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HomeMy WebLinkAbout030-2095-20-000 U 3d - zo ~ bZ.c7 - d o 0 79 AS BUILT SANITARY SYSTEM REPORT OWNER Ovti r. k ADDRESS_ SUBDIVISION / CSM# cnSECTION T-0 N-R q---~'0_W, own of ST. CROIX COUNTY, WISCONSIN S OW EVERYTHIN W PLAN ITHIN IE00 FEET OF SYSTEM 96 0 O 3 INDICATE NORTH ARROW Provide setback and elevation information on reverse El ~y Provide 2 dimensions to center of septic tank of this form. manhole cover. BENCHMARK: /dz / ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: f2~. Liquid Capacity: afro 60 Setback from: Well 76 House .2J` Othe~ Pump: Manufacturer ('~nlr~ Model# 31i L Size j T Float seperation ` Gallons/cycle: l3 3 Alarm Locat-iQn•.SOIL ABSORPTION SYSTE Width: .S Length 7S Number of trenches M Distance & Direction to nearest prop. line:-'. Setback from: well: „3Gb'f' House 3M_~" Other ELEVATIONS q. 1 Building Sewer- ST Inlet: 771 ST outlet: PC inlet 97.7 PC bottom Pump Off (?5, Header/Manifold 7q,? Bottom of system g8,' 7 Existing Grade- 1394 Final grade /off, DATE OF INSTALLATION: ? S PLUMBER ON JOB: LTCENSE NUMBER: 1563 ~P~ INSPECTOR' 'r 3/93:jt ~,~1~~9 r6 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM CountS y'T Safety'and Buildings Division . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryZi8T3t ft.: Personal information you provice may be used for secondary purposes [Privacy Lev, s.15.04 (1)(m)). "fL1C:sl7, Nan SON Eb~iity qbftV9 Town o : State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TDx3f);2095-10-000 TANK INFORMATION ELEVATION DATA A9700196 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing v' Aeration Bldg. Sewer Holding St/ICE Inlet TANK SETBACK INFORMATION St/Ht Outlet - x,1.3 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA DtBs~ / Dosing NA Header / Man. Aeration NA Dist. Pipe 5 7 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well 711 SOIL ABSORPTION SYSTEM BED / TRENCH Width 1 1 Lengtp, _ No. Of Trenches PIT No. Of Pits Inside Liquid Depth o~ #e DIMENSIONS 5 r DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO -ITU CHAMBER Moe Number: System: r4_) OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 24.30.20,SE,NW 1465 24TH STREET LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3197) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: „oso Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • C _Szt • See reverse side for instructions for completing this application State Sanitary Permit Number 989380 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. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro erty Owner Name Property Location E; 1/4ofw114,5 aiiij T ,N,RAOW)W Property Owner's Mailing A dre Lot Numb Block Numb r sue'' # S City, State Zip Code Phone Number Subtijyision Name or CSM N ber ( ) c !S~5 nit, II. TYPE OF .BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms EVT own of S - 6q III. BUILDING USE: (If building type is public, check all that apply) rcel Tax Number(s) ('e-) 1 ❑ Apartment/ Condo o3o - aog -1 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 ❑ Seepage Bed 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 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 ~ Elevation Required (sq. ft.) Proposed ft.) (Gals/day/sq. ft.) (Min./inch) It ` -73 -1~ ID ~ Feet D/r 5 Feet TANK Ca acit VII. in altos Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks I " Septic Tank or Holding Tank 60 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ba ~Ga t :b cz ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta tion of the onsite sewage system shown on the attached plans. Plumber's Name: ( Plumber's Sig at re: ( o Sta ps) /MPRSW No.: Business Phone Number: 0'ALS ~ P",*_ .0 '444 s -s~ Plumber's Address (Stre~City, State, Code): ULt-at K) Q 1~ it ~ joAe)A _'~Ztgnl IX. COUNTY / DEPARTMENT USE ONLY l ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Si s) harge Fee) (Approved ❑ Owner Given Initial / 3,4 S O~ G 2v -7 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety 8 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, 60$-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use- If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total 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, loca'tton of holding tank(s), sipfic 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; Q 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. ! f - - -r --i- i- 1 OLW1 I { I I ~ I I I I i I I nS~Lit.~ i ~ - I + I - I I C I I I i 1 ! I- F f _ r I I I I. T ~ ? ~r6 cnl i ( I i I I I ' ' I _ I 1 I ~ I I I 9 ' ' ~ ' ~ I f it I I , 1 I I ~ , I al r I r i i f I I 1 I y ~k + I r r i I I I I , ~ I I I I i ( I I i ' -I I 11 ( II I I , ~ I J ~ ~ I I f ' 1 ~ I I I ! I ~ --4 , I I I ~ I I I f ~ I 1 I ' i I I I ' I i ~ II ~ j f •T ~ _ I I f I , I 1 I I I I I I ~ ~ I ~ ~ _ I I r~ ! I I I f I , I I ~ I- i _ I I t_ ~ ! I I I i I I -t i I I ! ! 1 ! ~ ~ I I I j { I i I I I I I , I I _ 1 ~ I I I r I . I ~ I I I I I I ~ ~ I j I - - - - - I I I i. I I I r ~ I ~ ~ ~ I I I i I I I I I . I i I ~ l : I C r - I 'I I , : j I i I I I I f j I i I I 1 1 I I , I i I 1 - I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor tnd Human Relations Cfitor of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 in )nsi;?PI st include, but St . Croi not limited to vertical and horizontal reference point (BM), o cale or PARCEL I.D. # dimensioned, north arrow, and location and distance to road. 030-2095-10 APPLICANT INFORMATION-PLEASE PRINT FOF~ REVIEWED BY DATE PER CATION PROPERTY OWNER: ; f P 99 Vernell A. & Stephen L. Skoglun _ ~J ] GOVT. L E 1/4 NW 1/4,S24 T 30 ,,R 20 .,&or) W PROPERTY OWNERS MAKING ADDRESS CCK # SUBD. NAME OR CSM # 149 High St. na Country -1rig CITY, STATE ZIP CODE PHONE MBVILAGE SOWN NEAREST ROAD New Richmond, WI. 54017 2 St. HY. #35-64 New Construction Use 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 required900 bed, ft2 750 trench, ft2 Maximum design loading rate bed, gpd/ft2__.L_trench, gPd/ft2 Recommended infiltration surface elevation(s) 102.28-100.98-98.73 it (as referred to site plan benchmark) Additional design / site considerations step down trench system Parent material ptited glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND 7 IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ❑ U M ❑ U K] S ❑ U KIS ❑ U ❑ S f] U ❑ S 131U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trtalch 1 0-12 10yr4/3 none 1 2msbk mfr cs 2f .5 .6 2 12-19 10yr4/4 none sil 2msbk mfr 9W if .5 .6 Ground 3 19-45 10yr4/4 none scl 2msbk mfr gw na .4 .5 elev. 4 45-84 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 