Loading...
HomeMy WebLinkAbout026-1068-70-100 1 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Address City/State Legal Description: Lot _a Block Subdivision/CSM # y. LLjb~tl/. Vttq Sec. 2a, T,20N-R/_&W, Town of PIN # Oo?jz -/06 -70 -/Gb SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Lktt/ Size ST/PC / Setback from: House LIV~Well 95' 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 SYS M: Type of system: Width a y Length Number of Trenches Setback from: House 6V Well IV 7 P/L Vent to fresh air intake ELEVATIONS: Description of benchmark Elevation Description of alternate benchmark Elevation .156 Building Sewer r ST/HT Inlet ST Outlet 3, 7 a PC Inlet PC Bottom Header/Manifold -2: 7 / Top of ST/PC Manhole Cover r Distribution Lines ( ) { ) ( } lea / Bottom of System { } ~ ~ ( ) ( ) Final Grade ( ) ( ) Date of installation / /i //*ermit number State plan number Plumber's signature License number P r• 7 SVO'G Date Inspector xr4 Complete plot plan ow NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. 1- PLAN VIEW N OO ~ L a~ KATE NORTH ARROW VViscclnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299146 Permit Holder's Name: ❑ City ❑ Village XM] Town o : State Plan ID No.: KOPP, BERNARD RICHMOND CST BM Elev.: Insp. BM El qv.: / BM Description: Parcel Tax No.: 1,14 Gp 026-1068-70-100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( S 2GU Benchmark ~v ,CD Dosing O•~S Aeration4 Bldg. Sewer Hed'ing St/Inlet TANK SETBACK INFORMATION ol St/ ~I( Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 4 2(= Septic NA Dt Bottom Dosing NA Header. Aeration NA Dist. Pipe B GYJ~ ding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/-TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N LEACHING Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Mode 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 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 BedlTrench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 23. 30.18.349B,NW,N 475 H~n7Y~65L0'I2 0 ,e,2.-1 ct ."WW~jz_~ Z`e~ sae p~2 CX~4•- c~c f~ -e~~"2r Ire Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH s SANITARY PERMIT NUMBER: i j Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. `VIsconsin 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. S% Pe+rmit Number • See reverse side for instructions for completing this application State Saanniitaarry9 The information you provide may be used by other government agency programs E] Check ii revision to P- r vious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Ow r Name Prope Location va ul 1/4, s 2 3 T , N, R )g' E (or Property Owner's Mailing Addre Lot Number Block Number Z y, State Zip Code Phone Number Subdivisiy~ Name or CSM~amber 17 ' ijoZf l~ 0 c / _12V Sar o-t / 3 3 yz _Z 11. TYPE F BUILDING: (check one) ❑ State Owned ilia Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms p Town of i 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo - 20 /0 f- 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. New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an -__ystem-_______System_____________TankOnly 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 12E] Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill Z, s 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 / Soo ATO0 Z Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank Z Q l Z@Z~ ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the ons' a sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Sign re: (No S s) MP^/~MP,R/SW No.: Business Phone Number: Plum 's A dre (Street, City, State, Zi ode): -0. d y -Z?