HomeMy WebLinkAbout036-1079-20-000
STC - 104 /
AS BUILT SANITARY SYSTEM REPORTr"
RECEAD
7 T-97
OWNER aM/J ST CROIX
ADDRESS COUNTY'
ZON FI:ICE
IN(30
K"(~ 1\ l C h'rr 4 W 52e 647 - 0~
t
/C DO d~. L2 LOT
SECTION-_3/_T~/ N-R__~Q W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
pl~~
L) h !COQ. S
L
r 04 N
I
va
a, rlQ• INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
IIENCFiMARK : 4),
;E 'Q h e Tr /
ALTERNATE BM-
PTIC TAN / /
Manufacturer: Liquid Capacity: no
lSetback from: Well House ,
Other
Pump: Manufacturer Model# - Size
Float seperation 1A Gallons/cycle:
Alarm Location
> 4
SOIL ABSORPTION SYSTEM
Width: /oZ Length Number of trenches -
Distance & Direction to nearest prop, line: 1,[ 0~ t~Ja.a
Setback from: well:__ALI,_ House YOi Other
ELEVATIONS
• R
Building Sewer s, ST Iniet-,
ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold-13,, Bottom of system
Existing Grade Final grade ~5c 7
DATE OF INSTALLATION: PLUMBER' ON JOB:
LICENSE NUMBER: /$(o
INSPECTOR: 7/ 57.3
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor andHuman Relations
INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 299088
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
HRISTENSEN, HANS STANTON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
10-0' 1 CGi 036-1079-20-000
TANK INFORMATION ELEVATION DATA A9700407
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic w~ loco Bench mar ~ ,I 3 r{7 103•g1 / o
Dosing
Aeration Bldg. Sewer ni✓
Holding Inlet ~L/
TANK SETBACK INFO MATION (DJV Outlet ~,2 Cj~ Zz7
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 15d' A d` ±3 ( , ' NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe q.8o /o' ;(,7 43 ~7
Holding Bot.System 1C~-% Gj2 S!
PUMP/ SIPHON INFORMATION Final Grade -7,D C1 to •'17
Manufacturer Demand r~},y►~uN aolc q qq, 9Fl 48
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Zia. Dist. To Well
SOI ABSORPTION SYSTEM
ED / RENCH Width Length , o. re c ies PIT No. Of Pits Inside Dia. Liquid Depth
D EN I N 12 -1 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufa urer:
SETBACK
INFORMATION ypem CHAMBER
^ qD/ -7 1n8 OR UNIT Mo Number:
System orM►,nt~aao
DISTRIBUTION SYSTEM ST'rkl%2
Header /Manifold rr Distribution Pipe(s) x Hole Si x Hole Spacing Vent To Air Intake
Length T Dia. Length 9 Dia. y n Spacing (O 725"'
SOIL COVER x Pressure Systems Only xx M 91 nd Or At-Grade Systems Only
Depth Over Depth Over xx ;~pth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges To oil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STANTON 31.31.17.488,NE,SE 1833 OAK RIDGE TRAIL LOT 1
jyb1. ;ro GAG ~aM~ .
Plan revision required? ❑ Yes N0
Use other side for additional infor at n. It le q
SBD-6710 (R 05/91) Date Inspector's Si nature Cert No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
• Safety and Buildings Division
~•■~r■r,. 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 C
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
g7C168
The information you provide may be used by other government agency programs E] Check f revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. 1 ?33 0~, /d jZ r`-, State Plan I.D. Number
1. APPLICATION INFORMATION v-PLEASE PRINT ALL INFORMATION
Property ner Name Propert Location
11/4 rt 1/4,5 T , N, R j fir) W
-E 31
IT C>-Y\ 1~.~' l~ `1~•"~ Y~
PropertOwner's Mail,,, Add s Lot Number Block Number
t_ ri
City, State Zip Code PTt9 one Number Subdivision Name or CSM Number
N.x,,D42'~ArixoA -5v ®l C S
II. TYPE OF BUILDING: (check one) ❑ State Owned o Cityage Nearest Road
p
F] Public Z1 or 2 Family Dwelling - No. of bedrooms Vll Town OF Y7
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
~j --LL e G p
1 ❑ Apartment/ Condo 63L / v 7 c,? -_,-.Z D -/00
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. Q Replacement 3. Q Replacement of 4. E] Reconnection of 5. ❑ Repair of an
__~System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1: Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
-7--, Z/ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
y Feet
1 Feet qj,
5"_ / -
VII. TANK Capacity aclts Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks 'Tanks
Septic Tank or Holding Tank r: U"V (o i .QS c-~ ❑ ❑ ❑ ❑ ❑
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.
