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HomeMy WebLinkAbout030-1054-40-000 I o o o° o° ti tl N N N 4 o o ti ~ Y ~ m O c v E N N a (0 0 3 c6 O y o ~t a~ E i O > ~ Gy ~ 3 I _ I v, - m W O OO O N N C. z 0) C Z m L c Z a N m m lL c C X L c C O C y 0 LL O .C c 3 t 3 3 O E Q Q° c E Q w 1 O M O M a n m ~ N E E ~ J ~I~ E~ I f. o I Z ~ ~ I € v I ° 'o a m a m N H C7 O O Z C U N H Z c E E v E I ~ M I m y •g ~ a ~ I ~ I j ai c v •N~N a~ L ° t ~c°•, •i c _ Q z m z O 1 0 z z O o_ z N r~ v d ~T c ~ n E N a ~ - - Y a C7 1 a c N w a~ o U) rN v> j a v U) Urn U) Cj ~"~1 E a3 n'N E333 n ° Z • N a a a a v a a a u, a ! 3 N N y N~ Oo V7. 7 0 N N 00 O0 N Z O) 0) N fn J V! Z rn rn G) O1 y C r r C N ~~j N N N O 1 m m 00 O a~ o in O E O) 'O_ O O O O O O CD d Q' 'O m N o N _N 'O d Q U) Q to m q O ai a 1 H y O °O C N C C H C 00 1- O 0) m 0) O O O `rO L J 'e QI C -p N N v O ~ O d w O m O C = ~ M C G O N W N O c N yr y w "4" O *0 d M 0 m N p C 0) • , a) co E co ° 0 O1 m rn o m 0 O N CO !n N O Z C 2 N O 2 C fn ~ \ to V m •m a a €L €d at a ` a ` a 1 • a d d d c c d c r`Iv E ~ c ~ 3 o t A L)CL o;v~c~ ovici , Parcel 030-1054-40-000 12/09/2005 12:10 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.198F 030 - TOWN OF SAINT JOSEPH Current X'I 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 O - BIGHAM, WILSON S WILSON S BIGHAM C - SHUSTA JEANINE M SHUSTA JEANINE M 1444 RIDGE RUN RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1444 RIDGE RUN SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 23 T30N R1 9W PRT GL 2 COM E SH BASS Block/Condo Bldg: LK 339.5 FT S OF N LN, S 88DEG E 353.2 FT, S ODEG E 90 FT, N 88DEG W 362.1 FT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO LK, NLY ON LK TO POB 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/28/2001 657721 1727/621 WD 07/23/1997 1196/444 WD 07/23/1997 860/47 2005 SUMMARY Bill Fair Market Value: Assessed with: 83575 447,200 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 188,100 218,600 406,700 NO Totals for 2005: General Property 0.000 188,100 218,600 406,700 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 188,100 218,600 406,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 312 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 612.97 Special Assessments Special Charges Delinquent Charges Total 612.97 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT 4 , OWNER &E,9 -r r, TOWNSHIP ~5~. 30S¢PfV SEC.aT~N-R/9W ADDRESS kt-E ST. CROIX COUNTY, WISCONSIN. iU,~E&2 ~fc_ave SUBDIVISION LOT LOT SIZE f-Mold yin G 4 7i PLAN VIEW K4- Distances and dimensions to meet requirements of H63 HING WITHIN 100 FEET OF SYSTEM H SP A/ so ize 5rf le 111. p x r~ I U F C Gal ' O 9 A ~G V r/ s oo C fL rScdi a e o th Arrow 1 L : i U~~. W. ft N oru % T~6AR BENCHMARK: (Permanent reference Point) Describe: ~ of c,,oNGICLT£ Elevation of vertical reference point: ipa Slope at site: 3 57a SEPTIC TANK: Manufacturer : -s-i-/N & . Liquid Capacity / QCp ZIOWS Number of rings on cover : / Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer : 40 r, /.s 1: & S Number of gallons 750 6,o9L Number of gal. pump set Tor a cyc e - gallons; total capacity of- distribution lines gallon: size of pump, - head; gallon per minute /3 $ ; horsepower YL ND_ bran name of pump and model number W 'SON '41mh Q ft4r,i Pkw, a Type of warning device .41j,6,A'dky 4 yis u/9 e- HOLDING TANK: Manufacturer i Number of gallons Elevation of manhole cover DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABCIR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 XCINVENTIONAL DALTERNATIVE Stare Plan I.D. Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME ERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 40 r, BENCH MARK (Permanent ference point) DESCRIBE IF DIFFE NT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: E_ a 3 Nam f Plumb MP/MPRSW No County: Sanitary Permit Number: "I lo^ SEPTIC TAN LO ffANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER ''11 PROVIDED: PROVIDED: 00V DYES ONO DYES ONO BEDDING: VENT DIA.. VENTM L IG WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM LINE: AIR INLET: DYES ONO DYES NO NEAREST DOSING CHAMBER: COVER MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. JPUMP~~PHON MANUFA TUR EROOWARNINGED. LABEL PROVLOCKIINGDED: r~r c PrrR~vfVfID WILkla-.tn- DYES LDNO 7S 50 A- drai'Mc.- ( C (AI YES ONO YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL- BUILDING. VENT TOFRESH (DIFFERENCE BETWEEN 113 FEET FROM LIN SL AIR I LET: ` PUMP ON AND OFF) YES ONO NEAREST=_ I} ENU I H DIAMETER I'M ATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing [__F_0_R-C_E____ or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) _ CONVENTIONAL- SYSTEM: WIDTH. LENGTH JNO.OF JDIS~R. PIPE SPACING. COVER INSIDE DIA.. #PITS LIQUID BED/TRENCH TRENCHES Y N~ A PIT DEPTH. DIMENSIONS S( FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO IS R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPE ABOVE COVER. EL .INLET. ELEV END. PIP S: LINE: J LET: FEET FROM Z 2 L NEAREST f i MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL .`OVER. TEXTURE. PERMANENT MARKERS. OBSERVATION WELLS. DYES ONO DYES ONO DEPTH OVER TRENCH'BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. IMULCHED. CENTER EDGES. DYES NO DYES NO DYES NO PRESSURIZED DISTRIBUTION SYSTEM: .NIDTH. LENGTH. NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE IM AtNIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV. CIA. ELEV. PIPES. DIA.: ELEVATION ANDI DISTRIBUTION [INFORMATION Ho e slzE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES ONO DYES ONO COMMENTS_ PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ONO OYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: ~ TITLE. DILHR SBD 6710 (R. 01/82) APPLICATION 9 DEPART`AENT OF FET DINGS INDUsTAY, FOR SANITARY RF SION -LABOR AND PERMIT CE~~ 7969 HUMAN RELATIONS (PLB 67) C'~Ul)(hft 707 lRft Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensi or dr scale. ontal wqw and vertical elevation reference points must be shown. All appropriate separating distances and physical char tics as specifi hapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the de a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or copy must be included. Property Owner: Mailing Addres . L 1 5.41 TF/~S ? L~1,c~~'iC~~ravv !,v S 7 Property Location: City, Villag wnship: County: '/a S~'/aS 23 ~T 3d NCR 1 E (or) 57 . ?'O57/ CI.O< Lot Dumber: Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 7 GA ,1 w~- (If assigned) 41+ TYPE OF BUILDING v Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW EPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION N (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER (Y MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit lie/5- (ays-,2 fT ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner): Private ❑ Joint. ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/MPRSW No.: Phone Number: I'se Plumber's Address: Name of Designer: 2 ,v ST • o v~saw ~i s yai COUNTY/DEPARTMENT USE ONLY Signat a of Issuing Age/n Fee: Dante: (~q [,APPROVED -Sanitary Permit Number: ❑ DISAPPROVED Ol Jl eason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) DAl>'~ / aF 2 lpwfr INDUS DEPgRTMENT OF REPORT ON SOIL BORINGS A & BUILDINGS DUST"Y , RIP" ~ DIVISION ~IfA N, WI BOX 53707 7969 LABOR RELATIONS \ / PERCOLATION TESTS (115) tjo -~F HUMAN RELATIONS PERCOLATION TESTS (115) jo -I 3707 Ze . 194? r LOCATION: SECTION: TOWNSHIP/MUN CIPALITY: OT NO.:B O.: S SION NA ;Vg, ' j L3 /T aN/R/9 E (or) W 5-~ sEp h~- COUNTY: • OWNEE 'S BUYER'S NAME: MAILING ADD ESS: fl Gib/X L . S.ti~~STFiPS ~T • y I•4 Ss /-9. e USE DATES BSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE N O ~E5TS: &esidence ? /VA ❑New Replace I 14, qAy Jq -7 , ll J IN ` ~,qcK o ,B~.sA~ sPhee. o.,) -rte// 477 cHETt - RATING: S= Site suitable for syste U= Site unsuitable for system e"D-y L CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE .(optional) 6I-r &I s ❑u 1's 2U As El ©s ❑u as ®u s4111'OW ;Z If Percolation Tests are NOT required DESIGN RATE: S S ELEV. I If any portion of the lot is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- /,00. Ff L b i~ Z y n 13d' y A L/. AV' Cy Si L' / O i° D,~- L7/ • ~.t~ S G !Q a o Se,, u.~ fG. M*W ,rr ` -eh at 4aAJA,6-v oR- B- X107 f 4'.1- /Z 110. ScL w /'Y' -00f ~o B- Z ~3 qg. a Ff_ 39 3 q • r. as . iio1P. S /_J Sy s s A; ff Aark 'ko-14s ae-- 3(, B- Ff ) Y,,1341, G, Z O o o , 36 " --meju^4 a -o 40 PERCOLATION TESTS See- L TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER ELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 4,.4. ' :1-Y M-LEZ-5 i,V ' CODE- t P- A ,V P- P-. f 43- S'I'TE- P_ i N S dS~ U P- GGv !.u L~ P_ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show th it location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. l.30TTOH S A0A1.ariC1,D 13ED SAA1,1L EXAcTz y t r-7- (34/,. SYSTEM ELEVATION Uoem(4L I~EG~i E,vcE ~°olNr AT e/fv tr,'.) . ~.ti ► ,~.QE~4 S 40r 47 56- y _'J L41el 's. . v.Cz~,- ' fzGt x v XiA)l Ufa ! G '.v a - e v Ca ly~G 416W 5 moo- ) - - _l v2 /4(f X44 ` DTY & BIn 4 DEPACTiTMENT OF REPORT ON SOIL BORINGS ARAM ,INTRY, l DIVISION ABOR P.O. BOX 76 AN REDLATiONS PERCOLATION TESTS (11 11 F9 M ISON WI 53707 ~HU I01VING LOCATION-516 SECTION: TOWNSHIP/MUNICIPALITY: LOT N K. N . DIVISIO,. ME: ~j~.. t4 ti4 2-3 /T3o N/R If E (or) W 51 To&6/0# COUNTY:, OWNER'S BUYER'S NAME: MAILING DRESS: /K L. S.tiEE '1P ;r SS L~} D CCYS USE DATES OBSERVATIONS MADE NO. BEDRMS.74k,~t_ ER IAL DESCRIPTION: I PROFILE DESCRIPTIONS: PERCOLATION ESTS : AResidence 3 ❑New R eplace F? I RATING: S= Site suitable for system U= Site unsuitable for system MON 7fNT NVLI:M OUN D: IN-GNDPRESSURE: SYSTEM-INFFILLHOLDING®NK: R ,~DJSYSTEM: ~(optional) ❑ S U 141 S ~ ~J U [Z S aU ~S U W If Percolation Tests are NOT required rESIGI RATE: S ST L I If any portion of the lot is in the under s.H63.09(5)(b), indicate: I( Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E T. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 963 Fr `tom y" /3v. /y " 38 19y, 56/- w O~° 6~ . /`107~f -1o 6.3r/ Gaon `1P~'fv f„ MIXT'vv16 o~ ~•/3 4 g_ 97 Fir 7'~-- ) 76 L/& -6y 6R. SL i y off, SL oR s eK B- G 7 Ila 3 1, -GY L , I~ /3.J. 5 L, y^ Oip S~, ~G O.t'. . S - L w:d ti B- P/'Wi.VC r d iP 44 AV. /~l O f s fR 0'.1 5*6 " A0 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- Uri ;2- P- P- Z P- P P-I - - I n~::~ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION Qt:a . ~ v ~ ~ ~ W ~ ~ M W Pt ~ ~ aC _J W . a - TN g.. ca. m_ z 4 3~0 iC~ X 5y> O LiE I3~T~ 1~5T ; Ar try G PLB ~ 7 MEN>; RS i ~X►SU6.- IUE11 H 01-4 J~- PL-OT anci CRO 55 46 . Fr 5e., sqn " SEc71oN ?(AN.$ +~lt p1oaE I~nI£ ~ ~ A foay zti ~ T 0 q?) flo to j c 20 p ~ y~N -1y yAQ~~~ Pc-,e Soil l vERr~%~L cs r I A P PRO : ~~I a fgcEl C'a'v ¢-Z '4/~.PC~v J our r o v - /00. ;Aiv /o ! 22 !r _ v f3oQ& y ! ~ / I I h ~ g ! l o L s,~'IE~STE/P5 s NF 1 5, - 513 -r 3 0 kz R 19 x ~I IH I ~l S1 y $T• -ocx Co-. NED r ~ ! Fresh Air Inlets And Observation Pipe E r Approved Vent Cap i Minimum 12" Above i i Final Grade 0 Ahnvn [zinc 4" Cast Iron ~ t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ADDRESS- O./VI/VG opcF SUBDIVISION / CSMj LOT SECTION_~ T_N-R_.Z2 W, Town of_ /r2s~/~~/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a r lWe eGt /a7 0 /may ~ a r /~K /r yO .Surma INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: ALTERNATE BM: s SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: - Liquid Capacity: Setback from: Well House 1 Other Pump: Manufacturer„ _Model #2_ size_L_VZ Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length- L; Number of trenches J Distance &.Direction to nearest prop, line: Setback from: well: House Other ~ FlCOXa Ip f /b /YJCTf~ ELEVATIONS Building Sewer ST Inlet: 9.5? , ST outlet: PC inlet- y> PC bottom Pump Off Header/Manifold--/ , _ Bottom of system .27 Existing Grade Final grade DATE OF INSTALLATION: S - _C PLUMBER ON JOB: LICENSE NUMBER:- INSPECTOR: 3/93:jt ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving theP e ,A residence located at: /A) h Section T_ZO_N, R^L9, W, Town of 15 e J L,~~/ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: q~ Did flow back occur from absorption system? Yes ~ No (If no, skip next line) Approximate volume or length of time: gallons minutes capacity: /D~✓/ Construction: Prefab Concrete- Steel Other Manufacturer: (If known): Age of T k (If k wn) r 1 ~ l k / (Signature) (Name) lease print (Title) (License Number) Date ' Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113-Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis Adm. Code (except for inspectio opening 4yP=r-jwi-tlet baffle). Name 'i Signatur MP/MPRSi Wisconsin Dej artment of Commerce PRIVATE SEWAGE SYSTEM County: Safety-ai Buildings Division INSPECTION REPORT 5~, Gro f_ GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. p;9n 12 (o Permit Holder's Name: [I City [I Village t4 Town of: State Plan ID No.: c (A De+nn ls M Anu l L S~. 7os k CST BM Elev.: Insp. BM Elev.: B escription: Parcel Tax No.: 1c~n r 1 uv' to ' I S bGe - od cs `s o3v -1o5y _L(0 TANK INFORMATION ELEVATION DATA 9"7UO~ :3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptlc 4X~s : Lj C", 1000 Bench 1.0 > os ng Vq ,e e.,(< S ~'CSU AL*-. 6M 3>70 ~ oa Sa . Aeration Bldg. Sewer 5'71 100.51 Holding D to inlet 7R, RB:fv(o TANK SETBACK INFORMATION d * Outlet 98_q-7 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 0.75-1 97g7 Aep Ic ?s 5' M7a' (03 ° NA Dt Bottom )Z.2a ciq .O 1Dosi .t,gp' /Co° -10:)/ NA Header/ Man. 1051 q.