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Home My WebLink About032-1048-70-025 ST. CROIX COUNTY ZONING DEPARTMENT ^. j AS BUILT SANITARY REPORT' 4� Owner _ Address s City /State Legal Description: Lot Block Subdivision/CSM # ,►�� '�+ '� +, Sec., T,N -RAW, Town of _�� ,�l�E1� PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1 0 1 EF - Size ST/PC z/ = / Setback from: House -?,? Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: - Width 3 Length r, 2 Number of Trenches ,2 Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark o Elevation leffe Description of alternate benchmark Elevation Building Sewer 9s: V ST/HT Inlet _ 2 .. o:? ST Outlet 95!,x; PC Inlet PC Bottom Header/Manifold _ ? Z 7 Top of ST/PC Manhole Cover 1 Distribution Lines () L S - 7 ( ) _ 4.1 ( ) Bottom of System () 9 / Z Final Grade O 9 s 7 O O Date of installation 1 U /9p P rmit nu ber _ -To �, _ State plan number Plumber's signature License number Date rl / Inspector complete plot plan or Wisconsin Department of Commerce Safe and Buildings Division PRIVATE SEWAGE SYSTEM County: ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryEedrpiLAlr,2 Personal information you provice maybe used for secondary purposes [Privacy La CURLER, STEVEN K. s.15.04 (1)(m)]. Permit Holder's Name: [I i #g ' Town of: State Plan ID No.: �t CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T (D 0 �� To ro r- i e �-- 1048 -70 -025 TANK INFORMATION ELEVATION DATA A9800141 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic \ 4� Bench q 5 ( (O`j. ✓ 10o Dosing •7 I D T• 7 Aeration Bldg. Sewer l� 52 Holding t/ Inlet TANK SETBACK INFORMATION St Hw Outlet 6 -56 - B3 TANK TO P/ L WELL BLDG. Air r�take ROAD Dt Inlet Septic 3 G ' 34 NA Dt Bottom Dosing NA Header/ Man. to Aeration A Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer De nd Model>d<ber GP TDH Lift Friction S st TDH Ft Forcem Dia. Dist. To ell SOIL ABSORPTION SYSTEM BEDf TJtrNCV Width Length � No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D pth DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LE CHING Manufacturer: INFORMATION Type O / e C MBER w Mo a Num System: I (� 5 � r — OR IT DISTRIBUTION SYSTEM Header / Manifold t r ipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length LJ Dia. Length �(�.2 Spacing, SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only' Depth Over Depth Over xx Depth Of xx Seeded /Sodded Fx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 17.31.19,SE,NE 371 216TH AVENUE — RIVER OAKS LOT 6 Plan revlslon requlr d? Yes ❑ No Use ether side for additio a information. SBD -6710 (R.3197) Date Insp ors Signature Cert. N Ali SANITARY PERMIT APPLICATION Safety a nd Buildings Division 201 E. Washington Ave. Department of Commerce 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 8112 x 11 inches in size. r • See reverse side for instructions for completing this application State Sanitary Permit Number � The information you provide may be used by other government agency programs C a heck if re 1ion t pro s application [Privacy Law, s. 15.04 (1) (m)]. a /) vin V r r � ., State Plan I.D. Number I. APPLICATION INFORMATI N -PLEASE PRINT ALL INF RMATI N Property ner Name Property Location 1/12 & 1/4, S T I N, R K(067 Property Owner's Mailing Address Lot Number Block Num r City, State Zip Code Phone Number Subdivision Name o 5M Numb r ( ) 9 ales I ll. TYP B IL ING: (check one) ❑ State Owned 0 C Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 Tow OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 17. 