-] I)7ee 6 Ar you IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial I Surcharge Fee) QO dverse A47J Determination U X. CONDIT ONS OF APP OVAL/ REASONS FOR DIS, ►PPROVAL: 14454W ~ zl ( ~>r~ o`re 50 ! r/ v1 a ucul /e a7` c r?o r-- -J~ ej ~a +a ve~~ ~,vl -16ns. 5oj SBO.6399 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety S 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, 608-266-3151. 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 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 1/2x 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. 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. 7-U',17 s ~ 7 0 / 3 % 3 7 f~ ~S IS I I~.l ta" his b r e r ( G o r 4- s )S3~ ~g /►1 loo -it ~Gv S or F partment of Industry, SO1~ AND SITE EVALUATION Page I of Gabor and Human Relations in accordance with s. ILHR 83.09, Wis. Adm. Code Division of Safety and Buildings County 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 _ 7 O' O percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # caa ~ a c, Reviewed by Date APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location C, I op Govt. Lot X1/4 N W 1/4,S oZ'3 T 3 b,N,R' Z5 E (or I~P Lot # :111:11:41:111 Subd. Name or CSM# Property Owners Mailing Address a ~ • ' ~ P• ~ ~ 01 55 S . K 1" t C City State Zip Code Phone Number City Village ® Town Nearest Road 0-t I Nw'R',f r~ Sy (715 -9ao ~hr•, L) V-, CA A L-3,/ Residential / Number of bedrooms Addition to existing building ❑ New Construction Use: ❑ r4,~ ,r y p rn Replacement [$Public or commercial - Describe: r`^ ~7► tX ) btj Recommended design loading rate /L-bed, gpd/ft2~trench, gpd/ft2 Code derived daily flow 91~ ~ `I bed d/ft2 , ~j' trench, gpd/ft2 Absorption area required ~_bed, ft2 q oo trench, ft 2 Maximum design loading rate gP 3 ft (as referred to site plan benchmark) Recommended infiltration surface elevation(s) a ~ o h b4 ~ l7n Kr`v.w.a R S On'I- dl+ dditional design/site considerations 0 a S e A ej c-%.) t~ b cav s *-6L rZ~ r n c, re a5 r b o d S t ft II 5 Flood plain elevation, if applicable Parent material 0. L i r~~ l D Tank Conventional Mound In-Ground Pressure ASysteT~inFill Holds g S = Suitable for system S❑ U [AS❑ U ❑ S U Unsuitable for system S ❑ U SOIL DESCRIPTION REPORT GPD/ft2 Boring # Horizon Depth Dominant Color Mottles structure Texture Consistence Boundary Roots Bed Trench in. Munsefl Clu. Sz. Cont. Color Gr. Sz. Sh. m4cr 13-atf p`!'R yN Ground b elev. I0 mac. fh 5b ~ m;:- c 757 . s I J~ '5 y L r-\ 6b Fr C V-) ~ofzlZft. 7r SMR. -5 r^~ 10' S - Depth to Sf limiting- 1 1 - - b _ f -5 5 y/ a, IoyPr~1~ ~j L rr bk- +Yl r" V-0 in. L (•$-80.5` K4/ f - ~aL a mtbW- t~1~r Remarks: • Boring # S A L L rn 5 L w a P r '1 ~ S - l0'1 y Ground S ` r r~ 77 elev. 7•~ . 7 99~~ft. q t - V" Depth to limiting f1 t F G factor -4gXin. Remarks: Telephone No. CST Name (Please Print) Signature % 35 gQ SQ r^ D, Address oZ O J ~ p i~* ~a PROPERTY OWNER 1 r & cSl "S k SOIL DESCRIPTION REPORT PARCEL I.D.ff Page of h- loto~_ ?0100 Boring # Horizon Depth Dominant Color Mottles in. Munsell Teicture Structure 2 Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots b~ l 7~3 Bed , Trench L fv\ Fr F 5 1 1 Ground a R ~iLt, o?t^Sb~ Nh . ~a elev. lolev ft. S ~MSble no, r (,,t.