Plu tier's Name: (Print Plu tier's Sign ure: (N Stamps) rPRSW No.: Business Phone Number:
~Q vS 7
, Sta , Zip Code).
Plumber's Address (Street, Cit
Z rpk
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
'1 n
Adverse Determination 0 o~ "7
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings 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.
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 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, 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.
N Eli S5 Y, Sec. 3 17-:3 1 M R~7w
5 0~ 7 193 3 a-mK
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Wisconsin Department of Industry, SOIL AN V A L U AT I O N REPORT Page ot3
,Labor and Human Relations
Division of Safety & Buildings 8 C ` kH R 83.05, Wis. Adm. Code
COUNTY _
C Srt Crotk
Attach complete site plan on paper not less 1/2 . La in size. PI must include, but
not limited to vertical and horizontal refere int (BA ~irection and % of s pe, scale or PARCEL I.D. #
dimensioned, north arrow, and location an ' ance to Barest rc~ 2 " a
REVIEWED BY DATE
APPLICANT INFORMATION-PLEAS cP INT~ 4IIATION 7-f
PROPERTY OWNER: r ZoN;aOFF► f PROPERTY LOCATION
C h h I S r- C 'GOVT. LOT V 1/4 5,* 114,S~V T 31 N,R /,7 Vor) W
PROPERTY NER':S MAILI ADD E S j` LOT # BLOCK # SUBD. NAME OR CSM #
4,11A . A
CITY, ST PTE ZIP CODE PHONE NUMBER CITY []VILLAGE J TOWN NEAREST ROAD
4,A A'7 (ice aA6 New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow !!k5D gpd Recommended design loading rate bed, gpd/ft2 , S trench, gpd/ft2
Absorption area required IZQ-S bed, ft2 qo'b trench, ft2 Maximum design loading rate ,gybed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent m rial orj „ Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING, ~T4NK
U= Unsuitable fors stem S❑ U [9 S ❑ U ZS ❑ U MS ❑ U ❑ S R L ❑ S -P I
SOIL DESCRIPTION REPORT OM C 2 f o'er
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 0-16 v R / lU OrUL 1 C IS
~S
/o s N s/ K m~~ c.~ 19
Ground 3 3 S o S ortf2- S s V / ,
elev.
99.,5 ft. 7~S /S lm S MLA
r.
Depth to -_'3 So- /0 S o rh V § r. 7 $
limiting
factor
Remarks:
Boring #
'•titi
AWtJ e 5 p m r C ti. 7 ,1~5
Ground
elev. 50X65 7,S NOv~n- ~S m S m~ t- r ~S
/ S Dm s ~5.. 1
Depth to
limiting
factor
.Z~
Remarks:
CST Name:-Please Print Phone: 715' -a316 n
Address:
Signature: n! ' Date: -5-7-71-7 CST NumbeS3/
PROPERTY OWNER d,w ~f+4,, SQrSOIL DESCRIPTION REPORT Page ` ofd .
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground 0-0 .131 /D S 0 m S v Cc p /M 1
elev.
CLZ Y ,S
-S ft. 7, NONA6
Depth to S ~k-7 p o~ a rn s m r C
limiting
factor = /s 16 -4 s
Remarks:
Boring #
16~e -V12
Z 4 J< L3
;30 o S/ a s~lr M
L.ti<..
c,a /r,.~
-3 30.53 104 S N ~S s YA
Ground
elev. "
~Z ft. 4, 4 S Ow. S ra U V.
