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Home My WebLink About032-1087-20-000 a ST& - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~n fem. r~ I~-2 S5 ADDRESS /5 3 hn h) S s e T'7 SUBDIVISION / CSMf LOT f SECTION 3~T.;a/ N-R Z W, Town of -5 dm~ 5-.-/ ST. CROIX COUNTY,. WISCONSIN PLAN. VIEW, SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM q~ 1~! H ~ INDICATE RTH A W Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. . '13EHCHMARK: /IJ ~.Y, Jam' ALTERNATE BM: ; tt► ;SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 0 /A,,~ Liquid capacity: y cc) Setback from: Well House 1 Other Pump: Manufacturer- AJIA :Modelf Size Float seperation` Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /off Length `j' Number of trenches Distance & Direction to nearest prop. line:- . 2/ Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold 9'3, Z Bottom of system 9a.~ Existing Grade 45, Final grade 95-8 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER! / S C~3 INSPECTOR : 3"-- 3/93:jt Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and $uildings Division §T. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaW~e{rDitl)lo.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)]. L 7444 b0 ESSLER, s ROBERT~Sy~ge Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: ~~yy Parcel& A `1087-20-000 60 TANK INFORMATION ELEVATION DATA A9700262 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Inlet TA TBACK INFORMATION St/ V Outlet TANK TO P/ L WELL BLDG. VVe Intake ROAD Dt Inlet "J Air Septic Z ya' NA Dt Bottom Dosin NA Header/ Man. 3 / Aeration NA Dist. Pipe Holding Bot. System PUMP'/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Forcemain Length Dia. If Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Insid Depth DIMENSIONS DI EN SYSTEM TO P/ L BLDG WELL LAKE / STREAM L Manufacturer SETBACK INFORMATION Type Of CH BER Z Model Numer: System: O NIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Af _ Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 7Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 32.31.19.419E,SE,SE 396 180TH AVE LOT 6 < ~~;Zir2~j ouGk. Mk cl.l_ t Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F_ FT I IJ SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division V~L'■'■ i 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. 57. G ro X • See reverse side for instructions for completing this application State Sanitta~ary_PermittN4Number The information you provide may be used by other government agency programs ❑ Check IT revision to ptviouspplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location o .es l.~r SE 1/4 SE 1/4, S _3a T 3/ , N, R /9 (r or) W Property Owner's Mailing Address Lot Number Block Number 1s s Cai+~ p Ill- • (10 City, State Zip Code Phone Number Subdivision Name or CSM Number ~ SS ca&7 ( ~ h r. t cl ~~S II. TYPE F B LDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF 5 /5 4, III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo /off 7 -,Z O 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. pS 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 PISeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 