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HomeMy WebLinkAbout006-1043-60-050 n(A O 0 to O 'a 0 r.. o d F C f c lu o c " ^" m o m 0' CD a lu 3 co 3 X a� cn Z 0 0 O co 7 n O O 0 O 0 N 7 � `G O O `1 �• n a c ° m a m- oN C o a) .. T tR N n G N (o N _.. O (D N 7 t N 7 W (D 7 7 c= 7 O d1 W / O O (D O n N (D N (D rD T D O O CL O O ro t. (D (7 61 O .� .,� !0 N O W p, o CA W c c (D o� a Z D m a - w < D (D O y Q (D :U CD y d N (O C p c ? N .. �.., N N N O (OHO N lo t O L .' j j O (�a. 7 o (D c D O (D 000 < fn o c 00 00 m CD a N 7 7 O O O o CD O O O o� g c m T m v GQ Z CD y O CD (D .. m I CD - ^ (A o K J 0 v A ° y y o D D o O o 0 c 7 a n ? �It • N � O CD ® (D C 0 (D CD o c N CD y �_ fn 7 7 C A Z n A Z CD G) .. Cl) O N W m m w o a CL z 0 3 0 3 Z C G 3 H y Z C CD ro w w p o 7 7 N_ N - O Z D n (D ZJ �. ? (D 3 D. N y O p0� _ CL O Nn 7 CL n C E O' 7 %+ 7 0(c 7 . O r. G oy o (D > >. Q ooro a. D - o a < �m v c ro m o 3 cu c 5D 0 v o' N cn O OZ a j N 7 7 C p Q' 0 w CD a m m y �3 CD O D O y N y �. ate= 3w a co r m o �' o 2. O c p 0 7= N ID a N N 7 o- < p � O . 3 C N C = (D O , C .-. y (D y N � 7 fC y O 0 ' O c N N P CD C. w O .Z7 C ro N C :3 0 vi nes a o EL V O� (D J N S A O o o 7 CD A ti < CD � fA 0 69 0 r ti O (D O (D 0 •. 0 ! y p ppp- Wiscn s n Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Vh_: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). N a MPi ( PAUL) [�C¢t� village E] Town of: State Plan ID No.: ARM" CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tdv�JO —:1043-60 -000 TANK INFORMATION ELEVATION DATA A9800613 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IMEN ION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: 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: (Include code discrepancies, persons present, etc.) LOCATION: CYLON 20.31.16.298,NE,NW ar ..210TH AVENUE VTV n L P� Plan revision required? ❑Yes ❑ No (� Use other side for additional information. I SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: I I . Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E- Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less Coun than 8 112 x 11 inches in size. - 621 , , 11 - • See reverse side for instructions for completing this application State Sanitary Permit Num er The information you provide may be used by other government agency programs ❑ Checll vvision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S/ Prop Owner Name property o ation L 4 �w 1ia �va, S T j , N, R �G E (o� Property Owner's Mailing Address _ Lot Number Block Number Cit State Zip Code Phone Number Subdivision Name or CSM Number � ( =--- II. TYPE F BUILDING: (check one) ❑State Owned ❑cit Nearest Road _ ❑ illage / l -� l E] Public 1 or 2 Family Dwelling - No. of bedrooms own OF l•A •�tJ p? / 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Numb rW 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 w 2. ❑ Replacement 3 ❑ Replacement of 4 Xxisting econnection of 5_ E] Repair of an T3'ystem System Tank Only System Existing System ----------------------------------------------------------------------------------------------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 $Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit - 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSOR PTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L Required (sq. ft.) Proposed (sq. ft_) (Gals/day/so. ft..) (Min. /inch) Ele to 1 1 3 S� , ( , oe Feet f Feet VII. TANK Capacity, r in gallons Total # of Prefab. site Fiber- plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Exist in strutted Tanks Tanks Septic Tank k et "_3 - ❑ ❑ ❑ ❑ ❑ Lift Pump Tan er C >/ti I I ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plum er's N me: (Print) Plum er's Signature: No Stain s) P PRSW No.: Business Phone Number: 5 4-2 Z 1 7 S� Z S:av Plumb is Address (Street, City, St te, Zip Co S .