Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
042-1076-95-125
y y °o a °o N O O c c4 0 0 d 4 0 0 ~s ° O ° O N c0 O m aN- co ° t0 _ O N g U °O o w b C) C a) r O U E (6 O m U aa).§ -i U) o; ~ G CU C N 6) d t Ln a) a~ 0) - 0~ ° r- yw'aN ywoc ~xv_ o m .2 CU U') ao c 3 Cl) V)Ca ° m Vcn ~c00aa)ioE a) N~ rrnn N c O f6 i) O C: 0 04 L " O * O E" N O _ U N N N N N 'O N N N E N N N q o U o o ° o oa a o 3: u) in ca 0 c z o o c c z-0 c° c m c E -Fa 73 E a~mr a~ m M m mz o U. U S N U. C O) N Q N C7 Q CL O N (n ?r E O a) y N 'O "O a O aN !E C 10 a) Q H w a) n3 N Q LL U) a m W ° z z E E 00 ° 00 r 4.; 0 ° E ° Z L 6 L V o a m a m 0 (D N co H CD E 6 a o z d c c U r z N O N V fn I- O O O ID J\ 1~ N O N O_ O V~ m a) 7 C) N N CL N N O 0? C rn N O Cl 0) 4) U) CD _ C3 N F~h~1 C -O ~ C C 0 w i O Z o] Z Z I- Z ! z o ~M co N C C N U7 E E co O ~ N O) > a) - a) N - d - N m a o b O CL c m ) D o a G G a E E 0) co 0) CN cn U) U) :3 :3 E aQ zv>° X33 ~~3t3 a P 3 • ac's a a a a a a S; a _ Q N O C y N J U " (.0 ~O OOi z 0 rn a) m rn } 00 m 00 a) N N C O 10 LO CO E jZ O j O O~ Oj N a_! m co <1 z O LO N N v! ~.r N O O N C N N C ~ O r O E O O C U N U N N 7 O 0 00 CF) M 3 a) C a) c c: A N N 00 T to O F co c c d N c c N a0 LO a) 0 C') 75 c,4 N 00 -0 U • v oo o co co 00 m o 0 00 N m Co O y O N> U N O N z N O N (n RS 51 v a~ m a a x* a o i~ IL 1~ 0. • ACC a. ru U a) a) D U a O <n 0 ~ 0 to 0 i 4 0 CD M w ~ ~ I a o I N N O d a LL O C ! U ~ 'Fu N N AIM O W = E E 0 0 N O N N N i ~ z m 3 o t puNi v Evv` Q zmcu o III 3 ~ J z y c E j i E E O 2 Z o l a co 0) co F- C7 o I C 0 U O z c r ~ N aoi Z v o fn H r jl Z c E v .O ~ cn N C a t ~ L O C C Y Q lUp z H D z i. 0 co ~ C O 04 N M ! N A ~ 01 I! d ~ 01 a a W : c 0 o 0 IL D E zv> ~~v> > E w N $ a 0 ~w z IL IL IL a 3 o u) M J U Qi OOi 0 o r v N N O E 3 O I of o O a Q m N c L N N O N co O i co U) U) t r N LO C-4 O cp O C r C V a 00 00 ,It " 04 cD c6 ;6 ;3 W r C CO N 47 7 N N t=y~,l C T -0 M y N Z, C N a0 a0 O N? co O z c U) O r' i r CK v~ d € a ~ t a ` 0. r~• ~ am.~ m c r E` c c o A U00. ONv Parcel 042-1076-95-125 01/03/2008 04:36 PM PAGE 1 OF 2 Alt. Parcel 28.29.18.438A-05 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: owner(s): 0 = Current Owner, C = Current Co-Owner O - JANSSEN, DAVID W DAVID W JANSSEN C - GOETZKE-JANSSEN LAURA L GOETZKE-JANSSEN LAURA L 1128 76TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.264 Plat: N/A-NOT AVAILABLE SEC 28 T29N R18W PT GOV LOT 1 & 2 BEING Block/Condo Bldg: LOT 4 CSM 11/3206(2.14AC) INC COMM NE COR SD LOT 4; TH S 05'E 187.29FT; TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ALNG CHORD N 87DEG E 79.97FT; TH N 02'W 28-29N-18W 307.36FT; TH S 85'W 293.84 FT; TH E S 01'W 99.27FT; TH S 88'E 213.02FT TO more... Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687470 1952/259 AFF 08/19/2002 687469 1952/257 WD 08/19/2002 687465 1952/234 WD 07/23/1997 1230/137 WD more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 226880 312,400 Valuations: Last Changed: 08/28/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.264 41,300 189,200 230,500 NO Totals for 2007: General Property 3.264 41,300 189,200 230,500 Woodland 0.000 0 0 Totals for 2006: General Property 3.264 41,300 189,200 230,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 I!x3-063 'tio;s!H-83 'suo!jenIBA-L3 '193-led }xaN-53 'IGOaed •n9ad-t3 `1eaGUGO-63 8Z b6 LZ £L 9Z Z6 5Z LL VZ 0L £Z 60 ZZ 80 LZ LO OZ 90 6L 90 9L L5Z/Z56 L 0M NI b0 LL OS30ld OX3 (OVK'Z)90Z£/L L CO 96 WSO ON138 b lOl ON138 Z'8 L ZO 9L lOl AOO id M8 L~1 N6Z19Z 03S LO >118 lol lb'1d 0t VZ 3!DV3b10V l`d101 uo!}dposa0 Gull uo!