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HomeMy WebLinkAbout030-2014-30-100 ' T n A 2 V STC - 104 WhMOSNINOZ AiM= AS BUILT SANITARY SYSTEM REPOR r Vo tio Is _4 1661 10 A 0 N OWNER r /~l~•- - ADDRESS 03N303~ SUBDIVISION c% l 3 x.3 3 SECTION LOT # 7 LET 3a N_R_Zy W, Town of ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o r 1.. , 32 g F`V31 INDICATE NORTH ARROW Provide setback and elevation information on reverse o Provide 2 of this form. dimensions to center of septic tank manhole cover. BENCHMARK: ,t ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: L i~ c ~C !r Liquid Capacity: jZco Setback from: Well Go' House /F' Other Pump: Manufacturer /y kI Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM L Width: 13 Length 7 2 Number of trenches Z ~`u~,r. his Distance & Direction to nearest prop. line: Setback from: well: 7F7 House 51' Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - .r=z F PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: Red -71573 3/93:jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM v Safety ahd Buildings Division Count INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarxP~ur}TR.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)j. L t3 ~y 33 ttii 44 Permit Hold e: t Town of: State Plan ID No.: MAHR, G)~s E~~m ~ y g~i ~P CST B-M Elev.: Insp. BM Elev.: BM Description: Parcel ~ b:1-:2014-30-000 TANK INFORMATION eA1' dv,IV V ELEVATION DATA A9700200 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -4 r-,e- ( 12oc7 Benchmark JbO Dosing Aeration Bldg. Sewer ~l OZ 0/9'. Icl 'r Holding St/Ht Inlet I q7l TANK SETBACK INFORMATION St/ Ht Outlet ~V ' 9977' TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic 4-(67) 60 215 - NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe g ~7.27 Holding Bot. System /p.31 qSq PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand S*- W'Mk.Ie Model Number GPM I o o~p 5z ~K ~•01Z' C? 7-23 TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well 71 F SOIL ABSORPTION SYSTEM BED / Width Length , No. Of Trenches PIT No. Of Pits Inside Di Liquid Depth DIMENSIONS 3 7Z 2- DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufactu r: SETBACK INFORMATION Typeo , CHAMBER Mo -W mb System:e"V41 -fI(5p 3( - OR UNIT DISTRIBUTION SYSTEM St vj rvld -e-V, C,) Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing - - So SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Apsoil Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed / Trench Edges ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) VA ~ Zq ` LOCATION: ST. JOSEPH 36.30.19.410,SW,NW 1249 80TH STREET LOT 1 Plan revision required? 2(Yes ❑ No pp Use other side for additional information. 1111-7 ct7 I~ C41 ( ,P- F 75I SBD-6710 (R.8/97) Date Inspector' nature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Visconsin SANITARY PERMIT APPLICATION 201eE. Wand a hington Ave ision 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 8112 x 11 inches in size. ~f Gtr `A • See reverse side for instructions for completing this application State Sanitary Permit Number zim 3 g q} The information you provide may be used by other government agency programs Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)].~ State Plan I.D. Num er 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property,Owner Na e / Propert L ation 0 1/4 1/4, S g4 T 3 , N, R /q k(or W Property Own 's Mailing Address Lot Number Block Number / OL:~ fh ~f IfA City, State . Zip Code rPhoneNu Subdivision Name or CSM N mber "le II. TYPE F BUILDING: (check one) ❑ State Owned it~ rearpst Road C1 Vii age ~An) A > S~ Public 1 or 2 Family Dwelling- No. of bedrooms Town of CMJ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( C):~b - -~00 3l~. 