Depth to -
limiting
factor /
Remarks:
Boring #
NOW-
7:10 /0 a SIk, Vft7ir
04
Ground a R 5
elev ft 3sr-7.2 /D S Dh, Clsr i i 7 i S
Depth to
limiting
factor ,
Remarks:
Boring #
Fi
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
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ern 2' Aggeoyolo
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DISTRIBU710k1 PIPE
2"OFAGGREWE APPROVED SIJJ7NETIC COVER
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OR MARSM HAy
1:LEV, of FEAT (",01 lit `Zl-a AGGREGATE
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DIS'1•R15UTI(JN PIPE T(j BE AT LEAST
a>IU AT LEAS740 1AICHES BUT 1.10 MOR THAQ y2EuCNES 9 `OW GIWAL GRADE
FINAL. GRADE
• I
!'I~cIMUM WrN OF F-)ce • V
/1 ATIoI.D Fi~DI'1 0({IGYJAL b~hpl: WILL BE
1NNIMVh1 pEPrtt of EXCAvj1TImN "100 0916INAL GRAVE WILL eE - IIJCHes
INCHES
SIGIJED:
LICr_IJ5C DUMBER:
DATE:
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560046 'a 0 0 a 3
CERTIFIED SURVEY MAP
Located in part of the North ost Quarter of the Southeast Quarter of Section 1, Township 31 North,
Range 17 West, Town of Sta on, St. Croix County, Wisconsin.
Prepared for and at the request of: NOTE: This parcel Is created pursuant to Section 17.14 (1) (b), St.
OWNER: Croix County zoning ordinance, and may not be reconveyed by
Harvey B. and Linda M. Christensen Initial grantee except In compliance with sold section.
1492 County Road "K" NOTE: The parcel shown on this mu is subject to State, County and Townshl
New Richmond, WI 54017 p p
laws, rules and regulations ( Le. wetlands, minimum lot size, access to parcel,
Drafted by. Kristi A. E&ndt etc.). Before purchasing or developing any parcel, contact the St. Croix County
Zoning Office and the appropriate Town Board for advice.
WEST 114 CORNER EAST 114 CORNER
SEC. 31-31-17 SEC. 31-31-17
(ALUM. CO. AfON.) EAST-WEST QUARTER LINE OF SECTION 31-31-17 (ALUM. CO. MON.)
R = S 89'4620" W
,__1--- ---------M N 89'43'41" E 5468.55'---------
- 4148.93' -S 89'43'41" W 1319.62'-
EAST LINE OF OAK N lr
RIDGE ES TA TES FIRST S
ADDITION (SEE DETAIL rc) k LA O~ 2
SHEET 2 OF 3) •I~ c°n FILED
I UNPLATTED LANDS OF OWNER 6 MAY Z 8 1997
A o H.WIiLSH
0 0 K
`O stet d Deeds
{
$LC(
W WEST LINE OF THE NE $
1 a 114 OF THE SE 114
(SEE DETAIL SHEET 2 OF 3) T 1
F ~m a i N 89'55'40" E 660.00'
Ic
y 1Z
iD
aI Z N I
S I
PLAT OF OAK-RIDGE L 0 T 1 1D
ESTATES FIRST-ADDITION AREA: j0
DOC.-N0.-331198 217,780 SQ. FT. m
rERL WA tiE'WA IYNE 5.00 ACRES 10
VOLUME-4 PAGE 15 ORIIVE
ID
P p I
00 $ Irn
/ BUILDING SETBACK LINE j•
,
--------f-- -T
%
/ / S 89'55'40" W 680.00'
Mi NORTH LINE
woj Co 00I OF LOT 1
01 NI 1 / / SOUTH LINE OF THE NE 114 OF THE SE 114
22 . of 0i / LOT 1
< .1 a_I / - - - UNPLATTED LANDS OF OWNER
o: 0 r)j EAST LINE OF OAK ~~wa
1 f °I wl RIDGE ES TA TES ~ O N IA,
Ql ~i of 2 (SEE DETAIL OF 3) 1 SHL 1 2 g S
"Y
J! ~i ~WEST LINE OF THE SE AA--
I - - - - 114 OF THE SE 114 RONALD F.
wi £E DETAIL SHT. 2)
LOT 3 JOHNSON
I I
s-tteg
AMERY.
