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HomeMy WebLinkAbout042-1080-60-000 ry o ~ ° I 060 m CD a o a m L N c o I a y m h a ai . U)i (an) v Z o c LL c o O 3 v m o .0 a) O Q U N Cl) v CD Z jy lu E Z = o rn CL m N IN- fn O O Z '`V c 1 r :3 u) a0i Z v ° o F c a) v E N c a) 1 co 3 N O d C C O m0 N O C O Z F Z It rn aci E c co N E 7 N rn " d a) CL W y Cl) U) a) 0 O o C a .n Z > F F N t o a co ce) N O O 0 Z 2 CL CL a. 4i C) 24: a 3 0 U) 1-- 00 CD a) (D ( n J U vi M O O N -0 ~ moo E I N in m) L a V U) cu Lm r~ v 2 Q } co m 2. N y H L N r - E a) :3 O [ Ci 3 > r a °o 9 co CY) r- C-4 F°- o o c O L.7 0) U) (D CO 0 0) m 2 'D N ~p c O O N •O O N 0) 00 0 J N O Z C Q' 2 _ E vs a L: CL CL Z E c c _1 A ua.a ~oinv ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT r. 19 Owner 9, L N~ K 0''.` sr CRax Address "l ul t-L S ' COUNTY City/State Rd Ii l S W t S C. ~;V 0 a 3 ZONVING oFFICi Legal Description: Lot I_ Block IV A Subdivision/CSM # 31899 '/,S U M l; , Sec. aj, TIIN-R-LLW, Town of W A P-P w PIN # P)'l2--1080 (oD - 600 . W/"2:-/.- q . 'f 1 j,,,- SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer (w~ 4Z,C LS Size ST/W 111b0T/ Setback from: House al-V Well Nol ; N P/L S ' Pump manufacturer Model Alarm location - (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter ocahon Alarm location SOIL ABSORPTION SYSTEM: useD Zvi ~Ra er Type of system: s 1 she H -1 b Width 3 Length (o 5 Number of Trenches Setback from: House d a (e Well N-I' ; N P/I., 11o Vent to fresh air intake 0 u e ;1001 ELEVATIONS: Description of benchmark S fie e P aQ Elevation 100-0 Description of alternate benchmark T' Sfe e) F" PR Elevation 97-53 to,zl) ul',1 .Vut P,,f;- poi" Si11 f 14c. foi- 13pi c , mp4- foot 1aN k _ b'ncnwy~ Si-Rv faun. Tr,.IC T (~Rx~iHFitIQ 13 5f4pt(r. IIV,-(t aO, ~~~Unti+• ~i~~~+u~e{ Building Sewer ST/HT Inlet ST Outlet 14,01 . PC Inlet PC Bottom Header/M'" ,,}anifold Top of ST/PC Manhole Cover 9.13 rp.,.kq}, e,/ C~Pm h 6., of Distribution Lines 10135 t,. 14.3S USI ► a 9 9 ~1 Bottom of System (H) _1O 1) , 9 5 (t,) 10), 9S O ~ Final Grade (A) 101- ~ -5 (Z) )01 a Y ( ) Date of installationa / 7 Permit number D 89389 State plan number Plumber's signature r>^ L7ott ~ri~e~ License number 3Y0 Date a /17/?b Inspector fod s ) aqR Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 3 Bpo~ooM N~Me 0 C) ~ooo gpl SQ~~, c. ao' C I e►ani a U~ V 1 ~ as Tel N C' 3 ~ ~a_Sv INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County ` K INSPECTION REPORT S~ C_ l 1 GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. .2-9013 99 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: CST BM Elev.: Insp. Elev.: BM Description: Parcel Tax No.: / 'S CY-~a- °IDgO-Cp0 - ~C~ I Uc~ 1 l 0O' -Foo OF iron - e r's TANK INFORMATION ELEVATION DATA 4g7DDa©z1 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic wf_ I pad Benchm rkI 112Z~ 1 ~o ,ex S Dosing loo Aeration Bldg. Sewer n6 Holding St/Ht Inlet /0,30Gj'cj.tl TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic 2"r 0A 07' Z8 r NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe 7qc)' !