3 1 • 1 1 ay 3 A ®� - '10w- 2 C] 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. 0 New 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 aSeepage 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 /sq. ft.) (Min. nch) 9,3; 17 Elevation - - If 7 q Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Plastic Ex p er- New Existin Gallons Tanks Concrete Con- Steel glass astc A p p T nks Tanks strutted Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for,' allation 91 the onsite sewage system shown on the attached plans. Plumb r' ame: P Plumb is na MP /MPRSW No.: Business Phone Number: r I Plum er's Address t, C State, Code): L IX. COUNTY / DEPARTMENT USE ONLY I [:] Disapproved Sanitary Permit Fee (Includes Groundwater issue Issui A Si ature(NoStamps) proved ❑ Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SM -6396 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber SANITARY PERMIT APPLICATION S afet y E. W shinigton A ve Divi NAh cons i n 9 h ILHR i d accor with 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce In Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side'for instructions for completing this application State Sanitary Permit Number �6 - r7s� The information you provide may be used by other government agency programs El Check if revision to previous pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property 9wner Name Property Location ,. — 1/4 1/4, 5 7 T , 111, R (Or� Property Owner's Mailing Addre s Lot Number Block Nurrybhr Citat Zip Code Phone Number Subdivisio me or CSM umber H . TYPE OF BUILDING: (check one) ❑ State Owned ° It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms -� ° Tow of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo Q.� 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, a New 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 t 42 ❑ Pit Privy 13 ❑ Seepage Pit �o�- )1 E3 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.) (Alin. /i ch) Elevation f Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- plastic Exper. New Existing Gallons Tanks Concrete Con Steel glass App. Tanks Tanks strutted ing Tank "/ I — ,Abe ___1_+LZEka:: M El El ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 11 El 11 El ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for i tallation of the onsite sewage system shown on the attached plans. _Plu b (Pry Plum ber's n =S,) MP /MPRSW No.: Business Phone Number. • J _ J lumbe s Ac dress TS heet, i y, Stat p Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitar Permit Fee (Includes Groundwater ate ssue Issu' g gent Si atute (No Stamps) roved rx Surcharge Fee) pp ❑Owner Given Initial 6 �� (xj / I ENL4,v i Adverse Determination 6 UUU X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 IRA 1/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 _ I v � I ,3� veil - s i II j 3: i 4 r B 3� i,�o�os.zb w,�1 �s 13- 11P�osdo �Yo,rs� Ga��G� d/o r rv� Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page L of Labor and Human 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 S. 