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 Lto Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) ~l Elevation _1%.j / PAS 70? r Feet S. Feet VII. TANK Ca 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 ^ /M ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ El El El El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si nat e: (N Stamps) 7MPRSW No.: Business Phone Number: C aA v ~r. -TJo rS ? x.63 7S/6 -S/3f Plumber's Address (Street, City, State, Zip Code): /9 /BSS 10 5 7o IX. COUNTY / DEPARTMENT USE ONLY ~J ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) n/}'Approved ❑Owner Given Initial 1 surcharge fee) g Approved 4a Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi--ion, 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 Buildiogs 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. 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 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, lotatton 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. t _ , r I I I I I ~ ~ I es 5 { I I ( -J 9 1' wr I I i I I ~ I I I ~ l I I I I I 1 I I I I- i I ! I , i I I ~ I I I { , I I , ~ I I ~j , e~41,1 p7 I I I q I J - ~ - -t-- ~ I r- r I I r - - I r 1 ( I I I I i t ~ I I I I ~ I I I r 1 I I ! + i 1 1 i I 77777T-7 --r- I ! I ; I , I I ! ~ I ~ ✓ r r I I ~ I ; I ~ i I I { I ~ i I ~ I I { I 4 _ I 3,~_ I _ I T f r I I I I r I I I ~ I , I i , , ~ I I I { I ~ i , I I I I r_. I i I I , ~ ( l ~ ' I I ' ~ , I I I 1 I i , _ r 1 _ r IG , , I I i I I i I I ; I "ZI r r- t- - - -1- J _ - - - - i I ; { { I ~ I I I I I _ ~ I 1 + I I 1 ! ~ I j ! I I 1 . ~ I I i I r I I ~ I ! I I I I I, I ~ r l i I 1 I I I I I I I I I i I I I I I I ~ I . I I I I ~ I I f I I ~ ~ I I I ! I II I I I ~ i j i I 1 ' L i I I I - _ t I ; i I ~ I 1 I I i , I I I I I I I I ~ I li _ I I ~ I ~ r I_ I E I I 1 I I i I I r I r I ~ I I I I I ~ I ~ I ~ i I I I I ~ I i ! I II I I i I 1 1 i r I i I I I I I i I I r- I i I i 1' I I i ' ' I I i I I I I I I c I I I I ~ I 11 I ~ I I I I ' I I I , ; I. I I I I i i r--I ' I ~ I ~ I i I I I I I I I } 1 1 F I I I I , , , I I I I I r--r I i , I r I - - I I i ! C t- 1 I ~ , I ' I, I I , i- r - I ~ : L I I I , I I I } I I I I- Wisconsin Department of Industry', SOIL AND SITE EVALUATION REPORT Page / of- Labor and Human Relations Division of 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, G Y- o \ X 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. 63Q - 0 7 -,)Z) APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP TY OWNER: PROPERTY LOCATION s S. GOVT. LOT ,Se 1 /4 SE 1/4,S 3A T / N,R 1,9 %(or) W PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR CSM # S 1 C rflr• JjAr % k 6'%d 9 Ar'Te'& CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OOW NEARESTROAD New Construction Use [A] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow '4.5 b gpd Recommended design loading rate bed, gpd/ft2~-trench, gpd/ft2 Absorption area required/,. bed, ft2 60 trench, ft2 Maximum design loading rate bed, gpd/ft2 S trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 'yo Parent material ~.