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HomeMy WebLinkAbout022-1075-10-000 o ~ Oo I N ° e I 0 N Z a I •a z ~ I 0 3 E Q I I M CL I co ~Z o Ei 00 4) N w a m N I- Z o 0 z :!t ° I C y_ O N o a~i Z C N H E v ~ M I a~ y •3 N C N O d ) 0 O O O O a) ¢ w Z co Z o Nv Z 00 C,41 LO 'E ~M w rn m m_ d o 1 N O. 1~6 r Q' G LO v r O N 61 O C o O U) G G d E y N Z j ~v) rrrn~n dZ w t I N 3 Z p •N ~ ~aaa y I a o N o N J V rn rn Z N O ce) = I 0 CD C) n d Q } (n Q. I O O f~yA C , 00 O N C j rO p C G CL C a co D -o C-4 L6 cc E m 4) I- co CD -r- 'a o C, LO (D "0 1wi o W m N m • O N Y co O Z N Z:=s fA c y O I #t _a m 2 m c `1v ee .S m a E 0 c c r~ o r A 0 a 2 0 h V Parcel 022-1075-10-000 02/03/2006 09:26 AM PAGE 1 OF 1 Alt. Parcel 27.28.18.P417A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner STEVEN F NASH O - NASH, STEVEN F 197 CTY RD JJ RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 197 CTY RD JJ SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 19.200 Plat: 3581-CSM 13/3581 SEC 27 T28N R18W NE NE EZ-UT-1321/325 Block/Condo Bldg: LOT 1 BEING LOT 1 CSM 13/3581 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 03/07/2005 788961 2760/129 QC 03/07/2005 788959 2760/124 TI 07/29/1999 607733 1445/369 LC 07/23/1997 1021/424 TI more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 143774 186,400 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 17.200 42,500 0 42,500 NO OTHER G7 2.000 20,000 126,000 146,000 NO Totals for 2005: General Property 19.200 62,500 126,000 188,500 Woodland 0.000 0 0 Totals for 2004: General Property 19.200 27,000 100,000 127,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 560 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 FEB 9 2 2 3 sti 9 AEC ~~w~ 5 5 ~ 413 (o O sr. CROIX GOU,vTV ~ et ot,o - _SiIRI/EYOR'S RECORD R Gto~G., N CER~'IF S 'Y M P MARLIN T. KR AR me N o Part of the Northeast 114 of Northeast U4 of S 27,. Township 28 North, Range g West, Town of Kinnickinnic, St. nty, Wisconsin. a ~)ku ku (A x o x r 1317.12 UNPLA TTED LANDS W x ~ x 14' N 90.00'00"E 2662.33' N L 1 NE NE 114 1331.163' I 637.783' 679.34' / I QY SEPTIC , . 1 4' Q I AREA 631.823 1331.163' I y Y~• v I ~ I I Vf I I I DWELLING f-~ SNE9/ I t~ y I I ZI 145' 13• ~ I GARAGE 1 ~ I LOT 1 2 \ QI ~Ir CREED- I I 20,960 ACRES I .~p RO JI; I vN I ` ~?E ~.x I I 913,0/4 SO. FT. 1 TE- > C p i 20.349 ACRESEXC. ROAD R.O.W. WII2 II O I I , 893, /09 SO. FTI O HE D SHED I (~I ICI = l0 SILO' I ~I pRSN Y AR A I 1 514Y AREA Z J) `~I I r I I M MAR f Q a I ~1 M I I I, ~ 1 p~ J Y W s0 I o i~ I I 7 s' 11 ' c~m» S x t p,n I O/ l 1 W I I 1M O q x W v i ~ I L~ ~ I ~ x~ 115 J I N pCK SINE I I ( \ M W 1b • W U: IgE 9 I I o h a I W O I ~ :°I ~ ~ , p \ O b I M /Il p~ I? t:1 r~ In N o~ 13 I ~1 V N iLC J l x¢ M N h 3' I / W I I N LOT i Ilt p 0 N I I ^ II R \ 3 p 19.200 ACRES J% II O u': \ 836, 347 SO. FT.I ! x y, x 4 a:, died h to I O 2 /8.360 ACRES EXC. RDA0 R.O.W. v N q O i 799, 766 SO. F I Pc N I ?0 p I / //4,:r, s4i , bra O< ? Silt o q I ¢ ~ yi ''fig"g1! Q N In ca ku O ..Ana vg i40 cA 13 tii I WATERCOURSE I `u n 3 I Q W 4 p Q I ~b m Q Owner's Address: I : IN , 206 C.T.H. "JJ" ~I I W I o o o ~ J x - - -t . $ixes-Yalls-j WI 54022'-- - - - - - - • - QI ~ m c x O O sSB9•,28'S/"E /326./8'-+.