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HomeMy WebLinkAbout002-1020-40-100 1 Q a rr . O ti a 0 b I N U I i O I !r r tli O i C z L O LL O Q I 0 z w E z = °o c Z CF) > � a m ° C%4 c>n c 0 6 o z N z E � M a 1y 4 7 O m 11 O Q Q w Q z z o N m ; cv Q "Its N M � N w a 'M ` x LO L No rn m L O G o st a �� N N h w ¢ o Nw.J z > 0 0 0 *� Zoo •tea °_'aaa IL >` 0 0 00 co (A J U 7 001 a) O N N } N N m N O zs? a.1 N CN N n a ¢ z @ rO+ O O O N c c o a c E v D C O N m c -0 O O O l �D N c2 N E N N N O M O C D1 3 c q N - O F - N r r ►.1 N N 'O c ti - L co 0 M O z z -5 UA r w it O 4. . a 'u ' d a i 'c _ o 0 3 2 o G Ua� 0 cnc� Parcel #: 002 - 1020 -40 -100 03/26/2007 11:04 AM P AGE 1 OF 1 Alt. Parcel #: 10.29.16.138A 002 - TOWN OF BALDWIN 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 - CONNETT, ANNETTE & JASON R ANNETTE & JASON R CONNETT 1069 245TH ST WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1069 245TH ST SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 10 T29N R1 6W PT SW NE BEING LOT 1 Block/Condo Bldg: CSM 1213433 2.00AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 10- 29N -16W Notes: Parcel History: Date Doc # Vol /Page Type 05/15/1998 579176 1323/522 WD 10/09/1997 566677 1269/326 WD 10/09/1997 566676 1269/325 WD 07/23/1997 880/36 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 25,100 191,900 217,000 NO Totals for 2007: General Property 2.000 25,100 191,900 217,000 Woodland 0.000 0 0 Totals for 2006: General Property 2.000 25,100 191,900 217,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Z Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarystrT19 %. P e r sonal i you provice may be used for secondary purposes [Privacy La R s.15.04 (1)(m)], Permit Holder's Name: I ❑ e Town of: State Plan ID No.: CONNETT , JASON �� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tfy ft;.1U20- 40_000 _ TANK INFORMATION ELEVATION DATA A9800177 ��7 4 , A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. �nC Septic ?Cal Benchmark 6 Dosing Aeratio Bldg. Sewer /d (O� 90, Holdi St. / x f Inlet ? TANK SETBACK INFORMATION St 1Y Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic Z� 7 NA Dt Bottom Dosing NA Headw / Man. 3 '�� 9 73 Aeration NA Dist. Pipe 3,3d' �7 F` Holding Bot. System PUMP ' /SIPHON INFORMATION Final Grade Manufacturer Demand rn ye Model Number GPM TDH Lift �/ Friction Syste �J TDH�� 1g Forcemain Length Dia. Z� Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA G a u SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (I clude code discrepancies, persons present, etc.) f7 . � ( l l3ib ° � OCATION: BALDWIN 10.2- g.16.138,SW,NE 1069 245TH STREET V� � d v Plan revision required? eyYes []No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No- i s ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: V iscons i n SANITARY PERMIT APPLICATION 20 E w shn�gtonAve sion P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only)_ for the system, on paper not less County than 8112 x 11 inches in size. - • See reverse side for instructions for completing this application State sanitary Permit Number y ou p rovide may be used b other government agency programs 30 (425 Q The information y P y y g 9 y p q ❑Check if revision to previous apple n [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 70 Property Owner Name Property Location a 1/4,gf 1/4, S T A,? , N, R E (or Property Owner's Mailing Address Lot Number Block Number Ci y ate I Zip Code Phone Number Subdivision Name or CSM Number l / / �6 ( eS) - Sfil G S ? 11. TYPE BUILDING: (check one) ❑ State Owned C it Nearest Road El Public 1 o r 2 Family Dwelling - No. of bedrooms rs v o w a n OF ai CJ'r' 'Y5�7` III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) A 00 — 112 — y O 1 F1 partme t /Condo 2 ❑ Assembly Hall 6. ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify, IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. CENew 2 ❑ Replacement 3. E] Replacementof 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System_____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [4Mound 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 -FiI] 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 y 6-0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 1975 275 r 3 �C` Feet , l Feet TANK Capacity VII. INFORMATION in gallon Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper_ New Existin Gallons Tanks Concrete strutted glass App. Tanks Tanks eptic Tank Q i B C Y ❑ ❑ ❑ ❑ ❑ POmpTank G Q �a ��' ❑ ❑ 11 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) // Plumber's Signature (No Stamps) Business Phone Number: i Q ChU �z dLIle Plumber's Address (Street, City, State, ZiV Code): 6 S fP Id Af u 6� v IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Iss g A nt Signature (No Stamps) XAp proved surcharge Fee) �1 � I ❑ Owner Given Initial �qro � I D 9 Adverse Determination VVVV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBDMW (R.11/96) DISTRISUTM: Original to County. One copy To: Safety & Wirings Oivfsion, Owner, Plunber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable.. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questior:s 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: Property owner's name and mailing, address. Provide the legal description and parcel tax number'_,) of where the system is to be installed- 11. 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. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 Visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary April 06, 1998 CUST ID No.267341 ATTIC• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL Transaction ID No. 70618 APPROVAL EXPIRES: 04/06/2000 a . SITE: Site ID: 4255 ST CROIX County, Town of BALDWIN P L�� °/ � SW1 /4, NEIA, S10, T29N, R16W JASON CONNETT _ ' °`' FOR: t ," `5 "' CROI z> OUN Description: MOUND ZONING OFFICE Object Type: POWT System Regulated Object ID No.: 9832 The submittal described above has been reviewed for conformance with applicable Wisc.. Codes and Wisconsin Statutes listed in the regarding line above. 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: • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, f DATE RECEIVED 04/03/1998 FEE REQUIRED $ 180.00 BARD M SWIM , POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JSWIM @COMMERCE.STATE. WI.US Page of 6 MOUND SYSTEM . FOR RECF'!,:r"T A 3 BEDROOM RESIDENCE APR _ SAFETY & ftuu o. DfV. LOCATED IN THE 1 /4 OF THE 1/4 OF SECTION 1 tj ,T Zq N, R 1 b W, TOWN OF B 1N , sT c V_ COUNTY, WISCONSIN. INDEZ PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER ' PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR �PrSOrV COtJN ic'TT" aoX � zZ 5 ooZ 6 7 %a PREPARED BY WEGEE�ER SO !_ TEST S NG mss, #low" INN AND. DES I GN SEF;ZW I CE ��s ® S'/ P.O. BOX 74 421 V. KAIN ST. ARTHUR L RIVER FALLS. YI 54022 W EGERE 4 0-915 p VV 715 -4� r-0ib5 BuswoR TH, W • Coltditionally P 4 DEPARTMENT OF COMMERCE *00949662,11 DIUI OF ;FEI BUI LDINGS 3 - z SEE GOR NDENCE JOB NO. 913 - PLOT PLAN • Page 7 - of b Scale 1"= yQ ' C P;-1z! L t wi_% \ 1 O `C k 1 k l L 'Cp 3 E PrT U Sk' fir► Z S ' F12.0M 1 I -� �O0F 5 V) N - - -- a.