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HomeMy WebLinkAbout038-1074-10-100 ST. CROIX COUNTY ZONING DEPARTMENT R AS BUILT SANITARY REPORT - _... Owner Property Address City /State Legal Description: Lot �_ Block Subdivision/CSM '' "'�G op ,&L t /4 t /4, Sec. ,�, T,,ZL`N-R,,S W, Town of PIN # e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1A ' - Size ST/PC / Setback from: House Well �' P/L� Pump manufacturer Model ' l/! 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: _l�/�u,f�, Width 6 1 Length Number of Trenches Setback from: House Z,! �' Well k-;21 P/L �_ Vent to fresh air intake 7 4 ELEVATIONS Description of benchmark '� 4 ., o Elevatio Description of alternate benchmark Elevation 9,e, Building Sewer ST/HT Inlet !Z2/,-9 ST Outlet _5.�,2 R PC Inlet .9/-!5 PC Bottom S g7. Header/Manifold ��� r/� Top of ST/PC Manhole Cover Distribution Lines ( ) Bottom of System Final Grade 3yy q Date of installation / / Pe mit num er State plan number ._ Plumber's signature License number Date Inspector 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 . ,B� AQ1 a -A s i r 1 h INDICATE NORTH ARROW �t�� r S' 'Wis&onsin Department of Commerce Count PRIVATE SEWAGE SYSTEM 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)]. 344629 Permit Holder's Name: ❑ City ❑ Village 1% Town of: State Plan ID No.: RIVARD, Patric J. STAR PRAIRIE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: dv 1 / / ;, 038- 1073 -7 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic Benchmark M t.z 5! 02,T_?, U O 0 osin P 1 4 ,P;,{AA 3.75 6 Aeration Bldg. Sewer ? $ 94 j"Y/ Holding St/ Inlet q,�f� 92, &7 TANK SETBACK INFORMATION /r Outlet �' '�� qp- x T P/ L WELL BLDG. Ventto ROAD Dt Inlet 10.73 Air Intake eptic -f- JD y y �a AJ NA Dt Bottom osin rS_b S? 35 3 NA Header / Man. Aeration NA Dist. Pipe (� . �7 �$; Sir=. Holding Bot. System 7 36o 9' 7 F7 PUMP/ SIPHON INFORMATION w , . y I;� Final Grade Manufacturer 6-7 f d S Demand 54 rp 9" Z q 03 Model Number Li &o ! "'GPM — 7 .73 TDH Lift 1 Lrictio7 �� Syste i TDH� / ,74t -7 Forcemain Length Dia. FFfi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width �l Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D pth DIMENSIONS tP DIMENSION SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHING Manufac INFORMATION Type of / CHAMBER Mode Numb System: JD 3� )� OR UNIT DISTRIBUTION SYSTEM Header/ M nifold ,� Distribution Pipe(s) +/ x Hole Size x Hole Spacing Vent To Air Intake / �, Length Dia. Length © Dia. ' Spacing � �1 6 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.) STAR PRAIRIE 17.31.18, NW,SE 2130 100th Street Paw 9� z z� 9 � � t t°�► {owc s 9 73 0 ,4 1 4. T, Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's ignature ert N - r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �M g ........ _ .„ -- _. _ ..... _ �... ..... ,,.,... �.., m ...... i ,.e. r . m � � B g w.. t i { g B B B j a B t P a ...,., _.. e _.m. J E _ Lei { { F } 1 { f { ' r m� e K .. _se g 8 _ j ti_ [ } .. .. . . . . e a ..w D „..,. E ... .,.ew S � 4 .... ... e E y � { f { { j r } a € t Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Visconsin accord with h P O Box 7302 Department of Commerce ILHR 83.05, Wjsdm. Co2�72� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the s n paper no s County than 81/2 x 11 inches in size. , • See reverse side for instructions for completing this