}duosgO gull Ob'/L 096'/ M96 30NVJ WZ NMOl K NO11OM juaw:pedy OS adA1 --aweN 19946-- (Id Z/L # GsH :SS32ROOd Ail GdO&J AbONOIN ISel 2JMN 1N O3 JU32 Is-11=1 :3VIVN 213NMO V9£b'gV6Z'9Z jagwnN 193-1ed 00L-96-9L06-Zb0 2j39vm 2Gindnoo N3 : VM 30 NMOl 31ViS3 1`d32A Z02j0SX1 010 NISNOOSIM 'A1Nnoo XIO2iO as IV031 4 STC - 104 pc AS BUILT SANITARY SYSTEM REPOR4 'Cx RECENEO 9 F P 0 19 1997 J OWNER ST CFAXX OOUNW ADDRESS zONINGOFFICE p 6 SUBDIVISION / CSM# / ya/ ~~~c 3za 6 LOT # SECTIONT N-R_W, Town of •raK i ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f , i A9 G3 '7r • Z INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: S~ Ca~ ~y~,~r ,,an ALTERNATE BM: o y il. SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: fc~ee~r C Liquid Capacity: /aoo Setback from: Well__Z,::~ House V8 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length -7$ Number of trenches Z Distance & Direction to nearest prop, line: Setback from: well: /-23 House Other 7~ 4g;2 ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ? - Z~ - f 7 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: ~`hrc 3/93:jt 1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: tabor ancTHuman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Sanitary Permit No.: (ATTACH TO PERMIT) 289333 GENERAL INFORMATION 11 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MONDRY, PAT WARREN Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: 042-1076-95-100 L 0. OC ELEVATION DATA TANK INFORMATION TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /00.0 Dosing ' 33 Aeration Bldg. Sewer Holding St/Ht Inlet 1p, 5Z/ 100,59 TANK SETBACK INFORMATION St/ Ht outlet /6.-75 00,39' vent to ROAD Dt Inlet TANKTO P/L WELL BLDG. girlntake /3•roo' Z, 54 Septic > /0 7-i NA Dt Bottom Dosing NA Header / Man. y3' /3.ZS If Aeration NA Dist. Pipe 89 ' 4. ~5 9G~l~r 141941 Holding Bot. System .06' / PUMP/ SIPHON INFORMATION Final Grade Demand Manufacturer MGPM ctio System TDH Ft Dia. hi Dist.Towell SOI L ABSORPTION SYSTEM BED/TRENCH Width I Length S~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~ DIMEN I N Manufacturer: SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING SETBACK CHAMBER Moe Number: INFORMATION Type- ' OR UNIT System: 1~~?J opv 3` a DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) 1111111111 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 xx Depth() f xx Seeded / Sodded xx Mulched Depth Over Yes ❑ No Bed /Trench Center Bed /Trench Edges -=5.0 „ Topsoil ❑ Yes ❑ No ❑ ~i COMMENTS: (Include code discrepancies, persons present, etc.) j 12 d ~~~-C~ fJ , s . LOCATION: WARREN 28.29.18,SE,NW 763 112TH STREET LOT 4 d 8 r /O U e v Plan revision required? ❑ Yes M--.No a ,r Use other side for additional information. k' Date Ujo,,Sgntur, Cert No. SBD-6710(R 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: to Safety and Buildings Division v~■~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 than 81/2 x 11 inches in size. Cr'0 ix • See reverse side for instructions for completing this application State Sanitary Permit Number a4c", 3 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 Property Owner Name Property Location 1/4 Aft/1/4, S z T Z4j r N, R ~(or)Q Property Owner's Mailing ddress Lot Number Block Number 7 It Iz", 3f City State Zip Code Phone Number Subdivision Name o CSM Number ( ) NA J'A'I vl 11 3Z6111610 IL TYPE F BUILDING: (check one) ❑ State Owned ❑ it~ Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms T E] o age Town OF V Z°h, 111. BUILDING USE: (1f building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 6 y2 - J0 74o ° 9125, -~6z? 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- X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank OnlyExisting System ---------Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4- Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 7l 9e, Z Elevation yS~ 7So S'o Z z Feet iW3, LFeet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks Septic Tank or Holding Tank 100 ideekS 10 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ,4❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No tamps) MP/MPR A I . Business Phone Number: r ~irs.rv 2 765 77Z 3zi Plumber' Address (Street, City, State, Zip Code): a T otOf IX. COUNTY / DEPARTMENT USE ONLY X ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) A roved Surcharge fee) pp ❑ Owner Given Initial 6 Adverse Determination - ~J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) - 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 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- 11. 