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HomeMy WebLinkAbout042-1094-50-220 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 5 c,Address I (c a 6 AL) 2 t' City/State - r~ -t Legal Description: Lot Block Subdivision/CSM # 5tal t/1 Lug, Sec. 23, TAN-Rj-&W, Town of u & PIN # - b 4 V- SEPTIC TANK DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer w Size ST/PC /Rx / Setback from: House 30 Well 495' P/L Pump manufacturer "W Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: o4 Width Length Number of Trenches Setback from: House RR" well //D r P/L Vent to fresh air intake ELEVATIONS: Description of benchmark NE 4 :5;t4- 160 ~ Elevation 7 Description of alternate benchmark Elevation Building Sewer /O r ST/HT Inlet 6 ST Outlet (0 / PC Inlet i PC Bottom Z 3,3 O Header/Manifold Top of ST/PC Manhole Cover i Distribution Lines 3,1 ( ) Bottom of System ( } 3 9,57 { ) ( ) Final Grade { } ( } ( ) Date of installation /a I / Permit number (p0 State plan number -a/0 .3 A'sl . f Plumber's signature License number /'AA 2V94 Date Inspector T4, Complete plot plan or 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 N 7. I I jj r b 0 I 3n ~o- ~v INDICATE NORTH ARROW L Wisconsip Departmeptof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299062 Permit Holder's Name: ❑ Cityy ❑ Village Town o : State Plan ID No.: SCOTT, AARON WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax 0422- -1094-50-220 27 TANK INFORMATION ELEVATION DATA A9700379 6 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ) Benchmark 7b,5 l to , Dosing /,/x Aeration Bldg. Sewer ?/,o / Holding St/ Hf inlet 990 TANK SETBACK INFORMATION St/jx Outlet 91 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Airlntake Septic NA Dt Bottom Dosing NA +JWIMan. 3,/S Aeration NA Dist. Pipe Holding Bot. System 3. ' 2S( PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand y /d.rJ Model Number GPM TDH Lift Friction System TDH Ft Loss mead / Forcemain Length Dia. Dist. To well 3_9S~ n ~ SOIL ABSORPTION SYSTEM t BED / TRENCH width Length No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIMEN I N -DIMENSIONS LEACH SETBACK SYSTEM TO anufacturer: P/ L BLDG WELL LAKE/STREAM C BER Model Number: INFORMATION TypeO OR UNIT System: DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole size x Hole Spacing Vent To Air Intake u Length Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 33.218,SW,SE 1162 60TH AVENUE LOT 2 X" X- 64,1 0 .,a. t~, rvi • Q fe~0 r C . ~ drx A,.*`: li 1 ~tfn e a t ~j /J Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert- No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: j Safety and Buildings Division SANITARY PERMIT APPLICATION pp Box796ngtonAve. Wisconsin In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 Department of Commerce • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8 112 x 11 inches in size. state sanitary Permit Number • See reverse side for instructions for completing this application n/ The information you provide may be used by other government agency programs ❑ Check A' Vision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Propert Wrier Name Propert Location N, R E (Or 14 - 1/4, S )i ~ T Prope yO-N 's M ling Addr Lot Numbe Block Number City, State ip Code Phone Number Subdivision ame or CSM Number ( ) 7_3 I 15-75W A p Ity II. TYPE BUILDING: (check one) [3 State Owned Barest Road El Village Public 1 or 2 Family Dwelling - No. of bedrooms AeTown OF r' III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo _ 16 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home, 10 E] Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Restaurant/Bar/Dining Merchandise: Sales/ Repairs 11 E] 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) New 2. Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. E Repair of an A) 1. ❑ System Tank Only ExlstingSystem ___ExlstingSystem S stem 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,KMound 30 ❑ Specify Type 41 ❑ Holding Tank ❑ 12 E] Seepage Trench 22 In-Ground Pressure 42 Pit Privy 43 ❑ Vault Privy 13 E] Seepage Pit 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: Fee Final Grade 1. Gallo Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. E. i ~ I Required (sq_ Proposed (s q. ft.) (Gals/day/sq. ft.) (Min./inch) _ Feet t VII. TANK Capacity Site Fiber- Exper. in gallons Total # of Manufacturer's Name Conc ete con- Steel glass Plastic App INFORMATION New Existin Gallons Tanks strutted Tanks Tanks ❑ ❑ ❑ El El Septic Tank or Holding Tank Lift Pump Tank /Siphon Chamber 7.7 ml_~t ~ ❑ 4 ❑ El ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's ame: (P n Plumber's ' ature: (No m PRSW No.: Business Phone Number: 7 Y-5- Plumber' ss treet, taP ode): ~ ~ ~ ` % J Q© IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sa ary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps)- ❑ surcharge Fee) "IV Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber SBD-6398 (R.11/96) INSTRUCTIONS ; I. A sanitary permit is valid for twb.(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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 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. 09-09-1997 01:00PM FROM GUINN SWIGGUM & GILLE TO 17006345150 P.01 IAI, MOUND DESIGN RESIDENT INDEX AND TITLE SHEET . r.`:.... :•v" ii.i-•!!!!!i :•i Project rr! Owner AA&q tis C.e Address Legal Description SA✓e j .Sf %-YA-4- Township..-~ _ county 0", Subdivision Name Lot No. Parcel ID Number 64117-10-9-S-0 Plan ID Number fix- 2/04 .P.o.w.T,S. Conditionally INDEX SHEET PAGE ONE MOUND CALCULATIONSPAGE' TWO APPROVED MOUND DRAWINGS PAGE THREE DEPAR NT OF COMMERCE PRES. DIST. CALCS. & LATERALS PAGE FOUR DIVIS10 aAAFMAN0'P9NG3 PUMP TANK DRAWINGS PAAG`E FIVE SE CORRE ~CNDENCE Designer License Number I Signature Phone No. 7i =.Z` 9~~" Date Notice: Tampering With this file by unwAhortmd persons is prohibited. Defiberate modification will result in disciplinary action under s. W.90> Wm Stab. SBD•-IM62 E (R.OM7) Page 1 of 597-2703'7 s~7r z-/C 3-1, J 09_%16_/97 _TUE 09:34.. FAX 1 715._ 268 7207 NW SAVINGS BANK 10002 ,~L~.l'✓~o.X /z ern 597- z Jo37 the 5/0/c Ao.. Pip 0 4 Da,c~ 7G. y S97-2103!7 09•/16/97 TUE 09:05 FAX 1 715 268 7207 NW SAVINGS BANK 10 004 w •GC•~ low 4 (000 ~n~ per.. r~.1?,Q Q 1,444, s iA C,~QQ Cc,O/ Z G~ ' gel/ ~ G 3 ' ~o ~.co ..c e14 1 +;Z S97w21037 4-aal cam..,. 1 .Z 000 f9'z Jocap cj~ 09%16/97 TUE 09:34 FAX 1 715 268 7207 NW SAVINGS BANK 1aj003 S97 - 3 7 Ctt/ ~ G3 L e L I1.x C~tl z sys r 7;.: 7;i~ A1404w lo*J- Za,~ Plo f4~ OL.. 9 AJ L L" CA-CU A#d p &moo 1.0~ ~c a SO-1103'7 09716/97 TUE 09:34 FAX 1 715 268 7207 NW SAVINGS BANK 0001 ~3~✓ s/sa _ _ Page Of Sri?-7/o 87 Approved Synthetic Covering fl5Y*~ c ~j Distribution Pipe Medium Sand /,7&,j Topsoil F Elev. O/. E w 0 . 