ap Vk ion ® to Sanitary Permit Number Personal information you provide maybe used for secondary purposes ' ,� r heck i revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ST O! J99 to Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT A r ON Prop caner Name �, y L 1/4 , S 7 T , N, RZ E (or Pr perty Owner's Mailing Adcrress N r Block Number City, S e Zip Code Phone Number Subdivision Name or CSM Num r II. YP F BUILDING: (check one) ❑ State Owned E] Cit ea st Road Public 1 or 2 Family Dwelling - No. of bedrooms ° Tow of e ej j 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo — 7 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 jo New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an stem Tank Existi S ystem Existing S ------ System - y------------ S --------------- - - - - T -- Only g Y g stem Y 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 2119Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTI SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. to 6. System Elev. Final Grade rld Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Mire i ch) Elevation 3 S S ,� - Feet 9Z 9 Feet VII. TANK Capacit allo s Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st ironed steel glair Plastic App Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber r 1 42 F 9 ❑ ❑ 1 ❑ I ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the yndersigned, assume responsibility for inst ation of the onsite sewage system shown on the attached plans. Plum r' l ame: rd Plumber` atu MP /MPRSW No.: Business Phone Number: 1 [G� _ Ode P umber's ddress (Street, Ity, St te, Zip Cod IX. COUNTY /DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater E -1 4 te I ssued Is uing Agent Signature (No. Stamps) y Surcharge Fee) Approved ❑Owner Given Initial t , 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 a Safety and Buildings V iscons i n 15837 USH 63 HAYWARD WI 54843 -8107 TDD #: (608) 264 -8777 www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda I Blanchard, Secretary June 02, 1999 CUST ID No.224263 ATTN.- POWTS INSPECTOR ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/02/2001 Identification Numbers Transaction ID No. 227243 Site ID No. 173582 SITE• Please refer to both identification numbers, Site ID: 173582 above, in all correspondence with the agenc ST CROIX County, Town of STAR PRAIRIE; BRAVE DR, STAR PRAIRIE 54026 NW1 /4, SE1 /4, S17, T31N, R18W Facility: P JAY RIVARD BRAVE DR, STAR PRAIRIE 54026 FOR: MOUND SYSTEM, 450 GPD Object Type: POWT System Regulated Object ID No.: 472085 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: P•4; 1. This plan action is subject to designer comments on the plan. r,ond 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular AP to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. DEPARTMEI 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). DIV )a Of U A copy of the approved plans, specifications and this letter shall be on -site during construction and open to /«-• -- - inspection by authorized representatives of the Department, which may include local inspectors. All permits SEE CORE required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/14/1999 FEE REQUIRED $ 180.00 ✓.- -�2iL_ : j -mac ( FEE RECEIVED $ 180.00 PATRICIA L SHANDORF , P6WTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project P. JAY RIVARD Owner P. JAY RIVARD Address 1618 ALTOONA AVE. EAU CLAIRE WI 54701 Legal Description NW- SE -SEC17 T31 N -R18W Township STAR PRAIRIE County ST. CROIX WT ? 