y N 3 N _ � o a N N 3 �. z� z z W z O O n ro i (D N ro ro � CD cn N Z1 . N ro ro c N w c _ �A CD r/ c 'O N C CD CD II (0 a �' a a 3 ro 3 z (D ro N Q d P 3 O 7 W W m 3 c z A L1 O •'' O •" Z O 3 3 m N D N ro o w w � IIA 0 CD Q 3 m 0 0 y o Q ° n 3 a m m c 0. — 7 o a o@ o a 0 3 o m m CD ro_0 o y v 3roa I = o Vi i Z S m y Z H 0 Cn CD I I n � I, 0 CD o ti 0 5 CD v A 0 0 b m m b V 0 0 0 0 r Parcel #: 032 - 1008 -40 -000 05/03/2007 09:53 AM PAGE 1 OF 1 Alt. Parcel #: 4.31.19.506 032 - 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): O = Current Owner, C = Current Co -Owner O - PETERSON, WAYNE L & CHRISTINE M WAYNE L & CHRISTINE M PETERSON 463 COUNTY LINE RD OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 1.820 Plat: N/A -NOT AVAILABLE SEC 4 T31 R1 9W 1.82A NW NE COM NW COR Block/Condo Bldg: OF NW NE TH E 570' TO POB TH E 300' TH S 264' TH W 300' TH N 264' TO POB Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04 -31 N-1 9W Notes: Parcel History: Date Doc # Vol /Page Type 06/29/1999 605845 1437/617 WD 07/23/1997 754/87 07/23/1997 674/168 07/23/1997 537/410 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.820 29,100 108,100 137,200 NO Totals for 2007: General Property 1.820 29,100 108,100 137,200 Woodland 0.000 0 0 Totals for 2006: General Property 1.820 29,100 108,100 137,200 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 Wisoonsin Department of Health and Sooial Services Plb. #67 10/69 Division of Health PEW1IT APPLICATION for PRIVATE D4''IESTIC SEWAGE SYSTE:.";S 0 3,)- /DOy- VO - ()6� + a B A. Gil; OF PROPEi? TYPE O US L' BLACK I NK Name Address (Street City, Zip Code) County B. B. LOCATION OF PROPER` WHT.. S YSTr'1i WILE. BE CONS ALir.RED OR EXTE Check One: CITY VILLAGE LEGAL DESCRIPTION: 7r- � ._. j = � � '�, f � �. � G�- '.�- '►7C.. l C. IS LOCAL PEFUIT REQUIRED FOR THIS WORK? ES NO ?r� aS PEW11T NUMBER D. SEPTIC TANK CAPACITY ._ Gallons NEr! INSTALLATION _ ,4-- -- & ­ PLACEMENT ADDITION MATERIALS: Prefab Concrete &------P-oured in Place Stecl Other NT113ER OF TANKS TO BE IDSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Cor;"oial Industrial Other Specify Number of Persons to. be Accommodated Number of Bedrooms F. APilLIANCES, ETCj Food Waste Grinder YES NO Automatic Clothes Washer G-- YES NO Dis:ncasher YES NO Automatic Potato Peeler YES NO Other (Specify) �- G. EFFLUENT DISPOSAL SYSTEM NEW y FXTEINSION ADDITION REPLACEMENT Tile ize �' o in t Trench W `h um of a N .L .Fee ,renc�t .idth �--- Dep th _ Number Li nes kf r / Seepage Beds Length �C' Width � Depth Tile Size -y— No. Lines 4— Seepage Pit: Inside diameter Liquid Depth P E R C O L A T I O N T E S T Test Depth Character of Sail Hours Water Test Time Drop in Water Level Inc hanutos Number Inches Thickness in Inches Since Hole in Hole Intere'al Second to Ne�' xt to Last To Fall F.xampl e 1st Wetted OverniZht in Minutes u..:` - , eriod Last Peri Poriod One Inch P - 0 36 ' Top Soil 10 , Cl 26 1, 25 es or no 30 1/2 1/2 RECOFM DATA FRa`l MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Coda. S O I L B O R I N G S - Minimum 36" Below Prop o sod Absorption System �4 Boring Total Depth Depth to Ground Water Depth to Bedrock J umber Inches Lbserved Estimated Observed Estimated Character of Soil with Thickness in Inches 1f xample - 0 72 11 " 72" Blaok T oo Soil 12"; Clay 18"; Sand 18' Graval 24" RECORD DATA FROM MINIMUM OF 3 BORE HOLES I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in aocord with the procedures and method specified in Chapter EI 62.20 (3), Wisconsin A&minist.a.ive Code, and that, the d, rt;oorded and looatiun of test holes are correct to the best of my knowledge and belief. J i ! y z N } <C r / �--+� � —f-r -- -- 'P ITLE REGISTRATION NO. _ or MASTER P1,;A 3ER LICENSE No. ADDRESS DATE -_1 ! 