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HomeMy WebLinkAbout030-1040-20-000 0 l/1 p C v o + m O m `r1 (o m �' m v h t 4 �, ►� to 0 O O m O ° N C- tD N N W ° 00 • CD CD ^s 0 o Q � m 3 m 3 ? N � Q CD ° 3 a ° ° ° O F 10 d to c o o ID I CD CD 'U co A C O O O N Ci Q 00 R j Wz hey A { � _ Q y co � N c o M C O tt c • rT A 5 -� G G G " < - z o 0 p c f N N E '' ° D No _� 0 a D O C rn O CD N N N _ O CD cn CL z z z D o I 0� O � 7 h @ o N �• CD 1 c C 3 N W a N z N N (Q ''.I -I N p N n A 2 A a iz C) I W � cn o � CL z 'o a C .: C ° H z I w CD I 'I n a � I � c �z C. CD z O I N a z I y I I ti o � I ti 0 o I N Z . o O o 0 - ~ VAst3onsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations DivPsionofSafety auildijgs n accord ILHR 83.05, Wis. Adm. Code N 3 / COU 6 IF Attach complete site plan on paper not less t an 8 1/2 x 11 inches in size. Plan must include, but St Cr not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or I • D +�IR E6 R to dimensioned, north arrow, and location and distance to nearest road.'t fJ APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION IEWE9 BY 2 2 ,996 DA o PROPERTY OWNER: PROPERTY LOCATION CRi-AX Tnh1. & Carol Hendrickson GOVT. LOT SW 1/4 SW g � 9 Q F70 r) W ft PROPERTY OWNER' MAILING ADDRESS LOT # I BLOCK # SUBD. NA # 1405 Co. Rd. "V" 2 na CSM CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN Houlton, WI. 54082 (715 549 -6063 Co. Rd. "V" [x] New Construction Use [ :j Residential / Number of bedrooms 3 [ j Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft • trench, gpd/ft Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate • 5 bed, gpd /ft - trench, gpd/ft Recommended infiltration surface elevation(s) 100.34 ft (as referred to site plan benchmark) Additional design /site considerations system el. based on contour line of el. 99.34 Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem ❑ S ® U RkS ❑ U I EIS ®U ❑ S ®U ❑ S ®U [IS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourn Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch .1..... 0 -14 10 r3 2m r mvfr aw 2f .5 .6 2 14 - 10yr3 /4 none Sl 2mgr mfr gw if .5 .6 Ground 3 26 -32 10yr4 /4 none S1 2mgr mfr QW na .5 .6 97 elev. f. fff 7.5yr5/6 4 32 -50 7.5 r4 4 wet sl 2m r mvfr na na .5 `:.6 Depth to limiting factor 32" Remarks: Boring # 1 0 -14 10 r3 3 none sl 2mcfr mvfr Cly 2f .5 .6 2 '`' 2 14 -28 10yr3/4 none sl 2mgr mvfr gw if .5 .6 U 3 28 -52 10 r4/4 none is osq mvfr CIW if .7 �.8 Ground elev. 4 52 -60 7.5 r4 4 none vfs m na na na .4 1.5 10 0.34 ft. Depth to limiting f + r 1 Remarks: CST Name:— Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 15 00th Ave. ew Richmond, WI. 54017 m02298 Signature: Date: CST Number: 7 -1328 STEEL'S SOIL SERVICE Gary L. Steel Wm. & Carol Hendrickson 1554 200th Ave. CSTM2298 SWQSW4 S19- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of St Joseph (715) 246 -6200 t°t #2 j CSM /:' 0 //3 �- s / I CIS N 1 " =40' BM. = top of tel . ped C el. 00' A Avt Joe A( ►.I-: pis el� ` �. aM � so 4 3 `f �u 2 bee }� D N.0 �r �7 W 14-4 o� Gary L. Steel 7 -13 -96 ST. CROIX COUNTY ZONING DEPARTMENT r' ` AS BUILT SANITARY REPORT ^� �► R'LlVED Owner /t co Address {o `1 C7 P "t/ n E 3 1998 City /State 14 a Qs am w I sT CROX I\ COUNTY . - 2,'0N1NGCXFF4rA Legal Description: Lot _ Block `"" Subdivision/CSM # -S ' /. "/< Sk ; Sec. �, T ? ON -R�9 , Town of / PIN C TANK DOSE CHAMBER -- HOLDING AN INFORMATION an c anufacturer f/(r S,-�Fe Size ST/PU / Setback from: House 44 Well4 P/L `�� • Pump manufacturer -- Model Alarm location --- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location i SOIL ABSORPTION SYSTEM LEACH , Type of system: TR I" ILK f� Width . 