-. 0. h 3 620, 99' 705.19 ' N J 620,98' 705.76' /2' -E-V"LIREr N DRI VE N 89138'27"W /326.74' SL/N9' NF//d ,vc iid M INNICKINNIC s 17 T28N..R.18W forR SEE PAGE 29 Avg . L G ti .ti s N ~y' :n v ~ N • 4o P~Uune G/end¢ J. o ~Bea17'rce m Ha~o/~ ~l v Pado/oh 2aymond~ 63 Ne/son 77ffa/uen, Simonson, wd fz/ V Kceugrye~ //o'wa/d ° eta/ o p "j Uy A H n . /60 4 ' 725 /iL.7 Lb/man NL f/rno/d A. { 71.7 b' o o v 117s a y /975 /ss D Lorel7~ren s7.2 Ma/ceJ/a F \ Lueck Q~h p eZ \ V' { • E -.d 6!-L i' /30 04 N n~ .Bajde7/ .Pei riJ9"e/' NQt.4~_ k~~ 7h .Y rb /~aaef 90 .sB.dq 0 .40 V L o a U p Ba • craoms q - 5 Rober/F 9vi Ic /er' /ordr7' 2DZ ..,ederaJ rte.' •C v tltly x.28 Lubice/a/ 5 Ick~ ~ o /zo /x397 a~ L z~. m~ ~1•V 7446 /2o • i. r. • ` 70 ' B Gordon 6 Sher • • • N dame-.5' F/ Bo ,POba// K. SMYL INE Q aij;i~\4 Mae/%r 'tl fJrno/d FL £ 6 E/a,;ne ~ich to RD. • go C7e~¢/d 6 rtm •ro ~ ML! ecka Bo ath/ean Ra`y L/ssic .Q so ~r7 Ft/vii 12.1! ~ .Qeeiben ~ .Denson. Zl is7 k7.35 Z9ere M.P !/an .Be 4746 cin. F ~tsche / V~'M1SSG /60 ' o t¢/ b p (Tohn 6 Len f3v~ Panne •rRAC7s: e ,ia r6rlra fA 4 .Barbar¢ Coro/ Farm„S Inc. 24 5 Ka.o ' peg Tfiorrros, 2e5 7 Thomas, Fryeneisen n3 \ v • e/a/. • eta/,T CC y SS Q3h o ~rdo AJr t• Fierier/ck i~7 T STEE ti Lema/'d F eo /6 z. a y 6 .E u .Mar; /t kb A. ~ h Edwin ry 40 _ Tu JcGY/ fo f~ urf~ /s9S Luu/e r4o id E,. Yu Bise/ a /zo Phi//iPPs Ma Sep i Ler7e/73 N1 LA K ens 6-v .~oSnc. //i iho. T/.3 Em L L3 /2/ Potion a p p s a • ~ eu.cd FsG.e/ ~ • .MB o`er a 6 U o /7¢ F q n26 ei : m /11.72 pp n F,~ o/.~- a d Mau ice C p v rd 3 ~y 'Y • N • v Byce w v ~2 ~ N W ~ 80 6o FM ~ rS/E'Jen F Y LK V H •'eo6oro~ p ~•\Y C b s ~1. n6ese l/anassse ' '//4. .9y~o~°..,.c~ s er s Piip y V /40 ty IJ , 01 Fu//e~. ..Inc. o • SJo shy l\ t~ 7s.93 'f~J •O . SJ~ona/d F /er • ,v '0 ~+tl, b°i /s7 .7D9.L3 • yTus1- Drape .r j~ HSi//tee ~ it l vu weo s2.s 4 u ergo /4 mrY~v 5~ ro • C h zt son F _ Q Farm/y W a > ~u v 40 ' ~,swr Turf 4 W 0%13 cFihn - V yi JDT Wu p y °ren j~Q~Q/t>= C/~ es E C za W ti 9e/% dor• Th /40 • firisianson Lokowich W t ~ C Z b O p /4/ W ® 0 _ . m a omas d~ • Ba B/ N b . 2/OS ~TCrr Gibson, efvx QVfL DFQ. 'J et¢/ ~b•~:~ Fu//Pl Emi/ 6ri x anecL. ayfo/: va t e rse.s9 27s. rVe/sap i4/R ; Go/%s- Jacobson lkenr'e/cT F C o°eib v ~ /drs ~ tiC Ho d 'Q w • ~ • • Hnn ~T C ?N E v ,Ca /e- Y C • lormwicde Z ~v~ N~ ~ to, .b ao o ./o 3 5tlo o "uj8 /6BB ~ E etak, y.y N v q ~ Ja 7z7 v . CaE C7ordon Cjr/fj~e - ~ VV ~ Jbhn Jam' f or Mc //n ni ..,>a ~~~oj vo ~5~ /22.7L • E "Hil y~, .47 ~If( (i 17f { ii LC .SD. M ad- /cres r A . Hnd/ea ~L~ta Mar/in T O/H7 ' G 7 stet E 7 „ :scn W Kaf rirz d 9w 40 R . ° so rur oo2e a urea Krear ✓.f ee is 6 BG ' . Pechutrnri f ° fo. .Dk ~ ~ ~ • {G...:. 