Loading...
HomeMy WebLinkAbout020-1268-30-000 } n STC - 104 AS BUILT SANITARY SYSTEM REPO~Tu' 1,~°► f) S r CHO1Xl,91~$ OWNER V r ll~iy~ Q 1c.4 t Vk- OFAIOIE ADDRESS (01'3 lie,, c WOVE Z 5 4Cil b SUBDIVISION / CSM# Sk LOT # SECTION_ a 4 T_gq__N-R_I_L_W, Town of 4J so,.., ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100-FEET OF SYSTEM Se ~q ~7a o q INDICATE NORTH ARROW Provide setba k and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Toe 1A) w L ~T C-cr ht-r E2_ O d D ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WVESr(L Co, ,,c- Liquid Capacity: 1 SO 7S_a Setback from: Well w House 15' Other Pump: Manufacturer N~~ E 2 S Model#t~ F-_ Size Float seperation_13 S Gallons/cycle: q e,S Alarm Location SOIL ABSORPTION SYSTEM Width: Length_ 8 Number of trenches Distance & Direction to nearest prop. line: I Setback from: well: W;r ;W House a' Other ELEVATIONS Building Sewer 9G,L~ ST Inlet: 7p_ 37 ST outlet: PC inlet Cj,,, -20 PC bottom 5.53 Pump Off 64,03 Header/Manifold 1 00, S L Bottom of system 2,- Existing Grade Final grade DATE OF INSTALLATION: g.?/ 917 PLUMBER ON JOB: LICENSE NUMBER: ~a a s54 INSPECTOR: y11 .5'aS 9 3/93:jt . Wisconsin~r*DepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: 'Labor ancTHumanRelations INSPECTION REPORT ST. CRAIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 299025 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BIEDERMAN, BRIAN & LORI HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1268-30-004 TANK INFORMATION ELEVATION DATA A9700342 CAPACITY STATION BS HI FS ELEV. TYPE MANUFACTURER Septic P <</ << 1 Benchmark z Dosing i Aeratiorr- Bldg. Sewer 13.0 q Holding St/~01Inlet ~~.35! x.371 9 14 'I TANK SETBACK INFORMATION 1,~jlj~K Outlet Vent TANK TO P / L WELL BLDG. Airl to ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Hemx€r / Man. Aeration NA Dist. Pipe Holding Bot. System So ~~Z/ PUMP/ INFORMATION Final Grade Manufacturer Demand Model Number GPM ~o TDH Lift Friction System TDH Ft oss Head Forcemain Length , Dia. ` Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH With Length No. Of Trenches PIT No. Of Pits Insi Liquid Depth DIMENSIONS DI -L A Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM - INFORMATION Typeo CHAMBER Moe 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 !OVER x Pressure Systems Only xx Mound Or At-Grade Systems O Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes C] No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 24.29.19.1322,SW NW 814 HUTTON 14ILL RD LOT 2-5 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division v■~■■■~ 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 ~f% than 8 112 x 11 inches in size. C.,n( • See reverse side for instructions for completing this application State Sanitary Permit Number a o a'~ The information you provide may be used by other government agency programs I-] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name _ Property Location 5W1/4WW 1/4,S V4 T 9 N,R Iq E(or)W Propert ner's Mailing Address Lot Number Block Number w I 3 t' City„State Z~ ~ Phh3o8~ Nub Subd Sion N me or CSM Number ` ( )140 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village AA ~ _ nn ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of W~(, 5b I w YAe V rlm;~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1n Apartment/ Condo o 2© 1268 -30 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. Ig New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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,DK-Vlound 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 ~t Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) G~ c/ Elevation 06 Soo 54 1. - -`4.,cZ Feet `0t, $1 Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 50 - ) 2E 0 [ S .oY1~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber Zs6 Q I ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) MP P o.: Business Phone Number: Q,f R ens c 0a4.5S 215- 425 2i 76' Plumber's Address (Street, City, State, Zip Code) 1042 m r : %,%.4c, s IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge F ee) f~~ Adverse Determination U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 61 IV,// SHD-6398 (R. 015/94) DISTRIBUTION: Original to Counly. One copy To: Safety & Ruildings Divi pion, 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 purnper 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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 must 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. -------------------------------------------------------------------------7-------------------------- 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. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 27, 1997 2226 Rose Street La Crosse WI 54603 HEISE, CARL 1042 S MAIN RIVER FALLS WI 54022 RE: PLAN S97-41026 FEE RECEIVED: 180.00 BIEDERMAN, BRIAN & LORI SW,NW,24,29,19W TOWN OF HUDSON COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Gerard M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SHO.6423 (H. 01/91) S97-41026 MOVE THE EARTH CARL HEISE EXCAVATING_ 1042 South Main RIVER FALLS, WI 54022 Rece/vs D CARL P. HEISE AUG 25 715 425-2175 Owner 1997 FOR ~ ? . MOUNSYSTEM. SAFETY, & BLp6S D IV. 4 BEDROOM RESIDENCE LOCATED IN THE SW 4 OF THE w►~1 Q OF SECTION 24 , T21_N, R6q W, TOWN OF g L~So►U A, COUNTY,.WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAY-OUT PAGE 5 of G PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED.FOR F2IAN 4L0 r I BtED1:::i-) 141;+N 1613 PIWEW00D LN HUDSON W l ,4~lro p O`N:trially collai" o COO . IDEppi~ FEZ a~~S%oNO1 N~~GE R A ED By ~ GO C r P, else CST 3314 MPRS 3378 1042 South Main Street River •Fal•ls,WI 54022 f PLOT PLAIN ,-Oil ro p or haU1 L o r `~Tra !C k= ~ '1 L. Ct '5Io t X41 ti ! ~G/7~p CGY.~p~ is <.;7iGJ r~,~C '4sa40 i i 1 I t t i 'i M i i t SOtc~`., ~f,Uv.eti~ J 4t>>C F Di IOro I c0 Pipe DoI olI Page 9o~G E nd Vir•. ( FtrlorottG (nb •PVC FiDt ~P°R?'if1?JE1,~7 No" ~RKrs~I 0 \ Jpoy~~~~` ~r•ct l oto+rd Gn bottom, O t rr E ouoltp Spoctd S 1 Q • PVC FbrCe Uoin From Fump PVC / Moniloic Frpt y~ r • ~G~s+t+uu++or• ~ pipe I Lost Holt should Be to End Cop Fnr+ C.nn hictribUllon PiDt LoY0ui P S 3 X 58 " Y Hole Diameter '4 Inch Manifold . " 3 Inches rorce Main " Inches Lateran. " 1 '4 Inch(es) Holes Per Lateral 9 2,7-97-1 45 - 2 03 - 241• 319 -3~9 - g 35 _ q q3 F • SEPTIC TANK 5'PUMP CHAMBER.CROSS SECTION AND SPECIFICATIONS , 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATH]R PROOF ; ? 25' FROM DOOR, WINDOW OR JUNCTION BOX -APPROVED; FRESH AIR INTAKE WITH CONDUIT MANHOLE COVI FINISHED GRADE 4" CI RISER ;WPADLOCKS E 6" MIN. f- WARNTNG3I,AB) y ABOVE GRADE 'MIN'l ,i 18" IN. 6" MAX. 4n4 z.. o ,~'t a INLET r, ~:xa WATER TIGHT SEALS GAS- TIGHT r ; sp Orr BAFFLE A SEAL "A'APPROf` CI PIPE ` AI,M JOINTS 1 YC~ - rPLPE 3 ~ ~ONTC 3' ONTO ON . ---,,PIPE' SOLID SOLID. SOIL s SOIL C PUMP OFF ELEV. SS FT. OFF RISER 'EXI D PERMITTED Ol IFS=TANK, "MANUFACTUREF HA5 APPROVAI 3" APPROVED BEDDING UNDER TANK".*, ,Yw CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE. TANK MANUFACTURER: _~CJ FC,FRrt hO_ NUMBER DOSES PER DAY TANK SIZES: SEPTIC 1250 GAL. DOSE VOLUME INCLUDING „fDOSE p. GAL. .'368 a.1 4r ~q~ .x5 FLOWBACK. GAL': rALARM MANUFACTURERS VGTo CAPACITIES: A = INCHES= gGAL MODEL NUMBER: SWITCH TYPE: B = 2 INCHES = 29.~ ALLGAL PUMP MANUFACTURER: My 1: R._S C INCHES = L MODEL NUMBER: M 0' SWITCH TYPE: D INCHES n "Ps Ai REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR, 16 ~23~,,. VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.5,FEET' + 1 3O FEET FORCEMAIN X 2 FT/100 , FT., FRICTION FACTOR , FEET TOTAL DYNAMIC HEAD - FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETEx, LIQUID DEPTH 51 !4 j 70~~ } SIGNED: DATE: LICENSE NUMBER: 1/88 . -J ~t d1 ME40 SERIES 4/10 HP Effluent and Drain Water Pumps POWER & PLO xT CORDS PLUG DIMENSIONS Quick-conne.:L watertight Replaces switch assembly fittings are interchange- for manual operation. - 1'h' rlPr able, replaceable from > PUMP exterior. (38.Imm DwAmrge C.