1 S Subdivision Name Lot No. itionallv Parcel ID Number M V - � IT Of COMM FETY AN B , Plan ID Number Z tES ENCE I INDEX SHEET PAGE ONE MOUND CALCULATIONS PAGE TWO MOUND DRAWINGS PAGE THREE PRES. DIST. CALLS. & LATERALS PAGE FOUR PUMP TANK DRAWINGS PAGE FIVE PUMP CURVE PAGE SIX PLOT PLAN PAGE SEVEN Designer KIM A oc License Number Signatur ) t Phone No. 715 - 755 -3145 Date 5 -13-99 Notice: 'tampering with this file by unauthorized persons is prohibited. Deliberate modification Wit result in disciplinary action under s. 146.10. Vft Stat& SBD- 10462 -E (R.04/97) Page 1 of 7 i r e i RESIDENTIAL MOUND DESIGN El gt Bedroom Maximum Compleft info madon in red framed boxes as necessary. (y or n) n Is the s rstem over cxeviced bedrock? Slope 3 96 Number of bedrooms 3 Wastewater flow rate 450 gpd 1703.3 Lpd Depth to limiting factor 33 in 83.8 cm In situ soil infiltration rate (code) 0.5 gpdfie 1 20.4 Um' Contour line below the upsl o a of absorption cell 93.7 ft 28.56 m Use standard fill depths? x OR Designer speed depth in L 1cm Place X in baz to Lae staiMard depths (19 24, A++4 N►ckislve) OR spec#y design 11111 depth. Center or end manifold I a 1(core) Estimated hole space 4 ft Not a final eakukAWL Lateral spacing 3 Ift Minimum dose >= 10 times void volume Use a o lateral spacing for &wwJ & Pump tank elevation 85.7 ft Outside bosom of tank Number of laterals ] Force main diameter 2 in Force main length F 70 : lft Force main actual dia. 1 2.067 in SYSTEM SOLUTIONS Inch- pounds Metric Cell media "x" one only. Estimated daily flow gpd 1703 Lpd x Aggregate and pipe Chamber and pipe Absorption cell Design load rate & area 1.2 gwe 375.0 ft 34.84 m Linear load rate 7.1 gpolft 88.0 Lpd1m Design width (A) 6 ft 1.83 m Cell length (B) 63.0 ft 19.20 m Depth of cell (F) 9.9 in 25.1 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Dom-,slope fill depth (E) 14.2 in 36.1 cm Basal area required (gpdrinfiltration rate) 900 ft 83.61 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.4 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.3 f: 3.14 m Upslope toe length (J) 7.8 ft 2.38 m Domislope toe length (1) 9.9 ft 3.02 m Total mound length (L) 83.6 ft 25.48 m Total mound width (W) 23.7 ft 7.22 m Project: P. JAY RIVARD Plan I.D. Page 2 of 7 I MOUND PLAN VIEW of ervation pipes ct>picaI) W= 23.7ft AT A= 6.O ft 1.83m 7.22m [ B= 53ft 19.2m B K J= 7.8ft 2.38m 1 = 9.9 ft 3.02m K = 40 - 31 ft 3.14 m L= 83.6ft 25.5 m � I typ. obs. pipe A X B refers to absorption cell width and length (anchored securely) J = upslope width I = downslope width K = end slope dimension 6" (150 mm) T MOUND CROSS SECTION T!! cap D = 12.0 in 30.5 cm lateral topsoil G H E= 1472 in 36.1 cm invert 95.2 ft F = 9.9 in 25.1 cm elev. 29.02 m see note "F G = 12.0 in 30.4 cm H = .0 in 45.6 cm D E ASTM C33 18 Sys. 94.7 ft Sand Fill elev. 28.86 m F 93.7 ft contour 3% 28.56 m slope Nate: Absorption cefl medb viMi D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or WcMng ctnambws and pipe F = absorption cell depth as specified x Aggregate G = subsoil + topsoil depth at cell wall at right. eChamber H = subsoil + topsoil depth at cell center Designer notes: If aggregate is used, it is covered with code compliant material. Project: P. JAY RIVARD Plan I.D. Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption -cell Inch unds Metric Width (A) 1 6 Ift 1 1.83 Im Length (B) 1 63.0 Ift 1 19.2 Im Lateral specifications Number laterals 2 Holesilateral 16 hoes Lateral length 60.0 ft 18.3 m Perforation dia. 0.25 in 6.4 mm Lat. dis. rate 18.64 gpm 1.2 Us Sys. dis. rate 37.28 gpm 2.4 Us Hoe spacing 48 l in I 121.9 cm Lateral diameter Pipe diameter aesW options D—on dace Designer must 1)nrz5 mm Place X in red 'PC" one choice 1 1 /4in/32 mm box of chosen from the options 1 1rzuv4o mm X X diameter. provided. 2WVW mm X 3005 mm X Manifold diameter Pipe diameter Dougn options Design deice Designer must 1 inrz5 mm X" one choice 1 it4irum mm Place X in red frorn the options 11 ran/4o mm X ban of chonn provided. 2in50 mm X x diameter 3inrl5 mm X 41 mm X Distribtdion system contains 2 lateral(s). LATERAL DIAGRAM - END CONNECTION Place correct lateral dagrem by ticking in one of the drewings at right and drergging the dogrem irito this area. Laterals centered oval dimension Last fide drilled nerd to end cap cap P AN laterals are identical X —#I Holes drilled on the bottom of the lateral -pa%spaced S • Force main connection via tee or cross to mw*M at .my per. Laterais & farce main of PVC Soh 40 • = permanent end marker (per MAM Table 84.30 -5) Inch -pounds Metric Lateral length (P) 60.0 ft 18.29 m Lateral spacing (S) 3 ft 0.91 m Manifold length 3 ft 0.91 m Hoe diameter 0.25 in 6.35 mm Lateral diameter 1.5 in 40 mm Number of holes per pipe 46 Invert elevation of laterals 95.2 ft 28.92 m Project: P. JAY RIVARD Plan I.D. Page 4 of 7 i Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = .60 ft 2.62 m Are laterals the highest point in the Friction loss = 1.62 ft 0.49 m system? Yes "x' here. Total dynamic head = 13, 47 4.11 m If no, what is the highest elevation Dose Volume dovimstream of pump? Lateral void volume = 12.7 gal 48.1 L Force main drain Minimum dose = 127.0 gal 480.7 L bac to tank? (" k' one) Drain back = 12.2 gal 46.2 IL x Yes Dose volume = 139.2 1 526.9 L No Typical Pump Chamber Layout In combination with state approved treatment tank. Tank constnxtion as per Comm 83.20(3) WAC. approved manhole coves weather proof FL wh aming label and padlock j ee levels box "� g ' grade levels J quick disconect W alternate 4' vent pipe electric as per NEC 300 and �� outlet Comm 16.28 WAC \ location ` 18" (48 cm) min. 1 wall of pump approved chamber or outlet combination �� //� joint tank ) A 114" vveep Grade levels alarm on hole as pump tank manhole = 4" min. above fiNshed OnWe pump on B rMessary pump tank man = 100 mm min above tirishedgieds C verd = 92" min. above Mshed grade pump 86.6 ft � v«t _ 300 mm min. above fadshed grade off elev. 26.4 m �— D 3 " (75 mm) of bedding under tank and anchor tank as necessary 85.7 ft Pump tank elevation 26.1 m bottom of tank Tank specifications: WEEKS Pump tank = 19.21galfin Pump tank volume = 800 gal Capacities: Inches Gallons A = 24.7 470.4 Pump manufacturer: MOULDS B = 2 38.1 Pump model number: WE0311 L C = 7.3 139.2 D = 8 162.3 Project: P. JAY RIVARD Plan I. D. Page 5 of 7 Curves Pumps ? ,4 7 METERS FEET 1a0 - MO DEL 3885 -1S12E /4 Solids i ( - - -- - - 70 ?V WE10H — t 5 50 �- WEOSH - - }— w - -- - t 10 30 wEaJM --j- - 20 WEOJI - - - -- -r— -j - -- - —� - 1 0 0 0 10 20 00 4p w 60 70 60 SO 100 110 120 GPM I I p 10 ?0 50 m'/h CAPACITY PUMPS, I NC. '' a,_._J Siff.: •�., ,: K, �.