3 Length Number of Trenches Z- Setback from: House '/8' Well 9B'± P/L 40 - 21 ' Vent to fresh air intake 8l • ELEVATIONS Description of benchmark 3/u " P V C B• �• Z__ 2 • 2 Elevation /ay, - 5 Description of alternate benchmark To iP o f 81 Mg Fpd N fl K i/ t/q Z Elevation l o b S • O Building Sewer 4 to ST/HT Inlet �� �$ '" 9� 3 ST Outlet" f PC Inlet Q ',� PC Bottom ►- Header/Manifold 1 Top of ST/PC Manhole Cover 'q ? Distribution Lines ( ) q `�' S Bottom of System � S' `l �i �� O n , ? f ` = c , 6 ( ) Final Grade O 'S , S = 1 t�1 ) so S a P 0 1.4 ] ( ) Date of installation 2 / 1 / = Permit number 1 20 2 v!r State plan number Plumber's signature w cub License number t 4 ?t 1 S -d 3 0 4) Date/ Inspector Complete plot plan Or I • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division k. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaYPQ,rTiW_: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. Permit Holder's Name: ❑Sity 0 - Villff Town of: State Plan ID No.: ILLER, SAM 5TT aZT S1;Y CST BM Elev.: Ins BM Elev.: BM Descri ti Parcel o.' p 10� � p �� �� 11G a��' 1 0 4 0 - -000 TANK INFORMATION ELEVATION DATA A9800472 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se =1 4jr /��O Benc rk S a ?D O s,3 Dosing 16 N/l �` t I ° tZ /0 l • So Aeration �� Bldg. Sewer Holding ' W1111 Inlet - 7 9-2— TANK SETBACK INFORMATION _ SV IA- Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic y /V NA Dt Bottom �--- Dosing NA Header / Man. O.7 0 9 $, &a- Aeration NA Dist. Pipe W Holding Bot. System 10•-Z7 GDJ'"Z;L y s g7. PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand 9, 4ml Model Number GPM F !fls TDH Lift Friction S stem t Forcemain Length SOIL ABSORPTION SYSTEM BE R Width Length No. O renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .�2 DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type � �� CHAMBER mod Number: Syst m OR UNIT DISTRIBUTION SYSTEM j A Qom, T I. O v 5' Header/Manifold „ Distribution Pipes) Hole Size x Hole Spacing Vefttro Air Intake Length L_ Dia_ Length,% -2_'!;_'Dia. Spacing 7 1 , 1 4 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 I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) q. ";_ LOCATION: ST. JO 19.30.19.141A,SW,SW 1409 COUNTY ROAD V e L I/v J' 1 u)+ -7ae G �d v1d" 1 1t Plan revision required? ❑ Yes ❑ No Use other side for additional information. G I I 1(cbp SBD -6710 (R.3197) Date Inspector's ignature Cert. No. f Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Visconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County < s+ + �� •- than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes 3 zo Z�� ' I ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. / //0 � n ct � / A, n'� State Plan I.D. Number I. APPLICATION INFORMATION - - PLEASE PRIN ALL I RMA L ON Property Owner N me Pr perty Location S ►M (!(,, j W14 Cd 1/4, S T Q , N, R E (or Property Own is Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number L) osp L ;I N ( )Z �� /y(� r p•� t Y F B L (check one) ❑ State Owned o v I ( age Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF S � S NTH V III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 1771 Apartment/ Condo 19- 3 0. l / ' l y / 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. � New 2. ❑ Replacement 3. ❑ Replacement of 4_ E] Reconnection of '5 E] Repair of an System System Tank Only ________y _____________y Existing System ______________ g y _________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 j,Seepage Trench s"V EW / f M ❑ In- Ground Pressure 42 ❑ Pit Privy 13'❑ Seepage Pit Ii / N F /LrkAT 1 0 4- ° 3 X.re4 t %.r 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 /sq. ft.) (Min. /inch) 10 Elevatior) t !,j0 1 5L S ,y "Z.