107.53 Depth to limiting fa +U4" 7_7 Remarks: Boring # 1 10-12 10yr3/3 none 1 2msbk mfr gw 2f 1.5 .6 2 2 12-32 10yr4/4 none sicl 2msbk mfr gf if .4 i.5 ri:'• ~~:i\vn6 3 32-50 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 Ground Gro 4 50-82 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 elev. 105.53ft. Depth to limiting factor +82" Remarks: CST Name:-Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 200th. Ave., New ichmond, WI. 540 17 Signature: Date: CST Number: 8-10-95 cstm 02298 PROPERTYOWNER V. & S. Skoglund SOIL DESCRIPTION REPORT Pag1d ? of 3 PARCEL I.D. x 030-2095-10 , Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrer& >:w 1 0-9 10yr4/3 none sl 2msbk mfr gw 2f .5 .6- 3 2 9-24 7.5yr4/4 none sil 2msbk mfr 9w if .5 .6 i Ground 3 24-50 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 f 102. 23 ft. 4 50-80 7.5yr4/6 none S Osg mvfr na na .7 .8 Depth to limiting - factor +80" Remarks: Boring # 1 0-9 10yr3/3 none 1 2msbk mfr gw 2f .5 .67 4 2 9-31 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 31-33 10yr4/4 cid 7.5yr5/8 sil lfsbk mfr gw na .2 .3 Ground elev. ' 4 33-80 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 106.2$t, Depth to limiting factor +80" Remarks: H-3 less than 11 Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 ? 5R 2 10-2 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 3 24-80 7.5yr4/6 none sl 2msbk mvfr na na .5 .6 Ground elev. 10243 Depth to limiting Remarks: Boring # 1 0-12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 6 » 2 12-3 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 30-34 10yr5/4 cid 7.5ry4/6 sil lfsbk mfr gw na .2 .3 Ground elev. 4 34-60 7.5yr4/4 none sl 2msbk mfr gw na 1.5 1.6 105.78 ft. 5 60-8 7.5ry4/6 none 1 fs Osg mvfr na na .5 1.6 Depth to limiting I factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Vernell & Stephen Skoglund 1554 200th Ave. CSTM2298 SEgNW4 S24-T30N-R20W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 lot #2-Country Side Estates `fi N 1"=40' EM.= top of 111 steel pipe @ el. 100' Alt. BM.= top of SE lot stake C el. 83.44' 0 1 _ g~ 28' ~ I s;+r 3o 2T I J/0 l , Al" 20 10 " '6m Gary L. Steel 8-10-95 PAGE OF Cr~SS 1U11 Q~ A S Sllr%_) y~ v o f>:Soh 'I_.t`a ( SC~►•~ F14111 Alt Intall And Ob1•trollon Pips Soct '2 r4 1(~ Approvid Venl Cop t f~ MlrJ-- 12'Abov• •~~w~ M ~ ~g~ Ftnal Or•do 1•l i< ~ W WI SE It~ IU -S,, r- T:3a N RJG20.4Z'Above Plpp 4' Cost Iron 1 n.. f To final Oroo• V•nl Pips `Y^4 ✓~f / Ss ~~•4Q-9 Wr•b Nor Or Svnln.lk Covarlny Mon 2•Agora s~ -Ins r~ Mont pol• Olnutbvtlon Plp• 0 0 0 -yes : AOpropot• o Benaolb Pips perlotoled Pip• below o -CovOlnp Tennlnollnp Al Bollom 01 Yr►1em 5r• s%clt /tra ~ d SOIL FILL DISTRIBUTIom PIPE APPROVED S49T4E.TIC COVCR- r r ""'MATERIM. OR 4" OF STRAW 2"oFhGGRE GAl E OR MARSH HAy 9~ 3 l."OPlZ-zl/i AGGREGATE ELEV. oF_FEF-T--.. i T _<1 DIS'rRl6UTIOW PIPE TV BE AT LEAST C.~ IIJCHES BELOW ORIGIMAL GRADE AWU AT LEASTLO INCHES BUT 1.10 MORE THAI) 42 IWCNES BELOW FIIJAL GRADE /`WL"1UM WrH OF EXCAVAT100 FKoM ORI&NU 6gADa WILL BE IWCHES 1'U (IMUM 95Pr11 OF EXCAVATION FROM 0~144JAL (jRApF- WILL BE a INCHES SIGI ICO: O_,e~ to LICEWSC I.JUMBEIZ;_ DATE - - - 110 _ SEPTIC TANK 6 PUMP CLAMBER CROSS SECTION AND SPECIFICATIONS i~ Svc 3Y 1 vlQN ao ~~T a , ss r J,,S .