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. TI M M EXCAVATING JOB OF Route 1 Box 192 SHEET NO. Z-0-97 WILSON, WISCONSIN 54027 CALCULATED BY ri DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . . . . . . . . . i . . . . . . . . . . . . ..e.... . . . . .i . . . . . . . . . . i i • . 0 ' O.. +=^i i ^s ti f G1 t a _kz 1J~ , N N PRODUCT 205-1 ~ Inc,Groton,Mass. 01471. To Order PHONE TOLL FREE I-800-225.6380 r roe TIMM EXCAVATING SHEET NO. OF Z Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE 5~ Zo'7 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ` k J" . 19 . _ ..t~~ lot Z her t 0 ~h a wr 19 PRODUCT 205-1 ~ Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE I-BDO-2254380 kWiscensih Department of Industry, SOIL AND SITE EVALUATION Page 1 of 3 Labor and Human Relations Division of Safety and Buildings + i gordance with s. ILHR 83.09, Wis. l~ County Attach complete site plan on paper not less'th4h`6 I ~ in Lin size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and 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)). Property Owner Property Location part Gov't Lots 1 & 2 Dawn & Pat Moudr (former David/Carol Cover property) Govt. Lot SE 1/4 NW 1/4,S 28 T 29 N,R 18 lKxiio w Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 165 Crestview Drive 4 CSM 554947, vol 11, p 3206 City State Zip Code Phone Number Warren Nearest Road Maplewood, MN 5 119 (612 ) 739-8413 ❑ City ❑ Village t] Town 112th St. 11 )E] New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ 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 required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 •8 trench, gpd/ft2 98.2/96.2 upper/lower ft as referred to site plan benchmark Recommended infiltration surface elevation(s) ( p ) Additional design/site considerations install 2 - 5' x 75' trenches w/ 1' rock beneath laterals Parent material loamy/sandy outwash Flood plain elevation, if applicable NA ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ] S ❑ U ❑ S Q U ®S ❑ U [X (S ❑ U ❑ S 0 U ❑ S R U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0-14 10YR 3/3 - sl 1 f-m sbk mvfr cs 1f/m .4 .5 2 14-21 7.5YR 4/4 - sl 0 m mfi gs 1m .3 ;.4 Ground w occasional gr & cob elev. - 101.2 ff, w/ some gr 4 -58-4 7.5YR 4/6 mcos 0 sg ml cs if .7 ,.8 Depth to limiting 5 46-53 10YR 4/6 - is & s 0 s9 ml cs - .7 i .8 factor w some gr 100 in. Remarks: Boring # 1 0-13 10YR 313 - sl 1 f sbk mvfr cs 1f/m .4 'a, 2 13-36 7.5YR 4/4 - sl 0 m mfi cw if .3 '.4 2 3 36-60 10YR 3/2,3/3 - cos/f gr 0 sg ml cs if .7 ,.8 4 60-71 7.5YR 5/4 - s 0 sg ml cs - .7 .8 Ground elev. 5 71-10 10YR 3/3,3/4 - mcos 0 sg ml - - .7 '.8 10i.2_ft- Depth to limiting H_ L factor > 100 in. Remarks: CST Name (Please Print) Signatur Telephone No. Henry F. Grote 715-665-2681 Address PO Box 57, Knapp, WI 54749-0057 5/112/97 CST Number PROPERTY OWNER Dawn/Pat Moudry SOIL DESCRIPTION REPORT Page -Z of _3 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 1 0-13 10YR 3/3 - sl 1 f sbk mvfr cs 1f/m .4 .5 2 13-38 7.5YR 4/4 - sl 0 m mfi cs if .3 .4 Ground 3 38-72 10YR 3/2,3/3 - cos/f g 0 sg ml cs - 7 ,g elev. 1n3_~ft w/ very irregular 7.5YR 4/4,4/ sl (O,m) throughout he profil plus inclusions 10YR 4/4 s mcos + occasional r; more 1 than s; t is profil is not ptimum Depth to limiting for infiltration due to consid able to ural variat'on; techn cally su table fir factor oversized conventional but bes avoided 5 72 in. ; Remarks: Boring # 1 0-11 10YR 3/3 - sl 1 f sbk mvfr cs 1f/m .4 ;.5 2 11-40 7.5YR 4/4 - sl 0 m mfi cw if .3 :.4 w/ gr & occ sional cob Ground 3 40-10 10YR 4/4,4/6 - cos 0 sg ml 7 „8 elev. W/ som gr 101.4 ft, Depth to limiting factor > 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 # 1 0-22 10YR 313 - sl 1 f sbk mvfr gs 1f/m .4 .5 2 22-54 7.5YR 4/4 - sl 0 m mfi cw if 3 1.4 3 54-68 10YR 3/4 - lmc s 0 --n ml 7 Ground w/ gr ; elev. 4 68-10 10YR 4/4 - mcos 0 sg ml .7 ',8 97.2 ft. Depth to limiting ; factor 105 in. Remarks: Boring # 1 0-9 10YR 3/3 - sl 1 f sbk mvfr cs 1f/m .4 '.5 2 9-20 7.5YR 4/4 - sl 0 m mfi gs if .3 ,.4 w/ occasion gr & cob Ground 3 20-28 7.5YR 4/6 - sl 0 m mfi cs 1m .3 '.4 el 3 4 8-36 10YR 3/4 - mcos 0 sg 1 cs - .7 ;.8 ft. w! some r & o Depth to 5 6-10 10YR 4/4,4/6 - mcos 0 sg 1 .7 '.8 limiting fj~ > 8r w/ very occasional gr in. Remarks: SBDW-8330 (R. 08/95) u ~9 u pr r- 0 G rA-~ I --4 fq I 1 FA .r, to GtI t a 04 lei r✓1 J fl O l `p f .s z' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER RU MAILING ADDRESS PROPERTY ADDRESS 76, 3 I Z tk 5 (location of septic system) Please obtain from the Planning Dept. CITY/STATE 6L_r/s G•k ~'o 2 L_N-R _W PROPERTY LOCATION Tr_ 1/4, tVLJ 1/4, Section 7-1 T__jC TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME PAGE 320 , 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: DATE: - Z Z _rz St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 pa, t MnLjru Location of property S'r_ 1/4 NO 1/4( Section _g , T_2N-RIR W Township Z.J. -v r aK Mailing address Address of site '76-3 11Z 4ks &Aa 7g ~ a Subdivision name - CS n, 410 f 11 6a4= 3.7v 6 Lot no. _ Other homes on property? Yes No Previous owner of property _ Aa-zl` I fro,fir Total size of property /y Acrc Total size of parcel Date parcel was created _ / - Z?'- %7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes A No Volume 12-30 and Page Number 37 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"5 -n 37 , and that I (we) presently own the proposed site for the se aw ge 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 S- 2z - f7 Date of Signature Date of Signature 1 i2~3p 1 7 557337 STATE BAR OF WISCO~ F,R M 2 - 19R I WARRANTY DEED DOCUMENT NO. r=- - - _ _ FEG:S`R; CF--F David D. Coyer and Carol J. Coyer, husband ST CROIX CT`f, WI an wire, n v ua own r g Y an cacti In their MAR 31 1997 1 and 2:10 P. U conveys and warrants to Pat_r i enk A. Mon r' and paw` 8 1 Mondry_,_lhughand_ and wife an mint traT+xini-a ug L. `l •k - - o yr DeoCt THIS SPACE RESERVED FOR RECOFAwm DATA 1004E AND RETURN ADDRESS the following described real estate in St. -roiv cominirg (MIN LAW FIRM, S. C. State of VAsconsin: 430 2nd St. Hudson, WI 54016 A parcel of land located in part Government Lot 1 and Government Lot 2 of Section 28, T29N, R18W, Town of Warren, St. Croix County, Wisconsin described as follows: _ Lot 4 of a Certified Survey Map recorded frKl2 JU7~ wr~cE~IDENTIF~CATIONNUMBER January 28, 1597, in Volume 11, of Certified Survey Maps, at page 3206 as Document No. 554947; Together with and subject to a non-exclusive right of ingress and egress over the roadway located in Outlot 1 as shown on said Certified Survey Map. This Warranty Deed is given to amend and correct the legal description for the same property, between the same parties, contained in a Warranty Deed dated February 8, 1997 and recorded February 10, 1997 in Volume 1 1222 , at page 293 as Document No. 555420 in the office of the Register of Deeds for St. Croix County, isconsin. Q V F~ EXOM This is not (is) (is not) homestead propm)t Exception to warranties: Tp( WrM AND SLWWr TO any othm easements, covenants, reservations or restrictions of record, if any, but this 9*-"1 not be deemed to extend any such other recorded encumbrances beym d the term established by law therefor. - Dated this day of March A.D., rg 97 DaVid (SEAL) (SEAIJ D. (SEAIJ (SEAL) Carol J. AUTHENTICATION ACKNOWLEDGMENT Signature(s) Of Anft-ClarnI J_ State of wfisconsin, ss. a dry of Mainh_ 19~ ~l ewe I P we this Coumg day of I9 , the above toned ram- m.-dn TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me lbtowa is►w mite - Paste who executed the foReostg instturnm and a dimmmk a the sarne. THIS INSTRUMENT WAS DRAFTED BY Attv. Hugh H_ Groin- [sam T-aw Marco I . ' F v ~•,r 0l JAN 2 8 1997 KATHLEEN H Wqt Oleeds 6 'CrolxC0 S ' 5549,17 ~ 1 ca _ , T This instrument drafted an leskacek Proj. No. 96-67 O wFaZtt*C~ '"F v, Bearings are referenced to the east-west o J~odf~ 1/4 line of Section 28, assumed to bear N90a0010011E. o n 3 o H j Co N N Z q 0 8 JAN 2 8 W/Yj ~r y "Lnd 0 0) iv CQ'JN'ry na ri 0, a. K ^);;l'.: ~rI msive Platu~it n 0 la, wing and ( d t=i H. o ParKs Committee z 'o ti, z if not retarded -10 0 N o °o w ,,•..ri 30 days of tD ; rrt rt- o ,vvr ry,r-ii date C2 N kf ov,A 'Shalt be , vnid Q311d 0 0 ~ a, 411* Nd~ M o W rt SQ o °W r - Hjzl o (t 133 1S W F 1 Co x 3 w ~a~ua0 0. os i trJ 06 o - o a Z W m) eon uMO~ bo au 4l o - 40 " Z M~~1 E v1 06 44 m L4 00'99 Mir o80N a+ IC c'P o 0 w ti o Z IZ a c o fD w IZ7 c a -r1 -n K o %D 0 0. E) 0 W W N 1 W N t.