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FILED
_ JUN 10 1994 e► 0
JAMES O'CONNELL
! Register of Deeds
5JL 7710 St. Croix Co., Wf /
CERTIFIED SURVEY MAP
Located in part of the SWa of the SWa of Section 23, T31N, R19W,
Town of Somerset, St. Croix County, Wisconsin.
N
W} Corner of ;
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Section 23
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33' 33' S89 13'16"E 371.17' o -D
Ldi 338.17' H
WI 33.00'
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:. ;::vixCOUNTY 6 = SLOT 3 � (Vi
'" Praherrsire Pl"ig
Zoningww ° O° 4.45 Acres Inc. R/W r+
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�'x" s Casrunittee cv o 193,978 Sq. Ft. o _ J
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1. imt.recor(led 3.75 Acres Exc. R/W —i %i
urithim30 days of 3 —1
�ov4date _ 163,152 Sq. Ft. 3 ��i
rn
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13 1 16 11 W 1 72.95 1
SW Corner of N88 54 39 W 370.70' 200th AVENUE
Section 23 South line of th e SWi - - - - - -
M
CURVE DATA Y NID_A\ TED I_ /-\NDIS)_
CURVE LOT RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT
NO. N9. LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING
1 -2 3 —^ ^ 167_00 1 89 °1310711 N44 234.56 260.04 NR9oi3'1fillw Non °on1n411w
L
S'I'• CROIX COUNTY ZONING DE I'A1U'WN7'
AS RUILT SANITARY R1;1
Owner -12a U, /, f,
Address /
City /State -
Legal Description:
Lot .3 Block Subdivision/CSM it -/ 7 71,o2 - d,1 1,1
'/• '/, .Io)–, Sec.,.,., T -N -RAW, Town of _ �o� s�� PIN tt
SEPTIC TANK — DOSE CHAMBER -- FOLDING TANK INFORMATION:
Tank manufacturer Size ST/PCj / Setback from: House ,,1 Well -ZZ 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: f3E,, Width _Z2 Length s/ Number of Trenches
Setback from: House Well / T�2 P/L, Vent to fresh air intake
ELEVATIONS:
Description of benchmark ,��r /
Description of alternate benchmark Elevation
'� ��, �� Elevation z , 2
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold S" Top of ST/PC Manhole Cover
Distribution Lines () 2y,
Bottom of System ( ) 27 ( ) ( )
Final Grade ( ) /�, 3 ( ) ( )
Date of installation / , /� // Permit number 3,D.- ,?�/Sr State plan number
Plumber's signature -- License number
.� Date
Inspector
('uoiplctc plot plan
Wisconsin Department of Commerce PRIVATE SEWTE y:
Safety and Buildings Division AGE SYSTEM Count
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)]. 320245
O � S . ur SO�'I SIE� Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
fir. :a ' F ..�;.µ, n 032- 1061 -90 -000
TANK INFORMATION ELEVATION DATA A9800432
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �' Benchmarky
/Jo o
Dosing 9
Aeration Bldg. Sewer `/ r
Holding St /W Inlet I 3� /
TANK SETBACK INFORMATION St /Ift Outlet 0 7' 4
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
ir
Septic NA Dt Bottom
Dosing NA Header /Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade G �
Manufacturer Demand
Model Number GPM
TDH Lift Fri 'on System TDH Ft
e g
Forcemain Lth Dia. m ead Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 56 1 __1 I DIMENSION
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Type Of .ar� CHAMBER Model Number:
System: �..r. 7 L r /4 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 E] E] E] Yes No Yes No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 23.31.19.313B,SW,SW 2007 60TH STREET — LOT 3
,pry ,r
rj p9 ,t / ry ,Ch1 !..'�. 1� .✓L. G t... i,_.c K.� f,�..C�L"'S..k.'...
Plan revision required? ❑ Yes ] No
Use other side for additional information. /Q �/
SBD -6710 (R.3/97) Date ns eckop s Signature Cert. No.
SANITARY PERMIT APPLICATION Safety E and Buildin v e D ivision
Aisconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce 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.
• 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 E] Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. 6 1 CKJ State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Prop" Own r Name Property Location
1 1 T , N, R (or&
Property ner's Mailing , Addre Lot Number B(ock Num er
Cit ate Zip Code Phone Number Subdivision Name br _C5M.*u mb r
< ( )
11. TYPE OFF DING: (check one) ❑ State Owned its Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms _ o Town of O ✓
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
p 3� — /6G/ - 90
r
1 E] Apartment/ Condo R 5. 3 /. / 313 8
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 jgj 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 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 Inch) Elevation
�- 7 Feet Feet
VII. Capacit
TANK in gall g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
Tanks Tanks
New Existing strutted
Septic Tank or Holding Tank ® ❑ 1:1 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ I ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for nstallation of the onsite sewage system shown on the attached plans.
