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HomeMy WebLinkAbout030-2029-50-300 0 3 0) o d r� ' c ? 3 v1 a ' 0 0 A cn Z 0 N W r. N W • s d O N 0 O d l � ca Q ."3 j j N Q m N Ca CD O O N `A\ \ N O iV = O � O O O 1 cn cn cn O D -� O O O O Cl) CD 0 C4 W 0 3 0 N N O W W O E O O O N y 7 C !mil �► W C C O N (D ( N N O. � �' W c _ _ Cn C o. c' O W N O NfON 00 ! 00000 CA O. o j CD (D 0 E c�r cn 00O is a p 0 p A A A O 0 � A Z c C . 0 ' : D OD N N N N O 3 N � W N ir O Cl w 3 d N N <. CD A Z 0 a z j z O ro O D N 01 C) o • M C =r CD W o C1 Q 3 0) o Q CD O ? C C X o. D A z 0 j Z W N W CD CD 0 CL Z 3 I a O Cn N z m o f A I i C c n N C7 y CL O O T N O= N CD : Z f1 O O y = N z 0 0 O o 0 3 fD n A N O yC a CD fi ;x CD N w f v m <D - I Q. C1 (SD C+i o CD Op w 4A ~ A � 0 0 i ti 5 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services ;.� ccordance with s. ILHR 83.09, Wis. Adm. Code . Attach complete site plan on pa r cotless tha��8 1/2 x I�irlcft sin size. Plan must County , include, but not limited to: vert' 6a d ho ' rfEaTr�f�ence poifib M), direction and 4% �� �, percent slope, scale or dimen n north kta�oT;?atid46cation 4rid distance to nearest road. Parcel I.D. # ? 0 - ��z _ JV APPLICANT INFORM TIt N -.� &96 OrhifN inf .._� . _ at/on. Reviewed by Date r Gtk -rr Personal information you provide ay b0 used for s�C urposes �P� Law, s. 15.04 (1) (m)). � Property Owner t LpNhNG �` Property Location �,� O r,' ��/ Govt. Lot 1/4� F 1 /4,S Ta 9; ,R q, ,,E (or'�J Property Owner's Mailing Address -' Lot # Block# Subd. Name or CSM# 3 0 fl till" City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road M h SYO y Z) 77 / q I < 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 x7 bed, gpd/ft % trench, gpd/ft � Absorption area required 4 bed, ft 69'6 rr tr�trench, ft Maximum design loading rate 0 bed, gpd/ft _ trench, gpd/ft Recommended infiltration surface elevation(s) !�• �� ft (as referred to site plan benchmark) Additional design /site considerations Parent material (S r r 'q :tn Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S El ig S El ER S El [XS ❑ U ❑ s � U ❑ S On) SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 a L k a� rn lo-13b o r OS S ( C. Ground g elev. Depth to limiting factor t 0 in. Remarks: Boring # 0 1 r l z M f^ Q_S I r, 0 2 a -lz . o r.3 •--- .S m l CS Ground d / elev. Depth to limiting factor l, Remarks: CST Name (Please Print) Sigrigule Telephone No. Address Date CST Number it g -�- W C C&P� 1364r)E Cons. I-..a # '' _ ' �-► Arl 3 o 1 S - 2 O A1 1 3 0 if 00 w / f •o rvK U. I 1 aM i w�t1 I I o . I � I I ' I � sq ' ST. CROIX COUNTY ZONING DEPARTME)� AS BUILT SANITARY REPORT � '' ! R Ccti;EL 0 " ' y Owner AAf,0114F A Address 1 x/38 7 n" ST r , sT cRQ +x �. City/State uL,7 - on/ /'Us' Sid g� f �' c °uOF -T ZQNINGQFFICE Legal 1DoNarlpUuul �_...., Lot . U Block A&I Subdivision/CSM # t /4 A&& t /4 SiF, Sec. 2.L, TLo N -RAW, Town of S ?, asaa q PIN # 3,0 —6 02: 10 I S EPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer U /�= s c= J� Size ST/PC/ _sy / A Setback from: House Z Well P/L , ZTZ Pump manufacturer /y/l Model Alarm; location .44 ( OLDING TANKS ONLY) Setbac s: ad Vent to fresh air intake Water Line Meter ;location Alarm' 1oc SOIL ABSORPTION SYSTEM Type of system: 7 C>4 Width _ Length 1�2 , 5 Number of Trenches Setback from: House / Well P/L V -5` Vent to fresh air intake i ELEVATIONS Description of benchmark :& /-7- 1_o7 .try Elevation /Z.0 r OF Description of alternate benchmark ra�L