�7 2 c) ti / z - t ozs - IX. COUNTY/ DEPARTMENT USE ONLY El Disapproved Sanitary Permit Fe (includesGroundw ate Issue Issui A ent Si nat a (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 116 lim R X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Divr ion, Owner, Plumber i I INSTRUCTIONS " 1 . A s a nitary 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 -3815. 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 clallons, numl , i_r of tanks and manufal(turer's name, indicate prefab or situ constructed and tank material Corr .Mete for a / /,,eptic, pump /siphon and holding tanks for this system. Check experimental approval only i f tanks receives: experlment�ll product approval from DILHR VIII Responsibility statement. Installing plumbe- is to fill in name, license number with appropriatr� prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. C_:r : ��`eif_ plans and specificati(-rls not small er than 8 1/2 x 1 1 i; ci e o `)e su i ted : - unty The plans must f�rilowing p'of (t +ail, drawn to scale (, vvith CGii.u1 u;'. 01 1:)ldinct tank(s septic _rP _! �.lt[ �t.'.t�IflgSf rv... V,..U_. ._...,�� _ ::, ,' - ,ar�te pOr slphon - v r•- _ , sc :x;?tion ; f lihe building served; ACSV'_t- ei e110E` point`, -) r, . _.t� `Ur Cott .). d."�e 01u,;Ie; .n�eS '� f: iC. >� p,:rrmp f',rr• - firm _. 'J�Vr p_.....it'' - . Ar`" .. ;MP .- 'i {)rc" turer; D. cress section C3i S t r -�,_1 b `� , J.. s_'. 'test d al-, ,ter? �. _ 31) slZing nformatlOn. .; _ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of reg;.elated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P "" C 9 1) Q CIOSd 1 0 A PTY Mailing Address �� }� DZ P.* ,, ajj S Property Address (Verification required from Planning Department for new construction) City /State D ( /�i�2 /� U ,Parcel Identification Number &W - /d LEGAL DESCRIPTION Property Location N i ::1 '/4, LW '/4, Sec. - , T t N -RA—W, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # S3 3 93.3 , Volume 3 Page # Spec house ❑ yes ;Kno 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 master plumber, journeyman plumber, restrictedplumber or a licensed pumper 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 days of the three year expiration date. ��t w / �, oJ4 -,.— / S% SIGNATURE O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. a 4 4Ad::1 - 12 11 SIGNATURE OF APPLICANT DATE * * * * ** Any infonnation that is mis represented may 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 CROIX COUNTY ZONING DEPAW MEMY AS BUILT SANITARY REPORT Owner Address ��o -F k- City /State r C Legal Description: Lot - Block Subdivision/CSM It '/• / '/, , Scc -.: T3 N -R - _L LL2W, Town of N PIN It OI:Yo �3 SEPTIC TANK — DOSE CHAMBER — BOLDING TANK INFORMATION: Tank manu facturer /96-eAU - �,S ize ST/PC /�y,/j�S a Setback from: House 1 z Wel l P/L Pump manufacturer �' �d- ate. Model .5Fw/ L-py 5( Alarm location _ ,a, r ,p (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width S Length ZY Number of Trenches Setback from: House -3j' Well 2,_ P/L JU r Vent to fresh air intake o73c9 ' ELEVATIONS Description of benchmark %y.� Il l Elevation 1" �-- Description of alternate benchmark Elevation Building Sewer ,2. 3. - 5 - ST/HT Inlet is ST Outlet V33— PC Inlet /,.% . Si PC Bottom /g; -. 76 Header/Manifold Top of ST/PC Manhole Cover 7 F 9 Distribution Lines ( ) ) ( ) Bottom of System( ) () ( ) Final Grade ( ) ( ) ( ) Date of installation 1 / / Permit number State plan number Z ?,.3 /7 Plumber's siguatur icense number ®�..Z / y' Date / / 8 Inspector /2y Comploc plo( plan •r NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW � �j V �v PA Qv Ito i INDICATE NORTH ARROW S N =' Wiscetisin Department of Commerce PRIVATE SEWAGE SYSTEM Count • Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 320231 Pe rmit RSON , ( PAUL) �Y�'ON Village Town of: State Plan ID No.: CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: b �� 006 - 1043 -60 -000 TANK INFORMATION ELEVATION DATA A9800420 IF TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S ptl c �/I .h 1rtC 1000 Bench d 1.3 1 �. 