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HomeMy WebLinkAbout032-2072-20-000 o ~ O 6'3~ h °1 ~ I h o I c I N N tl c zi G N N c c Z ti o '0 3 -0 Lm -O t0 c o M v y z N O N O Cl) FM- Cf) a m o O z :i c d z a 2 o rn z C) c E P v ~ M I N O .C 07 N f0 N N C ~ O c p m 0 z m z z N C \ N Q1 N w CL n C O c m m c ° Cl) G G a a c E 0 Z c" d o z O O O •N cIL IL IL IL ° O O U U U 0) a) O U) -i z a ~ I a3i r- ° r- C, 'a ° g D m d c ° ~ N d 04 Q Q w O 7 w O N N ~ H C r.+ Cc, ~ p O. C d X 0 C) LO O it 0 r N n y d C -O N N V O O O p O 7 c°7 04 0 Q) a) 04 - 'a 0) • 7, M M O y co O c E R v O yr O r lA LL N O z L (n ` Cd #t w n a `IV E v c c ° rr~~ S u IL U) u ' Parcel 032-2072-20-000 01/28i2005 07:50 AM PAGE 1 OF 1 Alt. Parcel 13.30.20.779A2 032 - TOWN OF SOMERSET Current Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner ALL -D-WERMAGER L BERTY LORI ANN ALLEN D ERTY LORI-ANN 7HO 4 23RD ST ULTO N WI 54082 Districts: SC School SP Special Property Address(es): Primary Type Dist # Description 1512 23RD ST% SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE SEC 13 T30N R20W 3A IN SW SW LOT 2 CSM Block/Condo Bldg: VOL 3/709 EZ-UT-1340/297 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 08/29/2002 688730 1963/37 WD 07/21/2000 626820 1528/364 QC 07/23/1997 1186/371 WD 07/23/1997 1126/635 WD more... 2004 SUMMARY Bill M Fair Market Value: Assessed with: 11191 305,100 Valuations' Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 210,700 258,700 NO Totals for 2004: General Property 3.000 48,000 210,700 258,700 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 48,000 200,400 248,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 209 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS r (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M LITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SF? 1/45 w 1/ 13 /T30 N/R20 15~;r) W Somerset 1 n/a n/a COUNTY: ' BUYER'S NAME: MAILING ADDRESS: St. Croix Gary warty 1105 Stillwater, h]_vd., Lake Elmo, Mn. 55042 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: ER LA ION TESTS: Residence 3 n/clew ❑Replace 6-12-92 6-25-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑U EiS [ ❑U ❑ S MU ❑ S IE]U r,)ound, unless alt. area can be 11o d. If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the n/a under s.1-163.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS page 33 AmB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 63 96.90 none >63 0-10; 10yr4/2, L.; 10-20, 10yr5/4, L. 20-29,- 4/4 sl. 29-63 7.5 4/4, sl. - , si - 70 - - t0yr B_2 70 96.60 none >70 7,5yr4/4, sl. B-3 68 95.80 none >68 0-10,; 10yr4/2, L.; 10-22, 10yr4/4, sil. 22-68 7.5 4 4 sl. B- 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 P R o PER INCH P_ 1 24 none 30 1p 1 1 30 P_ 2 24 none 30 12 1 1 30 P- 3 24 none 30 1 7/8 7/8 '44 P-_ P- P- PLOT PLAN: 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 slope. SYSTEM ELEVATION 97.60 b_ % 0 s _ r j F E l ; E INSTRUCTIONS FOR COMPLETING FORM 115 - SBC - 6595 To..: a complete and accurate soil test, your report must include: 1. t- legal description; 2. Tl : use section must clearly indicate whe° ~r this is a residence or commercial project; 3. MA',IMUM number of bedrooms ore c I use planned; 4. Is a new or replacement systern; 5. C; the suitability rating boxes. A SITE iS SUITABLE FOR A HOLDING TANK ONLY IF ALL O ;YSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbe eviations st n here for writing profile descriptions and comp the plot plan; 7. MAKE A LEGIBLE diagram 'y locating your test locations. Drawing to sca preferred. A separate sheet may be used if do , 8. Male sure your benchmark a 1 elevation refere point: are clearly shown, ar ' e permanent; 9. Complete all appropriate poxes o dates, names, Jood plain data, pe St exemp- tion, if appro, riate; 10. If inform ( Ich as flc elevation) does riot dace N-A, in the ire box; 11. S! I for _ A ,.lace your cu; : _,ddress and your ce-_...