HomeMy WebLinkAbout030-1017-10-100
F
STC - 10 4
p ti
AS BUILT SANITARY SYSTEM REPORT rv 1 aEIV,EO
DEC
►~1 2.>3 1997a
~-er~v l i ~'l S~rtr»-~ S
OWNER !✓.T CROIX
~oUNTy
ADDRESS ~ j BONING OFFICE
1-6
u;,~Sv~-►- l.~ti ' , ~d6 G / 1U be
SUBDIVISION / CSMI LOT
SECTION T , 9' N-R_ZLW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
GQ~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE -BM:
h &J►1M0q (600
' SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- Liquid Capacity: Q-029
Setback from: Well a~i1rY~-~•~
~ House lJr Other
Pump: Manufacturer- 711 Model# -Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: ' , ~
Length J Number of trenches
Distance & Direction to nearest prop. line: / .0
Setback from: wells House c27 Other
ELEVATIONS
Building Sewer ST Inlet: tj ST outlet: % ~O2
PC inlet PC bottom _ Pump Off
Header/Manifold P 7x5 Bottom of system 0j
Existing Grade < Final grade 9Cf,
DATE OF INSTALLATION: -
PLUMBER ON JOB:
' LICENSE NUMBER:-
INSPECTOR: ,-t :J* •71S-73
3/93:jt
Wisconsin Department of Commerce SEWAGE SYSTEM
Safety and Buildings Division PRIVATE CountY
INSPECTION REPORT .S-> C ox
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit Noo..:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. _47? / o /
Permit Holder's Name: ❑ City ❑ Village kq Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
LOD, c~c7` -Tfl o Y` i D - /6/7-/0-000
TANK INFORMATION ELEVATION DATA A 9700
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Se /ODp Benchmark
2A -4 -7 S ~p /OS~ lb o
Dosing M4,
Aeration Bldg. Sewer
Holding <:5D/i•T Inlet -7,316 DEW
TANK SETBACK INFORMATION 01.1,W Outlet 7.8~( 979
TANKTO P/L WELL BLDG. Ai~rlntake ROAD Dt Inlet
eptic ?_o' Ina 1-7 NA Dt Bottom
Dosing NA Header/Man. $!IZ 768'
Aeration NA Dist. Pipe t
Holding Bot. System ('-2.. 96 -66
PUMP/ SIPHON INFORMATION Final Grade ,g /w.%
Manufacturer Demand 927
Model Number
TDH Lift L ystem TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
No. Of Pits Inside Dia. Liquid Depth
CUO-fTRENCH Width Length No. Of irernites FDILENSIONS
Man
DIMENSIONS I Z l SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING
SETBACK ER
INFORMATION Type O E) 15 Moe Number:
System o` OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold q Distribution Pipe(s) it x Hole Size x Hole Spacing Vent To Air Intake
Length ~ Dia. 7 Length S4 Dia. Spacing l0 /Qsol l S T_7Z
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Seeded /Sodded xx Mulched
Bed / Trench Center Topsoil ❑ Yes ❑ No- ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
~ ~ ~[f - i ~ ~ ~ ~o-w~ld"~~ (i oo. rya.
01 -1
Plan revision required? ❑ Yes CQ No
Use other side for additional information. Iq-7
SBD-6710 (R.3/97) Date Inspector's Sig ture
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
*6consin SANITARY PERMIT APPLICATION 201eE. W and shnlgtonAve sion
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 vi 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 ❑ Check it r Isi n to pre"vious application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
PropeELY Owner Name y, Property Location
n~ \ (gyp ►rh. IC 1/4 Ivy 1/4, S T r N, R 9 =W) W
Property Owner's Mai ddress~ Lot Number Block ^ lm er
~v
W~ tPhone 0 A_ J4 1
C"ty, State . Zip Code Number Subdivision Name or CSM Nu er -
ws s 017 > C13M-1 a
.-t I Ceq^4 t4 Ill. TYPE F BUILDING: (check one) ❑ State Owned ❑ Ity N( arest Road
F] I ae
17-1 Public 1 or 2 Family Dwelling - No. of bedrooms r Town OF os -ez tCO,~~ 44:k\,.- `Tr 1•
III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo Q~ a9' 1Q --/~A -1 Q 030 10) - 10 1490
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
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 gseepage 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
4150 13 ?G Feet y Feet
VII. TANK Ca
in a acltllons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Exist in structed
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.