4' _w SIGNAM FASTER PLUMER MKING APPLICATION rip Signatures �''L..c! Zi > � �• -'� License Numbers MP RSW f t (TTo h Compl ted by Issuing Agent) Date of Application / .����' Fee Faid Permit Issued (da�'o) J Permit Number Arent (name) s ' f ��. 1 ' f��' For J _ - Toren, Village, city,'County, etc. (specify) Notes The application ca -maot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10,00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTITiNT USE ONLY DATE RECEIVED —I ��(/ ACCEPTED BY 1J 4 RETURNED (Initials) (Date) See Corres. FEE RECEIVED l/ VALID. NO. r ) 13 PERMIT N0, ` Yes or No) REVIE6IED BY APPROVED DATE (Ini.tlals) (Yes or No) COMMENTS; t , E, Parcel #: 030 - 1023 -40 -000 04/20/2007 05:10 PM PAGE 10F1 Alt. Parcel #: 06.29.19.97B 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 O - LANGAGER, NEIL A NEIL A LANGAGER 1174 MCKINLEY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1174 MCKINLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 6.000 Plat: N/A -NOT AVAILABLE SEC 6 T29N R1 9W SE NW LOT 1 OF CSM 1/72 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06- 29N -19W Notes: / Parcel History: Date Doc # Vol /Page Type /09/2003 739205 2403/204 ROAD 2 I 09 003 / 739 / 204 2403/203 PR 2007 SUMMARY Bile �_ // Fair Market Assessed with: Valuations: Last Changed: 0710712004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0 74,500 210,600 NO Totals for 2007: General Property 6.000 136,100 74,500 210,600 Woodland 0.000 0 0 Totals for 2006: General Property 6.000 136,100 74,500 210,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Parcel #: 032 - 1008 -40 -000 06/28/2010 12:00 PM PAGE 1 OF 1 Alt. Parcel M 04.31.19.50B 032 - TOWN OF SOMERSET Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O - Current Owner, C - Current Co -Owner 0 - PETERSON, WAYNE L & CHRISTINE M WAYNE L & CHRISTINE M PETERSON 463 COUNTY LINE RD OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 1.820 Plat: N/A -NOT AVAILABLE SEC 4 T31 N R1 9W 1.82A NW NE COM NW COR Block/Condo Bldg: OF NW NE TH E 570' TO POB TH E 300' TH S 264' TH W 300' TH N 264' TO POB Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04-31N-19W Notes: Parcel History: Date Doc # Vol /Page Type 06/29/1999 605845 1437/617 WD 07/23/1997 754/87 07/23/1997 674/168 07/23/1997 537/410 2010 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.820 29,100 108,100 137,200 NO Totals for 2010: General Property 1.820 29,100 108,100 137,200 Woodland 0.000 0 0 Totals for 2009: General Property 1.820 29,100 108,100 137,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 'Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y s 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)]. 