6 % Slope (Force Main Plowed Trench. of h"-2V From Pump Layer Aggregate 0 Undisturbed Soil E I. q- Cross Section Of A Mound System Using F Ap, Zn I Trench For The Absorption Area G /Z.O Fn A Ft. H /P, 0 r^ B Ft. I Ft. Linear Loading Rate= y•$ GPD/LN FT J Ft. Design Loading Rate= GPD/SQ FT K /D•y Ft.3 L Ft Position of Force Main w 3,41 Ft. t W Distribution Trench Of ? - 2 2• Pipe Aggregate Observation Permanent Markers Pipp,es (7lnchtl~ securely) Mound Using I Trench For Absorption Area S97-21037 llalct- 3 09-09-1997 01:02PM FROM GUINN SWIGGUM & GILLE TO 17006345150 P.08 i . -Total dynamic head system head = 3.25 ft 0.99 m Vertical liiR = 9.00 ft 2.74 m Ana laterals the highest point in the Friction loss = 2.26 ft 0.88 m $ystem? Yea "X" here. Total dynamic bead = 14.51 4.42 If VA what is the highest elevation ;Oyes Volume downsbeam of pump? Eaters! void volume gal 48.8 L Fords main drain L..~.~J Minimum dose = 150.0 921 567.8 L track to tank? (X one) Drain back = 21.8 gal 82.5 L ~ Dose volume = - ! 650.3 L F7~7-fNo 1OX ✓"O✓z. /-rS T ~/3 Typical Pump Chamber layout 1n combination with state approved tnaaiment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole coven weww proof whvarrring label and padlock ' grads fevers Nncliotr box gvddc disooned - abernete 4« v el ftk as par NEC 3W and Oui12t Comm 1628 WAC location 18" (40 cm) min. Ei of pump L.. - approved = chamber or outlet - OWTlbinatlOn joint tank A lAr weep Grade towels alarm on Wo as r umo W* mw**W = 4• m.L above *W d sae, pump on 8 MOM" wmv ~ ~ =,oe ffmf ~ aDwe ~wa+ea grass. C vw v 17 left apove I W pp VWe pump 93.1 ft = sod no mil above 4r,WW wade j i off elev. 28.4 m D 3 " 5 mm of tang under tm* and anchor tank as necessary 92-0 R Pump tank eleveRioa 28.0 m bohom of tank Tank specifications: HUFFCUT Pump tank = 15 allm j ;Puimp tank volume = t100 Capacities: inches Gallons A= " 299 _448.2 ;Pump manufacturer. OEU.ER e 2 W 30 0 Pump mode) number. N98 C = 1j- D= t 4 8' j Project. AARON SCOTT 713 • c' 4 :Plan I.D. S97 x3037 Page 5 of i i g7-9,1:037 09%,16/97 TUE 09:95 FAX 1 715 268 7207 NW SAVINGS BANK 16005 P~c r I /am l.7ra dY $IRV* Sky ZjF j .S 337x9 h~/S w Warro~, Tw~ MOT Sca/e S~ er+ Alt a2 1037 S 9k.. 11 /aa Qom, 7"/ o ~j Rf' d• p Fed STOP a~ 01 the f -atA IL moo 20 Sao rO' 373 s1 '70 NAVIAW ~lcz~ S i~~ s S97-210 7 yo ,4e 09-09-1997 01:03PM FROM GUINN SWIGGUM & GILLE TO 17006345150 P.10 (a fir HEAD CAPACITY CURVE - /A• o I MODEL •'98 I 90 ~ - ! s/a . L 0, 1 117 11 1/2 Nr+'• 0 ~ y l (J LC rS 'n 70 30 t0 : n An 7u Ito IfU tt.,t 2~(1 a F1.Ow PER MINI ire ' I I r,v...~r.:Y" ns.iFanrrcn•r~nrtr i ..«r-..e.•a•~ s ,r~t;rrY 17 { MA7 {l,f;I ►rt?tlns am's I, Tits Ij 1.7Q 77 ar• 1 Ric 75 W3 { 11 •r.► va7ti 73- 1 11 tll. r ; J -L. CONSULT I`4^''r1RY FOR SPECIAL APPLI :ATIONS uctrical Mioiclatnr;;,, toff ti;Iplex 5v"401,115, ;Ira rvaildblo alul • Mosrury float swnct ; am available for ronlrolling 9inglo and. ippt~ej 1`114 ar7 alarm. tit tta phaso nplf tr CCtlafli61 attenwtrtr°,, tot c1u[~1t'7( ~yst•1,~; Itrs avail atNo with t.1 • iluut7b piggyback , urc:ury 11OM"SwitCh9S WS available lot !I-cAVt al;Itm :•,witche:• yr r•.,►t1.^,'^v9! 1,)r><j t {;III conffcls. I !:r+. Cc r+ON GUIDE _ SIJ.r1dir(1 all (Tr('dPt'. - Vt/Cft ht :S~ 117': is }i.P. s lr,{saralgo.. oor•s{eo i r, nre...+.r,~~.~.~:ti.w._:::~rtWtnd.AgVked. ' t 1..:wr.gStiplgpyGC44.x.{ roomsw of ~Atl~tkpl~F:•Wwfy.nett i T O ~i•.rl~_._- _ Cr`nt, d 91r e~i01~ .v.{rzfi. ttnrwr to rIt{i177 'tlvt Npttr'1+}~ Ik,ur f Awl _ .&im~(rc ....L-._. Uu tits j ,r. ~6w !sr)kai altfnrntcv tt 072 :r IV-m75. 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FWW13: v0*1.0,W@ tuns. 1; 6044/. -1.1 5Y•YJws Crarboal tw1411110." a•e,yb • s I •p IN wvl rMrwl MaWn• i,.a7••s C.... .