�., METERS FEET 120 MODEL 3885 35 T_ SIZE 3 /4 " Solids 00 BO - 7q I� r, —Y- ? l 1 T- -- -1— - WE05HH �7 30 t0 _ - 20 r _ 10 0 10 20 00 40 50 W 70 60 W 110 120 GPM 0 , o 30 m l/h CAPACITY •19" OwI Pvmpb. Inc. LAKUw jury, IYOA C)11+I� I - {seal_✓' -- �I I I s J9 _ _ — __ spa O: I I I I -} lop f f -- f ' I Aw , I 1 : Wisponsin 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Pj"Oel formation. R viewed by D Personal information you provide may be us,Rd. * , Gndary purposes (Privacyl.aw, s. 15.04 (1) (m)). Property Owner f 9lC r f'i"i Property Location �' ! Govt. Lot 1/4 1 /4,S T N,R (orN Property Owrf6es Mailing Address {.., Lot # I Block# Subd. Name or CSM# T - v4 City Stat p ode C;tBftgq�rq Numb Nearest Road i .�6tln! ❑ City ❑ Vil ge Town c New Construction Use: Res, e er of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _� gpd Recommended design loading rate bed, gpd/ft !�2_ trench, gpd /ft Absorption area required — bed, ft 7 trench, It Maximum design loading rate bed, gpd /ft � trench, gpd /ft Recommended infiltration surface elevation(s) 9 7 It (as referred to site plan benchmark) Additional design /site considerations o - Parent material � 4 /L ItC ' 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 El JR U S El ❑ S ®U El 1Z U CIS E0 U ❑ S ® U SOIL DESCRIPTION REPORT Borin g # Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench .417 lk E e Ground I elev. ey. - � � ' ft- s Depth to limiting facto i �in. Remarks: Boring # 5d kit, 625; Gez' A � cj S r r 6 Ground — /'' Abf elev. O ft• Depth to limiting factor / .�3_In. Remarks: CST Nam77 Print) Signature / — Telephone No. 3 X &- Address Date CST Number r ev SOIL DESCRIPTION REPORT PROPERTY OWNER ,'J�,�o Page of PARCEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Rood in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground _ elev. �ft. Depth to limiting factor Remarks: Boring # 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 # ; I Ground elev. ft. Depth to limiting factor in. Remarks: Boring # _M �Ha......, Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R.9/98) / ,6AA)c.</ /� off' /s�� r� - ,E! AV,I ' , CJ,�•c/C� /�,i1•l��of 75� ®T' � /`'rn /�OS7 � /� -��J�Y / �/� �.2/ e -222 7 y , ,gin 1 vJ ®sus '� o ? ry •i a / So 3a0• JUL -28 -99 09:45 PM BELISLE EXCAVATING 7152473038+ P.02 ST CROIX COUNTY i SEPTIC TANK MAINTENANCE AGREEMENT AND C !> •;' -!' a,i.., OWNERSHIP C1rRTtFICATIaN FORM r.� Owner/Buyer lG J. I Vo2ad Mailing Address c y g mey�_ - Property Address o O (Verification required from Planning Mpartinent for now construction) � 1 :y CitylState S �OT Parcel identification Number A .7 " ® 00 R CYF Property Location '/. ' Sec, T._RLN-R_jg W Town of .�� �y( A Subdivision , Lot # Certified Survey Map # 34-0 , Volume g 3 pag 3- Z04 Warranty Deed # 113 , Volume 075 . Page # Spec house Q yes Ono Lot lines identifiable yes O no SYSTEM MAINTENANCE �r Improper use and maintenanccof your septic system could result in is premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system i can affect the function of the septic tank as a treatment stage in the wasic disposal system. i ` The properry owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master lumber, ourne man lumber, restricted lumber or a licensed p umper verifying that the on -site wastewaterdis sal System P J Y P r P P Y g l () Po