>t L'__) Flood plain elevation, if applicable NIA ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U 19, ❑ U aS ❑ U ❑ S ® U ❑ S DR-U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1-5 5 Ground-3 7, S 51 rr sbk u LA) i 41 elev. 9~t flft. 9- 71 .4~rr #1L rd 0 0 V Depth to limiting factor Remarks: Boring # 0-9 /or= or 5 - _ ,s L Ground elev. _ ft. Depth to limiting fact Remarks: CST Name:-Please Print Phone: 7~r yb- S~-~~4'A 7 s v1 w2 r 5 Address: /6'51-' Aw- ~ Q yZ) '7 Signature: 9 R Date: CST Number: 2 - 27 0'.ta~_ pe~=~ 7-2 PROPERTY OWNER Rab.a.v-i i~ ess le r SOIL DESCRIPTION REPORT Page A uT-j PARCEL I.D. # D _ ?Q - / D 'J - o'ZO Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Tw& ••.:u;x.:•::•::•: ice::: s' ~~K y I S 6-30 6 R m14 Ground 3 6- 6 S~ a op($ k! V, I y elev. eft. ya-g8 io R S os °w,\ - - 5 ~ Depth to limiting factor ~ $k 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) I _ l I~ a s - I I ~ I jj - - { { { I t- ~ I I I r I I tat" I I I I I - 1 I ` II- I I I I I ~ I I I I ~ I ~ ~ I ~`I ~ I I I ~ I I ~ I I , I I 1 I , I ~ ~ 1 , I j I I I ~ I ! I j I ' I I l__ I I i i I i ` 1 , ; I I Q 1 I t 1 I I r- I ~ I I I I I I i I I I ' l i i I T I l i ~ f l l I I I I ~ j I'~ ' ' I I I t ~ I ~ I 1 I } I I 1 I I I , I I I I I I I I I , I 1 , I I I j ~ I ~ ~ I I I I i~ ~ I I I 0` , , a 1 I I i 1 1 , I I I I I 1 , I I I I , I 1 I , I I I I I I I I I I + , ~ I I _ 1 i- I--E I i I I I j I I _ , I ~ I I I(rt 1 ± _ - ~ ~ -1 ~ I 1__ I l I ~ _I I i I i I j I ~ I I ; I I 11~ I r . I I , 1 I I I I I I I I I I ' ~ . ~ ~ I I I I I I i I I } I ' I I I I ~ j I r j I ~ I I I r --k- ~ i , I li r I ~ I I I ~ II i I ~ ~ i i j' I I - i-- - j I f."_. ~ r- j i ~ - I ~ ~ r - - - I I i i i ~ 1 - r I _ - - , . I r ' - t ~ _ I ~ ~ _-l._ _..-.F ~ __._..l ~ I j I ~ I I _ _I ~j I j I r . { - ~ ~ -t + ~ ~ I t ~ ~ ~ ~ I t ~ ~ ~ ~ _ ~ r-_'_-_-._ _ ~ I t__. ~ ~ - ~ I I _ - F - ~ ~ r i ~ i I 1 _ h- - ~ I - I r ~ _ L i ~ ;--i I 'r;---~ I I ~ - _ _ ~ - - L I ~ I ~ - ~ j: - ~ - 1_ ~ ~ I ~ j ~ r ' ~ r - i - t ~ - - i j ~ _ t - _ I t r I ~ ~ , ~ i I - , _ ! _ I i - - - - - ~ ' j; i I~ I , i~ I i i r _ _ ~ i _ _ a _ - - j I j jr ~ i~ _ - _ ~ I ~ ~ ~ _ a _ I - I - - _ - ~ - r I I ' t ~ ~ ~ ~ i i - I 1 f I - ~ ~ - r- ~ - _ _ ---~i ~ - _ ~ - - _ - j r ~ ~ ~ ~ i _ i 1 _ _ I ~ ~ ~ i t ~ i - ~ - ~ ~ - E ~ - , i j r r ~ _ i ~ l j. f ~ ~ - - - ; --d- r- ~ - j I ~ I -rt - i ~ _ ~ - ~ r ~ ~ - - - - - - - ! j ~ I ~ ~ ~ j i I, ~ ; ~ I l I _ ! 1 I i . _ _ - - - - - - r ~ j i - ~ ~ ~ i i ~ I j . - - - ~ ~ ~ i_ I I I i i ~ t i- - , - ~ I ~ ~ _ _ i _ ' _ ' - ~ I ~ ~ I I ~ i j t- - r I t-- - 1 i _ - - ; F - I - T -L- j ~ I j t I T 1 r ~ I 1 r i i ~ ~ - - I - - --f--_ i ~ ~ ~ r r i ~ { - - t-- , ~ r ~ ~ , I _ I i ~ ~ I T ` , - - --I a i ' I i i ~ ~ ~ j ~ 1_ F i r I I , i, i I ~ i i ~ ~ I i ~ ~ I _ ~ _ f I I i ~ ~ i ~ ~ -r -T r j r I I r I ii ~ I ~ j I ~ j ~ i ~ f ~ _ T I_____...~ a--._ t. I I f - j I ~ ~ i I I T. i ! I I I r I- ~ I ~ L. _ I F ~ _ ~ ~ - ' _ _ - _ _ i ~ I- i ~ ~ 1 j r r. ~ j a_--. r - ~ ~ L__ i._ ~ ~ ~ _.__i- ~ ~ _-i t I_._ I t ~ I r - 1 i i r _ ~ r- - - _ ~ I ~ ~ ~ -i - i ~ ~ ~ j I r I I ~ ~ ~ r , _ ~ . - _ . 