___._.r number; 12. M ~i< i, _ ~.)ies and distrit as required. ALL SOIL TESTS MUST BE Flt '`ITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL_ TESTERS Soi and Textures . ymbols st - Y over 10") BR - c col) is (3 - 10") SS - +r, e ge - C^ . (under 3") - l me cs - Sand l :ion n,ted s n? Sand - ti srl k Lt, -n tl C~ - r fit. il,i' rn ck d tures disposal 3 /ertical R -r ,I 3 5 2 413 KSRTVC R0 COUNT Y EYOR'S RECORD CERTIFIED SURVEY MAP oil SW 1/4 - SW I/4 - SEC. 13 T-30-N ~ R-20-W JNQ~-. - p~NN~~ - I I I 6 6' I S 89°- 24'- 00" E 587.31' I I I `900 133' o ss., LOT ~ •ti~ ~ N APPROVED Q -01 o N 3.00 A. N~ N I OrT 171978 N I N I I - I ST. CROIX COUNTY a I COMP<EHENSIVE PARKS PLANNING I pp ~PNpS - AND iOAiNO C 3 8.9oE 24'-00" E _ ~ I 58 Ay 133' I y p~.y °i 293.33 I NPR 6~ q o D.tIN~ K`' rA -0 (D 'o w - O- S88 E a°.I a Bp~~ 260.28- - -i 33' I w w CENTRA_: I o% Off` XANGLE=100°43" ° I o ; v I ' SDI to'. co w 1NpR SO 151 I o Z 01 ' 15 M ROV 0 F- a tN pP O , 0,4 pP& .OF MEAN PS C S~ VtLM. I ~o x J ' m S89°-24'-00°E 1. Vl PVA0 Oit S~ ~t l wi p c v 50' \ S G S%le o w, C) VA o ~~FERSO of ► y l Q, g o I : = a LOT 2 o LOT 3 °I QD O M cv 3.00 A. 0 3.00 Q. ~ I z i I SW COR. Oh 1000 I I I I SEC. 13 ,ti'b• ,,tx, i CO-MON. 00 I i %0 292.68 ' I I _ 292,67'--- 0~' f I S 89°-24'-00" E N 89°- 24'-00" W 585.35' FD. f 133 I 715.35' I SOUTH LINE 2"I.P. 66' -a 1 1~j 19STC - 104 RECEIVED AS BUILT SANITARY SYSTEM REPORT OWNER 'MOM ADDRESS_ i • - I SUBDIVISION /.CSM# LOT SECTION_T N-RAW Town of ST. CROIX COUNTY, _W Q' / _ _ _ PLAN VIEW W EVERYTHING WITHIN 100 FEET OF SYSTEM I, r INDICATE NORTH A OW Provide setb4ck and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. `pENCHMARK: J ALTERNATE BM:_ ` .SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House_ _ Other Pump: Manufacturer ;Model# Size Float seperation` Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 7 / Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House; Other ELEVATIONS Building Sewer ST Inlet: q/, 71 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system_ 79 Existing Grade Final grade DATE OF INSTALLATION: -G~ PLUMBER ON JOB: \ LICENSE NUMBER: INSPECTOR: ZL2 3/93:jt 'Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM = Safety and Buildings Division CountYST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary8e~rwvw_: Personal information you provice may be used for secondary purposes [Privacy ~It, s.15.04 (1)(m)]. G 4 ti FISHER ,r J~SIEPH [j8VLZj Ve Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TaD~o_:2072-20-000 TANK INFORMATION ELEVATION DATA A9700235 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~u_~ 5 0 Benchmark ? /G J- Dosing- V/ Aeration Bldg. Sewer 6,6 a' Hold' St / W Inlet -73 TANK SETBACK INFORMATION St/►,,1-t Outlet TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet rl Septic 2 ___~o NA Dt Bottom Dosing NA Header- K. ' Aeration NA Dist. Pipe ' Holding Bot. System 7,1) PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Mod umber GPM TDH Lift Frict' Sys H Ft Forcemain ngth Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IMEN SYSTEM TO P/ L BLDG WELL LAKE/STREAM