� I z I 1 i 1 3o la oe � N � �P� � � I i 5- 1 1 801 p 1 of S ,,C1} at ab. b j 3 S.3 qS I °lS' o Ct 0.4 i d BMZ 1 1 I - r - -- � ;= vTL\Lk LOT \_)&C e NOTES : et9 S S S holy ""_)b . •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. - Septic tank to be Ntou 16So gallon capacity manufactured by C�fZecetsT, 1 N c 5. Bench Marks Qrj W 1- fit.. ao. o` c i j ruM` ►N ''il�E 6. Divert surface water around system to prevent .ponding at the uphill side. Page 10f Approved Synthetic Covering 1�3 C 33 Distribution Pipe Medium Sand _ Topsoil - ti F Elev - -� p 3 E b 3 % Slope Force Main Plowed Trench of 2" -2.1,2" From Pump Layer Aggregate Undisturbed D `•�) Ft. Soil E V\5 Ft. Cross Section Of A Mound System Using F C •-6 Ft. I Trench For The Absorption Area G N.a Ft. A S Ft. H i- S Ft. B 1 S Ft. I NS Ft. Linear Loading Rate= 6 D GPD /LN FT j 8 Ft. Design Loading Rate= 0.3 GPD /SQ FT K NO Ft. 1�1 }},�, ��.,,�., �, {� ��{{..��� L p S Ft. M-I.S.JG+' ate— Pa s4 - i i ,.� C..,. ee M, ' W G. S Ft. L Force — — — — t3.. K Ma A W Distribution Trench Of Pipe Aggregate 1 1 Observation Permanent Markers Pipes (Anchor securely) Mound Using 1 Trench For Absorption Area i Page Of Perforated Pipe Detail 0 End View Perforated End Cap.) PVC Pipe o� ° � as' Install permanent at end of each lateral Holes Located On Bottom, .� Are Equally Spaced Q End Cop * S PVC Force Main Distnoution Pipe Lost Hole Should Be Next To End Cop Distribut P La y o ut P -�S`4 S Ft. X 3 Inches Y 36 Inches Hole Diameter Inch Lateral V/y Inch(es) Manifold Inches Force Main Z Inches # of holes /pipe IZ. Invert Elevation of Laterals 0 1 - 1•1 Ft. tit, X.-1• \'1= 1q't3( kZz ze.U$ G Place lst hole � from tee with succeeding holes at 36" intervals. Last hole to be next to the end cap. Combination Sept- c-7 Tank and PUMP CHAMBER CROSS SECTIOIJ ARID SPECIFICAMMS PAGE S OF (� -VC IJT CAP WEATHER PROOF ju&JCTloLI box H'C.I. VEhIT PIPE APPROVED LDCKIR.IF. �!. 10' FROM DOOR. MAQHOLE COVER 41l .JINDOW OR FRESH wARtJIfJG LaBEI.. ALR INTAKE S coupv�T � F I ID Mlu. . ll` y "uasPetnora PIPE PROVIDE i — - -- IAJLE T "� AIRTIGHT SEAL 8gPrFuss 1 1 1 APPROVED JOIIJ APPROVED JOINT A W C.I. PIPE OR I ill wjC. PIPE�C'I'� / Tank construction i III ALARM shall comply with ILHR ('33.15 and 33.20 I I OW C I 1 CLEV. FT. PUMP —` - -� OFF 0 COUCKETE BLOCK 3" APPRO"= RISER EXIT PERMITTED OWLtJ IF TA►JK MANUFACTURER HAS SUCH APPROVAL %LVOINC SEPTIC f SPECIFICATIC)US DOSE IE J� MUMISER OF DOSES: 3 PLIL DAB Tt,1,J►( MAfdUFACTU0.1`R: TAWK 51ZE: 10Ub 1 6SO GALLOWS DOSE VOLUME e ALARM MAUUFACTURC.R: S•S• tLmlZ0 S Tr !s IAICLUDING D ACKFLOW' S 3 GALLONS MODEL DUMBER: 1 Ok NW CAPACITIES: A= ° INCHES OR Db GALLOWS SWITCH TYPE: M B= Z IUCHES`OR =!._ G�LLOUS PUMP MANUFACTURER: C= / WLHES OR \ 5 � GALLOWS MODEL HUMBER: 3g7 D= 9 WCC OR S � CALLOUS SWITCH TYPE: � C CI MOTE: PUMP AMD ALARM RC TO 6C 6 MIMIMUM DISCHARGE RATE Z$'ug GPM INSTALLED OW 5EP A RAT1 CIRCUITS VERTICAL DIFFEKEMCE OETWECN PUMP Off AUD.DISTRIBUTIOU PIPE.. \3 _ 'S FECT + M #IETWORK SUPPLY PRESSURE , , , , , . , , , . . 2.50 FEET + FEET O F FORCE MA K , ' 6 L F � FKICTIOL FACTOR__ 1 ' \4 S FEET f00 f[. .1 --� TOTAL DyIJAMIC HEAD = ��' 30 FEET Pump chamber DIAMETER — IUTERNAL DIMEWSIO1J� Of TAUK: LEAIGTN ;WIDTH — ;LIQUID DEPTH • — - - GAL BOTTOM AREA 231- - INCH / AS PER MANUFACTURER = GAL /INCH I Goulds Submersible 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 • Farms Motor: manual operation. Automatic and float switch attachment • EPO4 Single phase: 0.4 HP points. • Heavy duty sump 115 or 230 V, 60 Hz,1550 � mode include Mechanical • Water transfer RPM, built in overload with Float Switch assembled and 01 Power Cable: Severe duty • Dewatering preset at the factory. rated oil and water resistant. automatic reset. ■Bearings: Upper and lower RP 115 V, 60 Hz, 1550 RPM, SPECIFICATIONS • EP05 Single phase: , FEATURES heavy duty ball bearing construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • 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. SP- CanadianstandaNsAssocNon • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo- • Discharge size: 1 NPT. plug. Optional 20 foot p (CSA listed model numbers • Mechanical seal: carbon- length, 1613 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140OF (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running €' dry without damage to s 30 - components. Pump: EP05 a • Solids handling capability: c 25 %* maximum. a 7 • Capacities: up to 60 GPM. = i • Total heads: up to 31 feet. - 6 20 i • Discharge size: 1 NPT. z 5 , 30 • Mechanical seal: carbon- 0 15 rotary/ceramic- stationary, a 4 BUNA -N elastomers. o • Temperature: *- 3 10 104 °F (40 °C) continuous Ze • og 140OF (60 intermittent. 2 5 1 0- 00 10 20 30 40 50 GPM It ,. L L 0 2 4 6 8 10 12 nWh CAPAC11 Y 01995 Goulds PMM Mc Eftec" may, 1995 83871 Wi sconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page 1 of Division of Safety and Buildings ran dlocation dwe th s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not leCCs 'n size ' Plan must County include, but not limited to: vertical and hF..( M), direction and �' J percent slope, scale or dimensions, nort d distance to °nearest road. Parcel I.D. # RCO� APPLICANT INFORMATION - P 60h. -'f R i ed b Date Personal inform y be used fo s information you provide may eda Ot1M ' � r�pyf Property Owner *, j. ' `� Property Location I ' ' Govt. Lot 5 60 1/4 1/4,S/ T. N,R E o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number earest Road ❑City El Village � Town N EN New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate S bed, gpd /ft 61 ' trench, gpd/11 Absorption area required bed, ft _ trench, ft Maximum design loading rate j bed, gpd/ft2 _<5 trench, gpd/ft Recommended infiltration surface elevation(s) !Ff 46 ft (as referred to site plan benchmark) Additional design /site considerations e dw - fo ,Y' t7s, 4cr Parent material . ,C_ c' / c)gle4la5,� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system El S ® U rX S ❑ U ❑ S ® U ❑ S ®U ❑ S I EIS U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed ,Trench o, �' S' / mgt, if ,c' C 5 .2 f is-it 2 .ra b it yN F Ground .� r- /d .s' !v e Depth to limiting factor Remarks: Boring # t 6-16" F CS' S . G 3 7 "'1'0 j.4 S e j d /6 VR51f :5 :2 M 4 e r S G Ground glev Depth to limiting factor a_�_in. Remarks: CST Name (Please Print) Signature Telephone No. i a. A" S'c u m �e 1/, Y lrJ��� � 7t' P� .71.9 / Address Date CST Number l 7 d ? 1 SOIL DESCRIPTION REPORT J ` PROPERTY OWNER Page � of 3 PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground 3 , .3G 16 Yv S C. U Il elev. 9 K- _ 70 ft. Depth to limiting ; factor l in. Remarks: Boring Ground elev. ft. Depth to limiting facto( Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ae Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) ,�Jdr> P � =:N� �� � �'—' J �� �. � ! � rt �` �� " � a. �, I Z � O 2; � t� r' O� �. n T , y n n , �; o ~i � r f n � � Z p '� �" �, s � � � � i y � r 1 r � K � h �o � ` c �. m M1 y r o, o �. � � � _ - _ _ YI 5 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND --� A yw ; � OWN ERSHIP CERTIFICATION FORM Ow=03uyer �Ia�SUUl1 £i 4p' � Mailing Address `�D Q� 22 wt n w �, '`7D ©2.. ll�Ca �l Property Address XXX 5 (Verification required from Planning Department for new construction) City/State W �( r(4 I / Parcel Identification Number [�D — I p� C� � W '4 Q__ LEGAL DESCRIPTION Property Location 5 VJ '/., . •. Y., Sec. f , T ,N -Rj W, Town of 1I C� 1N n Subdivision . Lot # Certified Survey Map # 5 . Volume I Z . Page # 3 Warranty Deed # 579 /7ZO . Volume Page # Spec house ❑ yes *no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its 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 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 owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 4wrf the three YeQ expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on am true to the best of my (our) knowledge. I (we) am (are) the owner(s) of operty descri ve, y v' a of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE « « « « «« Any information that is rnis- ed y result in the sanitary permit being revoked by the Zoning Department « « « « «« #« 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 J D" 579176 �0L �3? 