4 - ~ fi - - 1- ~ ~ I - ~ --I- - - , ~ I _ , - 1 ~ 1 _ I I I ~ I i I ~ - - ~ ~ ~ - i I - ~ - ~ -~I- I-- - * - _ - ~ i_ I I ~ r- ~ - r~ , ~ 1 i ~ ~ ~ I I ~ r r I ~ _ F - - -i - a - - - r + i ~ j ~ I , ~ ~ i._ ~ _ ~ I. - ' ~ _ _ . ~ - _ _ _ - - ~ - - - 1-- a ~ - r II I r _ ~ { 1 L r J -i_ l_-.__ j I I I i l I ! j I I i G ~ - _ ~ . _ a ~ _ ~ - - _ I- _F- I ~ ' I ~ ~ ; i l . _ _ , I ~ ~ - I t r 1 I I i _ ' ~ I I r r ~ i i ~ j: ~ I ~ i ~ _a r- , - - t-- ~ - - + t- - - I i i j i I I • I"1 ob ~ w~' 't•~ ~ 55 ~ tee, ~ SF 'S~ S~ 3 a 'T 3i - I l-c~ Sly PAGE OF Cro5S SeC~IOn o~ S y Jern o~ Fresh Air Inlelc And Obcervallon Pipe Approved Vent Cop MIrJmwn 12" Above Flnol Grade 20- 42" Above Pipe _ 4" Cos( Iron To Final Wade Vent Pipe North Hay Or SYniholic Covering I yin 2° Agg'regole Over Pipe Diitrlbullon Pipe o 0 0 0 -Tee i B" Aggregate BeneotA Plpe ° Perloraled Plpe Below o -Covptine Terminating At Bottom Of Srilem q r!, CI { • 'P~u~vSeD ~►n~I . ~I~~ Ion R .SOIL. FILL DISTRIBUTIO1.I PIPE ` • APPROVED S~ MVETIC COVER OR 9" OF STRAW 2° oIF AGGR ~GA'f E . ' • ~ ~ ~ pR /+1A1cSU NAy' AGGREGATE MEV• of a. /FEET DI•S•1"1115UTIOU PIPE TO BE AT LEAST IUCHES BELOW ORIGIMAL GRADE AIJU AT LEASTLO 1UCHES BUT.1.10 MORE TNAU 42 IuCI{ES BELOW FILIAL GRADE MIMUM MM OF EXCAVATIOO FROM OWWAI CIXAoF WILL BE 3 IUCHES MINIMUM OFT rti of EAMIATIOM 'FROM. 0~14IWAL GR4pF- WILL BE _ IUCNES SIGWED: LICEUSE DUMBER: DATE: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor And Ruman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284279 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: HESSLER, ROBERT T. II SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 032-1087-20-000 TANK INFORMATION ELEVATION DATA A9700049 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. I f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER model Number: System: 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: SOMERSET 32.31.19.419E,SE,SE 396 180TH AVE L Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: S ° 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. J-f Cro • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it 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 Own r Name Property Location l,1- s 1/4 s= 1/4, S 3 T3/ , N, R /9 °~pr) W Property Owner's Mailing Address Lot Number Block Number 0 r` City, State Zip Code Phone Number Subdivision Nafne or CSM Number & ( ) /'I) $ rt d t5wa* 4e II. TYPE OF B DING: (check one) ❑ State Owned Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms F 4►'t16l 7-6 A oq-. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o~-~o~~-ate 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ASystemSystemTankOnlyExisting 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)f seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 QSeepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 6-Y3 $ 9X I Feet 07~.1Feet VII. TANK Capacity alloacitns Total # of Prefab. Site Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank / ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins ation of the onsite sewage system shown on the attached plans. Plumber's Name: (P t) Plumber's Sign ture: No Slam s) /MPRSW No.: Business Phone Number: ~~h ~ JSI 7~s- a S42-S Plumber's Address (Street, City, St te, Zip Code): J9116 91 s`-0 _-d, &J L(4~ F IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (InaudesGroundwater aent Signature (No S mps) AA//pp ❑ Owner Given Initial Srcharge Fee) ~j Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-639.8 (R. 0"4) DISTRIBUTION: Original to County, One copy To: Safety S 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, 608-266-3815. 