~ .y s 1 3 7SStiR LL -__t tt yk K, ~r 3 5`82.11/ /JF . Depth to SL. ~ Sb~. limiting LO 9 ,1 s R~~(p w $ , fa ~ Vin. 7 Remarks: 'rh Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles in. Munsell Texture Structure Consistence Boundary Roots Cu. Sz. Cont. Color Gr. Sz. Sh. GPD/ft2 Boring # Bed Trench Ground elev. ft. Depth to limiting factor in. Remarks: Boring # around !lev. ft. )epth to miting actor _in. Remarks: IBDW-8330 (R. 08/95) A - Wiscontjn Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of 3 Division of Safety and Buildings in ac9svdahd6-Vith s. ILHR 83.09, Wis. Adm. Code County Attach complete site plan on paper not less than 8 412 ~ 'inche~p size. t t include, but not limited to: vertical and horizontanceP~ ~ erection percent slope, scale or dimensions, north arrow' ocation'~r>FFti~sanr a to nearest road. parcel I. D. # 17 lb~,%-_70 00 97 APPLICANT INFORMATION - Please p1 t all infpr l) Reviewed by Date Personal information you provide may be used for seco urposes (F?jMpq*, s. 15.0 (113V4 Property Owner l 'Pcderty Location err r vt. Lot MW1/4 ~ 1/4,S a3 T 30 N,R l E (or Z Property Owner's Mailing Address Lot # Block# bd. Name or CSM# 5 S q 5. A Y, t, W~ -e Q. Q Su Vat. I t-I a itv State Zip Code Phone Number City Village © Town Nearest Road ❑ ❑ Cll,ON W t s ol7 (ors )~y~- 9oa R'. >^ror^ 14w ~j L-5 ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ® Replacement ® Public or commercial -Describe: 3 Da A. r d a w. m e.,& f I t D tM p s c' Code derived daily flow S D gpd Recommended design loading rate bed, gpd/ft2 i a trench, gpd/ft2 Absorption area required 1 50 bed, ft2 lq3 trench, ft2 Maximum design loading rate bed, gpd/f12_ -trench, gpd/ft2 Recommended infiltration surface elevation(s) 9 tP • ft (as referred to site plan benchmark) Additional design/site considerations Parent material q\ a t.. C.\- 'r*, 1\ I I o t S S Flood plain elevation, if applicable ft uitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank LD=Snsuitable for system ® S ❑ U t4 S❑ U ER~s ❑ u Cg S❑ u ❑ S 0 U ❑ s [_u 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 S, L_ F 6 R, rn r q a F -2, 3 124 oYt~• yl3 S:C .6\0 V_ w F r 3 Ground 3 -~y o R Nay S: G M sbk r^ w I F , 3 elev. l! I00JI-ft. l a5•a~1 7.5~ R 4 a M Sbk Y F V_7 I j Depth to s ~`l•3 7.Sy~y St, e;I mS\J►"t•. i`^W F rS , . limiting •3$ 7. S ~.y~ I-►S - S YH f for yk qj)L b _ 5 ~in. C S -7 Remarks: Boring # b- b b g 3)~. 5~ L F r hn~v- QS c t F . a L ar, btu T-A 16,20 -7 S >Z S C- en -5 ~b 14- T-N F7 v-~ 1 F 3 Ground b- 7.5`/e, S L K v"- Gw IJF .S . to elev. 5 -3 S YR 44 L r•. \oV, f r W 11,11 F , 5 . to tc o• 5 %4 9- l 1-5 e5 -St t-N L %1-0 r g Depth to limiting S p. N f -71 51 M L 1 17 i fa or '6Oin. Remarks: CST Name (Please Print) Signature Telephone No. r 'r\ t s - a ~ 8- 3sgg Address Date CST Number .D-7 la 'Z 00"'r cL y, k~~ eA le "9 C) 15 V o ~l to PROPERTY OWNER SCr•r a'4- YC o p SOIL DESCRIPTION REPORT ` Page C? of ' PARCEL I.D.# 014 $ 1 0' t)D . Boring # Horizon Depth Dominant Color Mottles Structure 2 . in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots • Bed Trench 3 0.11 0 31 L tF G r m~: Q s a .3 w;,', oy~yI 5,C. aM x a Ground Dy I~ y1 S i C, ;t M f e, V-1 o~ 3 elev. 10L.-06 ft. b- 3 7. ,5 Y R yJ) r~, bK. L w I F .3 Depth to -qj . Sy M k r,\ f" 5 .10 limiting y/ ~.5 Q•►~j Wsl f for -7 1 _Oin. S-0~o s y/ D L Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting, factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) f Y4 c3 I gee N A gel J ~ 0.c a. c L -t- l o _ i o I t k -i d i I i I Sow t o 1 S a CA I t 1 9g 0 9 i t i I - I 3 - + i I + i + 11. _ 1 I 1 Y-M e s oil CAL i 1.7 i 0 I" 'I i !roll • OWN it A o f. I I T -T i 1 I I I~ t " i i ~ I ~ i I 5 64575 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW f/4 OF THE NV14, Snnm 23, T30N, R f 8W, TOWN OF RICHMOND, ST. CROIX C0 111'm T4r1'SCONSIN. N OWNER JAMES M. RqpHAN 1307 C.T.H. C" W 4> LOT 3 C.S.M. NEW RICHMOND. WI 5.