•70 /DO,qq Aeration NA Dist. Pipe 105.lq q,57 /00--7 s Z~ Holding Bot. System 91-81v- PUMP/ ,3 75 SIPHON INFORMATION K VVN Final Grade Manufacturer 6_7 iJ Demand Sol- -6-v%V-VA.Ij 10(0,.-& `I•(03 /01 -SCI Model Number S7GPM gnn S. 7 ~.(03 IO`{ TDH Lift(,)56p Friction3q System2,5 TDHq.g5Ft ~•fq 10,5,14 / 00 oss Head Forcemain Length 3S1 Dia. a" Dist. To Well JA64- $M 3 5(0 %o.S _ 10a SOIL ABSORPTION SYSTEM TRENCH Width ~2~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 2 DIMENSIONS SETBACK SYSTEM TO P / L BLDG "VLL LAKE / STREAM L ACHING Manufac INFORMATION TypeO ` pt -70 - OR UNIT R m er: System IIY1oo~+- DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) „ x Hole Size x Hole Spacing 40E T ro Air Intake ~ ' fsa Length _4L Dia- sL Length Dia. 1 Spacing /y 81 1 3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil 9 Yes ❑ No ❑ Yes IS No COMMENTS: (Include code discrepancies, persons present, etc.) I qqq NOic~e un Zj S•~~ -;t5 1-)t 9.6M- &{1.owt,,.kic~iLj NE, come.,,, rs.. AAray~ 9a,rg 9°gi ct&7 ~l S ►~~sf bQ , ►~u I ~s ll -Twee s 704 6ui(Ji sec.we ,bor:l les5411&;I 4~•k4~.Cs - j2.30 1 CowA- 8i~4.os j covey ~n. 3) 1 hie, eXt4i sq4+~ ("K cl;et Kc~ kavc Cc ki peckl&i opcmI"? 6VC4 41e, 0A 4-) Sr~ Is- yb-, V~ t- Plan revision required? ❑ Yes & No Use other side for additional information. I's SBD-6710 (R.3/97) P1 oLj. 1 51 71 9t Date spector's gnature ert. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: 'I • Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 fill Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sa % I u ber The information you provide may be used by other government agency programs El Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. <gar ' - State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope Owner Name Property Location 1/4 - 1/4, S T , N, R (or) W Property Owner's Mailing Addres Lot Number Block Number Cit tate Zip Code Phone Number Subdivision Name or CSM Number ( ) II. TYPE F B IL I G: (check one) ❑ State Owned ❑ 72 age t Road ❑ VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a3. 3Q. N. R3F 6 & s X~5/^ 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. E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ®,Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./'nch) Elevation - Feet Feet VII. TANK Capacft in gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank S ❑ ❑ ❑ ❑ ❑ ❑ 11 Lift Pump Tank /Siphon Chamber 191 ILI L ! ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for i stalls ion of the onsite sewage system shown on the attached plans. Plu er' Na t) Plum r' Ign t s MP/MPRSW No.: Business Phone Number: Plumber's Ac dress (Set, Ci State, Z p Code) IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater 7atessue Issuing A nt Signature (N tam A Surcharge Feepproved ❑ Owner Given Initial ,~j Adverse Determination ' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 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 81/2 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. SAFETY AND BUILDINGS DIVISION 15837 USH 63 Nytisconsin Hayward, WI 54843 Department of Commerce Tommy G. Thompson, Governor 15-Oct-97 William J. McCoshen, Secretary K O Construction Kim A O'Connell 504 Third Ave Osceola WI 54020 Dennis McAnally Plan ID 9710605 NW,SE,23,30,19W Municipality of St Joseph Inspector: Leroy G. Jansky County of St Croix (715) 726-2544 Private Sewage plans including the following element(s): MOUND 450 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department. All permits required by the state or local municipality shall be obtained prior to commencement of construction/installation/operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, Carl Lippert Wastewater Specialist (715) 634-3484 Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plea c 97 - camy ib ,oJw L ~ Contents Comments/Special Instructions Pane r taatuded 'tbo copies aaadsd for all lane l Plot Plan 2 PIM View! , Return by Mail 3 q Talc It Pump) Q Fax Letter to (County) (Submitter) s Siph= information Circle One and Provide Fax ( ) 6 Can for Pick-Up: ( ) 7 Other 1, the undersigned, henby oert* that the Seal (if applicable) phuu mW speeltkatiotu nbmittrd benwuh Were prepwod alas arty direction and eo■troL A*bw unall y Fi tlu Atteckes wt AWkmdo. APPROVED SOWa i #V*AlMM DEPARTMENT OF COMMERCE Pie 41ON OF SAFETY AND BUILDINGS Needed for Heidi" Talc SubaWlab NVOUNPOL (0000b le ) EE,G RESP0NpENCE Needed for ~ 0OWWd oft" Apowmiea err "W at sa AP . CMNr 0840 on$ aedlaoew set ofPWW SOD-10268 (N.01r96) Ile - ~,J►s We ' ,moo _l s0/ .,e - airy _ _ le -42- 9;r, 17 Z~ /L ~O .clip . _ Coilditionaily _ A p RCE DEPART OF SAFETY AND BUILDINGS 51 PA OF SAFETY AND BUILDINGS D SEE G RESPONDENCE i... I paw Of • Slrow, Marsh May$ Or Syathetk Covering Distribution Pipe Medium Send - Topsoil .,s F J~ E o Bop of f= 2 j Force Main Plowed Aggregate From Pump Layer Cross Section 01 A Mowed System Using F A Bed For The Absorption Area F 6 . A ,j~2Q Ft. H ..z Signed: B -,/-y;, Ft. License Number: I ,J,49 Ft. Datel J ~1,57 Ft. K Y0, 9 Ft. Alternate Posltlon L -V, Ft. Force This w .3Z, S Ft. Observation Pipe-ft, ~wwwwww~www~wwwwwwww• ww•••w••••w••••w••www•y~ . A I~.••w~ N•wwww~~N~~~~~~~wwwww•www~•••••~•y' W ~~~~~~wi•ws~~ ~L . 7 Distribution Bed Of 2 yi Pipe Aggregate I Observation Pipe Permanent Markers Conditiona ly Using A Bed For The Absoro-ARROVED Plop View Of Mound DEPARTMENT OF COMMERCE ZLON011 SAFETY AND BUILDINGS E SEE CO RESPONDENCE PAge pt Perforated Pipe Detail 0 End View Per/orated rb~Ca u Lad Cop PVC Pipe NON$ Located On Bottom. ~,\s Are Equally Spaced Q d ~ st~O~ N~r~ ~v PVC Fares Irian .7 Alternate Position Of Oislrip•rtion Fore* Main Pipe Lost NOW Should of Nett To. End Copy Z / End Cap Distribution Pipe Layout P , Ft. R S X Inches 2 Yzjg~ .Inches Signed: Hole Diameter Inch Lateral " Inch(es) License Number: Manifold " -Inches Date: Force Main " Inches # of holes/pipe/ Invert Elevation of LateralsFt• RO T.S. Conditionally APPROWD DEPARTMENT OF COMMERCE Dl ON OF SAFE AND BUILDINGS i .6 0; SEE CO ESPONDENCE • b a w ~ w 0 aee W ro N A Q O 11~ A 1 A s O O M ro K a a a gw O ~ A s 1:13 0 M M r x ~ a A O rt P.O.W.T.S. onditionallY PROVED RTMENT OF COMMERCE DIVI 1 SAFETY AND BUILDINGS S Q CORRE ONDENCE a a a PA6 E ~ ...i1L_ PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS or W VENT CAP VENT PIPE WEATHERPROOF _APPROVED LOCKING fr- -7 1 JUNCTIOM 50A MANHOLE COVER WITH 2S' FROM DOOR. MIU. WAAMING LAINEL IL• WIN00W OR FRESH I AIR INTAKE GRADE I y" MIN. le• hlu. COWDUIT Io•nw. ~ 1 11~ PROVIDE I IMLET AIRTIGHT SEAL I III I II ri-T III APPROVED JOIIJT A APPROVED JOI I II W/ ' PIPE W/ PIPE EXTENDIW& 3' I III ALARM EXTEUDIUC. 