~ (38mm MECHANICAL FLOAT d c 4s SWITCH "I. Mercury-free, 900 angle operation. C c - I g------- 5.66 (144mm) 11.68 _..(296.5mm) ON" MOTOR HOUSING Cast iron for efficient heat transfer. OVERLOAD SWITCH Built-in to protect against 11 overload conditions. - ..orr- g 9 4/10 HP MOTOR 1600 rpm 60 Hz, 115 or N ^ 230V, single phase. Oil- r _ cooled and lubricated. h ROTARY SHAFT SEAL c Carbon, ceramic faces. 1 f _ _.i ~ my i PERFORMANCE CURVE 1 i CAPACITY LITERS PER MINUTE i I 0 50 IUO 150 200 250 300 350 40 12 VOLUTE/IMPELLER SEAL 35 RING 10 Maintains high efficiency 30 and reduces recirculation, 25 replaceable. - ENCI SED TWO VANE 20 6 IMPELLER - High efficiency, passes HIGH EFFICIENCY ABS 15 t; 4 6 /4" spherical solids, with VOLUTE 3 stainless steel wear ring. Corrosion resistant. Passes 1 o 3/" spherical solids. I i4" 5 THiI ST WASHER, SLEEVE NPT discharge. 4 BEARINGS o?p c'` E htanca Smooth operation O (0 20 30 40 50 60 70 60 90 100 and extend pump life. CAPACITY GALLONS PER MINUTE f K3319 5/92® F. E. Myers, A Pentair Company Printed in U.S.A. 1101 Myers Parkway Ashland, Ohio 44805-1923 419/289-1144 FAX: 419/289-6658, TLX: 98-7443 W'rx;rr, ~Departmentof Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor And Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ' i St. Croix 1 i _ ude, but lan must incl Attach complete site plan on paper not les ap 17x 11 i tA~ not limited to vertical and horizontal refer lnt (BMA; directif slope, scale or PAP.CEL LD. # b dimensioned, north arrow, and location n stance to rlears'~ 020-1268-30 APPLICANT INFORMATION-PLE PRIN~--~iL4 1*6REVIEWED BY DATE PROPERTY OWNER: cam' PROPERTY LOCATION Gary Talbert GOVT. LOT SW 1/4 NW 1/4,S 24 T 29 N,R 19 tor) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 189 Greenway Ave. N.~ 25 na Sunridge phase I CITY, STATE ZIP CODE E f~l~ f crTY ❑VILLAGE SOWN NEAREST ROAD Oakdale, MN. 55127 ( 28 Hudson IMcDiarmid Rd. [x]KNew Construction Use J Residential I Number of bedrooms 3 Addition to existing building _ I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 god Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpdm2 Absorption area required 375 rte, ft2 375 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 • is trench, gpdtft2 Recommended infiltration surfAce PlPvationfSI 99.56 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 98.56' Parent material pitted glacial drift Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ❑ S ®U as ❑ U ❑ S ®U S ❑ U ❑ S ®U ❑ S I NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trertct gw 1 0-10 10yr4/3 none 1 2msbk mfr 2f .5 .6 1 N-M 1 „ 2 10-24 10yr4/4 none sil 2msbk mfr 9w if .5 .6 . Ground 3 24-38 7.5yr4/4 none scl 2msbk mvfr gw na .4 .5 97.96 ft 4 38-70 10yr7/4 none fract red limes one . -7 CZ-r- IC: Depth to limiting factor 38" Remarks: Boring # 1 0-13 10yr4/3 none 1 2msbk mfr 9W 2f .5 .6 2 2msbk mfr gw if .4 .5 a` 2 13-21 10Yr4/4 none sicl 3 21-38 10yr3/4 none 1 fs Osg mvfr gw na .5 .6 Ground elev. 4 138-55 10yr4/6 lfd 7.5yr5/6 sicl M na na na np .2 99.01 tt, Depth to limiting factor 38" Remarks: H-4 fractured limestone through out horizon CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 155 200th. A e. New Richmond, WI. 54017 - Signature: Date: CST Number: 7-26-95 PROPERTY OWNER Gary Talbert SOIL DESCRIPTION REPORT Page.,.2 of ' 3 PARCEL I.D. # 020-1268-30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell C:u. Sz. Cont. Color Gr. Sz. Sh. Bed ITmr& 1 0-14 10yr4/3 none 1 2msbk mfr gw 2f .5 .6 3 2 14-24 10yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 24-54 7.5yr4/6 none sl 2msbk mvfr gw na .5 .6 elev. 99.01 ft. 4 54-72 10yr4/6 c2p 7.5yr5/8 scl M na na na np ! .2 Deptli to limiting f~c~or Remarks: fractured limestone through out H-4 Boring # ~L\ Ground elev. ft. Depth to limiting factor Remarks: Boring # a: Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. I Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Gary Talbert 1554 200th Ave. CSTM2298 SW4NW4 S24-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 t lot #25 Sunridge phase I N 1"=40' BM. = top of NW lot stake @ el. 100, Zvi CoO '4 -'2. 