~+ 54017 (A ~qmo m Z VOL_ 3 PG. 775 ma> C~~'~' VARIABLE Q.T.H. „0NORTH LINE OF THE NW1/4 C, RIGHT-OF-WAY m m NW CORNER N $9'44'42"' W 664.02' ul N89'44'42"W SECTION 23 1974.1 z~ N $944'42" W1494,46' N1/4 CORNER SEC710N 23 ".EXISTING ~Previou43yErecorded o HOUSE DRIVES °o as N89° ' ur i~on :E:~ . 0 . m 65' 40'c3 m , (b WELL SHEDS z m r*i , ~ z U { I r, zzCA u,xzv_ L 345' m I v$wwr~vao z r ,so' LOT I ~ ~ 16.207 ACRES o t.t1. t p 706,005 SO. FT, v o ~y s; 14.449 ACRES EXC. R\W m i o i { 629,399 SO. FT. o N N ~ Nv S2 (n C4 { {L~ 0 2 _ p I 41L m O I.~ N 4 IV i~ co .z Z m FILED AUG 2 9 1997 0 KOLO K WALSH r~ ~ C i ~ o' r~n Re~IStef'of oeed~ WI z SL Croix Co.. z 1 150 o '4 '4 664.02' a m I G7 42.94` I ul m LOT z rn 4.001 ACRES 174,261 SO. FT 3.743 ACRES R\W 4'~ 0 BAH U' 16 0. FT I I $0 45 42.43' STC-105 s SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER f~~-2 r,2~ s~~ s2 tom' y J< o~✓~ MAIIJNG ADDRESS s SR SU . i~r~o ~c/'s l ~vr/_ ,~Q / c~~m o PROPERTY ADDRESS ^ (location of septic system) Please obtain from the Planning Dept. CITY/STATE N >2r Gt ►rv►G . ~r . PROPERTY LOCATION l~ 1/4, iv ~v 1/4, Section 3 , T 3 N-R / 6 W TOWN OF ST. CROIX COUNTY, WI I j SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME 1 PAGE33 Y,~ , LOT NUMBER P- Im ro r use and maintenance of our s p Pe y eptic 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. j St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost f 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 I pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. i I/We, the undersigned have read the above w4uirements and agree to maintain the private sewAge disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stag 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: / o 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W l 54016 11193 1 i r l t r a •r iYY { This application form is to be completed in full and signed by the owner (a) 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, (81jec house), then a second form should be retained and comPlbted when r the property is sold and submitted to this office with the i appropriate deed recording. Owner of property ig r J ~rl Location of property. Nw 1/4ty 1/4, Section, a 3 , T -3 N--R J E Y Township__ 121 c«n.e" Mailing address J,V srx~ s,3. 1S.LC,,A.Fc Address of site f 7S / ,7 Subdivision name Lot no. _ 2 I i Other homes on property? Yes X No Previous owner of property cc QAL_,r Total size of property j Total size of parcel S Date parcel was created - Y 97 Are all corners and lot lines identifiable? Yes No Is this property being developed for /»v'/sa4ouse t-cpe-h ) - Yes No Volume and Page Number 33_Y.7- as recorded with the Register of Deeds. .~r---r--------------------w---------------mow----------I---------- M INCLUDE WITH THIS APPLICATION THE FOLLOWING: € A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE j 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 f warranty deed recorded in the office of the County Register of Deeds as Document No. ~o ` 7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an-easement,.to.xun 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. Signa ure of A cant P Co' Applicant Date of signature "Date of Sianature STATE BAR OF WISCONSIN FORM 2 - 1982 ti SiS219 WARRANTY DEED DOCUMENT NO. REGISTER'S OFFICE James M Rebhan and Gaii. C. Rebhan husband a-~d wife _ ST. RC OIL CO.