Plu be s Na int) Plum er' i �eo �am MP /MPRSW No.: Business Phone Number:
Plumber's K idd re (Str et, City tate, Z Code)
IX. COUNTY /DEPARTMENT USE ONLY
[] Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
A roved Surcharge Fee)
pp ❑Owner Given Initial
Adverse Determination AM l0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, owner, Plumber
ac�o l �� f
.5;�,�rs e %c�J� - Gt/.r.GC'S ,�m��✓ - � /I 9�' �� _ /�1.�siJ �567G3
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _/ of
M r and Human Relations
ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
FPAI UNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or C i I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY WNER PROPERTY LOCATION
GOVT. LOT 1/4 1 /4,S - T � N,R �(or
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOC # SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER [ [:]VILLAGE [TOWN NEAREST ROAD
]
p(J New Construction Use A Residential /Number of bedrooms [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate � - bed, gpd /0 trench, gpd/ft
Absorption area required bed, ft trench, ft Maximum design loading rate -,� bed, gpd /0 gpd/ft
Recommended infiltration surface elevation(s) 7 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material m „ 9,,;.. /�"� /D '& &� 1.,." S'.), Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U ® S E:] U [IS o U ❑ S R U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Barr>dar)r Roots Bed Trey&
Ground ZIC 7,
elev.
ft. _ -
Depth to
limiting
factor
9r
Remarks:
Boring # /
Ground
elev. 8
l ft. - x
s � �
Depth to
limitingo
factor E - "
Remarks: sr • "` "
CST Name:-Please Print Phone: � N ~
Address: e)_5-
Signature: / ? Date: C Nticn erk = '
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.
CERTIFIED SURV Y MAP
Located in part of the SA of the SA of Section 23, T31N, R19W,
Town of Somerset, St. Croix County, Wisconsin.
c i
W1 Corner of •° a+
Section 23 o d o
Ol M
O +T U O 2
O N y.. d .0
Co W y
x C_ A+ o
43
33• aa S89 ° 13' 16 "E 371.17'
I—� 338.17
WI C -4 N
33.00
WI Lam'°
d a1
m 7 N
V JI
100` rf--
�I N
a N •"•
(DI ,n N I
M i'n I
:LOT 3
CD - C" I
0 00 4.45 Acres Inc. R/W o J �
N °00 _
193,978 Sq. Ft. °o • — —
•� J
L : a ° N C'Jli�
N
C)
3.75 Acres Exc. R/W N z
163,152 Sq. Ft. �
—iI :t
° 00 01
3 - O
UI
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4 O M 0 if s
07 ,
N89 16 " W 1 72.951 N '•, , �.,' : � � �ti�� °r.
SW Corner of N88 54' 39 "W 370.701. 200th AVENUE
.o
Section 23 South lin of th e SW} M
CURVE DATA
UnuF)i_ni i ELD i_nNu�
CURVE LOT RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT
NO. N8. LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer u<q S d S
Mailing Address �I� U h� j e ILI, `' al �l/f i ✓. S ^ y3 Q
Property Address a O O 7
(Ver required required from Planning Department for new construction) ,
City /State SC�i�2fed -Q-Y , W Parcel Identification Number
LEGAL DESCRIPTION
Property Location s W ' /., (�v ' /a, Sec. a3 , T 3 1 N -R �! W. Town of
Subdivision 25.2 Lot # _ '
Certified Survey Map # 177 , Volume �y , Page # CP - Z .
Warranty Deed # � 19 Volume 125"3 , Page #
Spec house ❑ yes no Lot lines identifiable Dyes ❑ 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.
I/we, 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
day f t= three year expiratigiq date. a
SIG&AgXE 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 owner(s) of
the proptio desc ' ed abov C6 irtue of a warranty deed recorded in Register of Deeds Office.
SI 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
F X - 7
NO, L . 1 - i .1 , . , -
1 74
Dc` U GL'ks Cuscij
FILED
t? JUN 10 'Q94j-
AMCs O'CONNELL
FlagWWof Cleab
317710 64 crab[ co" va
CERTIFIED SURVEY - MAP
Located in P&rr Of the GW� Of the SWk of Section 23, T11N, A19W,
- TtMn Qf Somerset, St. Croix county, wiqton%�-n
W; r
Sec ,ian 23
�� a c. ItJ '�'1-471 TED
7
A
33' 31'
& 189 4 13' _16 " E 371,170 d t
330.
LJ
LJ
L
t I � � ... ]Ga �_
k
K 11"ei;
40EX COLWTV I a 'LOT 3'
zerniv,
6 119 sq. Ft,
dovs of I RIV t ' 1
y - -WrauW WW by -W 0 —jf
.'It 0 � � ,.� C)t
'4 IL w&d 01
3-1407
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f
Sw r(srntr N89 54`39"Pi 370.701 �y ,, � x Rt _� tf �� + J
soctien 2 bo th line of t3a $N} �AY �,
LOT MAD"S CEVTRA> CMDRD CMCRC ABC TANGENT TANGENT
NO, L!NM ANGLE Af LEM14 BEARING HEARING
• -2 LLEKD "olVO)" N44-36142,S)lq ?14,56' 260,04 ' Nb9-33'j6-'w K00
LK
Alumj?,,jm eok4mty S.,ti K*
ZV Iran Flpa amt, -60irg 1.68
p.r i1nmar foot
: ran Ptpt founj lkov- Parent
126 20 Avvv.uf
tj 540J5
tale in Feer.
f
0 50 log 200
TN;. intstfufent draf%od b M100ael Erickson Fr X.. 94.06
111
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