1 b a Dosi n M 'I.SD 1 11 - 7 f ( W _ Aeration Bldg. Sewer .6 Holding Inlet - 7 TANK SETBACK INFORMATION t ufE Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet 12• J �tj - /� Air intake e t �;L_! a NA Dt Bottom /s.7b osi ng ' � p � - f D � NA Header / Man. / 2 - 1c) 09.27 Aeration A Dist. Pipe Z Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade rv , Manufacturer 0a Demand �W4" Model Number P p e> ( y ..GPM TDH Lift Friction .l System2 TDH�, t Forcemain Length 7 Dia. H 1 Dist. To Well BSORPTION SYSTEM B TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type 0 , CHAMBER I Nu r Mci : Syste 3°I 70 3o OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s)� � I , � x Hole $i e ' ( x Hole Spa Vent To Air Intake Length _T_ Dia. Dia. Length � Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over N Depth Over xx Depth Of �� xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges I � Topsoil L➢g Yes ❑ No [JJ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 6exfd� /Y- j �- d LOCATION: CYLON 20.31.16.298,NE,NW 210TH AVENUE -�� All Yhob�� w-evJ n 5Pe,� We 9v-j 9 Iq -1 1 LH(-C ! !iaK4 �o-c-onrv-4 Plan revision required? ❑ Yes EErNo T] F Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a t 3 i, ST. CROIX COUNTY WISCONSIN ZONING OFFICE limp p p p p o ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 f - -- - ( 715) 386 -4680 September 28, 1998 Mark Anderson 2149 210th Ave Deer Park, WI 54007 RE: After the fact temporary occupancy permit Dear Mark: This letter is regarding the request to obtain an after the fact temporary occupancy permit on your property located in the NE V4 of the NW V4 of Section 20, T31N -R16W, Town of Cylon, St. Croix County, Wisconsin. The St. Croix County Zoning Ordinance per 17.70(3) requires a temporary occupancy permit by special exception to occupy a mobile home during the construction of a principal residence. There is no record in our office that such a permit was obtained. Our office received your application request on September 22, 1998 to temporarily live in a mobile home while you construct your house. This request will be heard by the Board of Adjustments on October 27, 1998. If the Board approves the request, they will establish a deadline for the removal of the mobile home. If you are unable to comply with this deadline, you must request an extension from the Board prior to the expiration of your original approval. Here are the steps to obtain an after the fact temporary occupancy permit: 1. Apply for a temporary occupancy permit by special exception. (Received on September 22, 1998) 2. Obtain a re- connection permit to connect the principal residence to the septic system from the County Zoning Office. (The mobile home must be connected to a approved sanitary system. Before the mobile home is disconnected from the sanitary system, reconnection permit will be required for the connection of the principal dwelling to the sanitary system. The current sanitary permit application must be revised to reflect the mobile home connection to the sanitary system. The county fee for the reconnection is $1l!9 ®. ) 3. Secure a building permit from the township for the principal residence. If you have any questions regarding this issue please contact this office. Sincerely, Rod Eslinger Assistant Zoning Administrator cc: Town of C Y lon Kermit Thompson file Safety and Buildings Division vLriA SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �/ than 8 1/2 x 11 