l Amber's Name: ( Plumber's Signat re: (N St ps) MP/MPRSWNo.: Business Phone Number:
`v Z -0 r- 1~ '*7lS -T!J-5
Plumber's Ac dress (Street, Cit ,State, Zip Cod
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Issuing Agent Signature (No Stamps)
X Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination [ate
7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 77
SBD-6398 (R.11/96) 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 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 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 1/2 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.
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.
PC7L 1,
a.
~ h
r
N
01
Q
9
o
_.w q 5
ti
P
1 z S ~
• PAGE - 01:
. R~,av'A-~ ~nd15# ro S S S c 11, o
Asti) Sys~~~
Ro t1, rzg~ N .2
`CIA ~ W f101n All Well, And ODNrrollon Plpo
MlnlMue I2'Apooo Approv4d Von, Cap
2 0 42' AOova Plpr 4' Cool troy
• of C
' To final credo Vanl Pipe
Mar 1A lia Or S niMtlo Covario •
Nin 2' AOOroOola
Oval PIP*
Olurlpvilon -
glpa o o - Tao
e1 4416 PIP, '
° Parloroba PI
po 6•aiov ° ~C8101n0 Twn,Ino11n0 Al
0
Gallon of
S1'Nani
I
P1%0p0CD t'in..l ``9ri%clt
' '~IcJwl• , o/i ~
SOIL FILL,
• 0ISTRiBUT101.1 PIPE
2"WAGGREGA-1E APPROVED +S`MPETIC COVCR
"a"MATERI&I- OR 9" OF STFtAW
.3c/ OR tjARSN HAy
• ~i.0
ELEV. oF_U..Y bpi !."OP%'212 AGGRCGATE .p
i .yam
DIS"rR15UTIOW PIPE To BE AT LEAST • - -AL /•IJU AT LCASTLO IUCHES BUT 1.10 MOR 1J y2ES IMCRES 8C BELOW p MAL GRADE
NAL GRADE ~
i
MNcUwM DEPni 4F F)(eAVATIOIJ ROM ot{IGtntgl. 6911DF. WILL Be -~lo
111KIMM 0EP1'rt ciF EXCAvATImN I"cHeS
&O^ gl4IRAL G PF- WILL_ BC
INCH[ S
i
SIGI.JCO:
LICCLJ•SC LIUMBEI,:
DATE: l D ~I0
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
rt3ivision`of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. C~'° N
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must' but +`d St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, I r r, PARCEL .D,1+
dimensioned, north arrow, and location and distance to nearest road '•V- 'Pending
RE~/IEWED DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: PROP CATION
Dean Lindstrom GOVT. L 5 I 9 N,R 19 iE (or) W
PROPERTY OWNERS MAILING ADDRESS LOT # SUBD. NAK~_.0 'C
481 Bluebird Dr. 4 ng
NEAREST ROAD
CITY, STATE ZIP CODE PHONE NUMBER ❑C UI, AA
Iftw4o''
Hudson, WI. 54016 (715)549-6672 Rolling Hills Tr 1j.
[ New Construction Use [x] Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 and Recommended design loading rate '7 bed, gpd/0' 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.39 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na 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 0 S ❑ U ERS ❑ U ❑ S RIU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlay Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
`;....i..'... 1 0-11 10 r2/2 none 1 2msbk mfr 2f .5 .6
2 11-27 10 r4 4 none sic
Ground 3 27-36 7.5 r4 4 none sl lcsbk mvfr crw if .4 .5
elev.