�• g '740 IS Feet 10 Feet Cap acit y VII. TANK in allo Total # of r Prefab. Site g Fiber- Expec INFORMATION Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl I ❑ I ❑ 1 ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: o Stamp) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): / 4 070 0 N slo I10 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanita Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) �. A roved LorN Surcharge Fee) a/ I Q pp ❑Owner Given Initial o ` Adverse Determination 1 X. CONDITIONS OFAPPROVAL / REASONS FOR DISAPPROVAL: CIO SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber f> Al fLLF< L T 4-,4-1 t A L F Al 5 - Uj E C -T 7 3.bd //'nom ������ kINbE cvckZ - ov"TFOI , 2-TA F.,v E .3 Z I T-'ZotTbOL -f do A 4. N6rE, CnT LINE -Te.) t'f J tDF- SurlHGLE I-dYSTrA I-AT /4 11 RF A 2 T i > . co b co (D E a �° N .+ LO ca c > m ti a> Q- m n. � CO 'v _ •� c 4-- 3 c M C C o o � o cti C, o o a) >CL rn X a iu is _ � N 0 .9 U C -y p N . C j. a) cU C in -tf L c E ar o C: QS N_ > O > a) d O J as u- E O :2 S U S vz $5 V S! 00 It N J LO ca � 4 / J U ® O ^g E ,n v 5. ' a ��• p� c�j m U ° a :,�• � O E g � a ® (� `° -6 w z a� cn 3 0 W . v — 3 ° N CY) f (1 E • • p A cu N • x0 N U � C C, m 3 f Q to w ®a s c) t o m v T �� G1 6 Z 0, i.- U) U - J D Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P of 3 Labor and Human Relations — DivWon of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach comp a / ST• C� �( pl site p lan on p aper er not less than 8 1 hos in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference ( ) r5ct"torittd % of slope, scale or dimensioned, north arrow, and location and n`�eares3 road. 0 3 0 - l pup - 1,0 APPLICANT INFORMATION -PLEAS ,T AqA P� RMATION' ^. R IEWEDBY DATE r/ _ (Q PROPERTYOWNER: '&fM E. `r"lt R -PROPERTY LOCATION /, �-;•� &9VT.4- S W 1/4 SW 1/4,S ) T ,N,R � 9 E (o4jW PROPERTY OWNER':S MAILING ADDRESS ST' O�O�X •� L ?T # BLOCK # SUBD. NAME OR CSM # tom- -b- t3We kSI >� "OON TV A - O-SY-7 VOL. 11 pcj 3Z S 1 CITY, STATE ZIP CO , PH CITY []VILLAGE ®TOWN NEAREST ROAD I�V� kJ I SVO 16 ;r't�� 3t36- `�, ST• Sp C"�1} V b(J New Construction Use [x] Residential / Num s 3 [ ] Additi.Qn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 4 SO gpd Recommended design loading rate bed, gpd/ft • `� trench, gpd1ft Absorption area required �`I.3 bed, ft2 bZ .5 trench, ft Maximum design loading rate bed, gpd 1ft - � trench, gpd1ft Recommended infiltration surface elevation(s) ° I.6 • S ft (as referred to site plan benchmark) Additional design/ site considerations _aka . \-ktu� TIEtT of s io n t l +C�H EI'+I�B S CSC ww Oh/ Rj Z, Parent material s t �-yy ouk "'S" 4 GZA UEL. Flood plain elevation, if applicable ti A It I S = Suitable for system CONVENTIONAL I MOUND * IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem OS ❑U EIS OU OS ❑U ❑S ® U ❑S ®U ❑S ®'U SOIL DESCRIPTION REPORT * _Z XS7�A_L6&Z) SfT$, Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& L Ground 3 2818 1•S �R �/y SC rn w,vr c� .3 -y elev. N OS. ft. y 8�z �. s�riz Sly — S 6'v �3 S9 Depth to S - L It) (4 [C)"rL Y /y SeC6h C) S9 limiting factor Remarks: Boring # •. D - l d 1. � � M \ S y S ly �s s 1 1 esbk Vrl � - �t� — • q - S Ground elev. 4 �04TI 1 u`iri V A S ft. Depth to limiting factor Remarks: CST Name: — Please Print Arthur L. We erer Phone' 715 425 - 0165 e�gerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: r _ / C/ 13 Date: _9 - 96 CST Number: 0 0 5 7 6 PL PLAN Page 3 of 3 SCALE 1 "= 140, I :f-� 4oT � CS`M I � p1, 105.6 ON )vl klQh , 3jv `Ot-g_ PVC 'l�tP¢ w✓L�, Lo y - csr� V 0 L Z. P9 3255 FX w G SAT u li E - 'M $E s u t Pn 9 i \'1�Z ``f� o R LOT \ sLOP�S Vfrlu(, SEA EL.EV s ( L , ,�. 