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 8 112 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. T~ ~ r I 1 Vv~l Or- or, I I I , I I t 1 Qom'` i_ ! ~ L I I ' I I i ~ I j I I I I II I I ~ I i I I ! ~ - - r _ - - - - / Ti I I I I ~ i _ 1 I _ I 1 ! I I I I { 1 I I I I I I I- - I ~ Ty r 1~ L I ' I i I I ~ I I -4 1 I f 1 I I ! I I ~ ; i { ~ t i i li I i I P ' 1 -4 I ! r + I I I I i I i i T I ' I ! ~ I I j I I ~ t f i i I ' - ~ ~ I E 1 I 1 f ~ I L I- ~ i I i I I, ~ I ~ I I ! ~ I I I I ~ ~ I r I I I , j ! 1 •ylV.ll" I ~ I I I t I I I I I ! , ~ I I I I i I I ; I i I ! 1 I , I I t I I , I I ! I 1 I Y I ' ' ! ~ I I ~ I , I ~ i I I j ~ r I . I ~ j I- I I I I ~ I I ! ~ { I ~ i j i I I I I i i ! I I i I I -_I - ~ I I, I j ' i ; i I I 1 I i it ~ - - - - - ~ ~ --y- J _ ~ . ~ ~ ~ -f- ~ - i- ~ I i ~ - F _ _ 4 1 {II- _ I i i i - ~ r-- f 1 7-- ~ ~ ~ I- ~ ~ ~ - ~ , i I I i ~ - i ~~l_ ~ - _ - ~ ~ i_~ ~ ~ ~ i--G - ~ ~ ~ - ~ ~ ~ _ ~ ~ _ ; ~ , ~ _i I T i ~ ~ I ~ I I i ~ 1 -t._ _i ~ _._j ~ - - ~ _ I i ~ _ 1 ~ _ F ~ ~ - r i 1_ - - ~---a i ~ I fi ~ ~ I, i II I I ~ ~ i 1 - - ~ r i ~ i i - i ~ F ~ 1 i~ ~ _ _7 _ i ~ _ ~ _ ~ I _ _ . 'r-- - -7 _ . ~ ~ ~ ! ~ t -i - _ _ _ I ~ _ i__ 1 _ t - r- i- r -I rt ~ - -j---~---~-I i - - ~ - - • - L_ i I ~ ~ ~ I _ I ~I i ~ ~ ' I _ _ _ j ~ _i _t_ - ~ ~ - - - i ~ ~ ~ i 1 r.__ L f a-- ~ ~ ~ i ~ ~ ~ ' t ~ ~ ~ ~ ~ I i ~ ~ ~ i - - - ' _ i. ~ r ~ ~ ~ ~ i i ~ ~ ~ ~ I - fi i ~ 7 - _ ~ ~ r ~ - I f fi- ~ + - - ~ ~ ~ _ r - ~ - ~ ~ t ~ - t i ~ i r ; _ _ _ , - - ~ r - ~ 1 ~ r ~ _ _ 1 I I I i ' _ ~ - - ~ - ~ _ F. ~ ~ ~ ~ i I ~ ~ ~ ~ - i -f - ~ ~ - ~ - - ~ - - ~ ~ ~ ~ ' i _ i ~ i ~ ~ -i ~ ~ - - ~ t_ ~ ~ i ~ ~ ~ ~ ~ ~ ~ - ~ 1 ~ ~I- ~ i } ~ _ ~ ~ - ' i ~ ~ - ~ ~ ~ ~ ~ --r-- - - i 1 I ~ - i - _ ~ - ~ 1----- i I ~ i i ~ ~ - _ - - i ~ ~ _ _ r i_ - ~ ~ ' ~ ~ I _ - - - ! ~ , i i ~ ~ fl F ~ ~ i i it ~ I ~ ~ I ' I _ - - ~ r I ~ ~ i ; ~ ~ ~ ~ I ~ - 1 i ~ - ~ - -r l _ ~ + ~ + ~ ~ ~ _ 1 _ ~ I - i_ r _ r- - ~ ~ ~ _ ~ - ~ _ E - ~ ' ~ - - ~ ~ ~ ~ I _ _ I_ j ~ ~ - i I I ~ ~ - ~ ~ ~ ~ ~ ~i I ~ I I ~ ~ ~ ~ ~ l ~ - _ - _ _ I - _ ~ __l - - i i ~ i i ~ ~ i ~f ~ ~ _ _ ~ _ ~ ~ ~ r I- ~ i j I ~ l i l ~ i ~ I + ~ i _ ~ ~ ~ ~ ~ 1) ~ ~ II~ ' ~ - a f._ , ~ _ II - - ~ _ - - I-- T I I t I ~ - _ _ ~ _ ~ - ~ r 1_ ~ ~ ~ ~ i _ fi ~ --F i I I - - y _ - - i I- - - ~ ~ - - 1 III t + - ~ - - _ ~ - _ 1 a ~ - i 1 i i i-- I = ~ - - - - - - - ~ f ---t ~ , I, i ' r r ~ + ~ T i ~ ~ t r i ~ i i ~ ~ r I i_ ~O PAC-'E OF CrUSS Sec~Ion p~ A S S~e~ • ~ s ~ fir- _ y 0o Fresh Air Iniele And Obceryallon pip, minimum 12'Above `~-Approved Vent Cap Flnol Crode 20. 42' Above pip. _ 4' Coel Iron To Final Grade Vent pipe 4toreA Hoy Or SynlAelle Covarin, I Min. 2' Aggrag,le Olilrlbullon Over Pipe PIP$ " 0 0 0 0 6• AoGrego! BenealA Ptpe ° Perloraled Pipe Balor ° Capling Terminating AI 139110m Of Syilem Pru(~aSeD PMAJ 9rf1c1.