99.96 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
mfr -9 .6
1 0-11 10 r2 2 none 1 2msbk
k:4 2 •'.v
2 11-27 10 r4/4 none sicl 2msbk mfr cfw if .4.5
Ground 3 27-84 .5 r4/6 none s os mvfr na na .7.8
elev.
100.16 ft.
Depth to
limiting
factor
+841, Remarks:
CST Name: Please Print Phone:
Gary L. Steel 715-246-6200
Address:
554 200th A New Richmond, WI. 54017 m02298
Signature: Date: CST Number:
5-17-96
PROPERTY OWNER Dean Lindstrom SOIL DESCRIPTION REPORT Page ? of~_
PARCEL I.D. #
Lot #4
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-9 10 r3 2 none 1 2msbk mfr 2f .5 .6
crw
3
2 9-22 10 r4 4 none sicl lfsbk mfr c1w if .2 .3
Ground 3 22-84 7.5 r4 6 none r
elev.
99.96 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
.gp :4::gg 1 0-12 10 r2 2 none 1 2msbk mfr cs 2f .5:.6
4 2 12- 7
Ground 3 37-82 7.5 r4/6 none s os My r na na .7:.8
elev.
99.66 ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
1 0-13 10 r2/2 none 1 2f 1 mfr cs 2f n .3
5 2 13-32 10 r4/4 none sicl lfsbk mfr if .2::.3
Ground 3 32-38 7.5 r4 4 none sl lfsbk mvfr C1w na .4::.5
elev. 4 38-82 7.5yr4/6 none s os mvfr na na .7::.8
99.56ft•
Depth to
limiting
factor
+82"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
•r
STEEL'S SOIL SERVICE
Gary L. Steel Dean Lindstrom 1554 200th Ave.
CSTM2298 NE4NE4 S5-T29N-R19w New Richmond, WI 54017
MPRSW 3254 town of st. Joseph (715) 246-6200
1 lot #4-csm
N
0,
BM.= top of SE lot stake C el. 100'
N
~~o z
d'
~ 71
Gary L. Steel
5-17-96
FILED
G JUN 2 S 1996 ► -'3
KATHLEEN H. WALSH -
Re,11slcr of Deads { o
St. Croix Co., WI
54610
)i
o Bearings are referenced to the
m East line of the NEk of Section
o z 5, assumed to boar SO0°49'14"W
_ j rJ 1 I >°a O
'a (t O O
o s , r• m O 0 n
I- 1S rq c 000 ° W
Ct -0
a~a n rt Ifi
O,o co 1 G) uv C' i : . 1~•, t1i
O
° I N r7: Cn r i~Cy' ' m. ' m
N a 11) .+`c' L U1 YG r, is f rf,' • S ;o E Q N 'JC F'.
1 U) .
4- 0 0 to
Or :T D Vtaio N• "~'A~'"' rh to fi
-43TH ST
m
s S0005312411W- West line of the NEk, 1of the NEk, (n 0 O
272.98' m M
9 (D
v
^ s W ` m to v rf
i 6Z m ::r
m P. w Oo It
c II 0 10 y If- (D. W Z
Ir, 0 00 N If- Ir) -gym 10
I< K trJ
Cr I-I c -----N IW o~ I-I IU L-1 44-
yc • N
~ co -4 I~
K V N IN Ir II- rOn fi O
N I~ -m S01°29'59"W 33'33' IPJ I~) i0 d I- 1-h
v - Ln IN 230.00' IT I'` m o m (T _h Ln O m in I Z IG> S 1- pFfi m
m I x fl) . o co
S01 0291-5911W v 0 w... _ _I co I i(p N 0 'Z
`
Z CO 0 230.00' m tow 1 N 1 O m t1i C)
a I< °s
,,e w° ma oo r F Fh ff m
1~ 01
00 N N n F IC) 0 I-h Fh
0 10) m O o N 1 ~ I C) m M I--~
F x N01 ° 29' S9"E 566.00' c I o° I S
z IT I I~ I-
W I- w 150.00' 500.00 350.00' 6 6' IG) O C
ID 4-1 N 216.00' N01°29'59"E 350.00' I~ N m
.4~0 0Z0 1 C
0 00 ICL~
0~ r° I 1 b N 1-3
a
I< If- wmw __4 -p m
Z4o CA 41 r v 00 1 ~C
iccar v o0°- O -It I-J I n ; I 00 r Q n z r° .