353241 Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.: Peterson Wa vne I Town of S omerset ---- -= CST BM Elev.: Insp. BM Elev.: BM Descripti Parcel Tax No.: ICM ,0 1 032 - 1008 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( n Benchmark g /e l. s 'S /019.0 Dosi ng L C,�►••v+'mp LAR. M h) . 9 T f Aeration ewer C � & Z T Holding nlet ' l g �-j (,8 TANK SETBACK INFORMATION u TANK TO P / L WELL BLDG. vent to ROAD Airintake Septic >5 r r - 3 NA Dt Bottom �a (��-• Dosing r NA Header /Man. V Aeration NA Dist. Pipe u2v - f} 1z.0 s Holding Bot. System L f2.4S 9 PUMP/ SIPHON INFORMATION Final Grade S, 3a 0 17. 28 Manufacturer Demand St cover (A IZ. o YK Model Number LJ10L9 / �f GPM �r►1� TDH Lift X3 Friction � System TDH 1� 0 Ft oss Forcemain Length 060 Dia. Ff " Dist. To Well SOIL AB RPTION SYSTEM 869 TRENCH Width r Len th i No. T nches PIT No. Of Pits Inside Dia. Liquid Depth DIM - DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type Of t CHAMBER Moe Number: System: , ?2,ft � 2eV �� -- OR NIT DISTRIBUTION SYSTEM C1 r f? Header/Manifold U Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake I I Lengtho Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Yo Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed/Tr ench Center Bed / Trench Edges Topsoil [] Yes ❑ No []Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: N /3 Inspection #2: 1 L Location: 463 Polk/St. Croix oad, Osc o a, WI (NW 1/4, NY. 1/4, Section 4 T31N - 1.) Alt BM Description = f39 0 2.) Bldg sewer length = -r 13A ' C GO o • o - amount of cover = T ffl: 9160 . 57 60 Lxot� Plan re qulred� s ❑ No _ Use othe side f a inf atioan g Rao °�'�� •0 t i D to pe is Signature Cert. No. cook SBD -6710 (R.3/97) t l �'•,��, p,� - .6LLW R. s_ 466 �yi , ' Safety and Buildings Division - - SANITARY PERMIT OC 201 W. Washington Avenue cons�n ' ' P O Box 7302 In accord with ILHR 8 .O §,N Department of Commerce s: �dm. Cody' -.' Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) forth smem,oRbwoF I t t IeSSr` unty than 8112 x 11 inches in size. • See reverse side for instructions for completing this a ji ti " 99c) ! to Sanitary Permit Number ST oFIQIX l 3S3 z Y Personal information you provide may be used for secondary urposes � Ty jJ'' Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. J/ 3 L f f �FFIGE /�� tat e Plan I.D. Number I. APPLICATION INFORMATION- PLEASE PRINT AL A VII Property Owner Nam r E � /4, L� tion �a �siSo..J S T ,N,R If E(or6 Prope y Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number *. & /0 Q 1 ( 1/< —) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C ity Nearest Road Village t Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ,e r Ar e gd III. BUILDING USE (If buildingtype ispublic, check allthatapply) Parcel TaxNumber(s 1 ❑ Apartment/ Condo 02; ed - -�C� 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 online B, if applicable) A) 1. ❑ New 2 . , § L Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System -------- System _____________ Tank Only ........ Existing S ___,____ 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 JK Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit Z 5 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 15. Perc. Rate 6. System Elev 7. Final Grade equired (sq. ft.) Proposed (sq. ft.) alstday /sq. ft.) ( n. /inch) , �� �! Elevation �/reet ' 9 Feet Cap acity VII TANK in Ca gallo s Total # of Prefab. Site Fiber- Plastic Exper- INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st on- steel glass App. Tanks Tanks tic ti O� l . C�e� { vim ❑ ❑ ❑ ❑ ❑ lift lift Pump Tank ® ❑ ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature No Stamps MAAPRSW No.: Business Phone Number: A) * 1`4 et Aot , Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) ' W Approved []Owner Given Initial Surcharge Fee) Adverse Determination S Z Z� "( r X. CONDITIONS OF APPR / REASONS FQR DISAPPROVAL: Well S�t�( ��- r',� < Ccr�; tu exfs;,�� jcf/��N^ S�ntrr�j L>e c °vi� ®r� ��r CUP- / SBD- 6398 (R.11I97) / DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 7 INSTRUCTIONS ' ± • Y 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: 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. � D e �b IS { NQ 1 M E C� d. o c2 • �1 le? Wisconsin Department Industry SOIL AND SITE EVALUATION REPORT Page Relations _/ Of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY �,C -- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to 'Y 3 e jt7 APPLICANT INFORMATION PLEASE PRI A L II�FOR AY10, REVIE D Y , D TE PROPERTY OWNER: P PERTY LOCATION LOT , J 1/4 tJ 1 /4,S T j! N,R j E (or IN PROPERTY OWNER'S MAILING ADDRESS COT BLOCK # SUB D. NAME OR CSM # . y39 3c 1 -7, 4 F_ — CITY, STATE f ZIP CODE PHONE NUW5R40( - .[16 []VILLAGE ROWN NEAREST ROAD ( Tab S T o L I i, . � [�] New Construction Use [X] Residential/ Number of bedroom_ s- .' [ ' 'ng I �P�ment [ J-- �tfblicbr�ommetcr'� `�/�/� Code derived daily flow ys a gpd Recommended design loading rate 0 r � bed, gpd/ft a : 4- trench, gpd/ft Absorption area required 90 bed, ft �7JO trench, 2 Maximum design loading rate '� 7 bed, gpd /ft o g trench, gpd/ft Recommended infiltration surface elevation bT 9d. G - 7 , t B 3 (e) ft (as referred to site plan benchmark) Additional design / site considerations S4 a C"ca-1, 0'a /N I /F�Lakvz's 10!yc „� ti,/ Parent material Lt N /C pt, r Flood plain elevation, if applicable Nf� ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem EIS ❑U ®S ❑U ®S ❑U ❑S �U ❑S au ❑S QU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. // Bed Trench t 3 �� aivi✓ S C TS A , ?W SL 41, l a 6. 0140 L 1")b IG Q S �Y 11i�/� t �'r l Zm s'd /lf Gw ',a 0 S. Ground 7 ,_ 7y ,uch�i cL ZEn�b /ham ��✓ /� >NtD �,S elev. 9 a.`)� Q X Npjvti, 'L !- Mi �� l�iN� 0,3 «•y Depth to 5' : 0c) JO e £ y N limiting 7 face V t 1 <8 , Q, Remarks: Boring # a / J // /q _ ..e4,;,a,:::•::•:: �%, S8 / f7 iz 3 �� ''� tJ /1l L �� i 1 T S G are '' 1'/L� L� . - /�✓i :., ? 0, 6 ::•...- ti + :] '7 W /t In 2 � f ✓ e_ S ;� 2^-5 :: . , .. :: /,n75 Ground 7,j R y `� N' >rV S GL Zana1 MO /L p elev. a,j7 . _5 Q " X/ IvoIV i C 2 � I�► R r� l hiN� + a,s' 7 ft. Depth to limiting ��/ /vc�r� d factor f' 1- 4 0/z f b 474� n IL- 'a i' Remarks: CST Name: — Please Print 7 Phone: Zvi,✓ ��l �S/ -�/�S -SyB� Address: t 1 1 l ° 1 fLi 2l' L t-) d ie5 2k� M i ,,v J` ( i �/ Signature: Date: �. CST Number: PROPERTYOWNER wwa'L PF I� aso,✓ SOIL DESCRIPTION REPORT Page 3 PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench D,S�'i 2 11 Ground 3 v, S3 7s n v ����� /�t� aE4- elev. c1 5,33 y� L 5L -0 Depth to ,S f, 08 /aye 4 � Gvow� ,y, , s a s /11 v �t a, 7 v.$ limiting f ctor I' 6,1 r 1)5 bj. Remarks: Boring # 0.5s 10, �Zr .4,45� o, O, /7 /d Q 5 Ground:;. 