-.<1 ••.d tlw G .cvONlw.l 5d•rr ...t: tai si\rYiy PC-WE t'ZYwU i(E S - i1/ii ' for unusual conzi,vur,; raS6n';; d:I%;i IS E ll; trr!t~r .110 Ine c nign or e•: ery Z :,7n 6 Atti'~ ~OIALit? P.Qt tldlf ra7u~ • . xw tw am" 14M M_ Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page a , of Division of Safety and Buildings In accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County G%~/~~ Include, but not limited to: vertical and horizontal reference point (BM), direction and 57 percent 91ope, scaI6 or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ff oft?_ . /OW- 5_0 APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal informstiori you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 2 Q 1716.!/it'// S /V>C/, ''DAJ Govt. Lot ,Sw 1/4 5,C 1/4,S 33 T 2f f N,R /p E (or) W Property Owner's Mailing Address a ~i Lot 1e Blockff Subd. Name or CSMff 2 y cry. RIO • X/ z Cs.Gi ,o=,vo1.v6-- City State Zip Code Phone Number Nearest Road RoAa S w/• S~foi.3 (7~S > 7 •3367 ❑ City ❑ Vil L~7 Town ~b i1v~ [JINew Construction Use: ❑ Residential / Number of bedrooms 3 - y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow y& b0 gpd Recommended design loading rate AflY bed, gpd/f? • 3 trench, gpd/it2 Absorption area required r~ _bed, it2 S~ trench, ft2 Maximum design loading rate bed, gpdfflz trench, gpd/ttz Recommended Infiltration surface elevation(s) -P2. ..3 • (0o ft (as referred To site plan benchmark) Additional design/site cons Ions S'/'T E" sVi .fA1&_ pyGy f Ojt!' lzle 49 7` E ~S ST~°'ifS Parent material SC~ ~07 SIA- TI4 /O ,9 S~Di~.Qvt7~S Flood plain elevation, if applicable ft O .v T' System in Fill Holding Tank S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade U = Unsuitable for system ❑ S I(d'U ~ ❑ U ❑ S L~ U ❑ S ❑ S I9-T ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/1`12 In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench !9-10 16,vX 5/3 1-65k e5 If Ground 3 . l lo Ylle y/ 57 L- 17el, Cs lev. 100-ft. y .ti AJ r- Depth to y~ /d ! limiting factor 34L__ In. 5ST Remarks: Boring # /O /d Y 3/3 L :.5- 2- o 100 Ground 2f-5-2 - 7.5 If G 5 G d A, h • G~ .C r . 3. ' , y ; elev. ~o o eft. S 3 P GG / nvt P7oi' ,V n Depth to 71 limiting factor Z$_In. Remarks: CST Name (Please Print) Signature Telephone No. 'Ro ti~rR r .1- 715 - 3b* • R/N S Address Date CST Number Uibricht & Associates l~. T-7- . CJ7-/40 )-q d'2_ PROPERTY OWNER SOIL DESCRIPTION REPORT pa 2 of 3 9e PARCEL I.D.# LOT 2- CSC-/ Boring # Horizon Depth Dominant Color Mottles Structure GVD1fl2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 25 /a Ke 3 S/G -76s Ground 7 S f 0i 7c ' . y S elev. ~18~ ft ~oli~ ` 12 >Q- 'fAt S Depth to limiting factor ASS Remarks: Boring # K ' Ground elev. ft. ' Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Boring # j , Ground elev. ft. Depth to limiting factor in' Remarks: III rop or c.v. ruE yoe 's 7 f/ z/' ig Lib /17 ----,o 2 f33 q2 3' I -)- i • 0 i _ ,(110 al • A, /V 2,,v/r=0,44 roA rave L i'NC /00,&c, / 313 ... 3,3 GOT 2- t Ulbricht&Ass clates Consultants Private Sewage 656 O'Neil Rd. ot6 Oudson>Wis. f F yP o -- �y0 ZP CL /10v,vv sysT, _ 90 is/. �o0 _ /34( -e b'rs N . 0 ,1 12--j-, 3. 6 0 9'cO cl tt F11.E~ ~ ~ 'C~~ ' 1997 3111 w G~ o T -a p` Kp~e~i~~oe 5GIS47 CERTIFIED SURVEY MAP DENNIS NELSON Part of the Southwest 1/4 of the Southeast 1/4 of Section 33, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. • 1" iron pipe found. Owner's Address: "Fence \NP~4 T.TE 1224 C.T.H. "N" o 1" x 24" iron pipe weighing 1.13 lbs./line _ ~1-44,,O-s, Roberts, WI 54023 ft. set. UNPL A r r£D LANOS~, -S- Dated: March 26, 1997 A. 45Z S 00.06'37"W 382. 