( 511C0 4A ton .SOIL. FILL • DISTRIBUTIOf.] PIPE APPROVED SyVPETIC COVER 2u 01F AGGMATE ~ '-MATERIAI. op, 9" OF STRAW ~LEV, of EET_~ 2 2/Z AGGREGATE ;p DI.S-r•R191JTI01,1 PIPE TO BE AT LEAST AUU AT LEASTLO IIJCHES BUT 1.1p M ILICHES BELOW ORIGIMAL GRADE ORE THAU 42 IuCNES BELOW FINAL GRADE M'Mur1 DaPrH OF EXCAyAT1'Do RlFshJq.~ 69ADF. WILL BE ~"RoM .d IIJCNES MirriMUM 9EPr1t of EXCAVATION 'F.P O M. Oik'619AL 694PF- WILL BE INCHES SIGWED: LIGE►JSE DUMBER: ~ - - j; . DATE: Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page_ of 3 Labor 2nd, Human Relations .DivisiofrofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Robert INessler GOVT. LOT SE 1/4 SE 1/4,S32 T31 N,R 19 MRor) W PROPERTY OWNER':S MAILING ADDRESS LRT # BLOCK # SUBD. NAME OR CSM # 1535 Cottage Dr. n//a Ni-hbridl e Estates C5'1ff,1TE r, PST. 55 50DE PHONE NUMBER ❑CITY ❑VILLAGE RJOWN NEAREST ROAD h/a North art Somerset 180th. .Ave. [k New Construction Use M 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 .7 bed, gpd/ft2 . 8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 ' 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.10 ft (as referred to site plan benchmark) Additional design / site considerations None Parent material outwash Flood plain elevation, if applicable n a It t=Uuni able fo r system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK uitable for s stem% El U C El U CAS El U 06 El U El S7 U ❑ Sl U J SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 1 0-12 10yr4/2 none L. 2/m/gr nvfr T? 77 2 12-27 10yr4/4 none sil. 2/m./sbk mfr g/w 1/f .5 .6 Ground 3 27-39 7.5yr4/4 none sl. 2/m/sbk mvfr g/w 1/f_ .5 .6 elev. 100.6f0 4 39-82 7.5yr4/6 none co. S'. 0/sg ml n/a n/a .7 .8 Depth to limiting factor R2? Remarks: Boring # 1 0-9 10yr4/2 none L. 2/m/gr mvfr c/w 2/f .5 .6 U2 9-18 7.5yr3/4 none LS. 0/sg ml g/w 1/f- .7 .8 3 8-80 10 4/3 none co.s. 0 s _ a .7 .8 Ground elev. 100.10ft. Depth to limiting o A factor 2 >80 a Remarks: dip 409 CST Name:-Please Print Gary L. Steel Phone: Address: 1 554 2. 54017 Signature: 4-27-93 Date: 2298 CST Number: PROPERTYOWNER Robert: TTessler SOIL DESCRIPTION REPORT Page 2 pf '3 PARCEL I.D. # - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench KIN' :n , ~r. 1 0-12 1 r4/4 none L. 2/rr/sbk vf_r g/w 2/f .5 .6 w2 12-30 10yr4/4 none sil_. 1/f/shl: mfr g/w 1/f .2. .3 Ground 3 30-38 10yr4/4 none sl. 2./m/sbk mvfr g/c~ 7_/_f_ , 5 .6 elev. 4 38-84 1 4/4 none co. S. 0/s ml na/ /a .7 ; .8 100.70ft. 8 Depth to limiting factor >84 Remarks: Boring # 0-o 10yr4/3 none L. 2/m/gr r=rv£r g/w 2/f .5 .6 4 2 9-24 10yr4/4 none sl. 2/m/sbk mfr g/w 1/f. .5 .6 a .,,,3 24-82 10y_r.5/4 none co.s. 0/sg r21 na/ /a .7 .8 Ground elev. 109~r~t• Depth to limiting factor >82 Remarks: Boring # 1 0-14 lr`yr3/3 none sl. 2/n, /,9b]', mvfr g/w /f . 5 .6 " 5l 2 14-37 10yr4/4 none sil. 1/f/sbk rift g/w 1/f .2 .3 3 37-48 10yr4/4 none sl. 2/rn/gr mvfr g/w 1/f .5 .6 Ground r it n./a /a . 7 .8 ele. V7(3t. 4 48-84 10vr4/4 none co. s. 0/s9 100 Depth to limiting factor >8 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1554 200th Ave Gary L. Steel C.S.T. 2298 Robert ITess?