3 1, 0 V's � 7� 2 �vo,v� S: � c Z � /)a le G w / �F„ a , �/ 9 S�S8 ft. /, S 2 �l i� ° ru L L / C aa�c M �,2 G� ! ,w� o, y d,S Depth to yZ 7,5 ca6'c M (,e- �r� a O, D,S" limiting �,aO /° 2 y Y N �'E` S s v,7 factor r � yo2� $6,33 Remarks: Boring # L� 4 ?1 ................. Ground �` 1,s R �y /L�'w� elev. , , y i y I1 � e y N�N� L. / e a ,'j c�,S ft. c.z y Depth to °5 9 S 2 �Y N �'no i SC. � �y� !11 F� limiting 3:: o , y factor 1 17 1 i° R l I ���5 RemarksA 6,6 � �£J �''z 7 5 , yA 9 /y Boring # 5� D 3L �wi S�, /�S Zv�sIk- /h��� ,e % In Ai `as - Ground i ` R /Y ��'� L Zm at„t~ /11 �2 �cJ / �;� 0 q e l y. ft. y 0 7,5 4/ cNe Depth to OA Q :7 0.s GI1 — a limiting factor Remarks: S8D- 8330(8.05/92) PROPERTYOWNER 6-�g SOIL DESCRIPTION REPORT Page Z °ref 3 PARCEL I.D. # > Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bourxiary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends l 0 -5 /0 � 3'z �d.v� -5 /;5 2.4, cam. as 37 0,S 0, d i- .5Wis /P Ae 4,-) Z 0, 5 - 0, (7 Ground 3 0, 7,S e /v In r< Gw elev. q, 5,83 ft. 4 S$ S 12 y� ,+v. .SL ea -- /yt �2 ��J l�,rf c:),y ©,$ Depth to 9, 0$ /OV /Z M s - v — 0, 7 v $ limiting f ctor (( 6*1 � ro8 rg6, Ly 75 `�" Remarks: Boring # :x< h:< ���� Ground:.. 3 f (} 0 7, P. /Y /Nvw�L Sic 4. Z 1h 6'-L/ v ,5 9 e lev. ft. s ©� S 2 Depth to I, yz 9 ,p �/y 0 S� / Cad�c '44 r- &L 0 o,S limiting ) 4 factor 7 ' a 0 J Y N °w� �� S O s /�1��2 6 0,7 86,33 Remarks: Boring # r 2 11 /0 n 31 �n,� s'1/ Zm56k e, Ground 3 0,92 7,S k fvo� c �v� GN �'r� �w o.S e lev. 4 1 ft. y /, ! 1 e %y NoN L. / e4-- 93S°` 5 0,9Z 2y /y Depth to N ��w E- S1 a �y1 !i1 r Q b v, 3 a, limiting 6 �, 67 7rs R oIW � 5'L 0 l G c� D ; 3 ON y factor Remarks � >33`— �, 67 F� !'�Z 7.SyQ y /y � a��, �,N� SJa;,,.:� Ba,��9s .ors � a ,fo Boring # 8 6 o Z ek- /*��� d:.titi 2 3 3 v A! Ground 2m -avc /11 d-w l �,we d elev. q b 83 '7 4/ w cNt SL I °ask 1 1 � I �;a c5, v a ,S 9 1,12 ft. rZ Depth to �I . D$ I d y/ N% c a� �, s' c; S �� L - a 0.7 0.9 limiting factor Remarks: 8Rn- RR3n(R nswwi or Li i I I - �': I f l �r tL { L !.__ -- _ -1- - ► II PAGt J G PUMP CHAMBER CROSS SECT ION AND SPECIFICATIMS VENT CAP 4"C. I. VENT PIPE WEATHERPROOF APPROVED LOCKINIG N 25' FROM DOOR, JUWCTIOIJ BOX MANHOLE COVER WINDOW OR FRESH 12 "MIU. AIR INTAKE ' GRADE 101 F _ CONDUIT k l� -- * lal ---- - - - - -- 11� IMLET PROVIDE I - - - -- _T AIRTIGHT SEAL f I r * / A I I � I I I I ALARM I I *APPROVED I oW JOINTS WITH E.LEV. FT. APPROVED PIPE 1 3' ONTO PU MP -� OFF D SOLID SOIL COWCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TAWK MAWUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOKIS DOSE TAWKS MAW UFACTURER: �7`000J�2 5CJ�� IJUMBER OF DOSES: PER DAy TAWK SIZE: Ye' d GALLOIJS DOSE VOLUME ALARM MAWUFACTURER: fUela IfJCLUDING 6ACKFLOW GALLONS MODEL UUMBEK: JQ CAPACITIES: A= /9 IAICHESOR L 'GALLOWS + SWITCH TYPE: N 5 = Z INCHES OR � j GALLOWS 1 I PUMP MAWUFACTUREPU ��'"��.� C= 91a INCHES OR 172 GALLOWS J MODEL WUMBER: LRe "K/ D = O INCHES OR A LF GALLOW`. SWITCH TYPE: e.('c r� �� MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE -2 GPM 7 INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEKEAICE BETWECW PUMP OFF AWD DISTRIBUTIOW PIPE.. l�! FEET + MIAIIMUM KIETWORK SUPPLY PRESSUR ✓ .. , , . .. . , . , . FEET + FEET OF FORCE MAIN X Z s� F �ooFLFRICT1oW FACTOR.. FEET TOTAL DYNAMIC. HEAD = FEET .2 lhw IWTERIJAL DIMEWS►OAIS OF TAIJK: LENGTH ;WIDTH - ;LIQUID DEPTH SIGI.IED: LICEM HUMBER: 2272'4d DATE:-/// .