Elevation /UW, /1 Building Sewer ST/HT Inlet ST Outlet 103.12 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines h 4 Bottom of System Final Grade Date of installation / / ermif number 320 2 3 S State plan number / 3f3 2 Plumber's signature - License number .22 Y Date/218/ f Inspector OG1 Complete plot plan Or Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Count Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 320235 NE t3KAb f r'IN STy JOSEPH Town of: State Plan ID No.: CST BM Elev.:- AlY Insp. BM Elev.: BM Description: Parcel Tax No.: 1 10 LIP r7U A. 030- 2029 -50 -300 TANK INFORMATION U ELEVATION DATA A9800426 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic V1 IutA 1Z5Z) Bench k NO - 1 ,00 osing r A-4, QsN 1 69 •ois Aeration �-- Bldg. Sewer (o. / 03, 89 Holding St /Hf Inlet 64 1D 3. S to TANK SETBACK INFORMATION St FK Outlet (p. b TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 22 j ` 3Z NA Dt Bottom y� Dosing NA Header / Man. S Aeration NA Dist. Pipe Holding Bot. System 12 27- 1 PUMP / SIPHON INFORMATION Final Grade Z /00. L Y Manufacturer Demand S4, (y(IVA e l c5 , (Z /p , Gj Model Number GPM T UV g 1 r. TDH Lift L ea H Ft Forcemain Lengt is . o SOIL PTION SYSTEM BED / Width 7� Leng h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / (0a DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING M anufacturer: SETBACK CHAMBER INFORMATION Type O �-! Mod Number: System y t fE OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution P c'�k.,�, x Hole Size x Hole Spacing Vent To Air Intake Length _UL Dia. Length (O2�J �B a. c� Spacing / ( l0� r 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 /09 Bed /Trench Edges Topsoil E] Yes E] No El Yes E] No COMMENTS: 0n1 code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 22.30.20,NW,SE 1438 7TH STREET �3 ` Jb 110 49 �ev'-CA �r � 1 G¢,. rf) Plan revision requlrea E] Yes No Use other side for additional Information. ( �� SBD -6710 (R.3/97) Date Inspector's 4griliture SANITARY PERMIT APPLICATION Sa f e ty Washington Avve. I) Lconsin P.O. Box 7968 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7%9 • Attach complete plans (to the county copy only) for the system, on paper not less County �+ //!� than 81/2 x 11 inches in size. c7fCa Di)C • See reverse side for instructions for completing this application State Sanitary Permit Number 3102.35' The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. /q,j R ny.L, s-1 i o. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N 13T Property Owner Name Property Location F j V W 1 5 1/4, S 2, T 3p , N, R (or)(0 Property wner's Mailing Address Lot Number Block Number S . �l �. TYPE Zip Code Phone Number Subdivision Name or CSM Number OF BUILDING: (check one) ❑ State Owned o C i t Nearest Road gg Public 1 or 2 Family Dwelling - No. of bedrooms o row OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a :9. 3 o. A 0.444 A -80 03 0 - -.1761 -- 50 3 400 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 0 Office/ Factory / Wa.. houyC 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1, pg New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System ________System _ __ Tank Only______________ Existing System ________ ExistlnaSystem 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 1' rat x / 2 42 ❑ Pit Privy 13 E] Seepage Pit •J l0 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) Elevation U 613 636 r 7 J I Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- E x per- INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete con Steel glass Plant" A structed Tanksi Tanks Se Ic Tan iielditlgTarfk y - '`- [a El 1:1 ❑ 1:1 E] Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 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) Plu s Signature: (N Stamp MP/ RSW No.: Business Phone Number: 221 17tl 7 / - — Plumber's Address (Street, City, State, Zip Code): c s J IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agentsignature(NoStamps) ® Approved []Owner Given Initial a,/ Surcharge fee) �� _ . Adverse Determination roo X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: fk^,� �,4. Ci 1 SBOWN (8.11/96) DISTROUT1011: Original to County. One copy To: Safety Z Buildings Division. Owner, ►krnber Tommy G. Thompson, Governor Visconsin William J. McCoshen, Secretary Department of Commerce August 26, 1998 CUST ID No.221741 ATTN: INSPECTOR DONAVIN L SCHMITT 586 VALLEY VIEW TRL SOMERSET WI 54025 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/26/2000 Identification Numbers Transaction ID No. 138766 Site ID No. 158458 SITE • Please refer to both identification numbers, Site ID: 158458 above, in all correspondence with the agency. ST CROIX County, Town of SAINT JOSEPH NW1 /4, SE1 /4, S22, T30N, R20W BRADEN CONSTRUCTION FOR: Description: NEW CONVENTIONAL Object Type: POWT System Regulated Object ID No.: 419456 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 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. Sincerely, DATE RECEIVED 08/24/1998 C FEE REQUIRED $ 110.00 WESLE C GRUBE , PLUMBING PLAN REVIEWER FEE RECEIVED $ 110.00 Integrated Services BALANCE DUE $ 0.00 (920)492 -5613 , M -R 7 -4:30, F 7 -12 W GRUB E @COMMERCE. STATE. W I. US cc: LEROY G JANSKY , WASTEWATER SPECIALIST, (715) 726 -2544 ST CROIX EXCAVATING SCHMITT & SONS SEPTIC SYSTEM . for BBADEN CONST !7 UCTION, INC. Houllon, Wisconsin 54082 NWIA SE1A S22 T30 R20W St. Joseph Township St. Croix County Pagel of q Soils Report Page 2 of q Work Sheet Page 3 of y Plot Plan Page 4 of Y Cross Section Prepared by, Donavin L. Schmitt 586 Valley View Trail Somerset, WI 54025 715 -549 -6651 MPRSW 221741 AUGUST 12, 1998 M1: Conditionally APPROVED DEPARTMENT OF COMMERCE I Of i 9TY ANO Wt Nti! C. CORRESPONDENCE Labor an d Hu amangel a ti Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Hun Rettigns piw:ieRot salary s 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 (BM), direction and % of slope, scale or PARCEL I.O. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Don Anderson & Barry Ciccbese GOVT. LOT NW 1/4 SE 1/4,S 22 T 30 ,N,R 20 X k(or) W PROPERTY OWNER':S MAILING ADDRESS LOTS BLOCK 8 I SUBD. NAME OR CSM # 275 125th. Ave. na I n na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY C]VILLAGE BOWS NEAREST ROAD Hudson, WI. 54016 (715 549 -6297 St. Joseph St. Hy. #35/64 [)I New Construction Use ( J Residential / Number of bedrooms J J Addition to existing building J J Replacement J Public or commercial describe unknown Cade derived dairy flow na gpd Recommended design loading rate • 7 bed, gpdM - 8 trench, gpd/ft Absorption area required na bed, ft 2 na trench, ft Maximum design loading rate ' 7 bed, gpd/ft • trench, gpd/tt Recommended infiltration surface elevation(s) 97.16 It (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S - Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ®S ❑ U KI S O U [IS O U [2S O U O S [RU [IS (D U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD /ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed ITrerxi `? 