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P/E 1014 Obc'fo d CE /Ue%sw~ COUNTY vSYC oix c•°~~ty, ws River Falls Grain Drying Grain Ba Medical Clinic, Ltd. HOI_KKA IMPLEMENT INC. Bu lk Handling River Falls, Wisconsin HIGHWAY 63 NORTH Liquid Fertilizer 425-6701 BALDWIN, WISCONSIN 54002 Custom Grinding - Mixing Ellsworth 684-4727 DEISS & NUGENT Medical Clinic FEED CO. Ellsworth, Wisconsin C~3a. ~t~m G E H L phone: 273-5066 273-5041 East Ellsworth, Wisconsin 54010 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / L f COC 674-k ADDRESS SUBDIVISION / CSM# _ LOT # SECTION T N-R__Lg W, Town of (~~tJ/C ~(✓~~//L ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM LL- (1D 61K r, o W 3~ r v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. C BENCHMARK: O es a s wr o, S i d ~l/ E COAnlcyt e ALTERNATE BM:_ 6 7 bid u S t~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: s Liquid Capacity: Setback from: Well 9.3 House z Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length ~T 7. Number of trenches D D i Distance & Direction to nearest prop. line: Setback from: well: House_ Other ELEVATIONS Building Sewer/L17, T / ST Inlet: 7`f -7 Z / ST outlet: 19<1`~e~7 7 PC inlet PC bottom Pump Off Header/Manifold La Bottom of system Existing Grade 13 Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBED: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor a Human Relations INSPECTION REPORT ST. CROIX ' =Safety and d Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284257 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: KREAR MARLIN KINNICKINNIC CST BM Elev.: , Insp. BM Elev.: BM Description: , Parcel Tax No.: ~ 022-1075-10-000 TANK INFORMATION ELEVATION DATA 3 O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , So2~ Dosing Aeration Bldg. Sewer 6~- 9s. 16 7 S/7 / Ing St/10 Inlet 55 ~1, a71 TANK SETBACK INFORMATION St/ V Outlet J ~ l 95107" TANKTO P/L WELL BLDG. Ventto ROAD 10606 7" r Air Intake Septic 54, NA Dosing - NA Headerd - j 93,02 Aeration NA Dist. Pipe 1. /Oi _i Hold' Bot. System 03 9a, PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syste Ft oss mead Forcemain Length Dia. Dist. To Weil SOIL ABSORPTION SYSTEM BED/TRENCH Width r) Length No. Of Trenches PI Of its Inside Dia. Liquid Depth DIMENSIONS r 6"P DIMEN I N LEACH 11 nu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION TypeO CH ER Mode Num er: T 991 A- 1 R UNIT System: ~Pd& at DISTRIBUTION SYSTEM Header / Distribution Pipe(s) Size x Hole Spacing Vent To Air Intake Length 1 21 Dia- Length Dia. Y Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade tems Only Depth Over tJ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ' /~s ~'1j ~4~CQCJ LOCATION: KINNICKINNIC 27.28 18 P417 NE„NE.COUNTY JJ Plan revision required? E] 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: SANITARY PERMIT APPLICATION BureaSafetyu anofd B uiitdiinng Water Systems gs ter 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 than 81/2 x 11 inches in size. 54" - l0 • See reverse side for instructions for completing this application State Sanitary Permit Number ,gNQ57 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)]. O aq i ac State Plan I.D: Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location a A, /V&A /V~l4,S ~ Z N,Rl 00 E(or Property Owner's Mailing Address Lot Number Block Number - -7 h fo Co City, State C f Zip Code Z Z (hone Number Subdivision Name or CSM Number II. 