_er SE':;SE'-< S32-T3111-P.1~T~T New Richmond, WI 54017 MPRSW-3254 town of Somerset (715) 246-6200 lot #6, Itighbri_clge Estates ®o'4- 0 .35-' aq C uk- Ste- SOAKS- d~ YYI Sze K, '21qo ~X `0 0 `n S d wb~in VIA ' CROI X COUNTY CERTIFIED SURVEY MAP N0. Ysium-1 Pao 13( ar th Section 32, andC rin th M of the of Section 33, all N 000 3e r11 E qN j,JR,ojtAI,p.A.,,of omerset ',dU 14 ro~ ~ounty, Wisconsin. S 86058'39"f; CURVE LOT RADIUS CENTRAL CHORD CHORD ARC ~ li i NO. NO. ANGLE LENGTH BEANINO LENGTH N go9- 2 I 678.08' 14005'00" 166,25' N12000'31"W 166.67' I/16 LINE PREP, BY DIRECTION OF LOT -8 MEL TOBIN 217,902.78 sq.ft. N 1745 UNIVERSITY AVE, 66 7. 5.00 Acres No ST.. PAUL, MINN. ` 1,1 oS~'Z9 yl N. PROJ. NO, 2375 FLO. BI(, 5 PO 14-18 a'bZ A w~ N i 5/9/ 75 J.T. C.S.M. 1 .R LOT 7 ' PRIVATE ROAD BEARING REFERENCED TO THE 1 , 223j937.20' N 87054'01 -,--391-24- f ~.14 Aorts 729.55 EAST LINE OF SEC. 3e 1302038- ESTABLISHED BY 9E~POULTER pN o Q+o ~C ~ , 43 E A8 BEING N 00039 Z3 E t0 Os o•, y~. r~ p~ o1i100 tw 300 goo e00 ea •~r o 0 = oP ~~~Dg6 N 218 8006 6rq.lt. a g w L07 5 SCALE I"• 1f00' I -s 5,02 ZOr 0 h N E .n C. S.M. pA I o~ a IJ v1 . 1 1/2" K 24" IRON PIPE $FT o MIN. WT. 1.13 LBO / L. F. TOWN ROAD N 870 2S71 ' _ - Z - - !V 391.66'- S4'41" `-042.1 "249.32•••' UNPLATTEp l.AN03 POINT OF 80INNINp - 3? 6 3 148.71' l SURVEYOR'S CERTIFICATE IRONIP PE FOUND I, Forrest G. Robinson, a Registered Land Surveyor, hereby certify: that'I have surveyed, ' described and mapped a parcel of land in the SWk of the SWh of Section,33, and in the SEC of the SEh of Section 32, all in Township 31, North, Lange 19 West, 4th P•14,, Somerset Township, St. Croix County, Wisconsin described as follows: , Commencing at the southwest corner of said Section 33; thence N0003812311B 148,71 feet to the Point of Beginning; thence N87°54141"W 395,61 feet; thence N22e12121"W 587,39 feet to a point hereinafter referred to as a common point; thence S56°13127"W 576.61 feet; thence N19°0310111W 421.29 feet to a curve; thence, along the chord of said curve, N12000'31"W 166.25 feet, said curve being concave to the east'and having a 'radius of 678.08 feet; thence N040581001W 422.67 feet; thence N0003811111B 20.74 feet; thence S860581391115 418.91 feet; thence S22012121"B 712,89 feet to said common point; thence N87154101"E•5293S feet; thence S8203814511E 391.24 feet; thence SOS0221411W 539.03 feet; thence N8705414111W 24932 feet to the-Point of Beginning. Containing 20;16 acres more or less. 4 I further certify that I have fully complied wi provisions of 236,34, Wisconsin statutes in surveying and dividing the same. 7-V ate orrest o anson, 900707 A4. G. r~/ ~ Nnin ROs 707ON * 0 ~ 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 f 0066" f Location of property 5iF 1/4 SO 1/4, section 3A ,T_:~at N-R 19 W Township Sprv.,er5e-F Mailing address SEYd a Sf /'I~aC ~l~w~ 32 ~,~lP Ak s.+61.54 q~.