~pl. TS sr ~t ~a rn ssog 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF' 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W1 PADLOCK 6 7 6 WARNING LABEL " MIN. _ ABOVE GRADE MIN. 18" IN. 6" MAX. INLET TER TIGHT SEALS GAS- WA TIGHTi 't, 4" BAFFLE A SEAL 1 APPROVED CI PIPE ALM JOINTS W/ CI B , PIPE 3' ONTO SOLIIDTO 1 , ON SOLID SOIL SOIL PUMP OFF ELEV. FT. c I ' OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TAN MANUFACTURER: oo ~1 BE ,..Qs.~r j (oo©,v~,1JUMBER DOSES PER DAY TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING DOSE n~ GAL. FLOWBACK: GAL. ALARM MANUFACTURER: QA- ;L CAPACITIES: A = INCHES = 30 GAL. MODEL NUMBER: ( w _ SWITCH TYPE:' B = 2 INCHES = 3 3' GAL. PUMP MANUFACTURER: C = g INCHES = X33, S GAL. MODEL NUMBER : l~~'.O 3L[ i-- SWITCH TYPE: D = ~ INCHES = ~ 3 3• ~ GAL. REQUIRED DISCHARGE RATE U GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE S FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 2.5 FEET + D-jT FEET FORCEMAIN X 69 FT/100 FT. FRICTION FACTOR'S FEET T.OTAL DYNAMIC HEAD = -z FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH (o A0, yv SIGNED: _ (3LQAI-'~ LICENSE NUMBER:3 DATE: 1/88 Ip~i 1 . GOULDS SUBMERSIBLE 30 tj qao to SEWAGE AND EFFLUENT PUMP 0311 sr J~-~ = DISC. EP pOt1PFP0311 142 EP0311 1/3 HP 115 V Effluent Pate 1/2" solids Y56.80 172.10 s.. ..;:Submersible a 4i... ° 4 . Effluent Pump M'oCoEL E» r r v METERS 25 ELT SILL 381 SOLIDS r ay b . 1 If, 20 rt11 , -Ij 10 f E. 0 00 4 tt 12 1s 20 24 28 32 36 40 GPM 0 2.5 5.0 7.5 m'!h CAPACITY I Pedonnance Curve M[Tl[!tf FEET • , 3885I90 - MODEL 3885 25 m - - SIZE 3/4" Solids Q 70 10 t j 80 r ~ WE0711--- ' so i ESN _ _ 3 40 t 10 b WE _ ~ WEOII 6 10 0 0 0 10 20 00 40 60 w 70 60 9o to0 110 190 am Q 10 90 30,100% CAPACITY LIST DISC. GO?,X0311J. 142 WE0311L 1/3 HP 115 V Loa H 3/4' solids X91.55 329.35 „ C~C~P14E0311M 142 WE0311M 1/3 HP 115 V Mod H 3%4" solids 491.55 329.35 00mrr.0511H 142 WE0511H 1/2 HP 115 V High H 3/4" solids 704.25 471,85 _ 1, 1 t ry" z` GOLT T0712H 142 WE0712H 3/4 HP 230 V High M. 3/4" solids 1143.65 565.25 •'►"SEE POLJ OWING PACE FM PERFCP14ANM AND SPECIFICATIONS. Y x, DkM 10/88 DEPT 30 PAGE 07u s MAY-19-97 09°14 PM LUND BUILDERS INC. 7154259559 P.01 e a 00 09 ,1 a I q I II~1'11t'E • I h:' ~wq o4oi "d 6 oB 100. N aaBl 008W6Ck1de~,p 6°gYtl9 P.1 y ea F-.,reej ■f hat4by Ifa\rled nl f !e \IPt IIJt 61 Paq.7e° Mfr ett. ► it°re In tle.t no IeVgaf ~.e /1.1~~ t. Veer, I e°nv ♦nJ . e• a ylw PP•\ton e ro ,esp welt 16411°4 A~fRaf • ,/~fNlet I one hee e h letelf 4avnh lll~huay JI• to allow" fn trot Nlatl It t n e°l.,epe P INUI•Dem belt fh8f tea 9If !fa f~,o / @snat1414ee f NV ie~~oa IS` 4ha Orfe~al~4tpQ 8lef guOBA® OfQe~~POe to Beetle" Aie°408, / f+ It fe♦e.rfoe •ee ml.w 9 re va(efineaOBf b ahl ~epaah..wt e1 toPevl otttt64n. it, P s All Oleeod vmo0. ObbA \bv t$o~ ♦ a~° ~ww4J Y - e etm6a. of °0°4°°04 ptelaw e ~ WAWA of afo {f t eto9mtoof 4q jo0q}Bygiooeee. woo oe Jb oo ibt e4om,~ ®tlos\e J, BO aloof , 8 BUOafewtlb9?o6 6a ~a~ O 46q 9v8 Omae ♦ I'll, Valli? aoloawt0 ~I 4ee6 Sot 1 ILI O/ m~9X a LOT 10 Ole 4. 4141 Win 1. '4 oat" ef COT .h / e 4 4411 Q 01. if #1111111 LOT 9! ✓ I et~88of~b~ ,s ,y r eg ~ B♦ p1 ° e LOT 7 " •oo,e a ov ee, 44L 2 e b SWIMM NMI VIM Le0'r 6 s GIOUP14P M4 c VAR a f4 belt II t 11, ZRI t•~ b . >t" do" 'As Qp~; (j75ALa11/ LOT 5 fo1e.1ef9 fe •4t4e4.1 re. ,w••••/ ♦ ~°~Y°"'l'1~. r..