inches in size. �J�'-� - /'D • See reverse side for instructions for completing this application State Sanitar Permit Number The information you provide may be used by other government agency programs ❑ Check if revision revious�application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I A PLICATION INFORMATION -PLEASE PRINT ALL INFO TION 151 o by Owner Name per Lo ation ` l /4 1 /4, S,ZL T,3 , N, R j E Property Owner's Mailing Address Lot Number Block Number C! , State ,,,. rr Zip Code Phone Number Subdivision Name or CSM Number t.tJ 0if r /� 1 (715 1 2W< _ *_ 57 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit N a earest Ro /J Public 1 or 2 Family Dwelling - No. of bedrooms -3 V ow a n OF 13. III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbe (s) QDGo– (OY3 -4 0 1 ❑ Apartment / Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 VNew 2. ❑ Replacement 3. ❑ Replacement of 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 Mound 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. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals /day/ q. ft.) (Min. /inch) Elevation S S Z I Feet Feet VII. TANK Capacity In gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ' �"� �� �L ❑ ❑ I ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's N me: (Print) Plum e ' Sign at re: (No St mps) /MPRSW No.: Business Phone Number: ,, �' ` � 3 ? cs Plumb r's-Address (Street, City, St e, Zip Code IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) �( A roved ` I pp ❑ Owner Given Initial �g"0 _ / Surcharge fee) CC,. Adverse Determination </ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05194) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Divr -ion, Owner, Plumber 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 questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. 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 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. 09/1611998 08:12 6581344 TOM GUSTUM PAGE 01 3albty and Buildings 16837 USH 63 RIF HAYWARD Wl 598438107 N*4 consin Tommy G. Thomoson, Go error Dep artment of Commerce William J. McCoshan, Seenrtay August 31, 1998 CUST ID No.227618 TOM OUSTIJM N134$0 937 ST NEW AUBURN WI 54757 RE: CONDITIONAL APPROVAL „ APPROVAL EXPIRES: 08/31/2000 Transact-ion )m No. 133517 Site ED No. 157431 SM: • W d i�i7' i ""4'ai.�7' • Site ID: 157431 ST CROIX County, Town of CYLON NEl /4, NWl /4, S20,'T'31N, R16W MARK & LAURA ANDERSON FOR, Description,; NEW MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 422299 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, its responsible for compliance with all code requirements. This plan approval is for a 450gpd mound. The following conditions shall be met during construction or installation and prior to occupancy or use: • This playa action, is subject to designer comments on the plan • Correspondence Note: • Maintain well setbacks per Comm. 83.15(4) & 83.10(1). 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 Jtditu m, required by the state or the local municipality shall be obtained prior to eommenceeAt of CQ construction /installation/operation. p 6? � gAF Inquiries concerning this correspondence may be made to me at the telephone number mber listed below, or at the address No on this letterhead. O1VlSi Sincerely, gEE GpRt DATE RECEIVIE13 08/18/1998 FEE REQUIRED $ 180.00 TO 13 UN , A R1rVIEWER FEE RECI=IVED $ 180.00 Integrated Services BALANCE DUE S 0.00 (715)634-3026, M - F 7:45 AM TO 4 :30 PM TBRAUN @COMMfiRCE. STA'T'E, WI .US MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project Three Bedroom Mound Owner Mark Anderson Address 1650 320th Glenwood City 715 -265 -7451 Legal Description NE SE SEC20 T 31 N R16W Township Cylon County St Croix Subdivision Name N/A Lot No. N/A Parcel ID Number Plan Transaction Number 133517 .s• F pa �/ Index and title sheet Page 1 � Mound calculations Page 2 0 THOMAS D. p Mound drawings Page 3 r C.M� �6S GUSTUM Z Pres. dist. talcs. and laterals Page 4 I A 1201 TDH and pump tank drawing Page 5 Plot Plan Page 6 - spoNpENGE �Sid Pump Curve Page 7 Designer Tom Gustum License Number D1201 Signature Z� -Z Phone No. 715 -658 -1344 Date 7/14/98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result In disciplinary action under s. 145.10, Wis. Slats. Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10462 -E (R.05/98) Page 1 of 7 MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch- pounds Metric Residential or commercial? r (r or c) (y or n) Replacement system? Creviced bedrock site? n (y or n) Slope 6 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 25 in 63.5 cm In situ soil infiltration rate 0.4 gpd/ft' 16.3 Lpd/m Contour line elevation 96.6 ft 29.44 m Use standard fill depths? I x OR Design depth? I� Jin cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold (c or e) Hole diameter r 2 in 0.121, o o o. 0.281, or r 0.3 0.313 3 inc only. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 3.00 ft Not a final calculation. Number of laterals Pump tank elevation 85 ft Outside bottom of tank. Forcemain length 60.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9/32=0.281 Estimated daily flow 450 gpd 1703 Lpd 3/16=0.188 5/16=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 goo 375.0 ft 34.84 m Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd/m Design width (A) 5.00 ft 1.52 m Cell length (B) 75.0 ft 22.86 m Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 15.6 in 39.6 cm Basal area required (gpd /infiltration rate) 1125.0 ft' 104.52 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.45 ft 3.19 m Up slope toe length (J) 7.20 ft 2.19 m Down slope toe length (1) 11.50 ft 3.51 m Total mound length (L) 95.90 ft 29.23 m Total mound width (W) 23.70 ft 7.22 m Project: Three Bedroom Mound Transaction Number: 133517 Page 2 of 7 r MOUND PLAN VIEW observation pipes (typical) �J 23.7 ft A A= 5.00 ft 1.52 m 7.22 m B= 75.0 ft 22.86 m W B J= 7.20ft 2.19m l K I= 111.50 ft 3.51 m K =F0,45 ft L12 m L 95.9 0 ft 29.23 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension 1W 6" (152 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm lateral topsoil H subsoil cap E = 15.6 in 39.6 cm invert 98.10 ft F = 10.0 in 25.4 cm elev. 29.90 m - - - - F G = 12.0 in 30.5 cm ASTM C33 H = 18.0 in 45.7 cm D Sand Fill E sys. 97.60 ft y elev. 29.75 m 96.60 ft contour 29.44 m elev. 6% slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: Three Bedroom Mound Transaction Number: 133517 Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 5 ft 1 1.52 Im Length (B) 75.0 ft 22.86 m Lateral specifications Number laterals 1 Holestlateral 25 holes Lateral length (P) 72.00 ft 21.95 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 29.13 Jgprn 1.84 Us Sys. dis. rate 29.13 gpm 1.84 Us Hole spacing (X) 36 in 91.4 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red X' one choice 1 1/4 in (32 mm) box of chosen from the options 1 1/2 in (40 mm) diameter. provided. 2 in (50 mm) x x 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) X' one choice 1 1/4 in (32 mm) None required. from the options 1 112 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 1 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & B dimension end cap P i Last hole drilled next to end cap IE X — I Laterals & force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5) equally spaced i = permanent end marker Inch-pounds Metric Lateral length (P) 72.00 ft 21.95 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 36 in 91.4 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 2.00 in 50 mm Project: Three Bedroom Mound Transaction Number: 133517 Page 4 of 7 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 12.20 ft 3.72 m Are laterals the highest pant in the Friction loss 0.88 ft 0.27 m system Yes "X" here. L.