©x.35' Holding Bot. System 4,3~j~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer De ncl To 2 M del Number GPM 4-13 /ptb-73 Dp' TD Lift Fri ction S ste T Ft 1 &6 26.7 oss Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED / R NCH Width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Li Depth DIM (02•~ DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manua SETBACK INFORMATION Type _0 1 AMBER ode Num er: System• I (pQ 1r1$ r'OR DISTRIBUTION SYSTEM ~h~i ~¢-V~~r- ~'l~{,ecJJ CY CiGtcc~n~' &Dft~gnckl Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Ven Air Intake Length i3 Dia Length Laf Jr 144w. 3 Spacing -r 1(,D/ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over epth Over xx ep xx Seeded / Sodded xx Mulched Bed/ Trench Center d /Trench Ed es i ❑ Yes ❑ Yes ❑ No COMMENTS: (Includ ct'li discrepancies, persons present, etc.) jp-~~ Low w,M i vo RK ~ti qke SJr` Ccufi Z ,,.mod es c l~ G~it~I~ rS J cg~Dl Gl- 'La vV6,.j -7 ~l~ -I'~/'fl~rtG~1 I ~-t~ , Plan revision required? ® Yes ❑ No Use other side for additional information. u6 lq~ 7 SBD-6710 (R.3/97) Date Inspector's Si nature ert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 7~ C, NJ S i ~Ah r Fh~~ s ~~to1a faao al. ~ ° W~~ ~'c'(~nw~ rra5 a ti'ti5~~ god 11v`. we'a ov+ tv_;,4k t, 5~dc w+ c~Rl4tAM1Gr colt{ S 4D bL uccaav f N 4 ~-Qcx I t ` v SANITARY PERMIT APPLICATION Bureasafetyu o oand ff Building Water Systems Water 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. O ' • See reverse side for instructions for completing this application State Sanitary Permit Number a lpl 3lp The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pro y Owner Na a Property Location 114 t/4, S T a , N, R E (or~ 6,7 Property Owner's Mailing Ad ress Lot Number Block Number City-State Zip Code Phone Number Subdivision Name or CSM Number 6 &)-r d II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City 71~Nearest Rt6 Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Vll age Town OF Warre I) III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ` 1 ❑ Apartment/ Condo N / 40& 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non Pressurized Distribution Pressurized Distribution Experimental Other 11 Weepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ 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 u So Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min../iinch) Elevation l (o 1 (p 49 - .107 09 . IS Feet b? ~ S Feet acit VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass App. New Existing strutted g Tanks Tanks Septic Tank or Holding Tank I-+- 1w)() ❑ ❑ ❑ ❑ ❑ 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. Plumber's Name: Print) Plumber's Signature: (No St mps) rPRSW No.: Business Phone Number: 3 %:F - 9a Plumber's Address 5tr et, City, State, Zip Code): IX. C UNTY / DE ARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Ag t ionatuna- No Stam roved Surcharge Fee) pp ❑ Owner Given Initial ~ t~s Adverse Determination xd v X. DITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 11.1 ZE4o a-ill fi1/7 7 SBD-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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by 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, 6Q$-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.4pproval 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, et 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 state or with corrmpletle dimensions; Iocattor-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 1 15 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. • . I--: n. L. 0 ( I-1 L U I A 11 I ) (—• I U 5 L) ',.