L ING urer: SETBACK INFORMATION Type O Aey v CHUNI -Nl Num er System: R T 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: SOMERSET 13.30.20.779A2,SW,SW 1512 23RD ST LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division : SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 63.05, 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. • See reverse side for instructions for completing this application State Sanitary Permit Number a~ gas The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope y Owner am Property Location e , N, R ~(ore 1/4 1/4, S T Property Owner's Mailing Address Lot Number Block Number Cit to Zip Code Phone Number Subdivision Nam o C_SM Nu ber r ( ) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ otv Nearest Road E03 Vll age ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o.-? V -~D7~ -~v 1 F1 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. 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 1 1 0 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./y(1ch) Elevation / Feetl 9,.f _:r Feet VII. TANK Ca pact in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank - J~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for i stallation of the nsite sewage system shown on the attached plans. Plum er' Name' Pr Plum r' ig S p MP/MPRSW No.: Business Phone Number: P y / Plumber's Address (Street, ty, State, Zi P IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) Approved F1 Owner Given Initial Surcharge f ee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 0' 5/94) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. 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. Il. 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 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 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. II Ste - sw Sze l3 - 7 3or~ ` ~Joszy~ ~5~~~ 45 ~ ` 110 I i /7~usic I 75- 3 ' = y s~ ,c yam, l~L Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page _.L of Bureau of integrated services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and '5/ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Props Owner Property Location Govt. Lot 1/45 j 1/4,S T j N,R X(or)(9) Property Owner's Mailing Address Lot # Bloc Subd. Name or CSM# .o 9 City State Zip Code Phone Number ❑ City c ❑ Village ®Town Nearest ~ Road,. ( ) New Construction Use: D9 Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 2LO gpd Recommended design loading rate , S bed, gpd,*_,Z_trench, gpd/ft2 Absorption area required ~Zw bed, ft2 Z.S'f2 trench, ft2 Maximum design loading rate -bed, gpd/ F_,Z_trench, gpd/ft2 Recommended infiltration surface elevation(s) 9:5'9 it (as referred to site plan benchmark) Additional design/site nsiderations Parent material ' Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ❑ U ® s ❑ u ®s ❑ u 10s ❑ u ❑ s 1~ u ❑ s Z u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ff2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z t5_ /9 j/ 134 Ground 6 C ~a -7svillz 7:1 elev. Depth to limiting factor > _9zin. F-F Remarks: Boring # 77 4Z /v- Ground 3 J lev ~ , / Depth to limiting NQ7 facto T CROIx 1in. Rem rks CST Name (Pea Pri Signa e ~ elephone Address Date PROPERTY OWNER _ SOIL DESCRIPTION REPORT Pag of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz./Sh. Bed , Trench 5 5 f Azk Ground elev. , 91 ft. 5- 3 5~ Depth to limiting factor Tin. Remarks: Boring # G Ground S / elev. Z-9-ft- 19 Depth to limiting factor 2 % in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground ' - - elev. ~ft. Depth to limiting factor Perin. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) sW%-swe/3 - r3on~-~t'~a cJ Sic r i i i A4f I ~ ,~/,~,c.L',,/~if~'i~ 7 ~ pf /S~k /!•lot= - ~.LiG'{i'.G ~ W/-1 41 3524.13 CERTIFIED SURVEY MAP SW 1/4 - SW I/4 - SEC. 13, T-30-N, R-20-W ~P~pS ~,j►~~5 vNP~P.o~NE - I I I 66' I S 89°- 24'- 00" E 587.31' I I 900 133' I I as' ~ I • `fS .r~ ~ I LOT N APPROVED -01 0 1 N I O- CT A. I I ACT 17 1978 N N I N N I I I ST. CROIX COUNTY I COMPdEHENSIVE PAWS PLANNINQ I ~ I ~PNpS . AND ZONING CS ~ 40 8924'-00° E p 58 133 1 293.33' JNQ ~Q 0~ - In I ~ j O\~ P 5~ ~ ~ I i ! W i (D Gw \J.~ a N. I oil , OWN' FL`'-- I CD .o~~E coo I Z - o ° m SZ • ~~a ~\~OAS E M E N T_ I q l ° w 80. 164.58 'I ° ° IWu) 260.28' 153' I W jw 0~ F/4-1 CENTRAL o I 3 O /ANGLE=1000-3,1'-43'1 ° I o , W ,NOR SugOP, tog o i -o° `OF ZN~S N ApPROVtEM• w ' co S890-24'-00"E PQ oovNOl MER S~Pj,G S~ ld° MWl o o 50' S SSE ' ' W o' in DING S 62;a0• I ; o I o ER %0 N ° I rn i J, Z 0 LOT 2 LOT 3 0 0 0l. (D 01 a 3.00 A. o 3.00 A. Z ~ I lb so SW COR. I 0 I I SEC. 13 CO-MON. -AL ~ 0°~ I I I , 292.68' I00"i 1 A--- 292.67'--- S 890-24'-00" E N 890- 24'-00" W 585.35' FD./' 33 I 715.35' SOUTH LINE 2„I'P 66' 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 yp.p ' Location of property 1/45 1/4, Section 1'S T N(-R_ C) W Town ship sOmer's Mailing address 1~r _ as Address of site re4 ` Subdivision name C'S/n 9 Lot no. , Other homes on property? Yes No Previous owner of property'-T' 5Z oC e '--h>Pv1Z' Total size of property 3 prC~ Total size of parcel c Date parcel was created 0C:-~- ~j 1 l 7E Are all corners and lot lines identifiable? _ Yes No Is this-pprro/pperty being developed for (spec house) ? Yes No Volume- - and Page Number 3 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. 4 f ignatu e of Applicant Co-Applicant Date f Signatu_c Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER o - :s MAILING ADDRESS 12 + PROPERTY ADDRESS 07 2 IZ~ ® St, (location of septic system() Please obtain from the Planning Dept. CITY/STATE A) F? t.~ Q~k nn rA N 1~ i.S S ~O ? PROPERTY LOCATION 1/4, 1/4, Section N-R-12 ?~)-W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAPVOLUME, PAGE fag , 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 y xpiration date. SIGNE DATE: St. Croix County Zoning Office Government Center 1 101 Carmichael Road Hudson, WI 54016 11/93 V1,15909 -pit \::R\~t~ ut 1 nt.;:.'t F:_C.STER6OFFICE 1 S6Pa ~ ST. CROIX CTY., W11 Pic, tr Peon! Bruce D. Biauer and MiCoele t. BautC, and AN 2 5 499f - at I1:O0 , At, ' - - a C 1 f _a.rNiW► T~ 1-.~ Joseph w._Fisher, _ - agt r d - _ St. Croix_ he i,II,n,.:TS ,,:j,: tlx',l real - - i xatc of \\'t~ vniu s v~ ('2-2072 V Part of SW1/4 of SW1/4 of Section 13. 'o-nship 30 North, Rance 20 West, St. Croix County, Wisconsin, •e=crlbed as follows: Lot 2 of in Vol. 115" , Page 7()9. aY Certified Survev Map filed October 17, WITH private easement as shoon on said Certified Survey Map. : T TOGETHER r Thts $_n 0 t Fomrst ad p "~rrtc }L X k, not) - _ E strict:o:,= and rights-of of record, 4 .cepuon to warranties Easements, re if any. ~j Dated ti,i> day of June fi ti ~lM >i:AL ; 'r J Racer k Bruce D. Bauer - - ; kSEAL) Al AUTHENTICATION ACKNO\\1EUGME`T 1 Mace of Wisconsin. St. Croix ► a til ut:.:tted this da of ` June - Bau"E r and ~,!ichele J. - , Eauer, husband and- wife: _ MILE LE MIMBER SJAJ E BAR OF SCONE N .u thur d h~ Or, V. r Y.ats ? (,`pnnp/S A"" joy ~y Pabl~c ttiS iNSTRUMENT LAS D2AFTED 6'. Y ` RJ-.• 7 ermi of WuconsiI # '