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. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT S�` 1/4 1 /4,S T N,R � (or l ' PROPER OWNER':S MAILJ�G ADDRESS LOT # t BLO K# SUBD. N E OR CS # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE RTO N NE EST ROAD _) - _ Pq New Construction Use d(] Residential / Number of bedrooms Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow J�� gpd Recommended design loading rate �Z b ed, gpd /ft _ trench, gpd /ft Absorption area required - 4� — bed, ft2 _1-- trench, ft Maximum design loading rate ,gy bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) , Z ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable &h 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 0S ❑U ®S ❑U 0S ❑U El X El OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Qont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I Ground elev. IW-1- ft. Depth to limiting factor y Remarks: Boring # i Ground elev. /W ft. Depth to limiting +, factor Remarks: CST Name: — Please Print Phone: : 72 _ a W Address: S L t Signature: ) Date: N I I I , , , I i j i i I i 1 t -- - -- I -- 1 -- ! r i , ! , 7 - , I I ! _ I ± I F i I _ —_. i��.iM�s__l.Y:[GG�}4I1,/f -4 _.....— " L 1__. — � __ ' I 1_I L � I• ..-�— i 1 + i i �. I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. So� Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 Property er Property Location Govt. Lot 1/4 - 1 /4,S T ,N,R ZZ/ Property Owner's Mailing Address Lot # [ BI&k# I Subd. Name or CSM# City tat Zip Code (hone )mbar ❑ City ❑ Village ® Town Nearest Road LM New Construction Use: (Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 5D gid Recommended design loading rate _ bed, gpd* , � -- trench, gpd* Absorption area required bed, ft .� /_� trench, ft2 Maximum design loading rate _ bed, gpd* _,-,f—_ trench, gpd/ft Recommended infiltration surface elevation(s) :2Z/ 7 - y',7. 94 ft (as referred to site plan benchmark) Additional design/site considerations 4Ao N Parent material _.5ic. �,�,rs, / Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ s ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munseil Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots �:... Bed ,Trench , Ground elev. W - Depth to limiting factor Remarks: Boring # 13 - Z / CJ Ground elev. Depth to limiting factor ?1Q_in, Remarks: CST Name (PI ase Pn ) Signature Telephone No. Address �� Date CST Number 14 , r Sea. rxsirf ,yam �1 r3�'r f /,DES �r a s 6 a 3 r _ r P4 R T RTHSOMERSET T 31 N. — R.19 W o 51 PN POCK -ST CRO /x POLK I COUNTY a it RD. I L, O ✓oe //vs G E C.brexe c. / /nm• r /es N 4Knfh r O a / tFar r .,., nice oncer P,nkei: orto Br ^%b// "e Sl Da�� w 72 L 44.32 PerersWl H nse fJo 4 ELONO RO. w (� JZ l C00 F2 � y FERR i r ® u Gary %ene 76 r Fro .r ca tl tl� 0 Inc. uN r d n ;rlee ��u fus f > �h 1515 /be /n, /40.55 rof{ o s ° p .Fisher tl 7an Edwards 40 M /Ued /579 �:� c HN �Terr Ma�f/ /GO � �'� j h Rrh La ✓enfu�e �o� � 66 an bkn, SitT /ow errs o� � � � ' Q/��\ /12/9 r, 2J2N achfne F / y d , x • iG�' • /54/ 3 b 4y 0 Portn 94 4 V l0 d/ 117 As f Lorraine 4 o r ro har /e f Ma y v° b ,' u� �i S 40 7— L y9 3 L - J N P y �i0 drr �° h M ¢ ook tT .e M °�, l9 /2D i` Kof// v�� cSchie 165,0 59 Kppes r3os Jue� "' N E at 40 iw 79 B2 e /n /s ,a zrvc - «.e b o Q V pp p W y�� d y{ o Otl ,tbbr'c/ Sc r- ; .I+ r r osePh ° ,p` ' SJOaot f S l�Un 3v� 1095 n p ��• D i7. .. r °d v.a° Mart `� v � 1 m Q 40 BLtPI/s7` y b . • '� cc I.,,: 3 yh C reh o/' 20 S 6 Lid ! / de a /Ph O C C y�� M.' 127 em¢s 0 chachYner P /ourde C 41 a �5 obel{ 11147 y. .hl LW 73.56 Lt°�Iisc / C i • WifmO_ /SC2 M /drt e d •• d q 0 2i0V under3k Y�� TR!