�7 y C,auIds Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor: and float switch attachment •Farms manual operation. Automatic • EPO4 Single phase: 0.4 HP points. •Heavy duty sump 115 or 230 V, 60 Hz, 1550 � models include Mechanical • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset.- ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset, plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding ■ EP05 Impeller: Thermo- * Discharge size: 1 NPT. plug. Optional 20 foot plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with improved performance. end in F' or AC ".) rotary/ceramic- stationary, three prong grounding plug BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel 10 • Capable of running dry without damage to s 30' I ► nom- 5GPM components. Pump: EP05 a I - -- ' - 2.5 FT • Solids handling capability: o z 25 I i 3 /4" maximum. w • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. 6 A -it' I I • Discharge size: 1 NPT. Z 5 i • Mechanical seal: carbon- >- 15 rotary/ceramic stationary, 4 BUNA - N elastomers. o EPOS • Temperature: 3 10 104 °F (40 °C) continuous !28. o pgq 140 °F (60 °C) intermittent. 2 i , I 1 ; I 0 00 10 20 30 40 50 GPM L L 0 2 4 6 8 10 12 m� /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 Mnn r BS y� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer n-(" �� e !'S O k! Mailing Address Property Address 46 7 d !k • 5 0/-0 i P (Verification required from Planning Department for new construction) City/State 0,5 cc * parcel Identification Num 3 �f . e , 5 �� LEGAL DESCRIPTION Property Location -AIL , VC c. y., See. T3 ( N R W T own of so me rs e– Subdivision Lot# Certified Survey Map # Volume . Page # Warranty Deed # _ � S ev�- Volume / 3 7 . Page # e: :� 1;2 Spec house ❑ yes ono Lot lines identifiable yes ❑. no USTEM:MARMNANCE useaadmaint= oeofyourseptic systemcouldresultisits consists of punq ing out time septic tunic every gm yenta or dun to handle wastes. PropermaiaLeaaaoe can affoct.the _fum�ction of &c if needed by a licensed pamper, What you pat into the system septic tunic as. a t �8'e in the waste disposal_ System The PrOPWY Owner agrees to submit to St Croix Zoning Department a cefficadon form. signed by the owner; and by a Autderplumbcr, jomney=IL phunbcr, testrictedplumberor a licensed pumper verifying that (1) &e on -site wastewaterdisposal system PwPct operating condition and/or (2) after inspection and pumping ,), the septic.tanlcis less than 1/3 full of sludge. YvIe, gee undersigned have read the above regal and agree to mamtaia fire pmratc sewage disposal system with the standards set forge, hereia.'as set by &c Department of Commerce and the Department of Natural Resources State of Wisconsin.. Cufification statmg gut YOur septic system has been maintained must be completed and returned to the St. Croix.Cormty Zoning Office wid a 30 days of gee three year expiration date. SIGNA OF PLICANT DATE OWNER. CEIZTIIMICATION I (we) certify that all statements on this form are true to flue best of my (our) knowledge. I (we) am (are) the owner(s) of gue desmlW above, by vitt —w of a warranty deed recorded in Register of Deeds Office. SIGN" OF APPLICANT 1 / 9 DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «� • «ss a• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 0O I,IMENT No. STATE BAR OF WISCONSIN FI 3 -1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 52t004 M 1094PIIF W REGISTER' �rr�CE ST. CROM CO., WI Glenn A. Peterson ............ -........ •...... •------ ....... .... Reed for r- -.:Ord ........................... - - - ........ ..._..__ ...-- - - -• -- ------ - - - - -- ----- - - - - -- ...... ------ --- - - -•- - ---• - - - - - -- SEP 2 1994 quit - claims to .... Wayne -.L. -- Peterson_ ... ............ ... .............. ...... at 11 Reg!star d Oeeds - - .............. . .... .. .. ..... - ---I.........._.._... - - -•- the following described real estate in ...........St.. Croix . .. ............ County, - State of Wisconsin: The North Half of Northeast Quarter RErVRN TO Section Four (4), Township 'Thirty -one (31) North, Range Nineteen (19) West, except commencing at Northeast corner of Section Four (4) ; thence South .3 �- / • s 573 feet; thence South 87' 33' West 600 feet; thence North 573 feet to the North line of said Section; Tax Parcel No ........... thence Fast to point of beginning and except part to Neil Langager and Lucille Langager in Volume "460 "', page 518, St. Croix County, Wisconsin, said Volume "460 ", page 518 being more particularly described as follows: That part of tl -e Northwest Quarter of Northeast Quarter (NW4 NE- of Section 4- 31 -19, described as fellows: Commencing at the Northwest corner of said forty acre tract; thence East on Lhe North line of said forty acre tract for a distance of 570 feet to the point and place of beginning of the real estate herein conveyed; thence East on the North line of said forty acre tract for a distance of 300 feet; thence South on a line parallel with the West line of said forty for a distance of 264 feet; thence West in a line parallel with the North line of said forty for a distance of 300 feet; thence North for distance of 264 feet to the point of beginning. By the recording of this document, the grantee does hereby assume and agree to pay the entire balance owing to the United States of America, acting through the Farmers Home Administration, United States Department of Agriculture, dated August 23, 1994 in the face amount of $174,000.00. qq. This ----- is not ....... homestead property. OW (is not) Dated this - _. .. ..St .................. day of .....- -- ...... ptembe2 .. 19..94... ( _ . - - -- - - - .. (SEAL) - !, - (SEAL) - _.....__.. �/�._ Gl - - -- -- -- -- ----- - -- - -- -- • ..... •.. - - -•- - - - - - enn A. -- Peterson,. . _(SEAL) -- - -- ---------------------------------- ._- ...(SEAL) ' - ... .. .... .... -- - AUTHENTICATION ACKNOWLEDGMENT Signature(s) --- --------------------------------------------------------- STATE OF WISCONSIN ....... Polk ....................... County. authenticated this -------- day of ........................... 19 - - - - -- Personally came before me this ... lst ....... day of September________________ 19.94 ... the above named Glenn A. Peterson -- ' .................................................. -- ---- -- - -• - -- ........................................................... �Y T -�' TITLE: MEMBER STATE BAR OF WISCONSIN �- (If not, . --------- - - --- C .. O authorized by $ 706. 