'TYPE OF BUILDING: (check one) ❑ State Owned El City Nearest Road _a vii ae Public 1 or 2 Family Dwelling -,No. of bedrooms ❑ Town OF j1VA11 C~,v.1~(C III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) / q-7 C/ 1 ❑ Apartment/ Condo 017' Q 8' loo. P4174 0 Z ^Z - /0!?~-/ `J 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 online A. Check box online B, if applicable) A) 1. ❑ New 2. KReplacement 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 f~ Required (sq_ ft.) Pro osed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ~'ro7f 5 -Feet 5- Feet VII. TANK Ca aat in gallons Total # Of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe " Name: (Print) Plumber' ignature: (No ) MP/K4?RSO'b"ido.: Business Phone Numbelr:/ Plum er's ddress (Street, City, State, Zip Code): CL IA,J -k- 44- UJ IX. COUNTY / DEPARTMENT USE ONLY te Issued ng Agent Signature (No Stamps) ❑ Disapproved Sanitary Permit Fee (includes Groundwater EhtA?Ia XApproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 pumper 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. II. 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 gallors, numl er of tanks and manufacturer's name, indicate prefab or site constructed and tank material Complete for all <Ieptic, purTip/siphon and holding tanks for this system. Check experimental approval only if tanks received experimert~, product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in )arne, license number with appropria_ prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only ~:e ,plete plan:. ar..d S~)2C1fICatlons not small, R 10 x r-ijs'. be suh `1*ed t:,"I~ _ ;rte/. The Mans must .;.(Jude the follnvvlnr. Aj plot olan, d(o-,, (.tvlscale oI Vllth CCltil~;i. LC SIJnS, iJ l r"c J;ng Sep,-lc I_IU, 7I p 0 ;Iph n c _-h, ~~1.r ~n~ , .rk'>, bt; I rir u15; ~are.ll<, u..r,_ - Liz 0'I i_,,/ yr 1 orp,' ni) s, reI)la: _r'iC':' P1 iJ:', it) I 1-';.!d nc =Er/ei~ J -ic,1., nn CI CS, --c on Cr` pt101'~,_" I{ _uJi~~', -IformcltlOn- GROUNDWATER SURCHARGE 198 17 if16uded the creatlor ol~surcharges (fees) ~cr a number C`I UI3teu pr, i it "i wf Icn Car, effect grouncivvater The monies collectel through these surcharges are used for monitoring groundwater conta n Iatir nvestications and establ ishment cf standards AJ ,74tj~ L rAJ Cla lb f ~vc- t A~ C 54- ,-toe ~jw f ZWL(AJ \C- PAGE OF CroSS Sec~lun O~ A ben SYSteen Fresh Air InISIS And Ob6arvallon Pipe n Approved Vent Cap Minimum 12' Above Final Grade 20- 42" Above Pipe _ 4' Cast Iron To Final Grade Vent Pipe marsh Hay Of syntMIlc Covering Min 2" Aggregate Over Pipe Ol~trlbutlon - Tee Pipe 0 0 0 0 6" Aggregate o Perforated Pipe Below Beneath Pip• - - -Coupling Terminating At Bottom Of System P~pPv1e~ ~ina' f3rs,c~< 5-1 SOIL FILL DISTRIBUTIOK] PIPE APPROVED S4MTIIETIC COVER MATER141_ OF Q~OFAGGREGATE-~~ c o e OKMARSM HA,-J gTRAW Fj: OF l2-Z1~2 AGGREGATE ELEV. of FEET 3 DI•STRIg+JT10N PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE AQU AT LEASTZO INCHES BUT IJO MORE THAN 42 IAICHES BELOW FINAL GRADE MAXIMUM DF-PTI4 OF EXCAVATioij FKoM ORI&INAL 6KAoF. WILL BE INCHES MINIMUM ®Ff" OF EXCAVATION FKWA OiK14,14AL GROE WILL BE INCHES SIGHED: LICEWSE DUMBER: A DATE: 2 Wisconsin Department of lndushy, SOIL AND SITE EVALUATION REPORT Page of 3 Labw and Human Relations Division of Safety & Buikings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper riot less than 81/2 x 11 inches in size. Plan must include, but Sr e not limited to vertical and horizontal reference point (Blum, 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 " h-tL u " ~•C~ R OOVf.