00 :9 112
i IZl IS' I- nOOi F I<j n A .
IW I (A ;v0 N
m .a N N I- K I•-+ jai %D
Icy Ion o :t w iN ¢m :c
I CA S 6¢ 2071.65' N• H .
49'14"W 500°49'14"W ~ O
110 ~JNVI S00°
iro N07°52'28"E 229.55' S611 E 182.87, CA z E 0 513.00' m m ~ H1
L% '-)T . 1. S..iv1. o j
> > East line of the NEk~ o ' m cn '
V )L. 6, PG. 1638 t„C; ' 0 co
- - tn, %
APPROVED PPROVED to o
I
o m
t I
~ Z T £ HOW IT '70A
q Q x
• zp0 uMO.L so,,
iCaezn`S Pa "F_-_a~ s tip.. q. gq AgTjzaa geaaq I
' S _aqq Alq_ Panozddp sz, cibl"
r
•90TApp JOJ PJVOg UMOs agvTadoadde pup aoij;p $iutUOZ Alunoo xzoaD
' qS aqq ggequos Tagzgd Atm ~Buidotanap zo 5uisvuoand eao~a~ ' qqa ' TaOapd
oq ssooop 'azzs qoT mnmtutm 'spuvlaam '•a•i) suoz~eTnBea pup saTna 'shpt
dzq~uMOy pup ~Jun6D 'agiegS oq ._ajaCgns si amu szga tito umogs Ta . ed ijaeg
• ames Butdd-em pup BUTAet ins
ui xioaD -IS go Aqunoo aqq go 931putpap UOTSTATpgnS pUpq agI pup sagngeqS
uzsuoOS-rM aqq _40' TE- 9£Z -aagdegD 40 suois'rAO.zd auaaano aqq gaim pa-rTdmoo
ATTn3 anpq I gpgq !pagiaosep pup paAanans Aappunoq aoTaagxa aqq 3o aTeOS oq
uoigequasaadaa goaaaoo a st deW AeAanS p9ij-rga9D sigq gegq AjTgaao osTp I
•paooaa 3o squamaspa TTe pup
(gaaagS ggqV) Aem-jo-ggBTu peon umoy oq goelgns ST Tooaed pegiaosep anogv
' qg 'bS 8TL' 8fij,) saaov 0£' OT sutequoo Taoapd pegiaosea 'Sgt~tt~r TbOiT
go qu-r~ aqq o-I jaa; 00'05£ 'au-ET gspa pips BuoTp 'g„65,6Z0TON aauagq
T' IOT ' Piles -4o- auTT Ispa,. agq_, oa ..189-4 68' ZZ':V 'T qoT Piles ;o auzT ggaou
e BuoTie .,-M."-I~, ZVO8gk a'O mm-a = T 1-0-1 -Pips go aDuaw au...p.._.Oq qaa_ -L8' Z8T `auTT
gsea Ptes BuoTp 'g„95,VT0ZTN aOUagq :auiT gsea pips uz quTod aTBue up oq
199.4 59' 6ZZ aoT. P TL M 30 .at-.t - lea_. aqq. BuoTE 112 .~ZSoLON aouagq !T qOT
ptleg' -.4o aauxoo HS aqI ..aq Iaag 'ST' 9E6 'T 'IOT-•PTVs-...;0 aurT `ggnos aqq' Buoty
'$u8T,6E068S aouagq !T IOT Pzes JO aauaoO MS aqq 01 ga9J 86'ZLZ..'T IPT.Ptps
-40 OUTT Isom 2gq Mf6te 'Min't, £5O00S 'aouggj =.t- ICT.'. pies lb •!auado MN le oq
q99.4• 85..SS.E..1auzT ggaou...pies Buoftt•'MuVfii&ZV-8'8N aOUagq =T -40T pies go auzT
ggaou p oq gaaj 00'OEZ 'au-rT Isom PT-es BuOle 'Mu6S.6Z0TOS aOUagq :autT gsaM
piles ui -au-rod aTSup up oq qoa; LS-LOT 'au-rT :Isom pips BuoTp 'HHVSIZ5099S
eouaga !BUTT Isom PTRS uz quiod aTSu'e ule oq qaa; 00'OEZ IT qoT Pips go auiT
Isom agI buoTe '.Muo-S,.6Z0TOS aOUagl :.t 'IOT piles .4o xauaoO MN..agq oa Iaa;
00'OZE IT IOT Piles 10 auTT ggaou aqq BuOTe 'MuVVtZVO88N Buinuiquoo aOUagl
!-buTUU-F.baq go flu aqq Fuzaq 'aot.4.;o pies anoge qe 9EZZ aged '8 amnTon