-~F~F~Y~. o ! QQ r•°r r ®I° ~~ppq®~~ 4 ~n a j°° 0~ Qer QB~ q7r ,J 1 ° p8B •r A /°e V ..bbl .°e. aFl o°n ..a.r u. r~ p~ L Y`.E AAdL, Marketed bye 'Fo'ot Nielsen/Bumat Really ~,!'ed "I a PIInd' a\s!/A e'ae~:. . WAY-19-97 09:15 PM LUND BUILDERS INC. 7154239559 P.02 ses 66. a 60 6 0 6n C 4 A e \1 t\•~... o S 0, 89 4~~ , c~a 1 e 1 P ~ ~ yyyy 4 1 P r LIP, A IX ° 3 ' ®1 .•~.~~a6 .A..~-.~ (gip E e, Soo tS CAS' w ••••EAYt OR m0 101K tOMY-1- sa6na~. a rvl C'd -`3dIt.Idllt-, 1 -t.). 1'.', r_# I1 11 1 V V V V V I V I~ L'V . v im l _ 306.00' ? I \ ~o Z a' 19C' o UI N i i I = I m I r I D~ m 0 0 i 2 p~ ' M 1 1 m w Iti iv Q o \ m z io m \Cn 11 % L -I u\ \ Ll \ I VA ~A co UJI o \6 2'1 ~I \ _ S00°16'03"W 368.58' ..N26 \O~ N= a' \ N ti` \ \ IF- v (D w W L ~Wp m Q © r N CD W I~J~ w $ Q ~ _ Z - n m w rn cn -4 o I I I~ S00°16'03"W 636.00' ~L N I IU i ~ I I o ~ r I y ti W 1 - o ~ D ~ g I C~ ~ - Irl \ ° rn i m IC7 NN -mi o I -1 i-I e Im IU SO0°16'03"W 636.00' I 1-1 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 C4 - c So Location of property_A6-9 /4s~ 1/4, Section Z`{ ,T-3o N-R ZO W Township} Mailing address Sv9 so~i), RRd s4pf.s~l~lw '-/n tj Address of site 00UI fV w 5 VO8Z Subdivision name Coj.A*-,4 S;D6 ~~fs7 'S Lot no. _ Other homes on property? Yes V/ No Previous owner of property Yahl .5KQ r Total size of property 3, J5 Ac kL S Total size of parcel 13 '7 . -(0'7 SQ, E~ Date parcel was created (-r7- 7 Are all corners and lot lines identifiable? V'O'Yes No Is this property being developed for (spec house) ? Yes v-' No Volume 1j and Page Number 1)q 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. 5 c,B3a 6 , 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. J Signature of Applicant Co A plicant Lq 7 Date of Signature Date of Si ature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER `7:S_ASa1,) T'. AOb Ek;C_kspl~ MAILING ADDRESS So Q So~`~ S~ RPM? 5- I b-24e wv rl S O p Z PROPEItI'Y ADDRESS ) y Z (location of septic system) Please obtain from the Planning Dept. CITY/STATE y l ~ w. 5 D $2. PROPERTY LOCATION ria- 1Yu-1 1/4, 59' NW 1/4, Section Z' , T 3 0 N-R ZO W TOWN OF _ S"f' ST. CROIX COUNTY, WI SUBDIVISION COL)N+,y S i l)c 'EC 7A lcs LOT NUMBER _ CERTIFIED SURVEY 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. SIGNED: tom. DATE: (o- I(o St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 P, VVI 11, vit 12,34 an WARRAMY DEED Document Number AEGIS MR'S OFF! ^,F 558224 ST CROIX Crf. vw r "r.,... Return Address APR 21' 1991 /r4; 4k"Qr~CC4 12:30 P. M N d s c MOWN of DO&A Parcel I.D. Number: 030-2095-20 Vernell A. Skoghwd and Stephen L Skoghmd c+amjc7 and warrants to chaos T. Erickson and Tamara Ann Erickson, husband and wife, as surviviorsl* namital property, the following described real estate in St. Croix County, State of Wisconsin: Lot 2, Country Side Estates in the Town of St. Joseph. St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rtb s-of--way of record, if any. Dated this day of April, 1997. (SEAL) SEAL) Vernell A. Skogl Stephen L. Skoglund AUT1fIFaMCATIOx TRAN FER # Signature(s) Vernell A. Skoghmd and Stephcs L $ O G Skoglund authenticated this I -T*I- day of ApmiL 1997. { l Kristina Og6d TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Wit ~16g~ Hudson, a