30. t q. yi(> 1 ❑ Apartment/ Condo 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. ~S 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 11E] Seepage Bed 21 ❑ Mound 30E] Specify Type 41 ❑ Holding Tank 12Z Seepage Trench 22 ❑ In-Ground Pressure 42E] Pit Privy 13E] Seepage Pit <-hZ41•10sr5 43E] Vault Privy 14E] 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 60 75ct;, 7 g,' -3 ~ Feet l,5Z> Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank / C 21 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name: (Print) Plumber's ignature: (No St ps) MP/MPRSW o.: Business Phone Number: Plumber's c d ss (Street, City, State, Zip Code), IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps) roved Surcharge fee) pp ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: i 81 ' F • • 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. 111. 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. l~bsorption system information. Provide all information requested for numbers 1 through 7. VII. 'rank information. Fill in the capacity of every new/or exist,ng 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 narne, 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. r JOB C~ rel, , k T.IMM EXCAVATING Route 1 Box 192 SHEET NO. Of 2 WILSON, WISCONSIN 54027 CALCULATED BY T,.r. DATE (715) 772-3214 (715) 386-5443 MPRS 03224 WI MPCA #696 MN CHECKED BY DATE SCALE ii . er bf` L t ♦ s 4 1 a j. f i \ y5 { w" I zi ~ - ~'X(.l: G wo i.~1111-1-s--;-%w R L PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE i-000-225-M I~9 JOB - TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE < 2 31... PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225.6380 Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water system! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County n--Lg d4Z 7' than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Nu b r The information you provide may be used by other government agency Y programs revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Own Name Propert Location l¢ 5jA4 1 /4 ~ t i4, S T , N, R if klorQ Property Owner's ailin Address Lot Number Block ber off City, State Zip Code Phone Number Subdivision Name or SM Number /G® W1 yo) I 1 323 II. TYPE F BUILDING: (check one) ❑ State Owned C1 0 Vil ftNea;? t Ro''a//dJJ Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town OF ®~`L Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0216- 1W4 ^ 3c 1 ❑ Apartment/ Condo d 30 - ;26 15 - zc:. 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 OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ 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 Requir d (s . ft.) Proposed sq. ft.) (Gals/day/sq. /sq. ft.) (Min./inch) Elevation 45;0 1 l~ Feet Feet VII. TANK Capacity gallonTotal # of Site INFORMATION Manufacturer's Name Prefab. Con_ gFiber- lass Plastic Appr New Existing Gallons Tanks Concrete strutted Steel Tanks Tanks Septic Tank or Holding Tank ! ❑ 0 El 1:1 ❑ 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. Plumb 's Name: (Print) Plumb is Signature: (N tamps) P/MP,, 8511 NO.: Business Phone Number: T32114 Plumber' Address (Street, City, State, Zip Code): Ah mil i(S J~I II/b Z IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin Agent Signature (No Stamps) XApproved ❑ Owner Given Initial Surcharge fee) Adverse Determination 3 I ~01~D X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS •t 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, 608-266-3815. To be complete and accurate thissanitary 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. 111. 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 13. 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 isto 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 soit 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. ' TI M M EXCAVATING JOB Route I Box 192 SHEET NO. OF Z WILSON, WISCONSIN 54027 CALCULATED BY ✓ ~r" DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . .............................i.......... 1 . f i C7 xf p . C' . 1 T l 1 OV a w w cr/ `mac I4..... : 4 \ y s ~I . \ z.