County Section Corner Monument I WIB. n
of Rennrrl .d<-_~•'`
CERTIFIED SURVEY MAP
Located in part of the Northeast Quarter of the Southeast Quarter of Section 31, Township 31 North,
Range 17 West, Town of Stanton, St. Croix County, Wisconsin.
Prepared for and at the request of:
OWNER:
Harvey B. and Linda M. Christensen
1492 County Road "K„ DETAIL
New Richmond, WI 54017 •
Drafted by. Kristi A. Eylandl NOT TO SCALE
I
( LOT 3$ ~ 1
I j-S 89V8'55" W
2.67
WEST LINE OF THE NE
1/4 OF THE SE 1/4
EAST LINE OF OAK RIDGE -•-j't
ESTATES FIRST ADDITION 1 t
•i~
= RONALD F.
i . JOHNSON
l~ Iq~. I AMERY.
into WIS.
a I I~i~,r•~0~ r
Q~T-OF A~ y A I 133
-Q.69 ##eoht saa o
RIDGE ESTATES I pm o l s
FIRST ADDITION FN-
- 1000
I I
• Set 1" x 24" Iron Pipe weighing I tlo! LOT 1
a minimum of 1.13 pounds per
linear foot. 1 a
0 Found 2" Iron Pipe r l i
G Found 1-1/2" Iron Pipe I -.-CENTERLINE
M= Measured As I DRIVEWAY
R= Recorded As
I
EAST LINE OF OAK RIDGE 1 i S 89'08'55" W
ESTATES FIRST ADDITION/ I , 1.02'
-------7Z-- --T--
NORTH LINE
OF LOT 1 Ir 01
PL.AT-4F 9.6 C"
RIDGE ESTATES LOT 1 IWNI WEST LINE OF THE SE
EAST LINE OF OAK I14 OF THE SE 114
w.
RIDGE ES TA TES 0
1 V11
JOB #97030 L L- - _ - - San:
Prepared by. 80
A & E
- - - - IN Ni _q RQ*nR'S5" w
CERTIFIED SURVEY MAP
Located in part of the Northeast Quarter of the Southeast Quarter of Section 31, Township 31 North,
Range 17 West, Town of Stanton, St. Croix County, Wisconsin.
SURVEYOR'S CERTIFICATE
I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor,
hereby certify that by the direction of Harvey B. and Linda M.
Christensen, I have surveyed, divided and mapped a part of the
Northeast Quarter of the Southeast Quarter of Section 31,
Township 31 North, Range 17 West, Town of Stanton, St. Croix
County, Wisconsin, described as follows:
Commencing at the East Quarter Corner of said section 31; thence,
on a bearing, referenced to the St. Croix County Global
Positioning System Network, along the east/west Quarter line of
said Section 31, South 89 degrees 43 minutes 41 seconds West a
distance of 1319.62 feet to the west line of the Northeast
Quarter of the Southeast Quarter of said Section 31; thence,
along last said west line, South 00 degrees 51 minutes 05 seconds
East a distance of 994.13 feet to the point of beginning of the
parcel to be described; thence North 89 degrees 55 minutes 40
seconds East a distance of 660.00 feet; thence South 00 degrees
51 minutes 05 seconds East a distance of 330.00 feet to the south
line of the said Northeast Quarter of the Southeast Quarter;
thence, along last said south line, South 89 degrees 55 minutes
40 seconds West a distance of 660.00 feet to the last said west
line; thence, along last said west line, North 00 degrees 51
minutes 05 seconds West a distance of 330.00 feet to the point of
beginning. Containing 217,780 square feet (5.00 acres). Subject
to all easements, restrictions and covenants of record.
I also certify that this Certified Survey Map is a correct
representation to scale of the exterior boundaries surveyed and
described; that I have complied with the provisions of Chapter
236.34 of the Wisconsin Statutes and the Subdivision Ordinance of
the County of St. Croix and the Town of Stanton in surveying and
mapping the same.