Y " is in proper operating condition and/or (2) alter inspection and pumpinr (if necessary), the septic tank is less than 113 full of stodge. iiwe, the undersigned have read the above reyuwrcrncnts rnd agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the De trtment of Natural Resources, Static of Wisconsin. Certification ' » stating that your septic system has been maintained must be completed and returned to the St, Croix County Zoning Office within 34 k> « �• , of the thre year oxpiration data .i,N• 1 Vl . SIGNATURE OF APPLICANT DATE Utz OWNER CERTIFICATION I (we) certify that all statements on this form arc true to tlic best of my (our) knowledge. I (we) am (are) the owner(s) of Bribed above, by virtue oi' a warranty deed recorded in Register of Deeds Office, SIG N ATURE OC APPiJCAN1 DATE "> • "•'• Any inforrntttipn that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •••••• •• include with this application; a stamped %varranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed TCLAUNI DEED R1 INFORMATION DOCUMENT NO. QUI 1-:13 8 72 s TEr,"S C. C ROIX Pamela D. Trice quit-claims her 1/4 venders' interest in the lajid contract recorded in F `C the St. C roix Cou: Register of Deeds on January 3, 1993 in Volume 988, Page 338 MAR 2 2 1996 as Docrunent No. 493598 by quit claiming a 112th interest each to Patric J. Rivard, 9:30 A. Joseph Ri iiii and Price S. Rivard the following described real estate in St. Croix County, State of Wisconsin: d Doi, �3 ................ RETURN TO: Bakke Norman, S.C. RPkk%_nT' W I Tax Parcel No: North 1 A of the Southeast !4 except the North 4 16.5 fee( and the North of the Southwest '4 of the Southeast Si all in Section 17, Township 31 North, Range 19 West. A This is not homestead property, Ffl? Dated this i day of 1996. (SEALI SEAL) i0i D. Inc: ___(SFAU Si'allature(s) of AUTHENTICA HON AC S FA FE OF WISCONSIN S 1'. CROIX COFN rY authenticated this day of Personally CAII)e hCUON lile this d3% 1 A Y: 1996 , the above n. Pamela D. Ince TITLE MEMBER STATE BAR OF WISCONSIN (It not, authorized by § 706.06. Wis. Slats.) known to he the permni__ who executed the tore instrument and Acknowledged the same. THIS INS fPUNII WAS DRAFTED BY: A BAKKE NORMAN, S.C. BALDWIN, WISCONSIN 'A 'v* Notary Public: County. Wi-wonsin * Names of per.Nons signing in any capacity slivuld be typed or printed below their signatures. My corilnas�ion is permanent. (If not, state expiration date: I J, I . • 3c,� y �✓ FORM NO. 985-A -- QFiG111im •`; Stock No. 26273 D ,\ 13 � L Ep 2 G08058 'c►�.`M CERTIFIED SURVEY MAP NO. 3704 L VOLUME 1 3 , PAGE 3704 Ln BEING A PART OF THE NORTHWEST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 17, TOWNSHIP 31 NORTH, RANGE IS WEST, TOWN OF STAR PRAIRIE. ST. CROIX COUNTY. WISCONSIN. East line- S.E. 1/4 S00' "E I I ' I I r I I v I J North is referenced to the north- I I v � 0 south 1/4 section line, which is J CL vi o assumed to bear N00'05'10 "E. I 1 o --I ss' J 4) m e I I ° !F I I f OD C�� of l c�c n UOO NI N IfV dN v 1 * I C . 