1 1 0 -9 10yr3/3 none 1 2msbk mfr gw if .5 .6 2 9 -20 10yr4 /4 none sl 2msbk mfr gw if .5 .6 Ground 3 20 -82 7.5yr4/4 none is osg mvfr na na .7 .8 elev. 99.55 ft. Depth to limiting factor , +8 Remarks: Boring # » >> 1 0 -9 10yr3 /3 none 1 2msbk mfr gw if .5 .6 2 2 9 -22 10yr4 /4 none sl 2msbk mfr gw if .5 .6 3 22 -82 7.5yr4/4 none is Osg mvfr na na .7 .8 Ground e1ev. 100.7 tt. Dapth to limiting Remarks: CST Name _ Please Print Gary L. Steel Phone' 715- 246 -6200 address: 1554 200. Ave. , ew Richm WI. 54017 Signature: Date: CST Number: 7-27-93 cs tm 02298 ER Anderson & Cicchese SOIL DESCRIPTION REPORT Page? of _ �.' A# Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. I Munsell Qu. Sz. Co Color I Texture I Gr. Sz. Sh. Consistence l B w xlary I Roots Bed iTrer - & 1 0 -12 10 r3/3 none 1 2msbk mfr gw if .5 .6 3 V if .5 .6 2 12 -21 10yr4 /4 none sl 2msbk mfr gw Ground 3 21 -84 7.5 r4/6 none co s Osg ml na na .7 .8 alev. 100 ft. Depth to limiting °actor 4 .84 11 Remarks: Boring # 1 0 -7 10 r3 3 none 1 2mgr mfr gw if .5 .6 4 2 7 - 10yr4 /4 none sl 2msbk mfr gw if .5 .6 3 27 -82 7.5yr4/4 none is Osg ml na na .7 .8 Ground 1C IL Depth to limiting f acto r +82" Remarks: Boring # 1 0 -12 10 y r3/3 none 1 2msbk mfr gw if .5 .6 5 .8 12 -90 7.5 r4/4 none is Os mvfr na na .7 .8 Ground clev. 99.45 ft. Depth to limiting f rtor + 90" Remarks: Boring # Ground e'ev. ft. Depth to limiting factor L - - - - - - Remarks: 580-8330(R.05/92) r' STEEL'S SOIL SERVICE Gary L. Steel D. Anderson & B. Cicchese C-STM2298 1554 200th Ave. � RS NW's SE's S22 T30N -R20W New Richmond, WI 54017 M W 3254 town of St. Joseph 1 (715) 246 -6200 1 " =40' BM= op of 1" steel pipe by NW lot cornier at el. 100' Alt BM.= op of 1" steel pipe at el. 100.11 yy 2� t5 � Q -Z w� �I Gary L. Steel 7 -27 -94 -- AIR zo GAL = a Yo &4z- F LOOR 0 214 -llvs 3 5 GAL — / So G A Z- /-?,45/ Al @ /40 GAL = !Od GAL yF0 CeAz l ac=R ®A% f 7 5 GAS s, r, �g yo C-AL s, i feg4i�?dro y9 G'A� p ,e 9,4 . 8 = G 13 170 FT /f F-fo 2P fir^ . e&qu,,f 4='o / 3�$ = 9. SiDECVinr IWF G T Use ,2o 02 TJP& C,= Al) G OAr� AkE,4 3G -0,F oq v 103 aN f1 A -3x 62.5 Zo?F�✓vc�' a boo I l 4 SANITARY SEWER � Watt Atr I � PROPOSED SANITARY I DRAIN FIELD 'LOCATION / Apt s l fC BY OTHERS I I � St SLOT I 3:00 ACRES i Z i I 7 i ioN pf/�E lJErv7' . • r 1 /*! is r/tAro,Q i - - -- - • !�! 1�Ik�TO -_- - - r� : I , , : I - Y : , r : , i I i - .- .- �..,..._.. _.- ?._._..} _..._`. f. .. __..1. _.. T . -. t.__... _ _. . -. _ 1. ... ..-- ___.. -..... _.. .. -. _._. _ _... ___...__.. _. •___.. _____._ -_, .. - i r i 44i ± Y 13 / 1 a � A 1 1' I � Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 L,7!, �r and Human Relations Division of Safety & Buildings in accord with ILHR B3.05, 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 (BM), direction and % of slope, scale or PARCEL I.D. # _ dimensioned, north arrow, and location and distance to nearest road. (06 - 2- 0 Z - 5 0 in c) APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Don Anderson & Barry Ciccbese GOVT. LOT NW 1/4 SE 1/4,S 22 T 30 N,R 20 Xk(or) W PROPERTY OWNERS MAILING ADDRESS LOT # - 7BL # SUBD. NAME OR CSM # 275 125th. Ave. na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ 00Wbf _ NEAREST ROAD Hudson, WI. 54016 (715 549 -6297 St. Joseph St. H . 