Ro ald F. J nson Reg. No. 1186 Date- X997
A & E Land Surveying Telephone # (715) 246-4319
P. O. Box 325
New Richmond, WI 54017
SURVEYOR'S REPORT:
State Statute 59.62 was complied with in subdividing Section 31,
Township 31 North, Range 17 West. The west line of the East Half
of the Southeast quarter of said Section 31 (East Half per
Government section breakdown) lies east of the East lines of the
Plat of Oak Ridge Estates and Oak Ridge Estates First Addition,
as shown on the Survey. Said Plats do no call the east lines of
the Plats as being the east line of the West Half of the
Gnn1-hnaat- n„nrl-nr „F -;A 11 fw~..4 U-1 F ~...,,...........4
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.
OwnerofpropertyanC CllI,L,~L --Q- w
Location of propertyl/4 1/4, Section ,T__fLN-R__Z ~W
Township - o Mailin address /1/yd !~A m le.
01
Address of site Q `
Subdivision name _ CS (Yu /.)-/3 a~ S - Lot no.
Other homes on property? Yes ~No
Previous owner of property r--~
Total size of property
Total size of parcel t
Date parcel was created S 7 7
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for ('spec house).?. Yes __X- _No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:.
A WARRANTY•:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by .virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. S'/0 6? *.1- , 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-Applicant
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix
ii County
OWNER/BUYER _a Q V N!& CIN r A'Q VISS _Q Vim, \
MAILING ADDRESS
r ~ rcx r
PROPERTY ADDRESS 1933
(location of septicc system) Please obtain from the Planning Dept.
CITY/STATE 3~ 0 (
PROPERTY LOCATION ofjO~' 1/4, S je 1/4, Section T_3/_N-R__W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE _aQ(40T 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:
DATE: 7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
4
DOCUMENT NO. WARRANTY DEED
A1J V
5GO 42 VOL 1244PAci574
Si CP10! c D., N11 a
fwc'd kx flw.uti
THIS DEED, made between Harvy B. Christensen and Linda M. JUN F 997
Christensen, Grantor, and Hans M. Christensen and Molly K. Christensen,
husband and wife, as survivorship marital property, Grantee, 10:50 A M
WITNESSETH, That the said Grantor, for a valuable consideration of +F
one dollar and other valuable consideration conveys to Grantee the following fibytsaar Of Ubdd,Y
described real estate in St. Croix County, State of Wisconsin:
Lot 1 of Certified Survey Map recorded on May 28, 1997, in Certified RECORDING INFORMATION
Survey Maps in Volume 12, Page 3265, Document No. 560046, located in . • • • • • • . ' ' . ' ' . ' . ' ' ' ' . ' . ' . ' '
part of the Northeast Quarter of the Southeast Quarter (NE 1/4 of SE 1/4) NAME AND RETURN ADDRESS
of Section 31, Township 31 North, Runge 17 West, Town of Stanton, St.
Croix County, Wisconsin. Bakke Norman, S.C.
1200 Heritage Drive
y New Richmond, WI 54017
TRANSFER I
, 60 TRANSFER
Part of 036-1079-20 FEE- (Parcel Identification Number)
This is not homestead property.
Together with all and singular the hereditaments and appurtenances thereunto belonging; and Grantor warrants that the title is good,
indefeasible in fee simple and free and clear of encumbrances except:
Easements, highways, utility rights and reservations of record, and will warrant and defend the same.
Dated this 3day of IM4, A , 19 97
(SEAL) (SEAL)
• * HarvB. Christensen
(SEAL) [ aiA . (SEAL)
* * Linda M. Christensen
AUTHENTICATION ACKNOWLEDGEMENT
Signature(s) of STATE OF WISCONSIN }
Harvv B. Christensen } as.
ST. CROIX COUNTY }
authentic a is 30th day of May , 1997
Personally came before me this Y f~ day of
June , 19 97 , the above named
* Timo v J. Scott LinBa M Christensen
TITLE MEMBER STATE BAR OF WISCONSIN
(If not, e F _to me known t0 the person who executed the foregoing instrument and ,be authorized by § 706.06, Wis. Stats.) aclcurnvledged ate same,
THIS INSTRUMENT WAS DRAFTED BY:
Timothy J. Scott
BAKKE NORMAN, S.C.
NEW RICHMOND, WISCONSIN Notary Pdb1.1c r St. Croix County, Wisconsin
*Names of persons signing in any capacity should be typed or printed below their My t6mmission is permanent. (If not, state expiration date:
19---)
signatures.