3oAcE522 . State Bar of Wisconsin Form 3 — 1982 QUIT CLAIM DEED DOCUMENT NO. ST. CROIX CO WI James A. Harer and Kay L. Harer, husband 8 for IRsaoird and wife MAY 15 1998 quit- ctaimsto Annette Connett *and Jason R. 10:30 A. M Connett wife and husband, holding as O,ILi, survivorship marital property Re i t of IHeds the following described real estate in S C rn i x County THIS SPACE RESERVED FOR RECORDING DATA State Of Wisconsin: NAME AND RETURN ADDRESS FIRST NATIONAL BANK OF BALDWIN 990 Main Street j Balld'win, WI 54002 002- 1020 -40 (Parcel Identification Number) Part of the Southwest Quarter of the Northeast Quarter (SW4 of NE4) of Section Ten (10), Township Twenty -nine North (T29N), Range Sixteen West (R16W), Town of Baldwin, more particularly described as Lot One (1) of Certified Survey Map filed March 31 , 1998, in Volume 12 of Certified Survey Map at Page 3433 , as Document No.576089 , Office of the Register of Deeds for St. Croix County, Wisconsin. Subject to a right of first refusal in grantors, or the survivor of them, for a period of thirty (30) years from date hereof, as evidenced by an unrecorded Agreement in writing between the parties of even date. 8 FEE PXEMPr"""" This is not homestead property. VS4 (is not) Dated this 1 3th day of M 19 _9$. (SEAL) (SEAL) James H ,, a \\ r (SEAL) j . ; A °t��•�`-� (SEAL) I * Kay L Harer I AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN Ss. St. Croix County. authenticated this day of 19 Personally came before me this 31 day of May _ , 19_9_$ the above named James A Harer and Kay L. Harer, husban and wife _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person S who executed the foregoing i strument a acknowledge the SRaEN H. PERRY THIS INSTRUMENT WAS DRAFTED BY Notary Public -State Of WWOrWn Thomas A. McC ormack --------- - - - - -- - - - -- * Steven H. Perry B aldw.in,___W1_54.002 - - - --- _ ..... -- .___ - -. - -___.- Notary Public __ S CrC!1X -- - -!_ -- County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) -- September 20 19. -98- ) *Names of persons signing in any capacity should be typed or printed below their signatures. QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 3— 1982 Milwaukee, Wis Nil 576089 Al s CERTIFIED SURVEY MAP t FILED 9 MAR 3 1 1998 LOCATED IN PART OF THE SW1 14 OF THE NE1 14 KATHLEEN H.WALSH OF SECTION 10, T29N, R 16 W, TOWN OF BALD WIN, Register of Deeds ST. CROIX COUNTY, WISCONSIN. St.Croixco.,WI I OWNERS 1 N1 /4 CORNER JAMES HARER Nz SECTION 10 1061 245TH ST. WOODVILLE, WI 54028 0 w F= 3 w o0 O u)� 0 PARCEL__IN o ° ° o V. 876, PG. 100 OM ---------------------------- Li Z N 1 " IRON PIPE FOUND � Q I `� N I S "W, 0.61' uj�m z FROM COMPUTED CORNER W F O N 86'38'37" W 26$.06' < won 0 33, 235,02' Fr ¢ I NORTH LINE OF THE SW1 /4 OF THE NE1 /4 w O o N m z ..- i 1 f LOT 1 o Z p ~ I o 2.00 ACRES INC. R/W I W I ° 87,012 SO. FT. N WI N G I C ry I M O u, Lv I I 1.75 ACRES EXC. R/W t� 76,287 SO. FT. Z F- 1 Q Q 00 1 co w J z l O i O - O ._I O r , Z t \ ' Z 33' 33' z r:- 3 2 0/97 w w r 33,04' �ti,ad :235.02' co S 86'38'37" E 268.06' :It co nu;; aw void I '� 0 UNPLATTED LANDS 0 -------------------------------- S1/4 CORNER SECTION 10 LEGEND 1.68 L S. 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