- 67 '2C.C3. C r f rn~fu~ S ~,7 PRODUCT 205-1 Inc.,Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-6380 Vftconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page-.---' of ,3 Labdr and Human Relations Divisiqn of afety & Buildings ) in accord with ILHR 83.05, Wis Adm Code ~t,,,•zzJC4<.~. ~ c~ ~t~ ~ ,L ~ tj ? ct~ E.' `~c z k- c .r. t-i.-i ~~i.S~, w- CQUNTY Attach complete site plan on paper not less than A 1/ x 11 inches in sde. Plan rhust include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # f /I/ dimensioned, north arrow, and location and distance to nearest road. alf/IdEAPPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION AR E (o~ l~E Vwx GOVT. LOT S4,) 1/4,4/~ 1/4,S3~ T _5,g> PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 4 ,00T ^ rnvf 70 ZE CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE EITOWN NEAREq_ROAD ~tl u~z -sw 7/ 2 # P - .ST. ' New Construction Use Residential/ Number of bedrooms .3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ~5' 0 gpd Recommended design loading rate . 7 bed, gpd/ft2 • trench, gpd/ft2 Absorption area required bed, ft2 57to3 trench, ft2 Maximum design loading rate gibed, gpd/ft2-trench, gpd/ft2 Recommended infiltration surface elevation(s) 3.S 9~D 1r~ ~i~~r,~C✓ ft (as referred to site plan benchmark) Additional design / site considerations /frAw 96.0 65cre Parenfmaterial Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0 S ❑ U EIS ❑ U OS ❑ U 0S ❑ U ❑ S m U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou dary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o s --.3 3 SL ~~Pv Z"rw s Ground 3 7 s- S S ~S /7iL - , 8 elev. f2~-j ft. Depth to limiting factor 3 Remarks: Boring # In AS 'A-1 2- 11-2~ 7.5 V15e -s L -3 Ai -73 A, m Rs' -s : T 125--V .2-5-- slke © G L ~4S --.7 F Ground elev. 7 S' e S p S~' /I~t L DOL ft. 3-p - Depth to limiting factor > 92 Remarks: CST Name:-Please Print I ~T Phone: -3 S t; EB 2 Address: !30 3v c rs Z= C 1 3 Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page? oil 3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench tn •q \w::•\v:yfi:} -5Z y9vzz) 95' ZM F- /2 -23P. X-5- .t S Ground 3 33 ,~C S G L S elev. , /a2,3 ft. - - ~r of L . ? Depth to limiting factor Remarks: Boring # Xoz, --,v S - 7s-~S S OS~r L - $ 3 - P Ground elev. , /per ft. Depth to limiting factor Remarks: Boring # sL o z S -Z - 7-S - VA/ SL ffs IF-.5 • Yt. Ground elev. ,/a. Y ft. Depth to limiting factor Remarks: Boring # . Ground elev. Ctc /Jy i m Lys !L ft. - fEZ` sl~~Cv uJ ~cez^T 'E~~ rd Depth to EA limiting f L factor Remarks: SBD-8330(R.05/92) - ~ Jill 44 I it Q S C~ ' a NRI 3 ~ ~ ~ 999 44 M t o I ^'1 ti kD P N OJ y ~ M UNPLATTED LANDS Ct 6 6' r-- S89049'13"W 314.78' CD 34.34' 1280.44' o -h Ct o I CD C) C> I IC 0 ° o N w cp Ir - I T~ w co i~ m co ILOT 1 _ Irn Id CA IC No 3.47 Ac. Inc. R/W 1z 151,054 Sq. Ft. a i "U w ° I r 100 o ct o IT to ° 1r 3.00 Ac. Exc. R/W w 1-I 1-I ~ 0 130 703 Sq. Ft. w 11~ I-{ i= ° ' '00 Its Irn . Its ' : I ,1, IC/) ---Tx) 'A ,p o o C 33' 33' I Wk Cor_ 02 Sec 36 6' ICS C) Wd.. i--~ C F o ° Ir I~ I 17:> 1 rn o Iz 1rn u, b _ 'd 1-I I cn N I 0' tzj I ~ti o~ LEGEND `p F f w CD N Aluminum County Section Cot ~ ° ti Monument Found °o 0 11' x 24" Iron Pipe Set, we CD _ /vfps 1.68 l bs per linear foot ~Q~'~~ - - - 100' Roadway Setback Line c~ 33' 33' G 55'7'785 CERTIFIED SURVEY MAP, Located in part of -the SWj of the NWj and in part of the NWJ of the SWj of Section 36, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. Of w~soo NW Cor ~Q' DOUGCAS~. Prepared for: Sec 36- 0 v1 ZAHLER 790gCty. Rd. Ar& E S-2145 * Hudson, WI 54016 HUDSO N oo ~A w N, Ray Brown owner p v w 7 8 N 00 7 S O X -1% UNPLATTED LANDS 0 w~s~ 6 6' 9 Pew, S89049113"W 314.78' -34.34' ~ 280.44' c'~'•G~~ c~ c cr ~ a ~ 3 o z I Vy O p IC o ° IZ N CD w i po M CD a M 02 LOT 1 00 " Im a IC Its c V N IZ o 3.47 Ac. Inc. R/W N N d I~ 151,054 Sq. Ft. Ir 100 w o ao' M 0 ID--- j~ w 3.00 Ac. Exc. •R/W 1r o cr Q 1-I IZ Co 130,703 Sq. Ft. w 1z co Irn 6i ao It7 a E' t~ ~ Id - I ,asr• IC/~ v~ dr n o. 33' 331 ~ I - o-. o I W0c4 Wk Cor_ F fi ct Sec 36 + rn ~ c~ 6' Icn Ln I an ' '97 1~ o Ir o Ia 11 ~ rn C~ ST I Iz IC01) 1--q Lntanni,Ig N oche anG i' arks Cornmittee txj I . 