~.,I .2.. ~i 1 IM to fh fn (A M It= 7 ID ` z Id K1 W ° Wo rA ,p. X20 / O 4-' 0 r01 Co - C9 M, C) M 01 ` C ~~4 Ic rh %-1 ,99 00 i~ 0 Ir- C) 4z ~ N la 41 0 00 w O m Its o _ ~d o to e H ~cn o s n ca - 07 1 43, AtS (A C4 It= ,i Z37 O S r+ n Q IS v 0- n r• ;o z ~ r0 -h 0 0 0 3' -3 r0 N P r0 ~ '3 O rp 0 u1 -1 3 (D C 0 3 3 Ln 3 n 3 U n e+ Q p Q Q n .t a~G N BEARINGS ARE REFERENCED TO THE ro ED D I ; c+ 3 tn 0 r+ rp C 3 NORTH LINE OF THE NW1/4 OF SECTION r- 3 rD N C •Z Q 3 r0 UPI a 28, ASSUMED TO BEAR N89°41'47'W. To1 'D y a $r fl F mZ r+ S O N p r0 N O 3 W 3 3 O 3 D -f1 0D 33 rp r+ rp Ul D7 C P (D :y r0 r3+P 33 p ro :3 zz M nr Qs P P (0 ro ISrp :3 ti j~~ mp0 4r+ :3 Q ~ <•< t,0•' ASS ~C W o (Ln r+ 3 Q. rp rai v m l m O O M. o z- 11 (J) -0 °oD rnp rrl 000 ,90' L89 l O ,n m O Z lOl 1N3WN>:13A00~lJOp 2ND 9.bZ.ZZ.00S 4 0 -30 3NI11SBM Q Z rn N 'Z~ 2 i~ :ni 'I m~M V) m E: 0 Nrr 1~ 1 0 ter. I O Z 04 A W N A 3 C N X59'6:-) g 3uL716Go L~ m go X z t ee os I I ,cZ'ss a -A ~ r•y 111 w R pN A, N' 1' 1' I ~I 1 I' I \ A g g ~j O >y 1 t l+ 1 1 1 1 1 1 1 N m W W W l~ a a O ` 6 ED IA 1'' I ;II I; 1 I I A t o 8 8 S 8g`~ D 1p1m I 'i'i'i'i'i'i'i'i ?t;0 O j O ND(~ mo NI'1'I'I'I'I'I'I'I z I~ M 0 1 v W O (OD n W I' I' I' GD I G? u~ > I I I 1 I I 11 I i N+ ' I I I I C z t" C5 CU A N N ff I I I I 'J ~ Z m z z z z TO ^ I I O C_ 1' I' 1' I' I' I' 1' I m I p co V V D d W 1'1'1'1 'I'I'I N C v tD o» r m 1 1 1 1 1 I I CD I 0 Ln p~ a i l i l i l i l I' ~I I I1 1 I~ f- I I 1 1 1 1 K2 CP m rri m m z I _ r i 1 1 ~i 11 lO O N I I ,8Z'L9~ 50,90 50S)I I' (I I I I I I I I I I I I I nOn o I l~ i l l ,bb,9E• I I~ I I I I o V N A r I ( 1 1 1 I' I I 1 1 1 1 1 1 1 1 Iv° -n I I I I I'I i I 1 1 1 1 1 1 vy (D O A (4 m I~ '','III r'IIII111'1'i)II'I'I' ,~I 1I'I1IIII t0 V 0 a 3 0 = i I 1 1 1 1 1 1 1 1 1 1 1 1 Q~ I 11 1 I i m m I i l l l l l l l l l l l 1 1 1 1 1 V b) N W 0 p I ~Q I I I I I I I I I I I I I I I I I 1 1 1 1 1.k I O A -0' 15 ~ I~ ~I I I 1 I. I ~l I I I 1 1 1 I 1 1 I 1 1 1 1 I 1 I 1 I 1 I I I 1 Z cD o m .9E' LO£ 3u9y(I• vowwS Z V (O -49 O (o w W N) g Z o C N cm CD 1 Ag -n z z z z m N m~ co ci~~~ C4 z ~M rtLinrvrA CD mA ~w pO m Z Z z --i y~ I I I I I W:~D W" A (3,; (a'q ~ 'III' o p o W w 0~m • a~ 4; di P-1 $1 A - An e t C ~t G ~t 3 O d C C w 7 p n 3 K 7 (D A 7 (D y I Q (D 'O ~ O ik c T X O S D) D) m O co 00 O p OD D) IV N y,,,~ A 00 (D 7 `Z O CD W a (D (D N ~ (D r lA\ m p - OD -4 V OND 3 y W O O O N N CL 7C < O y~, t~" K' OD OC c(D (A j 0 i O G 0) i~ M Co CD N fyA OD -O.. Vt N O C, -4 c o d J m Cn D cn z D t'p a (D (n (D y a > D~ a = i N CD y < CD co < C: CL 3 ^ OOO C~1\1 SD ~ 7 O (p N N N (CD cn CL ;o X O Z (p O 0 r. CA (VO (JO p ((D .pi C lr pA OZ 0 c000 CSiO 0 0 <0 (ate !r N 3 c co N co N) $ p III. 0 A D ~t~41 CA) ~vv, ~vo CA -0 'U 0 CD co 3 `m 3 N N (D (D z Zoo z CD z o O v o D0' o a' ' =r cn o ° !r m CD U) CD W m (AD N c ;a a c 'y0 N (p N c CD W (G a c. a 3 m = 3 Z (D m CD tl] -1 N w a a A G I o eMD ~ OD CL OD i C y Z y z G A CD A F I d d Z D y d (D Erp -I D CD CD CD CD aCL C CL vaaCD p 3 a C y y a CC •C y N 61 C C(D ~ -4 =1 n N C (D (p O O) y(n p O (D p- -4 0 CL N CL fD p Gl (p M C. N CL y CD 07 y ?y OO bs O (n n N N O 7 j C p (CD (D 07 Er ;r O (yA D. C CD ~Q ° a v -a-Wm ga 4v ~~o a d (nA~ S N N y (p p CL O j 'VC co - * CO CA D a ° gym` Ty o J CL c l) - v % O Vj CLNWy O N ; O cn 0 = o O p b N N CD p * * I b CD CD o CL o CL Parcel 042-1076-95-125 o7/o6i2oo5 12:48 PAGE 1 OF 2 F 2 Alt. Parcel 28.29.18.438A-05 042 - TOWN OF WARREN Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Owner(s): = Current Owner * JANSSEN, DAVID W GOETZKE-JANSSEN LAURA L DAVID DAVE GOETZL 1128 7OBERDistricts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.264 Plat: N/A-NOT AVAILABLE SEC 28 T29N R18W PT GOV LOT 1 8,2 BEING Block/Condo Bldg: LOT 4 CSM 11/3206(2.14AC) INC COMM NE COR SD LOT 4; TH S 05' E 187.29FT; TH Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ALNG