5 4CL boy ? g.5 / e•y 3�.s' g.�o 3 a• 9 LIt. too B•3 3 � S S �iyE►vt1vD ��ebl Ik �t 9g6 • ( 1 S "rc t_ cclel. 9s.� l�letF 1 , C 'Y1 #1 _�1,LOO,Ct ON w 31y Dl�1, 31 4 D'R- Y \3c NPe W /uww- PVC PIPE wl�fiN, • PVC Ptp� w��. VYO U Sl;�r '4 © F PTT Lvn T Z S FIB wV_�L , u !So' k 9S -la3 (715 ) 4 25-016 9 I4 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department Industry, Labor and Human Relations bons � — SOIL AND SITE EVALUATION REPORT P of 3 Division of Safety & Buildings in accord with ILHR 83.05,W Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST• CQ�U UC not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 30 - t OU b - ?,0 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV DBY DAT R i y� PROPERTY OWNER: '& " E. Mr k_LQR PROPERTY LOCATION m t L L Z,. kA'QVJ( Z5 GOVF- S KJ 1/4 S W 1/4,S ) T ,N,R 1 E (oreW PROPERTY OWNER'.S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # tom- -o lozX Vs - CSC VOL. 1) I p 3ZS1 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD I-kU\,') , I SVCt6 (,cs)- m1 &_-n69 I C - `Sl* - V` 64 New Construction Use [X] Residential / Number of bedrooms 3 (] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow LA SO gpd Recommended design loading rate bed, gpd /ft • $ trench, gpd /ft Absorption area required b'13 bed, ft S 6 z .5 trench, ft Maximum design loading rate bed, gpd$ . % trench, gpd/ft Recommended infiltration surface elevation(s) ° l- 6 . S ft (as referred to site plan benchmark) Additional design / site considerations 1 S .-) S LW VqtT of s Lb�-m k,., �z. sett 0-" fBeW% CSC md) oxi P-3 z� Parent material s t \.- 0Ut zsf�'r\� 4 ( Ue Flood plain elevation, if applicable Na 1�) ft S = Suitable for system CONVENTIONAL MOUND * IN- GROUND PRESSURE I AT -GRADE � SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem S ❑ U ❑ S O U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S of l SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bandary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch Ewa Z C) -zb vn i�- cry Ground 3 Zts �$ 1•S `1R �! S$sl ° rn y1i C)�J •� y elev. � y g9t2 S 31y O S9 r�► CIV • 1 Depth to S z Iy fb fl - SIGH US m 1 -1 -� limiting factor Remarks: Boring # : ::: S 1 I z�' A �v - t.S liIZ 3!v 1s s1 \ e Sbk yy �, _ •y S .Grow >.,. 3 3c1 -83 -) - SVR_:1 /y � � �� C low , w, 4� e � ,� •Y Ground elev. k4 y/Y c os. 5 ft. Depth to limiting factor Remarks: CST Name.- Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: / Date: CST Number: M00576 PLOT PLAN Page 1, of 3 SCALE 1 "= 14r ' c ' R • o.w C T� y 114J6 t V y V,wr V o �.. �\ P9 3ZS 1 •. �L rt,o.J V t M LrL, 105.6' oN \1 , 3 `rJ14- Pve L." . �T y - GS1ti1 • P9 3L55 lo la - b� sz,w68 `g ExVTn t-13T 1..1PJ -'M '%E \-QMSZZ) - M Su l.`r LL S`-J STQM s u t 0 Jt�l'ttp ►gyp f R�2 BUT 1 r / 67•y 37.5, 6.10 I 0 l�iZt3 I� / S ^ � NCO - s -z ta- uz, s �• 3' �� � N�1 "tl�-t `1�tkrli C 1i o5 �t � 3 � Dot lgflebl � 13.1 / g , 3 31.g. I St0�1vi1v a • e�.�.q� • � sKs� et. 9s.o ��! • K z m # 2 - k�L L02.t ON Y Z %E, •ion' 48 31 4 D1R- W/Ln -R. vC p(PE W A PVC Pty W /L,y;}l `�U �'4 �E � t_..�S Z S ' )✓i� -U�'J �2..�1C.