'y~ • If not recorded within 30 days of PProval date I C3 aPProval shall be LEGEND nuii and void Aluminum County Section Corner Ct Monument Found ~ Co ~p• ~1 .`'`~i O 1" x 24" Iron Pipe Set, weighing ` Q i 1.68 lbs per linear fob ~ v STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS 11 f / PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 6i,; 1/4, /Z iJ 1/4, Section 3/,, T N-R~_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP `7 1JVOLUME tj PAGE 32 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. SIGNED: ; k L ` 1 ~1 C~'.....L- 7,11 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC - 100 4 V . 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 111", Location of property ;K4 1/41/4, section q& , T_.3_N-R W Township Mailing address Address of site / 7,~ jj 2M 5/ J / ,b Qn Subdivision name Lot no. Other homes on property? Yes~_No Previous owner of property _ O Total size of property Total size of parcel Ae-e Date parcel was created - 0- j? Are all corners and lot lines identifiable? --r1-Yes No Is this property being developed for (spec house) ? Yes No Volume - 3 and Page Number 63A 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. _ ~'ef15/~ 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. r Z Sign/~, ure of Applicant Co-Applicant Dat of Signature Date of Siqnature a x. /00 4lOGUMF-NT Nb i; WARRANTY DEED !STATE BAR OF WISCONSIN FORM 2- IMM 559i-t0 ~t T~JOPALEIh)O REGISTL- G I ST. oRC.IX CJ., ti'!I it RAY G. BROWN and ELEANORE J. BROWN, dt"F1P1° husband. and wife • MAY. 8 1997 I................... . - 4:15 P.f' conveys s and warrants to .7lt,t.~~ it II GREGORY A. MARR- a•nd...RI1 $Rh ..S.... MAHR,. husband and. wife-~-• holding. as -survivorship-.-_------- marital -property..... - for x.1..00.. and..other-..va.luable -.conslldexa-ti.on._.-_ _ ' ,~,,,R» ro II . Gregory Kimberly Mahr ~ 790 Co. Trk. »E» & "An II the following described real estate in S.. Coonty. Hudson, W1 54016 it . State of Wisconsin: Part of: 030-2014-30 Tax Parcel No: 5...0-30.-2l11S_-2-0 it A parcel of 3.47 acres located in the SW's of N-W% and in the NWk of SWk of Section 36, Township 30 North, Range 19 West, Town of St. Joseph, ;j ~I St. Croix County, Wisconsin, described as follows: f! I~ Lot 1 of the Certified Survey Map filed April 10, 1997, in Vol. 11 of CSMs, Page 3233, Doc. No. 557785, in the office .I of the Register of Deeds for St. Croix County, Wisconsin. ii i+ Subject to town road right-of-way over the westerly side thereof as i~ f shown on said Certified Survey Map, and to easements, reservations, j restrictions and covenants of record, if any. '~tR I ego S- I ` J not This . homestead property. (is) (is not) jl Exception 0 warranties: II I I I 1 Dated this . day of May 19. 97. ~I I ~I R ......(SEAL)~'~4 v _ (SEAL) I Ra G Brown Eleanore J.rown Y -----------(SEAL) (SEAL) ii s AUTHENTICATION AC!<!f01V LZI)CIMENT II II Signature(s) of..RaY-__Qt.,...B.rQ.vn...and STATE OF WISOUNSIN Eleanore J. Brown ss County. II a n~ie . -d _My 19.9.7. Personae' caste before me this ................day of J - 19--••- the above named f!!!!!._ Ailliam J. Gilbert i TITLE: MEMBER STATE BAR OF WISCONSIN i (If not authorised by 706.06. Wis. Stats) to me known to he the person who executed the foregoing instrunwat and acknowledge the same. II Tina 1WSTW1iu9uT WAa nRAIMM wv ~ ~ ~ A J ~ JOB L9/P1y"(EC,~Y T,IMM EXCAVATING Z 2 y Route 1 Box 192 SHEET NO. OF / WILSON, WISCONSIN 54027 CALCULATED BY 71 DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE Gt , 2 At ell . z ~r w.. 92" ' a L i Jam. ` / PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-6380