31 OWTO SOLID SOIL I I I ONTO SOI,ID It* e I 1 ow I ELEV. _W- FT. PUMP b OFF 0 COAICKETE CLOCKg RISER EXIT PERMITTED OWLJ IF TAWK VEDMAWUFACTUR uK HAS TU H APPROVAL SEPTIC f SPEC.IFICATIWLIS 005E ) TAIJK MAIJUFACTURER: WMBER OF DOSES: PER DAB TAWK SIZE: 'I - GALLOWS DOSE VOLUME INCLUDING DACKFLOW: GALLONS ALARM MAUUFACTURER: MODEL WUMDEK' CAPACITIES: A= _.I►JCHES OR GALLOW SWITCH TtIPL: PUMP MAUUFACTURER: C:_:Z_IIJCHES OR /-r?'. GALLO MODEL MUMDER: 0- _ R INCHES OR ,Y'L2 GALLO /.0 t SWITCH T`JPE: MOTE' PUMP AUD ALARM ARE TO DE INSTALLED OW SEPARATE CIRCUITS MIWIMUM DISCHARGE KATE GPM VERTICAL DIFFEKEIJCE OETWEEIJ PUMP OFF AUD DISTRIBUTION PIPE.. FEET + MIWIMUM METWORK SUPPLY PR/E~SSSUR,E//. . . . . . . . . 2.5 FCET + FEET OF FORCE MAIM X 1..IlG_F/Onrr.FKICTIOU FACTOR.. FEET TOTAL OtAJAMIC HEAD '4(j~14l~T.S. g~111t"c~'fiditionally TH IIJTERAJAL DIMEIJSIOUS Of TAWK: LENGTH iWIDTH P-p . K LICENSE pN4S A@q}ZM ~ fNT OF COMME~NQ4TE' 51G►JE 0:___ - j~ EE CO RESPONDENCE w Performance z>uumersioie nn ueni Curves Pumps pr.e al°Ae METERS FEET MODElLSd 25 6o SIZE 3/,' olids WE15H 70 20 WEtOH 60 -WE07H 15 .40 WE L I 10 30 WE03M 20 - WE031 w__ I till S 717 0 0 0 10 20 30 40 50 60 70 80 100 110 120 GPM P 10 d Z 30 m1lA CAPACI~Z M~ D [(b]GOULDS PUMPS, INC. 5e*CA 4US t*w rCO..),,.. METERS FEET 120 MODEL 8885 35- 110 WE15H H SIZE 3/," Solids 100 30 00 25 70 20 60 O 50 ~ WEOSHH 15 40 10 30 20 S 10 0 OO 10 20 30 40 50 60 70 60 00 100 110 120 GPM L 10 20 30 m+A► CAPACITY • 1 W6 09wo Pwnp•. Inc. golloa .lwy. 19" 01111 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 -Labor aril Human Relations Division o~,Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030-1054-40 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Dennis M. McAnally GOVT. LOT NW 1/4 SE 1/4,S23 T 30 N,R 19 f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1444 Ridge Run na na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE R]TOWN NEAREST ROAD New richmond, WI. 54017 ( ) na St. Joseph Ride Run [ New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 -6 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Reccmmended infiltration surface elevation(s) 99.75 It (as referred to site plan benchmark) Additional design / site considerations system el. based on ocntour line of el. 98.75, Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitablefors stem ❑S KI U ®S ❑U EIS 97U EIS ®U ❑S flU EIS KlU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertctl 1 1 0-5 10 r2 2 none sil 2msbk mfr 2f .5 .6 2 5-51 10 r4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 51-80 7.5 r4/4 none scl m na na na np .2 elev. 99. 1, Depth to limiting factor +80" Remarks: Boring # 1 10-7 10 r2 2 none 1 2msbk mfr 2f .5 .6 2 7-24 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 24-35 7.5yr4/4 none scl m na gw na np .2 Ground 5yr4/1 elev. 4 35-72 7.5 r4/4 c2d5 r4/4 scl m na na na n .2 97.15 ft. Depth to limiting fac35 Remarks: CST Name: Please Print Phone: Gar L. Steel 246-6 x Address: 1554 200th. Av . , w Richmond, WI. 54017 298 C~ p1CE Signature: 7- Da e.96 umber: S PROPERTY OWNER Dennis M. McAnally SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 030-1054-40 , 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 0-10 10 r2 2 none 1 2msbk m La 2 10-23 10 r4/4 none sil 2msbk mfr if .5 .6 Ground 3 23-53 10yr4/4 none sicl m na na n .2 elev. 98.65 ft. 4 53-69 7.5 r4 4 none Depth to 5 69-80 7.5 r4 4 none scl m na limiting factor +80" 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 Dennis M-T30N-yR19w New Richmond, WI 54017 MPRSW 3254 NW4SE4 S23T30N (715) 246-6200 town of St. Joseph N 1"=40' BM.