\Y75 „ Sch¢chtner /� rYo /en W 11 M 0 1,6 0 20 U. S A ro 3 LTOhn E. rhordrpWC .Qon ¢ f Gen .Tohn s Z _ N �vJ / S C. 3/4 'Y Wa sh f3mi /Ei 75 Donn¢ a. e l N F 77 1w mB,i/ `; � rYar7ntr V, d- R .. Samma ektf /20 r _ EcY.,,ard e L o ers la w � Tow � " tW /ma. r.a• HCAN f � � S 7 r� JB $ch¢chtner' °a.cs ssrs:: //B.95 2 15 1 ;..� �� o l! C7ermain � y � 2147 A Riac 5 VE. roo n, 1. 15 r CS/eVen 1'✓ J BO W W ,cQ� ,1 �k .�CfuX Mi lroe/ Lu r {, J ,� M 3ro� • 79 ff¢rnsen of n J ($ g V v ° 79 L c$ L end R°bf t .q ytl u o Davr¢' 7742 17 � y� — } n rc // Y-, - 4'A L Z t/ �� Os� 1 • (� • vE O UN 0 LAf Dh�a /d C N/O. /fel f 3 o z ° O1 R ae v Debra ti i C ° Me /v n i W N Im. ;ms- 4 F• a O. ,Pobert Cor ufe/ v Germ¢in .; � C U tl O F�xK tu rut /22/ T �V /7arY /0/75 4 F O '~^ /ZVC s: ' 1 Oito q y c . w DenNis C �n �UU u ° L«rw.a 1 D R. .40 S /ha . P✓ /SS B7 /GO BO N�umOnB L p a p 0 S a R 203 TN • h 4D •AYE. S 5 410.BP / br rn ''� E Jens L7ohn 70 N h 4 • SM T ::: .... ..... 296.67 40 400 Zw2ke v htl ql W . Sivs 7uiTif ::: J2 � / /.5 'f0 a J C fSlonna N T MI4La ::: 5 :sic 1 r/ ° ffarv- K.pPes ,� Lora,., e• O v tl s Gr o r g .F 4./ .0425 wson2 40 5 C ti Z Pn+ .. s. / URTL ':: 8 t of r • 200.7R a o j D n a Z tl A wman F 2 Neumann C h 4( h 80 Iflfl [1 5 I r G E Leonard 6o 91 t1 r J` fo Ear / L. f ..... f T /be ' A c ° E/ abefh qnn to - /59 f �j aqe r 24 RemiC L;nd¢ L�a (7O/ne V 230 ` 'a 39.55 �j� / EsYa/es - •a tl H Load y L Mi- G74 F /eda fi? N U z f ` /3o./rae ac y - 40 qq cSa Pa,r •rxD ZwicKe /S 5 /42.97 AVE. E/ R Qi f e .d N. ; /O S Urxi¢ . P Eh /e s F ner arc _ � q Son S J w Mond r 1 W¢[r// Asm 47 40� �� c !a �✓ se s Mar /e / %4B ST L..S: Oo O A N ✓ /Cto/' /o N6 / /¢c em/<f Rob Y /o- F ✓eNM 1'qL�. TM /d SD AVE 0) 1,9, Pamrla, k _gtt� /9 _ u a 411 0 ,r, Ga o y +mot sx. e �/, Lemire ft-,7 Caro/ etle b a R.wr I B4 Bro Ceti/ a F R J RI 40 0 (6 7 1d A 1 � VN 1 3 z v /eyJce .� s 5 Be/sk ourrte v�v 35 b 40 40 v _V . ac et a n F� p )B F0 rTosep/rJ i,C \ z x p s iB . s. Lhrel SO ! W N '1 k. an.c s: ^rc 1011 ScvnersetT 'C W S.4494 CEN T �. srt oW J za 35 1 6+ O o 300 � c � ^ 6 - 99{ .QockforrY Mc�o SEE PA 1 GE SJ 400 500 600 700 800 BANK OF SOMERSET LANDRY =' Save With Us — LANDSCAPING �� J Help Build Your Community MEMBER FDIC Black Dirt - Crushed Gravel SOMERSET, WISCONSIN Driveways - Landscaping Phone: 247 -3348 Phone: 247 -3480 SOMERSET quarter of Section 17, Township 31 North, Range 19 West, Town of ,Somerset, St. Croix County, Wisconsin. 4 OWNER: R�fver Hill Family Trust LEGEND Gary Gifford, Trustee FOUND ST. CROIX CO. MONUMENT 452 280th st. • FOUND I" IRON PIPE Osceola, Wi. 54020 SET I "- 24" IRON PIPE WEIGHING O 1.68 LBS. /LINEAR FOOT. UNPLATTED LANDS all stoke s� F .t�: ,':,�kc,l t�, y it /r:, ------- - - - - -- -- - - - - -- I NORTH LINE OF THE SE V4 OF THE NE 1/4 N87 34'02"E 694.60' 294.93 399.67 — — - W c F 'S C C0 s m 1' maz DOUGLAS J. (P ° 7 N W 8 co 7AHLER o r > - 2145 * m in m 193,880 SO. FT. 0) 'm. 1e0,036 so. FT. HUDSON, W o m - 4. ACRES f ��S, /� � 4.133 ACRES m � 'V r/� �;mm m 2 1 V. c,• I A ° I Z 0 '\ A k c° 0 I 1 z m G� 4 o p 8 + p -{ m 690 56 32 7 e 3 9Y��2/'' m rn � 3 ' " o Fence _ R' O? � � EXISTING 66' ROAD EASEMENT - TO BE 1 N on iin � � �� DEDICATED TO PUBLIC � 1� Z N 1` II -- —.