}f - rvs . t4 q1S -lQ3 715 ) 49 -0165 M00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e!f A / / /z Mailing Address _En k � /-S , ' Property Address q 0 c f C T N _ (Verification required from Planning Department for new construction) City/State Ay_b S o 4 Parcel Identification Number LEGAL DESCRIPTION Property Locatio Gt/ '' /4, S W ' /a, Sec. T 3 0 N -R wn of m Z 14 %ibdivision c S. `7>t Certified Survey Map # / 2- C2 , Volume , Page # ;.Warranty Deed ao Z / Volume ,Page # Spec house 'yes O no Lot lines identifiable L Z 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 sys tem 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 and by a master plumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site w: .c water disposal syste —, is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sl Itwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system h 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 St. Croix County 7 mina Office within 30 days o f the three year expiration date. 'S TUkf Of APPLICANT DATL '_WNER CERTIFICATION ' certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the pro pbfty. described�above, by virtue of a warranty deed recorded in Register of Deeds Office. AT OV XPPLICANT ^ � * * * * ** 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 S,ATE BAR OF WISCONSIN FORM 2 - 1982 560021 WARRANTY DEED j DOCUMENT NO. YOL 1 241 P v'' + a �T J r ST. Cn01X M. VA *"'d IN MCA William A He and Ste rol E Her�rick�on -- _husband and wife, — M AY, 2 8 1997 11:00 A M i= conveys and warrants to Sam E. Miller a single pe . on — -- TNS -z p& - - ESERVED FOR REUORD!NG DATA _ NAME k%C kc—T; RN ADDRESS the following described real estate in St. Croix County, escr State of Wisconsin: t 0 - 104 - 20 PARCEL CY4 NUMBER Part of the SA of SWk of Section 19, Township 30 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 5 .:f Certified Survey Map filed in Vol. "12 ", Page 3255, Doc. No. 559508. TOGETHER WITH an easement for ingress arvJ egress over Outlot "1" of said Certified Survey Map. and Part of the SW4 and SWti of Section 19, Township 30 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lots 1 and 3 of Certified Survey Map filed May 8, 1997, in Vol. "11 ", Page 3251, Doc. No. 559126. y� N' C This is not _ homestead property. })m Us coU Exception towat-Tat.nes. Easements, restrictions and rights -of -way of record, if any. 27th A o , 1 , ) -91- Dated this --- -- day n( __ __� — - - -- � -• --� ��cf�� -PLC tSEAL) • Carol E. Hendrickson • Wi � Hend _ - -- - -- -- ,. — — — iSEAU -- - — -- (SEAL) "a a AUTHENTICATION ACK`OWLEDGMENT State of Wisconsin. Signatures) St. Croix — -- - - - - -- - -- County. — - -- authenticated uas day of 19 -- Personally came bc:, :e me this 2 _7 th —_ day of _ - - - _ -- -- May - - -• 1997_, the above naked 1i A HPSir1rickann ane L farrol - -E - -- __ Hendrickson_ - tnishand- -and--kTife - - -- - -- 111 LE MEMBER STATE BAR OF 1\ ISCONSIN — Brenda Poulin — - -- - - -' - - -- - -- -_ t1t n at. - _— _._. -_ -- — Notary Public - -x u['r,urtzed by §706 .06. b1 is. 5[ats) to me kno , !o he the : � _ -- who executed the foregomg State of Wisconsin in,trttme ndx.l:now THIS INSTRUMENT WAS DR; BY h��ann.` 1 L // Attorne Kristina 0 land Brenda Poulin -_ - --y----- - -�- -- -- - - - -- �tz0a u . c �o� 'o w CO w E few X 3� U U a m a a �� Q' U m o) x W J V- _ V- : j G � W p J o w p U w �- U ao a� Q� a� N Ir Z ow Ir O w LL owC M C c r. � u �Q w t� co Q� QC'J w N = N I- O V- tG l W m C0 N c a O � U- 1 °' o my m E O 1 Z ti .6. 