4 z I • . J O '' o :oz _ CD I > I 1► N ` v im.: ° x W< ,ogvi �' a IN �,, c\ 7 3 ��• f' �1`u • NI W rN N O o� ai 7 +' c 44 � � /� ••• •••� I J O Z U cV C> a E o a'� �ii l • rte •• • �p'����� J W I ��' 04 CW'� x E o v, �un�uiumull��l\v \ \`� I W Q v E° I U b \c :E v d J W I v) O E o, cow :: I I C7 (A 3 0 - - 6 3 >1 I J 0 0 vm c z I 1_ �. at E Unplatted Lands I I `r 0 „ CX , - - - - -- J I c O w I> c I I �'a W I I Z ° o I` 0 S00'05'10 "W I I ;° C F 0.00' ° I� ° b I CV 00 v► E o f W 6 3 66.00' z I E o J I t0 00 *co- N01'49'24 "E C O w O o ` � � N , 00N o'm DI N OOM a �I ��," 4. v c I Z �I �Im � z� n CD aS D >Y o m s "w 250.00' s00• "w ^ `` 0 00 U 3055.57 N00'05'1 0 " 1979.63' —�`- IL oco north -south 1/4 line n ; J w t a CEDAR CORPORATION C.S.M. Vol. 5, Pg. 1232 — — — — — — — — — 604 WILSON AVENUE MENOMONIE, WI 54751 (715) 235 -9061 PAGE I OF 9 VOL. 13 PAGE 3704 -- FORM NO. 985-A FLC TMNv Stock No. 26273 CERTIFIED SURVEY MAP NO. 3704 VOLUME 13 , PAGE 3704 BONG A PART OF THE NORTHWEST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 17, TOWNSHIP 31 NORTH, RANGE 18 WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. SURVEYOR'S CERTIFICATE I, Steven J. Waak, Registered Wisconsin Land Surveyor, hereby certify that I have surveyed, divided, and mapped a parcel of land being a part of the Northwest 1/4 of the Southeast 1/4 of Section 17, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, and more particularly described as follows: Commencing at the North 1/4 corner of said Section 17; Thence S00'05'10 "W along the north —south 1/4 Section line of Section 17, a distance of 3055.57 feet to the point of beginning; Thence S88'10'36 "E, a distance of 320.00 feet; Thence S00'05'10 "W, a distance of 250.00 feet; Thence N88'10'36 "W, a distance of 320.00 feet to the aforementioned north —south 1/4 Section line; Thence NOO'05'10 "E, a distance of 250.00 feet to the point of beginning. Said described parcel contains 79,963 square feet, more or less, or 1.84 acres, together with the following described ingress and egress easement: Commencing at the North 1/4 corner of said Section 17; Thence S00'05'10 "W along the north —south 1/4 Section line of Section 17, a distance of 3055.57 feet; Thence S88'10 36 " E, a distance of 320.00 feet; Thence S00 0510 " W, a distance of 250.00 feet to the point of beginning; Thence S81'27'38 "E, a distance of 2305.40 feet to the east line of the Southeast 1/4; Thence S00'29'01 "E along said east line, a distance of 66.83 feet; Thence N81'27'38 "W, a distance of 2312.00 feet; Thence N88'10'36 "W, a distance of 62.13 feet; Thence N01'4924 "E, a distance of 66.00 feet; Thence S88'10'36 "E, a distance of 66.00 feet to the point of beginning. Said descibed easement contains 156,602 square feet, more or less, or 3.60 acres. That I have made such survey, land division, and map at the direction of Mr. P. Jay Rivard, Packaging Technologies Inc., 1618 Altoona Ave., Eau Claire, W. 54701. That such map is a correct representation of the exterior boundaries of the land surveyed, and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, Chapter AE 7 of the Wisconsin Administra— 'vi 9 Y tive Code, and the subdivision regulations of St. Croix County, in surveying, dividing, g, and mapping the same. Said survey is subject to easements of record, and as shown. Dated this day of �aE ,1999. ", ..� Steve J Waak R.L.S. 1610�y ST EVEN wAAKJ a ' 3 -1610 MENOMONIE ; Q,� 1119 •. wis. , p IL I gin" CEDAR CORPORATION MENOMON� VOL. 13 PAGE 3704 AVEN I 54 1 2 2 �714� 235-01 PAGE_OF = O � W O V c i cn N CD f i V �\ r C .� O i 1 �J to o t d o ` Ww / . a� t � w• Q6 2a- 89 RED 15:22 Fa.Y 219 825 3050 Holly Park. Inc. 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