__ i ID z'm m 1 \ ro Ic y J n 'I - �ts� \ :0 I T 5 V/ I I 234,729 S0. FT. Off, 225,058 S0, FT. 1 W 5.389 ACRES P 5.167 ACRES Ul tl l0 /h - - - - - - -- -- - - -- O (00 03 V A U W I W 1 1� I EI /4 CORNER SECTION 17 T 31N, P19W S87 49 '3.9_ "W 645.43 _ S87 49 39"W 694. 61 SOUTH LINE OF THE NE v4 z m O U N cn UN_PLATTED LANDS w m This instrument was drafted by Douglas ,7. Zalller F ° N 0 LOT 5: $22,500 10 ^ LOT 6: $22,500 LOT 7: $23,500 SE col7NE R SECTION 17 LOT 8: $22,500 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S� @� 2 C url -ems Mailing Address C "su o4 S iLreu oml Property Address A- (Verification required from Planning Department for new construction) $M�� City /Stat Parcel Identi fication Numbe LEGAL DESCRIPTION Property Location SE ' /,, iU F= ' /,, sec. _1, T 31 N -R I � W, Town of Sa"►'�Q'f5� Subdivision r6�) e J a , Lot # Certified Survey Map # , Volume , Page # ��71.fz Warranty Deed # I , Volume !�� _, Page # 0 J 56 7 Spec house ❑ yes9 no Lot lines identifiable`Il 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 wastewat: rdisposal 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. I /we, the widersigned 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 s of the ee year expiration date. :5' /1 /9F� GNATUiCE OF APPLICANT DATE OWNEI C ERTIFICATION I � :ve) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of propel. scribed above, by virtue of a warranty deed recorded in Register oC Deeds Office. SIGNATURE OF APPLICANT DATE * * * *•* Any infnrmatinn that ie mie- rrrrr may result in the sanitary permit being revoked by the Zoning Department. •• *••• •* 1114 1011 INN 111414irr11io11 :r .I rnrl , ,l from thr of Peal% of(irr a copy of the certified survey map if retcrence is made in the %varranty deed Located in part of the Southeast one - quarter of the Northeast one- - quarter of Section 17, Township 31. North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. OWNER: River Hill Family Trust LEGEN Gary Gifford, Trustee FOUND ST. CROIX CO. MONUMENT 452 280th St. • FOUNO I" IRON PIPE Osceola, Wi . c,4 O SET 1" . 24" IRON PIPE WEIGHING 1.68 L.BS. /LINEAR FOOT. UNPLATTED LANDS - t SCALE 1" 200' NORTH LINE OF THE SE 1/ OF THE NE 1/4 L _ Moc N67 34'02 "E 694,60, 200 100 0 200 294.93 399.67 P �a 0 f W /s 0 , m i i X '� ,�'� DOUGLA6 �. N ° a w r ZAHLFA s o r b. 7 8 * $•z14S m WA pp HUDSO * > 193.880 90. 7t. gyp. 180,038 S0. FT. - w S. Q. X ~.mi 4.450 ACRES 4.133 ACRES m M N O ~z • y � IR NI >r I( — OCR rn I ) �+C r O y0 OUILDJH4 �, S ° p 1 N IC/) 4 N' ig: IY �Z. Y'1 , T V �J��fj•, Mi 'M t ► 3 pj EXIST IN ea' R EASE TO BE o[DICATE r Pup�IC _� iO I DETAIL I� I D M iz < II _ 0.4 2' 270,729 SO.fi• N Q.FT. irJ 5.389 ACRES -Q) 5 167 ACRES n 1 NE CORNER 1 4#" Oi M 0 -- • -— -- — — — — — — — - SECTION 17 j �. (D N 1 a INS I \ 1114 CORNeoi v \� /✓� SECTION 17 N T31N, R 19 A 2' 4 ' A S87 0 49' 39 " W 645.43' S87 39 ' 694, 61' SOUTH LINE O/ YHE NC 1/4 T+ This instrument was drafted by Douglas J. Zahler N r 1 I s V1 C 3E COR!![R SECTION 17 SHEET 1 OF 2 SHEETS a