733UV ZO €5Z L o `� •� 49'44 VVL9V 3 ..OZ .8€ °00 N fv Z9'66 $ 7f y �t� s A ` t t i a ? � c N >' W I V I C OI 7 O�Q ? �I :3 CL, a � N OI C)I�� � WI uj w J I WI O N • s7 O • I • � y,iZNV CO DESCRIPTIONS: The following descriptions are located in the SW I A of the SW I /4 of Section 19, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, being part of Lot six ( 6 ) of the Plat of Pine Curve Addition and part of Lot one ( 1 ) of that Certified Survey Map filed in Volume 11, Page 3251 as Document No. 559126 in the St. Croix County Register of Deeds. PARCEL "A" Beginning at the NW corner of Lot six ( 6 ) of the Plat of Pine Curve Addition: thence S00°38'20 'W 114.61' along the West line of said Lot six ( 6 ) ( bearings reference to the West line of Lot six ( 6 ) of the Plat of Pine Curve Addition, previously recorded as and assumed to be N00°38'20 "E ); thence N60°40'55 'W 119.48' to the Southeasterly right of way line of County Trunk Highway "V "; thence Northeasterly 119.57' along the are of a 766.69' radius curve concave to the Southeast whose chord bears N6 1 °59'23.5 "E 119.44' to the point of beginning, containing 6,192 square feet ( 0.142 acres ) more or less. PARCEL `B" Commencing at the SW corner of Lot six ( 6 ) of the Plat of Pine Curve Addition; thence N00°38'20 "E 99.92' along the West line of said Lot six ( 6 ) to the point of beginning; thence continuing along said West line of Lot six ( 6 ) N00'38'20 "E 253.02'; thence S60 40'55 "E 12.48'; thence S24 °00'00 "E 129.32'; thence S27 °l4'47 "W 144.82' to the point of beginning, containing 8,687 square feet ( 0.199 acres ) more or less. PARCEL "C" Beginning at the SW comer of Lot six ( 6 ) of the Plat of Pine Curve Addition; thence N89 ° 2 1'40 "W 50.00' along the South line of Lot one ( 1 ) of that Certified Survey Map recorded in Volume 11, Page 3251 as Document No. 559126 in the St. Croix County Register of Deeds; thence N27 °1 4'47 'E 111.64' to the West line of Lot six ( 6 ) of the Plat of Pine Curve Addition; thence S00°38'20 'W along said West line of Lot six ( 6 ) 99.82' to the point of beginning, containing 2,495 square feet ( 0.057 acres ) more or less. L Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that I have surveyed and staked the above described parcels in accordance with the rules and regulations set forth by the State of Wisconsin and the Ordinances of St. Croix County and the Town of St. Joseph and the map attached hereto is a true and correct representation to scale of said parcel. GRANBERG SURVEYING � 0 NSA 1239 C.T.H. "E" 1i_;s \ 1N. New Richmond, WI. 54017 °► EPH Phone ( 715) 246 -7529 v A � = MA OND Job No. 98 -030 This instrument drafted by Joseph W. Granberg. Ji 9% Q a c E> ca tv o E o, cc > v, E 8 •° W 0> > c CL D a: o c E oN cr a CL a - m E U 559126 CERTIFIED SURVEY MAP Located in part of the SW1 /4 of the SW1 /4 of Section 19, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. W 4J N �I QI M 4-; OWNERS ° o CSI m William & Carol Hendrickson .= L ,_,I 1405 County Road 'T" z° N a =1 W1 /4 Corner of Houlton, WI 54082 a �1 Section 19 0 o d 4-) O n t pql +' y �I O E QI x N y � U N i0 � N Y U � UNPL_A_TTED_ LANDS M N \� , \ 107.17' / ' c M o ® 23 143.65' h .o 6 ``E � v C' N ' 6 .9 / E q E Uj OI Ln // W . N .- JI 001 N n s32 °28'40 "E O /i ,f 6 ICI z w L a o LOT 1 N ". z:1 / 3.84 Acres Inc R/W � M (167,146 Sq. Ft.) ° t `. ''` �I �•/ 3.00 Acres Exc R/W Z (130,854 Sq. Ft.) 52.24 ' ` °• ' t` 1 / �: 427.18' BM 1 Elev. = 100.00 �S89 0 21 40 n E 479.42 W / O Septic z ft XYxm�s �' 33• HN / 0 LOT 2 x r i House U N / VVVV O 27.38 Acres Inc R/W E' ° ao 50' �/ Well — t (1,192 753 Sy. Ft.) v © i� 26.76 Acres Exc R/W �I r-4 4-) (1,165,521 Sq. Ft.) I — I -I OI 01 cnl N I h N ^ Shed JI - 1-- -J C >I ICI c °r° w I S88 °51126 11E BM 2 : 327.1 5' El ev. = 86.15 �1 - `•327.1 3 ti N �! —^.- 50.00' °_ ao C° _ L 4.) Ln l!) O O g o W W :LOT 3 0 N - I N 3.46 Acres Inc R/W -r