*) I" L I I • •) 1\1 . . .L. . . P R 0 J EC T P L., U M (± N • 1... I- NAME "Da,ve (.ct/ti?e,t^ NAME ... ... .. ..... .... ..... •:, ,;.! P L 0 T Nil A P „-... ..! • .i• ; . . . . . • . A(62 650-1.e it 4115),) 1b0' • . • • . • ltt.i.., • . . . N)ate •. 64)1 .IS . rrPrt.• fl.e. . • •. . .. . . . . , 1.6).) co' - , K.0... sirtiL ' - .... . a- 5\5 s -f T.,-, • . • . • . . • . . -i---). 0 • • .. . r- 0 • . . . . . . ., (14,AN01.1'r --_____ ) 7 6/0 • - .,. as'•Am, 7 s, giro 0 0 6'° • • .;' ,, 4 No os,p) ,\. tj , 1 P S r fc fpl .QH I •• ... . ,• 1 9 •, ... . a •r:4 . •.. ...• 4 i I ' AL4/-• sLia 4 Alt Bm • i 4- a 2 . :, (: se• i 0 A,,,,t, i . 6 3 . ' 1. . • i V8 ' • .,'; •1,i;.. . /01)(.. / •• , • 1Ja.f.- N .0 %iv ci A 1 t • . . . FRESH AIR INLETS AND OBSERVATION PIPE J-. CROSS SECTION • _ (TT) Approved Vent Cap . ---6 " --c-• . • ' - „ • •'N . Minimum 12" Above IFihb) QWQR Final G..rade • ... . kt ,, .: . I),pN-• 4 " Cast Iron Above Pipe (El. Vent Pipe To Final Grade • • - - • , • _. ______• • . . . Marsh Hay Or Synthetic Covering . .. Min. 2" Aggregpto • , • Over Pipe \i, imj • Distribution .-___ ___ Tee . . • Pipe ,, "itt.',INcLJ `-'?__ . • Aggregate ( 0 2-— is Perforated Pipe Below • Beneath Pipe Coupling Terminating P . • t b.) . - VS- / Bottom of System .. . • . . - . Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 x Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference rj$ irection slope, scale or dimensioned, north arrow, and location and di to rre,K road. 042-1080-60 APPLICANT INFORMATION-PLEASE rt TL{1 Rkl~lTl REVIEWED BY DATE O N' PROPERTY OWNER: PERTY LOCATION Dave Langer t-•~ ` LOT SW 1/4 NE 1/4,S 29 T29 N,R 18 xE (or) W PROPERTY OWNER':S MAILING ADDRESS A'11-1 J1T # BLOCK # SUBD. NAME OR CSM # 808 1st. st. ~e 1 na csm 3/899 CITY, STATE ZIP CODE QCITY [JVILLAGE MOWN NEAREST ROAD Hudson WI. 54616 ( Warren 107th. St. New Construction Use [x Residential I Number of bedrooms 3 [ j Addition to existing building (j Replacement [ J 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, gpdtft2 Recommended infiltration surface elevation(s) 102.95 It (as referred to site plan benchmark) Additional design/ site considerations area of b-1&b-2 to be cut to el. 106.95 or code Parent material outwash Flood plain elevation, if applicable na it S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for svstem 6 S C3 U ❑ S L - 1 I!TS O U ctS O U 1 S U ❑ S fRU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. I Bed Tte & ti...'1 1 0-8 10 r 3/3 none 1 2msbk mfr gw 2f .5 .6 2 8-22 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 22-44 7.5yr 4/4 none sl 2msbk mfr gw na .5 .6 elev. 108.05ft. 4 44-12 7.5yr 4/4 none cos osg ml na na .7 .8 Depth to limiting factor +120" Remarks: _ Boring # 1 10-9_ 10 r 3/3 none 1 2msbk mfr w 2f .5.6 2 19-42 7.5yr 4/4 none sl lmsblc mfr -w if .4 .5 ~+Alt'v.3:..axa 3 42-63 7.5yr4/6 none 1 fs Osg mvfr gw na .5i .6 Ground elev 4 63-12 10yr4/4 none co s Osg ml na na .7 .8 . 