ut pepaooea deW kananS patlzgaaZ jo T qoZ 90 aauaoO gN aqq oq gaaJ Z8'8EL
'MuT,TP.ZV088H aOUagq :gaaj 00'ET5 'uoiq.Oas pies go :P/tgN aqq go au-ET gspa
OqI E'-IOTC 'Mint, 6%OOS aOUagq !Si ac,Tlaas go iauao;) gN aqq qp BWM
;amoTTog se. -pagiaosap aaggan; .aOi3j0 spaaCl
go aagsTBa-H AqunoD xzoaZ) •qS aqq qe 9EZZ aBeg '8 amnTon ui pepaooaa dew
• 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
Location of property 1/4 ~E 1/4, Section , T Zq N-R 1 W
Township Mailing address
Q(2-~ ~5•~~ IS40%0 I r
Address of site V-0 L_ i--i"ly Pty TILT OSL
Subdivision name [->'1 Lot no.
Other homes on property? Yes X No
Previous owner of property :T:1'M'3ioiy
Total size of property - a4
Total size of parcel ~717 P•Cdf~-G"~
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? Yes No
Volume Sbl and Page Number I9 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 office of the County Register of
Deeds as Document No. --7 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
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 'D{cA" r Wf]` `j 1
MAILING ADDRESS A `sC N ~N t O ( +C1
PROPERTY ADDRESS X4AX
(location of` s-ep`tic system) Please obtain from the Planning Dept.
CITY/STATE t~JS0 " ~1l 1 5 +C~1 %a
PROPERTY LOCATION 1/4, h1 c 1/4, Section, T 2-9 N-R 9 W
TOWN OF 31 - ST. CROIX COUNTY, WI
SUBDMSION LOT NUMBER d
CERTIFIED SURVEY MRP 6'1S VOLUME , PAGES, LOT NUMBER -T
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 Julv 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 svstem 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 comple:ed and retumed to the St. Croix
County Zening 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
Form SL-311 (6176) 343135
MORTGAGE LO///AN NO 5100-~1 DOCUMENT NO.
5~~~~1 rC SPACE RESERVED FOR RF OROINO OATA
KNOW ALL MEN, [hat the gLidcrsigncd Dean K. Lindstrom and
Linda C. Lindstrom.,. husband and wife.
REGISTERS OFFICE
Mortgagors,
of :fit. Croix _ County. Wiscon,,ln, herchy mortgage to ST. CRt~IX CO., WIS.
First Federal Savings and Loan Association of Eau Claire a (:orlr vat wn, Rec'd. for Retord this 14t Al
-
Mortgagee, of Eau Claire _ County, Wisconsin, for the sum of
Thirty Thousand and NO/100------ day of Sept. A.D. 1977
Mllars 30.q 000.00 at 9,h5 A4111 M.
the following descnhed real estate in St. Croix _County, Wisconsin:
i
R~pbl~r of Dw~d~
'TA erv NO
.l RE RN TO MORTGAGEE ASSOCIATION AT
A parcel of land located in the I -41 of the NL of Section
5, and the NWa of the NW-4 of Section 4, both in T-29N, R-19- j
n 319 E. Grand Ave.