�J Total dynamic head 15.58 ft 4.75 m If no, what is the highest elevation Dose Volume downstream of pump? L� �J Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.5 gal 47.3 L back to tank? CY' one) Minimum dose 125.0 gal 473.2 L x Yes Drain back 10.5 gal 39.7 L No Dose volume 11 135.5 gal 512.9 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with 'IF weather proof warning label and locking device grade levels junction box rade levels disconnect g alternate 4' vent pipe electric as per NEC 300 and F— outlet Comm 16.28 WAC location 16'(46 cm) min. wall Of pump — approved I chamber or outlet joint combination tank A Provide 1!4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 85.9 ft C - pump tank manhole = 4 (10 cm) Off elev. 26.2 m d minimum above finished grade D - vent = 12" (30.5 cm) minimum L IP above finished grade 85.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 25.9 m bottom of tank Tank manufacturer Midwestern Pre Cast Pump tank capacity 19.5 gal /in Pump tank volume 750 gal Pump manufacturer JHydromatic Inches Gallons Pump model number Josp33 o A 21.5 419.5 rn B 2 39.0 Alarm manufacturer JSW EI _ectr_o E C 6.9 135.5 Alarm model number 1101 p D 8 156.0 Project: Three Bedroom Mound Transaction Number: 133517 Page 5 of 7 O ct �I�i2�C O 1..2 S' alD - fz. /4)`7 tip= rc�� s z v �s j ) V i t 16cr1 Z)Zz W 1) tie G t) r -5 7 l i T7Z/ � A7- is -sue S i Y rz �O y l� Sf Ae f O d tb y 47 1 14r,O 32C, N �� ell P) �% J r s� • (ro i X �^✓ �� �� 43 Rif 1 Z y�. 9d / Xa3, 7� 6� .��� Me- F orrY C leol I MO dad A !VY2 7,2 5' oy r L �. oc- se 70�o ©F 1 p o, /r So, � ,D r r i �Iq• S' ✓ 30 3 Y iW� ,5C4 1,t- I'h M O VII d O r e C1' j c�'S 4 S AJ,4 a A 4 4Z[Cili, W' 1E=* :�Ct_c I ilk Performance Data 32 Pump Characteristics Pump /Motor Unit Submersible Manual Models OSP33M1 OSP33M2 W za 1/3 HP Automatic Models OSP33A1 I OSP33A2 W x Horsepower 1/3 c—' 16 Full load Amps 7.8 4.6 0 Motor Type Split -Phase a R.P.M. 1750 0 $ Phase 0 1 BID# I Voltage 115 230 0 Hertz 60 0 10 20 30 40 50 60 CAPACITY -U.S. G.P.M. Operation Intermittent Temperature 1401 Ambient Total Head (feet) 4 8 12 16 20 24 25 NEMA Design B GPM 1 1/3 HP 60 55 48 39 28 7 0 Insulation Class F Discharge Size 1 - 1/2" NPT .� Solids Handling 5/8" Dimensional Data Unit Weight 50 lbs. 3a /8 6 -3/4 5 -1/8 Power Cord 18/3, SJTW, 18/3, SJTW 10' std. (20' opt.) 20' std. 1. All dimensions in inches 1 -1/2 NPT 2. (omponentdimensions 4 -1/4 may very ± 1/8 inch 3 Not n unless Mat erials of Construction certified purposes unless certified Handle Steel 33/4 4. Dimensions and weights are approximate Lubricating Oil Dielectric Oil S. We reserve the right to make revisions to our Motor Housing Cast Iron products and their Pump Casing Cost Iron specifications without notice Shaft Steel Mechanical Seal Faces: Carbon /Ceramic I Shaft Seal Seal Body: Bross "* Spring: Stainless Steel Bellows: Buno -N 1z -1 /a Impeller Bronze PUMP 11 -3/4 s (( ON Upper Bearing Single Row Ball Bearing Lower Bearing Single Row Ball Bearing l Base Cast Iron r 2- + 3/4 l 3 Fasteners Stainless Steel PU OFF ✓� AYROWHYDROMATIC Pumps, Inc. Va l o 7 1840 Baney Road, Ashland, Ohio 44805 (419) 289 -3042 { W isconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 L'Abor 'no uman Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (1314 and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distapee r,est toad 006- 1043 - - 000 ^' " �' -" IEWED BY DAT APPLICANT INFORMATION - PLEASE P . INS {ILL I FO MATION � c PROPERTY OWNER: OPERTY LOCATION John Anton VT. LOT NE 1/4 NW 1/4,S 20 T 31 AR 16 k(or) W PROPERTY OWNER' MAILING