66 , is. Scats.) to me known to be the person --------- o Y!t fore go•n and f a l cck / nowled - same4 _ THIS INSTRUMENT WAS DRAFTED BY I, Pypyc \ ` Z Durand Blanding, Attorney at Law -- -- --- ------- • -- - - - - -- --- - --... a Colleen J. Carlson _ QF WV St.._Croizc Falls,, Wl .54.Q24 Notary Public Polk - - ---- -- - - -- - - -- �s. (Si: natures may be authenticated or acknowledged. Both My Commission is permanent. (If not, st ft expiration are not necessary.) date: .............. ---.- September_ - ll. , 19.. -Nacres of persona signing in any capacity should be typed or printed below their signatares. N.C.Mdler Co,nperry� - STAT BAR FORM Yo 1— 198 . Stock No. 13003 VOL 1437PAGE 6 605845 ' STATE BAR OF WISCONSIN FORIM t - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS Ibctimpni Numher WARRANTY DEED ST. CROIX CO., WI This Deed, trade betty zen Leland J Kendrick and Jean 1. Kendrick, RECEIVED FOR RECORD husband and wife OE -29 -1999 9 :30 AN Grantor, and WARRMITY DEED _Wayne L. Peterson and Christine M. Peters husband and wife,_as E (�1 �Y FEE: survlvorship marital property COPY FEE: TRANSFER FEE: 252.00 RECORDING FEE: 10.00 PARES: 1 Gr: ntee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address Wayne L. Peterson 463 Polk —St Croix Co. Rd. Osceola, WI 54020 032400840 Parcel Identification Number (PIN) . This is homestead property. That part of the N9V1 /4 of the NE1 /4 of Section 4- 31 -19, described as follows: Commencing at the Northwest corner of said forty acre tract; thence East on the North line of said forty acre tract for a distance of 570 feet to the point and place of beginning; thence East on the North line of said forty acre tract for a distance of 300 feet; thence South on a line parallel with the West line of said forty for a distance of 264 feet; thence West in a line parallel with the North line of said forty for a distance of 300 feet; thence North for a distance of 264 feet to the point of beginning, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this 1 + day of June, 1999. * I-eland 1. Kendr T i s Je Kendrick AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ` !SCONSIN ) ss. authenticated this _ day of S t7 G� oT County ) Personally came before me this I +tn day of Jute, 1999, the above named Leland J. Kendrick and Jean 1. Kendrick, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN to the known to be the (If not, person(s) who executed the foregoing instrument and authorized by § 706.06, Wis. Stats.) yac w ledge the THIS INSTRUMENT WAS DRAFTED BY --- tlpyt�pyb; L�t4etNAa00ngM1 Attorney Kristina Ogland ' Hudson, WI 54016 Notary Public, State of Wisconsin (Sieratures may be authenticated or acknowledged. Both are not My Commission is permanent. (If rat, state expiration date: necessary.) •Na,oes of persons signing in any capacity should be typed or printed below their signatures .. ,. WARRAN - 11 DF.,EG,,: STATE BAR OF WISCONSLN FORM Not 2 - 19" INFORMATION PROFESSIONALS COMPANY FOND DU LAC, YNt 900-555-2021 i W vi %wevS.F& i 1 %01 &M i I SEG q? R. 300 - 40 4 N tp 50 B " 1 300 NW 114 - NE 114 0 q � 50 i I i _N N C I N ,. I I N� // 114 pr