5 ; C,- it s 2 , Vo y~ / Iva gel.. IS$6 1 Gary L. STeel 7-26-95 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property t ( r can T. B1 e.,!erma n u V~u C,d /4. B~ e~ern,~.,, Location of property _5W 1/4 njVJ 1/4, Section 2LIT LLN-R /q W Township 14 u j5o n Mailing address 13 f -ne w or d Lq Address of site 8 41, PC,, 14, 1~ Rd. i 14a dson Subdivision name Ju n r cl <i Lot no. Z 5 Other homes on property? Yes X No Previous owner of property Total size of property Total size of parcel .O 2-Z- C c eS Date parcel was created 3a04- 01, s `I Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes A, No Volume 115Y and Page Number Q as recorded with the Register of Deeds. ~0 INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5 3 71,E .Sj , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. OrL lilhlC~~ J Signatur of Applicant Co-Applicant a z 9T ~i~U Cj~ Date of Signature Date of Signature STC-105 C~ZO IZ6ft ~o SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER b r i CCO J , a vi J I. o r, & 1 e- r m wh MAILING ADDRESS i 1 3 i V) G, UU r. 0 c1 Lt c~ S O r-) PROPERTY ADDRESS N L y o 14; 11 Qd H A 8 So,, , W (location of septic system) Please obtain from the Planning Dept./ CITY/STATE P Ll J ~O r PROPERTY LOCATION 1/4, )-)1-()1/4, Section T 2c_ N-R~W TOWN OF u .5c:ST. CROIX COUNTY, WI SUBDIVISION Su'-) I` ; c Q LOT NUMBER . 5 CERTIFIED SURVEY MAP , VOLUME 115Y, PAGE, LOT NUMBER a 5 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. r /~(,m SIGNED: DATE: " 9 7 St. Croix County Zoning Office Government Center 1101 Cann ichael Road /a Hudson, WI 54016 L - 11/93 02 SG1'iF BAR OF w`ISCOtiSIti FORM l 199, t.,C Y 53'7t~i•~0 W'ARRANTt DEED 1 4 2-29, oocutitENT No. D EC 2 0 1995 Y b; 1. .0:30 A. ti. Greenwcod Enterprises, _Inc., t This,Deed, made be)ween i a Wisconsin ccrporation _ - 3 - , Gra tor. Brian J tie-derman and Lori A. Biederman, husband and - • and wife as surv ivorship marital ro er y _ Ff E L _ _ , Grantee. 7N~S SPACE RESERVED FOR RECORDING DATA Witnesseth, That the said Grantor for a valuable cronsideratit n Qf Qne . dollar and other good and valuable conSideCTOix _ Br ADDRESS conveys to Grantee the following described real estate it, - 1613 Pinewood Lane } County, Stare .f .Visconsin: Hudson, WI 54016 d [Parcel Identification Number) s a St for Lot 25 of the Plat of SunRidge, filed in Office in Voltmeg5sofrPlats, at . Croix County, Wisconsin, on September 22, 1989, Page 71, as Document Number 451750. - TRANSFER FEE- is not homestead property. This (jff) (is not) Together with all and singular the herediuments and appurtenances thereunto beioogrng; And _ _CiieeSlh?44$. n rt)r.1Ses.-~~~--- - warrants that the title is good, indefeasible in fee simple and free and clear of encumbram cs except , easements, restrictions and reservations, if any, of record and will warrant and defend the same. 19 95. Dated this day of GREEISWOOD E`TTE RP , C. By: GR;ae D ENTERPRI , INC. / _ (SEAL) By-- - (SEAL) I-- s cretary _r us, ch _ (SEAL) AUTHENTICATION (SEAL) ACKNOWLEDGMENT A 1Laeut- STATE Of WISCONSIN ss. Signaturc(Y; --ame9--E-Puach- St. CLOlx County. i day of came before me this _--2--- auth70 y of Deeembe , __95 emir 19 95 the above named: m d' .4e Mry S_ B•isch, its secretary Murray T MEMBER STATE B OF WISCONSI - - (If not, person 1 - - who executed the to me knorts to be the pr i authorized by §706.06, Wis. Scats.) fnrtQUinr ,nsaztim~r:t and acknowledge the same.