ADDRESS ;; i S T # I BLOCK # SUBD. NAME OR CSM # 2103 210th. Ave. c L RO�^�t� na na na CITY, STATE ZIP COD ' 'RR 1`' CITY ❑VILLAGE UFOWN NEAREST ROAD Deer Park, WI., 54007 C 1 2 525/' `' C 1010 I 2 10th. Ave. ti [� New Construction Use [x ] Residential / Nu f e�rdorh , , [ ]Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 300 gpd Recommended design loading rate .4 bed, gpd /ft trench, gpd /ft Absorption area required 250 bed, ft 250 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 97.55 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable s stem El ® U ® S El El CZ U El 12 U ❑ S ®U ❑ S RI If SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch 1 0 -8 10yr3/3 none 1 2msbk mfr cs 2f .5 .6 2 8 -14 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 14 -29 7.5yr4/4 none scl 2csbk mfr gw if .4 .5 elev. 4 29 -65 5yr4/4 c2p 7.5yr5/8 scl 2csbk mfr na na .4 :.5 9 Depth to limiting factor 29 11 Remarks: Boring # 1 1 0-9 10yr3 /3 none 1 2msbk mfr 9w 2f .5 .6 2 2 9 -25 7.5yr4/4 none sil 2msbk; mfr gw if .5 .6 3 25 -34 7.5yr4/4 c2d 7.5yr5/6r sl lcsbk mfr qw if .4 .5 Ground elev. 4 34 -60 7.5yr4/4 c2d 7.5yr5/6 scl lcsbk mfr na na .2 .3 97 ft. Depth to limiting factor 25 1, Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. v . New Rich nd W154017 Signature: Date: CST Number: m02298 7 -22 -98 PROPERTY OWNER John Anton SOIL DESCRIPTION REPORT Page �of_' PARCEL I.D. #_ 006 - 1043 -60 -000 Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10 r3 3 2 10 -17 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 17 -28 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 elev. 94 4 28 -55 7.5yr4/4 c2d 7.5yr5/6 sl lcsbk mfi na na .4 .5 Depth to limiting factor 28 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBO- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 John Anton New Richmond, WI 54017 MPRSW -3254 NE4NW4 S20 T31N - R16W (715) 246 -6200 town of Cylon 40 acres N 1 " =40' BM.= top of 12 pvc pipe C el. 100' �Z ©� Alt. BM.= top of 12" pvc pipe C el. 93.45 77 r A r a v Gary L. Steel 7 -22 -98 _ t t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 Mailing Address A! -S Property Address o?_ (Verification required from Planning Department for new construction) t -e City /State 0 1 r Parcel Identification Number LEGAL DESCRIPTION � .���,4 Property Locatiol7 ' /., 4, Sec ---�IC) . TAN -RW, Town of LO .cJ Subdivision Lot # Certified Survey Map # . Volume , Page # Warranty Deed # ..525 2. - , Volume 13 5 Page # Spec house ❑ yes J W 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 days of the three year expiration date. A�1'444' A Z C 44 - �l��l p� SfGAAtbff6F APPLICANT DATE OWNER CEATMCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. all d ST A" OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed p .. y„ , _ �`� � �:F •!+*aXJK"% ."Ka i:' ,•e_: r ;1b :.ler w�r^+r -a 5 -t- 583933 WARRANTY DEED Document Number ULLI 1 Return Address JUL �epp Farm Credit Services l N7v 186 County Road U ref 3:50 P M River Falls, WI 54022 �, / � J�" no moor of 000* Parcel I.D. Number: OC6- 1043 -60 006- 1043 -90 John F Anton and Eloise Nl. Anson husbaod ac.j wife, conveys and warrants to Paul M. Anderson and Laura L. An husband and wife, as survivorship ritaf pMperty. the following described real estate in St_ Croix County, State of Wisconsin: NE',6NW',4, SE'/NW'A, All in See. 20- T31N -R16W. SUBJECT TO a 20 foot roadway easement along the West bourx ary of said NE 'A of NW 'A. for the benefit h of that portion of the NW'k of NW'A of Sec. 20- T31N -R16W which lies East of the river. This is not homestead property. Exception to warranties: Existing highways, easements and rights—'Of—way of record, if any. 4 Dated this 7 1- fyday of July, 1998. _(SEAL) Jo Anton Eloise %L Anton } AUTHENTICATION TR NU;FR Signature(s) John F. Anton and Eloise M. Anton, 35 husband and wife, authenticated this 244- day of July, 1998. Kristina OgGrld TITLE: MEMBER STATE BAR OF WISCONSIN TIIIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson. WI 54016 i ,r r . 