CHORD N 87DEG E 79.97FT; TH N 02'W 28-29N-18W 307.36FT; TH S 85'W 293.84 FT; TH E S 01'W 99.27FT; TH S 88'E 213.02FT TO more Notes: Parcel History: Date Doc # Vol/Page Type 08/19/2002 687470 1952/259 AFF 08/19/2002 687469 1952/257 WD 08/19/2002 687465 1952/234 WD 07/23/1997 1230/137 WD more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/28/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.264 41,300 189,200 30,500 NO Totals for 2005: General Property 3.264 41,300 189,200 230,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.264 41,300 189,200 230,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 V~ `YJV 43 5 3 435A-20 322 '12 411 1 /1 j 436A-10 1 I CSM 18-4760 I I W` I~ ~y I% 436A-05 m 438A-05 w 1 1- ~ O LO 1952/254 II q~ 259 tAo N c unn VOL 11 P `3206 N it ~.(0~ ~437A-06 0 1 D~ l 438A-02 i i _4.37D i I 1 i 1 LOT5 1 i X11 437E 1 CSM VOL 14 PG 3840 1 509.3 I 1 CSM VOL 10 PG 2747 it i N 437C i EAST TWIN LAKE 1 Ni LOT3 j 1 ~ 1 1 i i 1 333.64 r - p L C ~ ~ o `~~Q . ~ ~ r r r 00 u . ~n% 882 86th Ave PC? 20 21 8W c 04t Av 8~ A e. C 830 o C 4-9 8r8l 8 r' 8 1 ( r 8 • 818 L i 9 ac ao m n 81 0 o c~ o o o 80 Ave. 796 r, 794 792 c c c M a r ° 7 CPI 78 781°~ IV 7 ~a 775 N/WnsN~jf S MRS' N 7 0- 76 767 760 7 • F.757 2g 1 Q-1 28 750 762 752 7 . 737 746 736 740 743 738 ! T- -0 728 733 Twin es I~ 722 721 722 i N 714 7 721 N o o) T Hall i 70th ~ve 70fi i . 688 ° N p M N G N O N r r. 4..r 667 V , g o 33 ~ o 651 32 ° sa3 •T 638 Cker F6-32- 631 628 OD 632 C? c 621 615 N o ♦J N aa co Q ~ O m r ~ r r C) 607 605 PLAT T-2 9-N • R-18-W IL m.a a ' See Page 112 For Additlonal Names, RICHMOND PAGE 48 1100 19 ki 1A )Q 1500 NREE Clarence & ten & , KES Ma Hn 77 `'k 1 s z`J'-` 68 Connie& Gar 40 Js 6 N 118th » a Mary Robert 65 N Mueller Inc 78 ' AVE Maloney Derrick p. r+ T aec d Trust67 158 3 275 c]To_hn ~e m Louis 114th ' ;0 2 1 Mc$Docnel2 Mlckelson Vernon s, & Jenny AVE Fred Thomas e3 o eM Nelson ' Rolf Greenfield Maloney zmnv~ 120 Il_ 36 sy s L - o~ Allen & Donald • tr Greenfield 39 = A F a ' ° 40 _ 216 2 39 40 180 154 _ 318 240 cn tt B 0 'Jeff & Kenneth & 2 C. Dale & 110th AVE Cws gn.ro,. n d I 14 0 Redmoa Pamela Ronald VIrRinia 80 z4 d aw 60 Herhlk z 2 Meyer Fre Brick RHK e Y~ Y M! del A Wesley & Farms tt Ellis ~ D-h- C\1 0 mat M Inc ' Frederick C i 54 m` 21 &Ls Io 160 u by 40 310 120 Tnut 404 1 Fred 80 & Thomas R4 F az 0 1 Nona Gordon Sullwold ~Truesdill Inc ' ~ aer. 142 F2 14v 138 2 ' 4 200 Tens,o 150 160 01 160 470 160 ' e 3 d' Bs David & N 6 Walter 4 100th AVE Burl a ' W~ ° e 60 Kenneth M Nechville VanBeek xa 1 cKenna Frederick d er 80 80 5 ' ary 96t ^ ° e \ tr iameur zo oom Av tl sec HNech ville C 1 °IZ 168 80 Viola e & F & 195 C F%1, Frontier c °s Tepe z Delores 13 Gillis ' ~g F-- David & Land Dean & T1ust Schulte Farms d cr Diane M veerltt o McKenna q Corp Mueller Trust Inc _ u 6 1~ 1st 119 , 78 H&c 344 x jj;a ) 2 4 n r-f 1 101 PSI Ill , Mueller 150 160 12 240 316 1 se s a s tr C 10 ; Furlong Il R 10 ^ 2 2 0 Z C u&a W Ls--,.C t DAIS Eugene c n 2 37 Walter & Gillis G ' ji U) Elsa :0. $ ~y Berg s4 JR 5 RF . E F Carpenter I arms ~ i u l8^th VE 148 1 11 s 25 n 139 160 78 Ali 3 , N 132 tr Sonnenta G - Fm1Y Gardiner & s Farr ° 1 n o A E Ltd Violet 31 116 Pechuman 00 p~ Prtnr Graham 1 Mark is d~ Gillis ' tr° 122 z aznlln Io c a Farms s 163 ROB x~ 41 ~a0 Inc E C11- 1.4 - 108 154 3 3s„m 1 Z e TO x c 2 TT H H 10 w F^ 2p Ella Ia ~1 ]awes & s 1 C 4i 1 L +g 3 enucd W e& Geo Ruth En ' r Date z p s 65 Rill a " x Bloome OConnell Stewart i $ 8 \ u 80 Hacker 40 w 30 E 2 n-7 44 tr 6 2 a 70 307 Haazmlin 2 160 J wao E ro enT Jufle Q b Earl 98 Dana 16 Lenert. ' C 4 Craig etal 164 sag TWIN 5 v Smith Pechuman gory & Sherri 110 ° C z M 4 LAKES Keith & : And son Pinke o Patrick 1 Deborah e Solimar S ry ' 1 85 160 143 ieve ,0 70th AVE 3 187 80 Deland 6s z E is Three , 9 a 6 1 3 M bold 45 Putt 41 \NN'O , ILC 37 tr ^ Sonnentag Clara Mer 1.