= top of NE lot stake C el. 100' Ss` k a1ti 2i O . ICA 4f aGary L. Steel 7-30-96 STC-105 A SEPTIC TANK MADITENANCE AGREEMNT St. Croix county OWN]• , . I fe, -t 44 e AA4 11. MAII.JNG ADDRESS 9`7 I ~ ~~JD509, r&&,,o ~6 PROPERTY ADDRESS fQ (location of septic system) please obtain from the Planning Dept. CITY/STATE DI~Gl,J el I- 7 a PROPERTY LOCATION 1/4, _ 1/4, Section . . TOWN OF bdk410n ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP VOLUME , PAGE , LOT NUMBER 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. C SIGNED: AIM I - 1P DATE: IQ - L Y- 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8TC- 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 Deor*c 41-raniala Location of roperty NIA) 1/4 1/4, Secti W Township Wai kcAmovl Ma ling address 9-71 Z2 W i n 50 r- -re d S5 Address of site 104- wn k 1, Subdivision name f Lot no. Other homes on property? Yes No Previous owner of property 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 _X_No Volume 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 office of the County Register of Deeds as Document No. , 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. C S nature of Applicant Co-Applicant /J_zy-97 /L~°'o`~` 7 Date of Signature Date of signature 548567 j~ STAT' BAR OF WISCONSIN FORM 2 - lees WARRANTY DEED ~ DOCUMENT NO. ~91.11~~~IlCf•~~_ ORCE I~ II 'Sam ra Ellen 4rha1linoon- Cm-0ire Stican Polka MVI E09 Pamela 4nnT, H°u~` as Ten l nts in QMMM - 6 conveys And wonnu to Dennis R. ~ly end_Patt~ M M. 11Y, husban ~t a II TH&S SPACE AESERM FOR MICOP&MO WA~-_ II NAM! AND MITURM ADDReSS _r the following described real estate in St. Croix CroymY Bank of New Richmoor~~J Y 1 is Slate of Wisconsin: P.O. Box 128 I New Richmond WI 54017 I I -ra " - 030 - los5~ - ~fb a+AACa. iocMnncAnoM MtnteaR Part of Government Lot 2 of Section 23-30-19, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the northeast corner of Government Lot 2, Section 23- 30-19; thence West al=g the said North lino of said government Lot 2 for 1300 feet; then-se South and parallel to the East line of said ~s Government Lot 2 for 300.00 feet to ten point of beginning of this ~i description; thence South and parallel with said cast line of government Lot 2, for 380.0 feet, more or Less, to the Casterlr II shoreline of Bass Lake; thence Northerly along said easterly 1 shoreline of Bass Lake for 92.0 feet, score or less, to it's intersection with a :Line which is parallel to the last mentioned `I line and at a distance of 90.0 feet North therefrom; thence East and iI parallel to the North line of said Qovernment Lot 2 for 360.0 feet, more or less, to the point of beginning: together with an eassstent II for ingress and egress over a 33 loot road, the Kest line of which is as follows: Beginning at a point is the center of the tor. road, 11 which point is 1300 fast Next of the Southeast corner of Section 23- thence worth and parallel to the East line of said Section 23 fo~~ ~ e 2322 feet to the and of said 33 feet easeient. 'A ~t ` Dated this 8- 6 -g(e dri of Aufust . A.D.. 19-46-IfY IlJ~ - +~aY II OPAL) a.ajAa~ L)4, P) ~ 2-6-21L(SEAL) ndra Ellyn/~Schelli as Cat:dice Susan Polka I ~ c58A1.1 - - rf 01AU all w• y i~ _ ~e