W, Town of St. Joseph, St. Croix County, Wisconsin, further Eau Claire, Wis. 54701
described as follows: Commencing at the NE corner of said
Sec. 5, thence S 00-49-14 W along the East line of said Sec.
513.00 feet; thence s 88-42-44 E, 140.00 feet; thence s 00-49-14 W,
3419.00 feet to the point of beginning of this description; thence
continuing s 00-49-14 W, 390.00 feet; thence N 88-24-44 W, 475.00 feet-9
thence N 00-49-14 F, 7391.00 feet; thence s 88-42-44 E, 100.00 feet; thence
s 00-49-14 W, 49.00 Feet; thence S 88-42-114 E, 375.00 feet to the point'of
beginning. Above described parcel contains 5.05 acres.
including all apparatus, equipment, tixttires or articles, whether in single units or centrally controlled, used to supply heat, gas, air
conditioning, water, light, power. refrigeration, ventiLt+ton, or otherwise, and any other thing now or hereafter therein or 'hereon the
fumishing of which by lessors to lessees is customary or appropriate, including screens, window shades, storm doors and windows,
floor coverings, screen doors, awnings, built-in stoves and water heaters (all of which area fixtures and a part of said real estate
whether physically attached thereto ur not), together with the privileges, hereditaments, appurtenances and improvements now or
hereafter belonging to or erected there,ri, and all the rents, profits and income which shall arise or be had therefrom, hereby releas-
ing and wailing as rights under and bl irtue of any Homestead Exemption Laws, and all r,Vht to retain possession of said premises
after any default in payment of the nh c. .)bligation, or breach of any of the covenants or agreements herein contained.
phis mortgage is given to secure wi,ndettedness to the Mortgagee in the atone mentioned sum and such additional sums subsequently
advanced in accordance with and J~LVSU.Ir;' too the terms of a mortgage note of even date, executed hN the Mortgagors, which note is made a
part hereof.
It is the intent hereof to secure ;•a.ment of said note whether the entire amount shall have been advanced to the Mortgagors at the
date hereof or at a later date, for h.,c •rtg teen advanced, shall have peen repaid in part and further advances made at a later date,
but at no time shall this mortgage ticCUre advances on account of said original note together with additional advances in a sum in excess of
_Thj:rty_ Thousand and N01100------------------------------------ Dollars, ($-.N_1.000.00),
providing that nothing herein contained ,tall to considered as limiting the amounts that shall t.e secured hereby when advanced to protect
the security, or in accordance with covenm,ta contained in the mortgage and the note hereby secured
The Mortvageirs agree that in the event of the foreclosure of this mortgage they will he bound by the provisions of Section 846.1111
of the Wisconsin Statutes
In the dent of the non-performance of anv of the agreements contained in the note or mortgage. said Mortgagee is hereby authorized
to grant, hargain, sell and convey said real estate at public auction, and make all needful deeds of conveyance to the purchaser thereof.
In the event that the mortgaged premises or any part thereof are sold, conveyed, or transferred, or in the event that either legal or
equitahle title shall vest in any other persons than the Mortgagors for any reason whatsoever, the entire indchtedness pursuant to this mortgage
and the note that it s!-cures, shall become due and payable forthwith, at the option of the Mortgagee, without further notice.
If only one person executes this mortgage, the term "Mortgagors" and the use of the plural number herein shall be read and construed
accordingly.
_ Wisconsin,
In Witness Whereof, said Mortgagors have executed and sealed this instrument at > l.lsworth
this ..day of 19.77........
Executed, seaW and delivered in presence of:
_~-'vy'Y'h~(.... ..-:.`C..f?-~-".'~ / ~C.'~^t............(SEA )
Ti thy J o son Dean K. Lindstrom