112164 [ New Construction Use [) Residential / Number of bedrooms [ [ Addition to existing building Replacement [4 Public or commercial describe unknown Code derived daily flow na gpd Recommended design loading rate • 7 bed, gpdm .8 trench, gpdtft Absorption area required na bed, ft na trench, ft Maximum design loading rate 77 bed, gpd/ft - 8 trench, gpd/ft Recommended infiltration surface elevation(s) 97.16 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ®S ❑ U I K] S❑ U [3: 0 U a ❑ U O S au D S MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsistencelBound3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed lTmn& 1 0 -9 10yr3 /3 none 1 2msbk mfr gw if .5 .6 1 — <"; }n< 2 9 -20 10yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3 20 -82 7.5yr4/4 none is osg mvfr na na .7 .8 elev. 99 ft. Depth to limiting .,� factor I !r t Remarks: Boring # 1 0 -9 10yr3 /3 none `� 1 J 2 k mfr gw if .5 .6 2 9 -22 10yr4 /4 none t 2msbk mfr 9w if .5 .6 3 22 -82 7.5yr4/4 none is Osg mvfr na na .7 .8 Ground elev. 100 ft. Depth to limiting + ' Remarks: CST Name:- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 2 . Ave. , ew Richmond, WI. 54017 Signature: Date: CST Number: u 7 -27 -94 cstm 02298 STEEL'S SOIL SERVICE Gary L . Steel D. Anderson & B. Cicchese 1554 200th Ave. CSTM2298 NW4 SE4 S22- T30 -R20w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 1 1 " =40' BM= op of 1 steel pipe by NW lot cormer at el. 100' Alt BM.= op of 1" steel pipe at el. 100.11 th 0A, ' m C ry' ' . X19' ?r� 10 ` Q 0 Gary L. Steel 7 -27 -94 .FROM SCHMTT & SONS EXC PHONE NO. : 715 549 6651 Aug. 31 1998 01:49PM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/]Buyer 6 , Mailing Address 80 Property Address ll o r _ (Verification required from Planning Department for new construction) y 29 f - City/State .u�T'dnr ��,� parcel Identification Number © ©� LEGAL DESCRIPTION Property Location %, _S� ya, Sec. T22- N_ ,"_W, Town of _Si, y --sACR'// Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # Ste(, y 5` . Volume , Page # 4 V Ll Spec house ❑ yes Z no Lot lines identifiable yes Cl 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, signod by the owner and by a masterplumber, journeyman plumber, resttictedplumbcr 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 4 days the a year expiration da URE OF 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 owne rs) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Ofliee_ SIG 4 ATURE OF APPLICANT DATE Any informatiion 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 r � 1 �. FILED a P: 0 `1 3 1994 ® Z JAMES O'CONNELL 9 Register of Doeds 258 St Croix Co., WI CERTIFIED SURVEY MAP ^' Located in part of the NW I-4 of the SE ; and in part of the NE 4 of the SE 1 4 all in Section 22, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin. OWNER Henry Lentz 123 S.T.H. 11 Houlton, Wi. 54082 UNPLATTED LANDS North line of the SEJ, Section 22 S 35�_ S89 ° 59'26 "W �— - - — - - S89 °59'26 "W o �_ _ o N89 ° 59'26 "E - - - 165.90!' 1328.82 o Corner Ctr. Section Se Section 22 Section 22 C - 8 .90' 80.00 / o� 7 ° cn ° - °° Z O C N D o a :� t p10 ° N o CO ,fa, 1 LOT 2 A 0 0 0 rn 0 d ..• C7 Ln N c a 3.06 ACRES D 0 m 133,426 50. FT 1 m F a I O [Tl o ce I�7 � -� 1 0 o '94 f+ co I M 501 I f O J (� /_ 0 l l 1 t' (0 I m m _. co o a IC p S89 59' 26 "W r ID � cn � o 303.00 0 ' 40' 40' i A 1 o rn r-j d rn I m E o IC7 i ro 1-0 1d r•,3 LOT 3 m I r : r I� 3.06 ACRES d Y ' C:D 133,422 SOFT. 6 80 I '^ 10 N - -J - - -. 2 H(- N I 1 m I G7 A 3 (n t w N6a o•�,� 0 E!" .< 5° o p IL A s- LOT 4 0 `� T 3.00 ACRES r � c 130,725 S0. FT. WNR.a +•'��� 'fib co CD o I 142> ��yl'04:1�1<fiV'1� o r