109.15ft. Depth to limiting factor , +125" Remarks: CST Name:-Please Print Gary L. Steel Phone. 715-246-6200 Address: 1554 200th. Ave. New ichmond WI. 54017 Date: CST Number: Signature: 4-27-9 16- PROPERTY OWNER David Langer SOIL DESCRIPTION REPORT Page 2 b!.3 PARCEL I.D. # 042-1080-60 Boring Depth Dominantcolor i Mottles Texture Structure I Baibaryi '00' G Bed PD/ft iTrench # Horizon Consistence in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 1 0-9 10yr4/3 none sl 2mgr mvfr gw lm .5 1.6 3 v....... 2 9-35 7.5yr4/4 none sl 2msbk mfr gw if .5 1.6 I Ground 3 35-80 7.5yr4/6 none Co S Osg ml na na .7 1.8 elev. 105.95 Depth to limiting factor +80" Remarks: Boring # 1 0-9 10yr4/3 none sl 2mgr mvfr gw lm .5 .6 4 <j! 2 9-78 7.5yr4/6 none Co S Osg ml na na .7 .8 Ground elev. 101.05ft. Depth to limiting factor +78" Remarks: Boring # 1 0-12 10yr4/3 none sl 2mgr mvfr gw lm .5 .6 5 2 12-78 7.5yr4/6 none Co S Osg ml na na .7 .8 Ground elev. 100.6 ft. Depth to limiting factor +78" Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel DAvid Langer 1554 200th Ave. CSTM2298 SW4NE4 S29-T29N-R18W New Richmond, WI 54017 MPRSW 3254 town of Warren (715) 246-6200 t lot #1 N 1"=40' BM.= top of 1" steel pipe C el. 100' Alt. BM.= top of 1" steel pipe C el.99.53 all downslo s within 20' of system to be kept less than 20D/ - alt. alt. site system to be step down trenches at el. 101.9 & 97.6 le' o~ E~ S~ zp/ Z:.3 Gary L. Steel 4-27-95 FORM NO. 985-A IIGMfI~rCmpny~ ' CERTIFIED SURVEY MAP SCALE IN FEET UNPLATTED LANDS 33'3 THIS INSTURMENT DRAFTED BY I JOHN D. NICKLEBY 0 200 1400 SW-NE I POINT OF BEGINNING CERTIFIED SURVEY MAP AS I RECORDED IN VOL. 3 PAGE 86 S8804S488W S 88° 43' 48" W 131 T.53' 88.45 448, 55 W 1/4 CORNER 0_6 24.5' 537.00 15 w 15.95' E 1/4 CORNER U) t erg: SECTION 29 T29N, R18W Nom' ` I_ - W 1/4 SECTION LIN p O p ~O 1 O 1 o tiLo 2° I z I LEG~ND- Z I o- -n N 2.90 ACRES } N V 3 U O0 a 0 6 o EXISTING I° IRON PIPE QI W W Z~ 2 N 88°.43'48"E 537.00' 3 Q J w w Q 7700 o-11 460.00' AA w 3 pa of Q 3/4" X 24° ROUND IRON BAR wI w u_ _j F m op p C zzl 1,502 LBS./ L. FT. SET HI W O W °jo 2 ~ F- Y JI aj O > w o 2.16 ACRES p c o SECTION CORNER BERNTSEN CAP al z W W I- NO N cr N NI WI z a 1, z 0= p 460.00' I , EXISTING 3/4" IRON PIPE ~I a-a3 ' W N O o r <1 m a)- a N It S 880 43 48"W w_ z al m v EXISTING FENCE A W W V) U N p to p 3 I a s O Lo s Lr) W= tL p 2.16 ACMES 3 o Q ~ O ° N ° F L c-D 87.Od 210 4 6 0 . 0 0 17 ° 02' 55° DIEn s~ 89 Fa S 88° 43'48"W 947.06' ~ so. 57` 1, V ~'A F+ zo,, 66' PERMANENT EASEMENT'` coo -(0 00 0 *swf~ OF a°"~• N W - S E OR iro, GOVT. LOT 2 t3: r 0 ~ ol - I 4 " N APPROVED 14.59 ACRES n1) - (D Z 0) 1510341111 . N OV 2 9 19?9 RADIUS LENGTH= 267.00' ,4V1 W CENTRAL ANGLE= 56051,13811 ~ti~ ST. CROIX COUNTY TANGENT-BEARING=N2°2457°W p /^1 r` O/ N CotAPRENENSIVE PARMPLANNING °N BARN ryc°o ryvj6 s/ ANDZONING COMMITTEE 10 pow SHED AIPROVAL OF THIS MINOR Suzr)jV'1S,,t g °~h2 N53°39'41"E • °s, <1 DOES NOT MEAN a° 13.30' 6i APPROVAL FOR n°% I-" BUILDING SITF nD cC.,,....._ _ - 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. Owne r of property 4/19 LA-wcoaz-- Local ion of property_ ~VJ 1/4 1/4, Section T ZIN-R ` W Township LA40t &j Mailing address 909 0 1 ~~10 Address of site 1 Subdivision name Lot no. Other- homes on property? Yes No Previous owner of property £v;&LL- Total size of property 7 , 0 4 4-fztS Total size of parcel Date parcel was created 17e[ . f ~-7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes < No Volume 3 and Page Number ge N as recorded with the Register of Deed:. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAW.PY 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 (ate) 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. i/L1 .1 , and-that I (we) presently own the proposed site for the sewage disposal system or q-, (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 o.f. Deeds as Document No. 5-2-9 Li L4 I 0 7 Signature of Applicant Co-Applicant 11-it- OI 1:11111at-ilre Date of Signature ~f GL-12- i0So --(fl0 STC - IOS Srl'TIC TANK MAINTENANCE, AGREEMENT S(. Croix County ONVNI?ItAM11IF.It JI n 61. - MAUANG ADDRESS « PROPERTY ADDRESS I (localion of septic system) Please obtain (tom the Planning I)cl)l. CITY/STATE qo i-;&Z 1 S PROPEIRTY LOCATION t,~l 1/4, a(- 1/4, Section TOWN OF 2(~7 ~j ST. CROIX COUNTY, 1YI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAI'3L12j / , VOLUME, I'AGE 4'9q , L,OTNUMBER i 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 (lie 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. 'lllc property owner agrees to submit to St. Croix Zoning a certilication 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 ;Ind (2) alter 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 al;rce to maintain the private sewage disposal system in accordance with the standards set 1`61111, herein, as sc1 by the Wisconsin DNR Cellilication stating that your septic has been maintained must be compleled and returned Io the SI Croix County Lon;ng Officer within 10 days of the (lire scar expiration d; c til(;NFl) ~ ~ - I)ATI". `I t'Imx l'(Inn1Y zoll'111; ( )Ilict. l;tlvCrnlntrnl Ct•ntc1 1101 (':)1Imt•11.10 Road Ilnds,tn►. \\'I +~I111(+ t l/'It C7p~{ ,4 Stns Bw of WbwnsW Fong 2 -190 DOCUMENT CUSAENT UMENT 't NO. L rot 12.43 ra'f 0, r ~,,~~GIStEA'S GF~7r~ SL CROix Co, ,!i Thomas F. Sewell, by Kristin Ogla:d, his turd for attorney- - act, MAY 3 0 1995 at 800 AJA conveys graata to David E. Lamer and Danielle K. OdJu alzIA MY A Al mint tan/nt= De0ft THIS rFACr RrarRYlD FOR WORM* DATA /000 NAMr AND NT I{00111p tb idlowia f doerftd ad a" is St. Croix Caulty. am d Wboods (Parcel Idendficedom Number) %Vt of Gaw~t Lot 2 of Section 29, Tounddp 29 North, Range IS West, $E. Croix Ctxaaty, Wisconsin described as fallms: Lot 1 of Certified Survey ft filed Delcewber 13, 1979, In Vol. 3, pqp 894, Doc. No. 361791. it, not - moltil may Baowdon to wwmaim Easements, restrictiaos amd rights-of-way of record, if any. DtIMi°~lir 4O day of may ,19 95 , (SEAL) t P O, ]z (SEAL) •1 Thomas F. Siwll. , Hta (SEAL) atbamey-ln-last (SEAL) AUTHENTICATION. ACKNOWLEDGMENT - STATE(F WISCOTI IL - Se. caatitti Cous>ty: sodWa imed this' --do of , 19 hraoASAy came below me dds 26di` day of . Its- do sh, strand U~ P. Samil, ad". ft TRUE &WAIM STAM BAR OF WISCONSIN (K c "*wind by f 706AC Wis. Su&) on aw kown to bb the pamcm Y~1iMd titre meat! red:iv • THIS INSTHUMENT WAS DRAFTED BY irRq`y4i~ _ _ ' t i