- RWI SEP 11 1997 conveys and wan-ants to Bernard J. Kopp and Shirley F. Kopp. 9:30 AM husband and wife, as R trv vorshin marital property .t.."0C ~~J^ Ra shr et DNd~ THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the follaving described real estate in St. Croix Cut:T[}c (~p~ .i.~ fJ t~~I We7~'~ State of Wisconsin: Ppx Part of the NW 1/4 of the NW 1/4, Section 23, T30N, !5g0pJ R18W, Town of Richmond, described as follows: Lot 2 of Certified Survey Map filed August 29, 1997 in Vol. 12, - Page 3342, as Document No. 564575. Part of 026-1068-70-100 PARCEL IDENTIFICATION NUMBER s T Ak ISFER FEE This is not homestead property. 7WK (is not) Exception to warranties: Subject to all easements, restrictions and covenants of record. O da}' of ~1tI IlhlltJlj Dated this A.D., 19 97 - (SEAL) PLCC~fY~ (SEAL) • James M. Rebhan Gail C. Rebhan (SEAL) _ (SEAL) ii I it it AUTHENTICATION ACKNOWLEDGMENT i~ State of Wisconsin, i Signature(s) ss. County j~ authenticated this day of 19 PtrxxssTl► came before me this day of 199, the above named TITLE: MEMBER STATE BAR OF WISCONSIN i (If not, authorized by §706 06, Wis. Swis.) to me Ii to be the person S,__ who executed the foregoing instrarnestt :fe "iowledge the same. y'~~ j~j THIS INSTRUMENT WAS DRAFTED BY T r y ~VVi,oasi Eden A„ooisrtm 1996 DOCUMENT NO. REAL ESTATE MORTGAGE (For Conasmsr or Boeiaess Mortgage Traosactioae) BERNIARn J KOPP and SHIRLEY F KOPP, HUSBAND AND WIFE ("Mortgagor," whether one or more) mortgages, conveys and warrants to BANK OF NEW RICHMOND, 355 KNOWLRA A NEW RICHMOND, WI 54017 ("Lender") in consideration of the sum of ONE HUNDRED THOUSAND AND N01100 Dollars 100, 000.00 loaned or to be loaned to BERNARD J KOPP and SHIRLEY F KOPP ("Borrower," whether one or more), Recording Area evidenced by Borrower's note(s) or agreement dated AUGUST 29, 1997 Name and Return Address the real estate described below, together with all privileges, hereditaments, easements BANK OF NEW RICHMOND and appurtenances, all rents, leases, issues and profits, all claims, awards and payments PO BOX 128 made as a result of the exercise of the right of eminent domain, and all existing and future improvements and fixtures (all called the "Property") to secure the Obligations described NEW RICHMOND WI 54017 in paragraph 5 on the reverse side, including but not limited to repayment of the sum stated above plus certain future advances made by Lender. 1. Description of Property. (This Property is the homestead of Mortgagor.) 026 1068 70 100 (b) Ce ea) Parcel Idenuner No. DESCRIBEDHASNFOLLOWS: LOT 2WOF/CiRTIFIEDNSUR?/EY3W FILES AUGUSTF29IC1997 IN VOL. 12, PAGE 3342, AS DOCUMENT NO. 564575. ❑ If checked here, description continues or appears on attached sheet. ® If checked here, this Mortgage is a "construction mortgage" under ;409.313(1)(a) Wits. State. If checked here, Condominium Rider is attached. 2. Title. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordinances, current taxes and assessments not yet due and n/a 3. Escrow. Interest will not be paid on escrowed funds if an escrow is required under paragraph 8(a) on the reverse side. (will) (will not) 4. Additional Provisions. Mortgagor agrees to the Additional Provisions on the reverse side, which are incorporated herein. The undersigned acknowledges receipt of an exact copy of this Mortgage. NOTICE TO CUSTOMER IN A TRANSACTION GOVERNED BY THE WISCONSIN CONSUMER ACT (a) DO NOT SIGN THIS BEFORE YOU READ THE WRITING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED. (b) DO NOT SIGN THIS IF IT CONTAINS ANY BLANK SPACES. (c) YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. (d) YOU HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND YOU MAY BE ENTITLED TO A PARTIAL REFUND OF THE FINANCE CHARGE. Signed and Sealed AUGUST 29, 1997 (SEAL) (SEAL) (rrw of Orpni- an) *BERN By: (SEAL) (rue) • HIRLEY F KOPP • (SEAL) By: (SEAL) MUD) AUTHENTICATIO? OR ACKNOWLEDGEMENT STATE OF WISCONSIN 1 v C) 3 of O d _ as Q t; ] Cl) • O N N S 3 N O O N O CO 'O W I•I S Z 3) CD :3 (D y v 9 0 p a' O S O 00 O O 1 c c o CO C o (D 0 CD O O CCD O D. O o to N A7 0 7 D H O N C en O.