+-% A)EE- 1/4 K) 1/4,S Z.1 T N,R l 8 E (ore PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SZtJ C-OUN - S z" - CITY, STATE _ ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD 'RN'UE2 t-rttS WI SgoZ,Z. hIS)47,S_ x118 1Q"`0-\.,-IQQ GovtvY~ " ?S [ ] New Construction Use [64 Residential / Number of bedrooms 3 [ ]Addition to existing building ( Replacement [ j Public or commercial describe Code derived daily flow %AS0 gpd Recommended design loading rate S bed, gpd/ft2 ' b trench, gpdAl2 Absorption area required a oO bed, ft2 -i S O trench, ft2 Maximum design loafing rate 'S bed, gpd/ft2_ trench, gpdtft2 Recommended infiltration surface elevation(s) 2 -S` it (as referred to site plan benchmark) Additional design /site considerations RE CA w'I H &-j0 X16' SC So" COkQ y Q-'PJ Tt cwht I QQb Parent material S N^/D`( " 0v TzvR SH Flood plain elevation, if applicable TV • R . It S = Suitable for system CONVENTIONAL MOUND "ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system IR S ❑ U S❑ U ®S ❑ U RIS ❑ U 2S ❑ U U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Con, Color Gr. Sz. Sh. Bed tend ~r3 R z 1 z - 1 s \ 'M s ~1t m u a. S - . g Z t~ -4 t~ H R 31 ~s s m c~~, 5 b Ground 14b-n m `t2 S!L - ~S 0 S9 rn • S . elev. It. Depth to limiting factor 8 Remarks: Boring # 0-10 o~ R z-1 z - l s Z do-~3 1,0'-j t? Z X16 -s o sg r~ cw . s b 3 `0-80 ll1`tR SI6 `~S O Sg ~5 ;-L Ground elev. q5.5 f, Depth to limiting factor N Remarks:' ` TName:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil T stin & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number- q-1-Z7 t -Zl `'~1 M00576__ PROPERTY OWNER ~CRN SOIL DESCRIPTION REPORT Page - -of_3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 o-ZZ ~o~~ itZ - 1s 1V1, s\0 vnvi-~- ors ,-1 .S o S9 wt > CLv 5 • 6 Ground 3 A --I Z M `LZ S/6 p S,3 w~) c s . S • 6 elev. a X1.5 ft. 12-BO S16 cZ S't R 3 [ ~S O S wt ` Depth to S ter U ~L~ G G i limiting factor 7-T Remarks: Boring # Ground elev. ft. Depth to limiting } factor Remarks: Boring # 131 i Ground ` elev. ft. Depth to limiting ' factor Remarks: Boring # E33 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30' 4 8,Z 'D L-Lgy S \6 9s S y - , s 8n nwi or- eseb eLe.) , a Z N a tE\-q65 I i s 19" `'}3 lU 5 6 w~ ~l ' - w~L. LS > SO' sovT?} OF ~ ~usT!~ S\-tSm)Lj . - L~ lbo -u' CAN 30T)13M OF S\p►~G NT tie C1JlZ1~JLlZ. OF 1-4-t)vS ~ . 9-1-Z7 (715 ) 425-0169 140,0576 CST Signature Date Signed Telephone No. CST # 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 2 Location of property_&E1/4_.,VC`'1/4, Section _Z,T"-R Township Al/A k"' / /AJA //Mailing address 72- 0 6 ca J Address of site ~j~4 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property 002 7 'C 2 L Ac IZ Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes __6~-No Volume zs(. and Page Number ~ as recorded with the Register of Deeds. 