~ Dorwes Jodiark e & 75 1 F:r o / Farms Nv e sas o^ G en Ltd Y Peskar Inc z Shn \N Gaud 0 E Wiese • 1684 ' Trust t1 n13 U -02 I 99 tr 2 115 160 223 tr 110 Inc , Robert & 'STAR Andrew & Rd1L E is i Dt~~ Bernadine 88 B LN Rose / GDean & len 10 e q1 0 1Neskau LN KER 7 in RudesW da ay 27 1 „ Hansen 30 g h E 4 Butler ro 26 ism esi: 92 A °N ~n s~ 17 _ _E 6 36 50 b s zs tr =26 126 L, 194 a i tr 4 ' 60th AVE r ll■ Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Homan Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) sanitary Permit No.: GENERAL INFORMATION 268585 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: COYER, DAVE WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600291 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO 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 mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N LEACHING Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER INFORMATION Type O Model Number: OR UNIT System: 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 T xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN.28.29.18W, SE, NW, 112TH ST /i/3ZDC~ - AjetTirn Plan revision required? ❑ Yes ❑ No F1 Lj I 14"q VT Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. e ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: via.~R SANITARY PERMIT APPLICATION Bureau o oand ff Buiui safety ilddinng Waater System-. teri 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application- State Sanitar Permit umber 261615_ The information you provide may be used by other government agency programs ❑ Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name ~ropper c /4 S p z , N, R f f~E (or~ uif- fS~ Property Owner's Mailing Address Lot Numbe T r Block Number dr C.& "2 hK .?,Y City, State Zip Code Phone Number Subdivision Name or CSM Number L) II. TYPE F BUILDING: (check one) ❑ State Owned ❑ It Nearest Road ❑ village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF klACAOCASW sT, III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 991111- 1 E] Apartment/ Condo tOZ - -9S V 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. W 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 (A 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation J 0J7 -7 .7 p Feet d 41eet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /2001- ! ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the site sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature:~amps aaacMPRSW No.: Business Phone Number: 0"1* 1 J9. AacsAl 7, d. -It?r -7 fe/f er's Address (Street, City, State, Zip ode): L 3 IX. CO NTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing A ent Sign r (NOS mps) I Surcharge Fee) Approved ❑ ner Given Initia Ow Adverse Determination / X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) 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 permii maybe fenewed 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 mustbe 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. Onsit'e 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'krmit 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 8 112 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; Q ,soil test data on a -115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 4,10 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. 0 ~ 4 o YVV d n w ^C j ° Nt 4 . •C A~i e e ~ \ o ~ o f v 1 ~ o -Ilk l o ~ --,cam--- - V ~ R ~ "C /I l n rn -e And ~ - ab ato RoC `1 4N1 In ~ ~ Q ' frb Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page of 3 Labor and Human Relations Division of Safety and Buildings 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 ST 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)). Property Owner Property Location O Govt. Lot 1/4 1/4,S ,Pg T N,R E (or Property Owner's Maili g Address Lot # Block# Subd. Name or CSM# 6 S Cff /2Es7- !