^ r~ cn D m 4 y W a -o CD 3 - 0 z 10 t * O COVO CO C-0 ;p o o Co .O r . 3 3 T ~r -0 -0 CL Z 000- t~~l O A O C~ < N Z 0' w y co CO) D r'vv aQ Novo O CD a y N ~1 CO W gN CC 'D -4 CD ~O !r N a W N CL r► Z O O Z 0 O N O D d 7 !1 CD IIN~V • w CD (~D N N lY c c m CD I w a Z ((D O O O A Z C~'f z O N O A Q 3 o. < O W CD e0 G CL z 3 3 r z w z CD 0 a o : c z a O_ CD N fi A A I b a ~o w N O O p O r N R w 69 V O O S a b O L ti Wisconsin Department of 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 Attach complete site plan on paper not less t 1;i n size. Plan must include, but St. Croix ~ of slope, scale or not limited to vertical and horizontal refer cy' PARCEL I.D. # Y, di /o dimensioned, north arrow, and location ce:lo earest \ I & " C e" APPLICANT INFORMATION-PL ~RI(q OR REVIEWEDBY DATE -79- YLk PROPERTY OWNER: ' ' Y A PROPERTY LOCATION - fta1,~ r GOVT. LOT NW 1/4 NW 1/4,S -T- 0 AR 18 :k (or) W PROPERTY OWNER':SMAILING ADDRE L BLOCK# SUED. NAME CSM# Z ( 3 1307 Co. Rd. " " r4sm CITY, STATE ZIP CTir NUMB ❑VILLAGE MOWN NEAREST ROAD New Richmond WI. 54017 Richmond St. HY, #69 [14 New Construction Use [ Residential / Number of bedrooms [ j Addition to existing building j I Replacement I Public or commercial describe l~leAl/ ` Code derived daily flow 450 gpd Recommen eslgn oa Ing rate --J-bed, gpd/ft2-trench, gpd/ft2 A~~ Absorption area required " np bed, ft2 375 trench, ft2 Maximum design loading rate ._bed, gpd/ft2_trench, gpolft2 Recommended infiltration surface elevation(s) 101.50 ft (as referred to site plan benchmark) Additional design / site considerations system el based on contour 1 i nP nf P1 1 nn Sn , Parent material pitted glacial drift Flood plain elevation, if applicable 13a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE T SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S NU RI S ❑ U El S ®U ❑ S ® U El S Ed U El S ~ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0-9 10yr 4/3 none 2msbk mfr aw 9f .5 .6 2 9-24 7.5yr 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 24-32 7.5yr 4/4 none scl lcsbk mfr 9w na .2 .3 elev. 100.9 ft. 4 32-70 7.5yr 4/4 c2d7.5 r 5/6 scl lcsbk mfr na na .2 .3 Depth to limiting factor 32" Remarks: Boring # 1 0-8 10yr 3/2 none 1 2msbk mfr if .9 :.6 2 8-16 7.5 r44 none Sici 2mSbk mfr aw if .4 i.5 Ground 3 16-33 7.5 r 4/4 n elev. 4 33-70 7.5 r 4/4 none c bk mfr n na .2 .3 100.6 ft. Depth to limiting factor +70" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ye., New Richm nd WI 54017 Signature: Date: 6-25-97 CST Number: m02298 PROPERTY OWNER Jim Rebhan SOIL DESCRIPTION REPORT Page 9. of 3 PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncky Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 3 1 0-10 l r V2 none 2msbk mf r 2f -9 1-6 2 10-22 7.5 r 4/4 none sicl lcsbk mfr crw if .2 .3 Ground 3 22-36 7. elev. 99.8 ft. 4 36-75 7.5 r 4/4 d7. mfr na n .2 .3 Depth to limiting factor 36" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Jim Rebhan New Richmond, WI 54017 MPRSW 3254 ~4~4 s23-T30N-RiBw (715) 246-6200 town of Richmond N 1"-40' BM.= top of 12" pvc pipe C el. 100' Alt. BM.= top of 14" pvc pipe C el. 97.90' API, liv- I ~o 1A 3 'ITS. p4o V ~o Gary L. Steel 6-25-97