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 of ice of the County Register of Deeds as Document No. _Z 7 2 ,.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. Signature of Applicant Co-Applicant Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT 9 / St. Croix County OWNER/BUYER ~✓y E" P MAILING ADDRESS 2 CC) PROPERTY ADDRESS S~ M (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION /U 1/4, 1/4, Section T N-R_Z W TOWN OF (Z/^I NC C- ST. CROIX COUNTY, WI LOT NUMBER SUBDIVISION CERTIFIEDSURVEY LOT NUMEBER 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 cf 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. SIGNED: DATE: ` St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 TIMS a}AC[ R[f[RY[D ►OR R[CORDIMO DATA - ~ -STATE BAR OF WISCONSIN FORM 1- 4D000MENT NO. WARRANTY DEED MGMRS OFHC! QQ11 ST. CROIX CO., WIS. 412V724 78i fAr,F 1Zec'd. for Rlycrrd HS 9th Marlin T. Krear, and day of June A.D. 19.!7 This Deed. made between f and n-...... e- at8:45 A.__$ Darlene. Krear,._husband nd wife,.. __G LaMgine- ...Krear. and..Bernice•• Rrear, O'Connell Krear-....,1. Grsntar. mom a 'r ear. and..Darlene_Krear.,._.husband in... Tlf Kr and Far tin and property Deputy Grante% Witnesseth, That the said Grantor, for a valuable corsideration----__ - - - - " ..conve, ...-..s ..to G-. G. ranntt -ee --the --------following -escribed - Cxoix--------- GaY lord Law Offices,S. real ~ - estate " in'~t-•••- p-~- $OX 46 County, State of Wisconsin: River Falls, WI 54022 The Northeast Quarter of the Northeast Quarter (NEk of NEk) Of Section 27, Township 28 North, iE No: Range 18 West This deed is given in fulfillment of a Land Contra ab tween Marlinst. Krear and Lamoire G. Krear, as dated 6/29/78,recorded 6/30/78 in Vol. 6 , of Theodora e Kre Krear, deceased, page 407, as Document No. 385739, in the office of the St. Croix County Register of Deeds. . r~ so---:~' a is not This homestead property. (is) (ia not) nt s belonging: Together with all and singular the hereditamenta and appurtenances there+D a IaMine_ G. KYBar and tear Marlin T._-Krea~r~..P3rlepe..Kr!ear.,..I.?~???e.-G-..Rr~ And...-•--""'-•-- indefeasible in fee simple and free and clear of eoc-s b~ces except Bernice warrants that the title is good. easements and rights of way of record, if any, and will warrant and defend the same. , 19s7 Bth __Ju Dated this (SEAL) --------------(SEAL) _ _ Lamoine G. Rrear arlin T. Krear ----•---(SEAL) (SEAL) - - Darlene Krear Bernice Brea------ - AC=7ff0WLBDGUBNT AIITHBNTICATION STATE OF WISCONSIN as. Signature(s) Pierce County. - - Personally came before me this _ 8th-•----_•~,y of authenticated this -..----.day of--------------• 19 June 19.$7._ the above named Marlin_ T_Xrear,_.-Da rlene__Krear,._. _-Lamoine__ G- Rrear,_-•and_-Bernice.__-•rea TITLE: MEMBER STATE BAR OF Vi1ISCONSi author (If - who executed the not, ued b by 1706 .Q5, Wis.Stats.) to me known to be the ~aelcn no s dge the same. Z6t,ir,~ -a naAFTED BY OT&-7f_-__P_t 10 _ 4 t