7s ` "Revised this 21st*_. 1 _ day of May, 1997." o E LINE SWI 4 S£ 114 1 `11/11111/l~11i = h ~~I/ O N ~ ' LAUR NCE' ~I p m . m W M PH c~ h MI S 718 m o VI ~N 0 2 N FALLS,,: J~ °o W I N W WISC. JQ. ,4 Y a ~I v C1• a 0 40 Laurence W. Murphy o UNPLA rr£D LANDS C) Reg stered land Surveyor °o S 01•05'20"W 439.7/' ( y M 30 373.70 . I 6. 2 Q -4) O W W h I h W ~ a~ Q~ N ° 0 0 ~ 111 I O m t. V N N h v M 1~ Q 4+ J I a N O I N N N O I h O W I b Q I „ (h I LU h W 373.70' 160/ N Q ~o Q: C- a •l ) l~ h C, N O/• 05'20 "E 4 J 0 f\ N O Z Q 3 O O 'n I „ 6 6' ° ki o ~ I Q~ J i N N I = I O° Q N ALL BEAR/N 6S REF. TO TH£ SOUTH LINE OF THE p „ 2 v S SE 114 OF SEC. 33, ASSUMED N 90.00'00"W I li O Q ~ O N. ? I~ 2 h M Q F t,~ JI 3 I h t' I ~ ~ I O Y f Q O> m O C O~ V 1. ~ O Z This inGt.rument drafted by Laurence W. Murnhv ~i g 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 Location of property _,j_ l/4,5L: 1/4, Section ,TacjN-R/,A W Township Mailing address ;,4 1,c~( Address of site //(v v2 - A LI Subdivision name Lot no. Other homes on property? Yes___&_No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for ('spec house) ? Yes _.k No Volume / f;~ and Page Number 33-~3 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY.:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the off* e of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. r~ J Signature of Applicant Co-Applicant S T! [ -1 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER G r h S C o-1" MAILING ADDRESS PROPERTY ADDRESS z to vZ - ~12 o A 2(location of septic system) Please obtain from the Planning Dept. CITY/STATE - 7 PROPERTY LOCATION 6 tq114, s5/Gi/4, Section T~N-R /CqW TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME PAGE 1G' ZOT 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 expi tion date. SIGNED: - lizIr-1 DATE: _ f I l / St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . - y VOL 1253PACE 11.8 WARRANTY DEED Document Number: AFG15f : 'S OFFI A 562780 S7 CROIXM.,Wt Return Address: -n J j + 1 2, y. 199» / ;La a 71~ 10:00 Ra„i-tat .:t CSeode Parcel I.D. Number (PIN): r 1 This Deed, made between Dennis R. Nelson and Faye F. Nelson, husband and wife, Grantor, and Aaron W. Scott and Denise F. Scott, husband and wife, as marital survivorship property, Grantee, Witnesseth, That the said Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 2 of that certain Certified Survey Map dated March 26, 1997 and revised May 21, 1997, recorded on July 2, 1997 in the office of the Register of Deeds for St. Croix County, Wisconsin, in Volume 12, page 3293, as Document No. 561847. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging: And Dennis R. Nelson and Faye F. Nelson warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. e~E Dated this ZZ day of ~~Ly 1997. # 'ZZSS~ Dennis R. Nelson da-j~f' Faye Nelson ACKNOWLEDGMENT STATE OF WISCONSIN) 1 ss. ST. CROIX COUNTY ) Vol ~:253PacE1~9 . . Personally came before me this z: 2 day of 1'51', [V_1 1997, the above named Dennis R. Nelson and Faye F. Nelson, to me known to be the persons who exeecuted the foregoing instrument and acknowledge the same. Notary Public q a r _ ' St. Croix County, Wisconsin My Commission •'"~Jjrrrnnr~r~a,~,~~~'r'I THIS INSTRUMENT DRAFTED BY: Steven B. Goff Bye, Goff & Rohde, Ltd. PO Box 167 River Falls, WI 54022 SBG\Nelson, Dennis\61 Warranty Deed.doc -2- t