0Ql`° " y , N 4 t4 "TI `. l oov-,Aofo�— 0000— 'Ift W y r, Fv 1 t 9 � Sv s t Y pppl a *'" vzo �V c C 5..11 + 4 }® so c o Co k i t l� o f j c 0 CD 3 n 3 r* H m Wo v • CD m I � O n Z m Z O co O j ''.' O O `j • CD 7 CD c CD I WD N 7 O O W N N 3 x :E ( 0 p) o CO 0 m Wn n c o CO o 3 a a Ul "• m o p d v < C D C a v CD t(. : to O. N '' CD C O C A ` N � N N N 1 �v WA i Z - Q o CO m < t7 r r- Wb 00 m 3 o c a M c ' O O O 0 CD A O WD !V D m Z v o m 3 Ln N .. N a v G v �I, m p' N N A N ?� ii O O D fD 3 d A N O Q 7 O Z I .. N Zz� o m ° O� D D c o �3 :3 \ ` °. N � � (D W 7 � a O 3 Z x Wo Z A I o o Z w o ao m m � z _ 'I CD CL 3 A o p z rn C 3 g N � CD A () O 3 -` o 3 Z D WD a c o �3av a mo�,'� o a — o W CD V fb (D N 3 O O p�j O 60 H WA O" c O A N L O_ c O C O CD N ?. A N � O fD 3 n 7 O� y'0 fD S _ O c :3 °p CD- 3 N O O n WW2. V O O O A 7 a a R O CD d0 b to O t, 0 m a 1.344 11.E 5=9:1933 WARRAN CY DEED Document Number Y Res *d re 44dsrr Return Address p p �p Farm Credit Services JUL 2 9 1998 186 County Road U 3:50 P River Falls, WI 54022 R� siN d ONd� Parcel I.D. Number: OC6- 1043 -60; 006 - 1043 -90 John F. Anton an Eloise N1. Anton, husba and wife, conveys and warrants to Paul M. A nderson and Laura L. Anderson, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: NE' /4NW' /a, SE' /4NW' /a, All in Sec. 20- T31N -R16W. SUBJECT TO a 20 foot roadway easement along the West boundary of said NE 1 /4 of NW I /4, for the benefit of that portion of the NW rA of NW 1 /4 of Sec. 20- T31N -R16W which lies East of the river. This is not homestead property. Exception to warranties: Existing highways, easements and rights -of -way of record, if any. Dated this _ 7 , kday of July, 1998. (44,C :: (SEAL) John . Anton Eloise M. Anton AUTHENTICATION Signature(s) John F. A - _ton and Eloise M. Anton, 3 SFFER husband and wife, authenticated this day of FEE July, 1998. Kristina Ogla, d TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 Parcel #: 006 - 1043 -60 -050 03/28/2007 11:20 AM PAGE 1 OF 1 Alt. Parcel #: 20.31.16.298A 006 - TOWN OF CYLON 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 - PETERS, JOHN J & JOAN L JOHN J & JOAN L PETERS 2149 210TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2149 210TH AVE SC 3962 NEW RICHMOND we SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 35.250 Plat: N/A -NOT AVAILABLE SEC 20 T31 N R16W PT NE NW & SE NW BEING Block/Condo Bldg: THE E 35 1/4 ACRES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20- 31N -16W NW Notes: Parcel History: Date Doc # Vol /Page Type 11/16/2001 662205 1763/363 WD 08/17/2001 654194 1702/266 QC 08/17/2001 654193 1702/265 QC 07/29/1998 583933 1344/115 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 25,000 356,100 381,100 NO UNDEVELOPED G5 7.000 8,400 0 8,400 NO PRODUCTIVE FORST LANDS G6 23.250 56,000 0 56,000 NO Totals for 2007: General Property 35.250 89,400 356,100 445,500 Woodland 0.000 0 0 Totals for 2006: General Property 35.250 89,400 356,100 445,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 547 Specials:. User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 , n m D ■ - � k (D \\] A I CD 2 w 7 � / Q 0ƒ f f/ 0 % ¥� 2 R Q - = e § $ G\ k @¥ m d) � G k . \ j \ § E E ¥ / 2 \ § § \ \ 2 ( } 3 © ° § O C « \C\ % a n — ` = w E\f E / ( « ¢ 2 9 2 C ° » / \ § § CD � \ j j } F @@ y n r a co OD CO %�§ / \ o o J \ ( . \} D j j j w § G M o v \� ° rZ G) L) \( / E s " k \ \ f .. a § ( o � \ q \ k . ƒ I [ { 2 a co K 0 2 — ) | I Z w to M 3 0 E ) { $ ° Z 7 ) \ / ¥ � I � CD ® 2Fk \ & }n §: 2@[ ƒ {{ % &\m m/ I 0 / / ƒ 4 � � ® } / � f \ £ 0 $ fA o ^ CD 00 \