-tr Xtk Sx_--E W5tg1--_I 1 (SWY4 o''SWYq )Q1r6{*4 ' .33 Address of site "-3 - 11 \a W Subdivision name 4iZ_ , ye Lot no. Other homes on property? Yes ,~No Previous owner of property 6rtce d-- Dr-4,14 r1 Total size of property 5, &a. 4c.ret) 'I-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 4,-' No Volume and Page Number 13D as recorded with the Register of Deeds. A5:> ~e~coi in VJ. ioo7pgje !7s 45 p-c. ."0, ygt-575- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A i4ARRANTY.: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. Signature of Applicant Co-Appli nt 3-?-- R 7 3-9-97 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER (Zabe \ . (~2SS~e r~ MAILING ADDRESS 15 33' c o }i ~Y ~V° 5~ 11 N~ A/ 5 50 4s z PROPERTY ADDRESS /V (location of septic system) Please obtain from the Pfanning Dept. S,t 0, CITY/STATE Sc,r„eCSe~ 1n. SC~nsi n PROPERTY LOCATION SL 1/4, S'Lz- 1/4, Section 3.2- , T 31 N-RLQ W ~ + ~so4- S W yq) 04 S c c l of . '3 3 T~~ TOWN OF -:Dov..er5e k ST. CROIX COUN'T'Y, WI SUBDIVISION hr1"c.12A 4cr'es , LOT NUMBER 4 CERTIFUD SURVEY MAP , VOLUME l , PAGE 130 -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: r DATE: 31" - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 f , TUE 15:05 FAX 715 386 4687 REGISTER OF DEEDS 10001 V3 /11/97' 4 7314 9 SrwcL 1lL,LpvCC po* X:Cf`NDING O.T. I~ II 1 ~ rNin .i DOCUMENT No. WARRANTY DEED I STATE BAR OF WISCONSIN FORM 2-1s&41i I i f 'I 499525 9L 1Q Qwz 631 REGISTER'S OFFICE ! ST. CRW CO., vN BRUCE..A-._-TO13IN .AND••DiAiJ~►-i!s...Tg$Z.Ne.... ftedIMRscord f husband.•and_-x3fa............. - . MAY 2 4 1993 conveys and warranta to RQ~,T..x,,..~I 581.-~~.._._.......... 9:10 '%'/~i'~ + a~ SFiERU..L..-..HF..3SLER&..husband...a11d..Y.l.fe . - ,s . . . *Crum" To u the following described real estate in t-.•--'(...1`03.--------- . state of Wisconsin: Y Tax Parcel No:........... Part of the Southeast Quarter of the Southeast Quarter (SE1/4 of SEi/4) of section 32, and of the SoRthwest Quarter of the Southwest Quarter (SW1/4 of SW1/4) of Section 33, Townshi~(:o31 ns ordESCr Range 19 West, Tom of Somerset, St. Croix County, I as follows: Lot 6 of the Certified Survey map filed May 30, 1975 ' in volume I of Certified Survey Maps, Page 130, as Document Number 327332, and re-recorded in Val. 1007, Page 175 as Doc. No. f 498578. I11 Il TOGETHER WITH an easement for ingress and egress over the easterly corner of the following described property: Part of the Southeast Quarter of the Southeast Quarter (S91/4 of SE1/4) of section 32, and of the Southwest Quarter of the Soutbvest Quarter (SW1/4 of SWI/4) l ~II of Section 33, Township 31 North, Range 19 West, Town of Somerset, ~I St. Croix County, Wisconsin described as follows: Lot 9 of the Certified Survey Map filed May 30, 1975 in Volume 1 of Certified Survey Maps, Page 130, as Document No. 327332. This ....----iS..II1Clt homestead property. (is) (is not) vt~ ` Exception to warranties: easements, restrictions and rights-cf-vay of record, if any. , K/T' ' K47 Dated this day of ~ 1~.... ~ +.'cJ•~-~~ -~•-...(SEAL) . . (SEAL) Bruce A. Tobin Diana L. Tobin . ...(SEAL) (SEAL) • - ' + AVTAENTICATION ACENOWLSDGMUNT a STATE OF WISCONSIN gignatnm(a) Bruce A. Tobin, Diana L. Tobin ]a._!3 Personally came before we this .....---------dxY Of antbentiosted tltiia _~sy d--Al y 9 I j ; .........6 It....... the abode named _ 114 I Kr i s t i na g land TrTLE: 1idEI[BE$ STATE BAR OF WISCONSIN