/~,c r rJ 4/C. - - / 7 y ',eES City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 12,6-d gpd Recommended design loading rate 7 bed, gpd/ft2 , S/trench, gpd/ft2 Absorption area required J"5_8 bed, ft2 7S-y trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 3 = /c~D 3 y /vO.o r ft (as referred to site plan benchmark) Additional design/site considerations 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 ❑ s Z u ❑ s ❑ u ❑ S O U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure GPD/ft2 Boring # Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '0-7 /o - L tL 1r,51/or/C ~S 2 . ` Ground -3 L -5 O /S elev. _ Depth to limiting factor - in. Remarks: Boring # L ?M S " Z 1-7-S ~ O /I o ~ 2 z L to ^ y - SrL c sl3 < /ut L 1 IYI s 3 3- y L o sG /~1 L cl - Ground S t^~ o O C_ A"I L S • 7 N elev. s s /kI L - 7 /o-"tt. s -9 /o - 6 Depth to limiting factor < < ~ 3p o in. Remarks: CST Name (Please Print) Signature Telephone No. Date CST Number Address i` 0/?~A77 w~ Sx/01 7 3-z33 0 0 PROPERTY OWNER Z~qvC Co yE/~ SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# c' Ll o'76 _ qy Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots, Mft 3 Bed , Trench ~ -a /D-3 Z L x S Z I 2 - S-~/ StL zc 5 Ft 2K , Ground 3 elev. - S - LS ~ I/ P7& /03..5 ft. Depth to S o-9 !D _ limiting ` 8 factor - in. Remarks: Boring # E ©-7 0- 3 2 Sr ~ r c s ~t~t g Ground elev. i L /oS.Oft: , Depth to limiting factor in. Rem8irks:_2~~ Horizon IthDo minant Color Mottles Texture Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Boring # / iz 4S - ssL c S/s c c s 2 c J Ground elev: S G s Depth to limiting factor in.. Remarks: Boring.# Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMUWR--- MAILING ADDRESS PROPERTY ADDRESS 7014/ (location of septic system) Please obtain from the Planning Dept. CITY/STATE .ZQ9_C_Z_Z4 - *,"02.3 PROPERTY LOCATION S'E _ 1/4, Al~a 1/4, Section 2_1' T___!; f_N-R___j4:t~__W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE r---,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 I, 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 . SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i 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. Akye Location of propert;- 1/4WI&Z_1/4, Section .Z.P ,Tg_fN-R_&E~_W Township Mailing address Address of site 7Gy S-T, Subdivision name - Lot no. other homes on property? Yes No Previous owner of property Total size of property Total size of parcel s~jyr~ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes J,.- -No Volume ;!7 and Page Number %6S' 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. ~_!p , 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. 0 Signature o pplicant Co-Applicant Date of Signature Date of Signature } DEED HL LIPV ED i PL IORC N6 . DOCUMENT NO WARRANTY STATE BAR OF WISCONSIN FORM 2-1982 _VOL 1077r415 * ' 516401. OFFICIt- Evelyn. M. Brathall, a widow and not remarried. FAdd tl:rR+axd • MAY 6 1994 ~n - at 1:45 conveys and warrants to V1CI D. CO~r and Carol J -C4Yer, t-(,}• 1 his. wife, as joint tenants v tlaspsoa•at>.eatt GWTn & Wertheimer, S.C. 430 Second St. P. O. Box 1Qe it. Croix udsM Wi 54016 the following described real estate in . County, State of Wisconsin: 042-1076-90 Tax Parcel No: t All that part of Nh of NW; and all that part of Government Lots "1" and "2" (Sl of Frlcl. N h) of Section 28-29-18 lying Easterly of Centerline c.F Town Poad• L.i_ %his deed is given in satisfaction of a Iand Contract between the Parties dated April 3, 1984 and recorded April 20, 1984 in volume 616, at Page 171, as " Document No. 392632 in the office of the Register of Deeds for Ot. Croix County, { Wisconsin. This iS...... homestead property. (is) (boom E:-ception to warranties: TC(2 ~ WPM AND Sj1B,7ELT 'o any other easements, covenants, resexvatiols or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encmbr beyond the term established by law therefor. `•r••AM,~~•• day of May 19 94. - c .(SEAL) (SEAL, I s~f ~~!ll~f••'•°~~~ (SEAL) - - (SEA1.t . AUTHENTICATION ACKNOWLEDGMENT { I Signature (a) /-a------------------------------------------------ STATE OF WISCONSIN ss. St. Croix a cunt Y • I i, authenticated this --....--day of 19 Personally came before me this .`?!---.--day of x' !aY---- 19...94 the above named : - Evelyn M. Brathall, a widow TITLE: MEMBER STATE BAR OF WISCONSIN - ~i - - - (If not, - - - - to zed by 706.06, Wis. Stats.) me known to be the person who executed the f foregoin trument a ? :1, n ledge the same. • ' THIS INSTRUMENT WAS DRAFTED BY f... AirtortV-y--Hugh..H...i3win........ • s .o t,~