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HomeMy WebLinkAbout010-1034-50-100 ti ~o O (D 00 I r~ 0 c N f`. U N O y C y .o ° E E ~ I x 0o o ~ Y L C co I ha n 0 N ~ p U C 7 O U. c C C O (O M V N Z N U) O Z m m O d m w 0 0 c C7 m O Z d Q cUi Z ,s`t' c z E O T M E C~ A C N O O •!V 'a L - C N O Z Z ° N Z Q CF) W N C N Cl) N m W O O O M O 0 a al co Z > F- 1- z .N 4i ~aaa :3 o N N v~ V E rn rn co (D ~J U M O O N O CD C) 6) a) : Cl- lV p 7 M7~ N O o o U 0 i+ O C ~ O N O 6~ © ce m 3 to v m o 0 0 O N O CO 0 0 0 0 r \ N ~ - v) vl 'Y V o) m V rO„i MO 7 U N 7 Z -Oj Op a O M O N rn E M U W LL N O 4 h O .ter a i • a d ;v d v E riw 3 'o e l `1 7 ~ 10 Gb. j STC - 10 4 AS BUILT SANITARY SYSTEM REPORT, fr y3. ?.t wr0,5 / ST caa+x OWNER 1Z- ZOhfl ti ADDRESS 1LA~ r::~) sS~o S SUBDIVISION / CSM# LOT SECTION l y T,3 Q N-R l5 W, Town of~~~r! ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q a_~ 60 o ,A x INDICATJNNORTHHARR Provide setback and elev ation information on reversProvide 2 dimensions to center of septic tank ma BENCHMARK: elk ALTERNATE BM: O 4'YL SV SEPTIC T PUMP CHAMBE / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well _~I~y ~ House Other Pump: Manufacturer_ -~1 Model# L Ll~ 4,3," Size Float seperation S `f Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM width•• 3a..? Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well: ij~ ~ House (L Other ELEVATIONS Building Sewer ST Inlet. ST outlet Pc inlet 7 PC bottom Pump Off Ze~ Header/Manifold Bottom of system /C)3. 7 Existing Grade 0.2, Final grade %Q CJ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: S- INSPECTOR: 3/93:jt Wisconsin Department of industry, PRIVATE SEWAGE SYSTEM [Sanitary ounty: ST. CROIX Labor and Human Relations INSPECTION REPORT zSafety and Buildings Division (ATTACH TO PERMIT) Permit No.: GENERAL INFORMATION Permit Holder's Name: 'El Cty E] Village R Town of: tate Plan ID No.: FULTZ, CARL Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: rdb 00. O r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic dL~G,aca.a ~4 r 1j Benchmark Dosing Aer a 1 9j-~ Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic _NA Dt Bottom's Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System 39 / PUMP/ SIPHON INFORMATION Final Grade Manufacturer C,-'-~tQ. Demand p 3+k - biz ~1 GPM Model Number (J E TDH Lift ~P Friction ) S stervt ° TDH Ft Loss - H a Forcemain Length ~W Dia. " Dist. To Well Ll SOIL ABSORPTION SYSTEM Width Leng(, 11 th No. Of Tr riches PIT N No. Of Pits Inside Dia. Liquid Depth BED /TRENC H DIMEN 1 N ~°_30 Manufacturer: SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING SETBACK CHAMBER Model Number: INFORMATION Type0 ,4 System: Pliful•u.A /60 d OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over xx Depth Of -l- xx Seeded / Sodded- T~~u l ched Depth Over Bed/Trench Edges Topsoil V'Yes E] No Yes ❑ No L Bed /Trench Center COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD-14.30-16W, SE, SW, CTY RD G 'Y,d equlrecl?° ❑ Yes [ErNo Flan revlslon Use other side for additional information. Date Inspector's Signature Cert No SBD-6710 (R 05191) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e i. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 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. ST CROIX • See reverse side for instructions for completing this application State sani ry ermit Nlmer et ire ~Trs lon, P The information you provide may be used by other government agency programs C E] Ch [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S96-40382 Property Owner Name Property Location CARL FULTZ WZS /4 SJW 1/4, S 14 T30 , N, R ,1' F/VWW Property Owner's Mailing Address Lot Number Bllyymber 1]VV/A 408 W 18TH STREET N/A City, State 1 'Code Phone Number Subdivision Name or CSM Number HASTINGS MN 53033 (612) 437-8078 N/A 117 II. TYPE OF BUILDING: (check one) ❑ State Owned E ~tNearest Road ❑ "rage EMERALD CO ROAD G ❑ Public 1 or 2 Family Dwellin - No. of bedrooms _ 3 Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 010-1034-50100 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only______________ Existing System _________Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 900 900 .5 N/A /03.65 Feet !0 ?0 Feet VII. TANK Capacity site Prefa Fiber INFORMATION in gallons Gall tons anks Manufacturer's Name Conc ebte Con- Steel g ass Plastic App- New Existing strutted Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 650 650 1 MIDWESTERN PREM~ 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) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON L /C MPRS 3215 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signal tamps) urcharge lee) Approved ❑ Owner Given Initial `1 Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SHD-6398 (R. 05194) 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. 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 oily one on line A. Complete line B if permit is for tank replacement, reccnnecticn, 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 r. Vli. Tani; information. Fill Jr) the capacity of every new/or existing tank, list the total gallons, numl)e, cf tanks and manufacturer's m-,,Me~, indicate prefab or site constructed and tank material. Complete for a/P _~el:,ti:., pump/siphon and holding tanks for tl;is system. Oi,eck experimental approval only if tanks received experiment,;I product approval from DILHR VIII. Responsibility statement. Installing plumber is to fill in name, license number with pproprlate pr( fix (e.g. MP, etc.), address and phone nurnber. Plumber must sign application form. IX. County i Department Use Only. X_ County i Department Use Oriiy. Y_ t 11 ,catiu, _ n R 1/2 x 1 ;n,_h•_ suf,,,, n The plans must 1"Oi. I✓ i, Oravvi,! U. Or'vvl .i •,.O rll F;i r'I"•ii Or I 7. J g tank(s), septic ,..j f i_vrlp or siphon b.._ cling served; GI: _ Ose volume, C . , _ ;a' ~i: •t, v'_st uai~ vita iig ,nf -,ri-nation _ GROUNDWATER SURCHARGE 1983 Wiscons.n A.ct 410 included the creation of surcharges (fees) for a number of regulated practicf,:s h,ch can effect groundwater The monies c' -cted through these surc~iarges are used for monitoring groundwater con amina l,> i j tigat-ons and estab~,sl it of standards. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations May 22, 1996 2226 Rose Street La Crosse WI 54603 HELGESON EXCAVATING W1229 770 AVE SPRING VALLEY WI 54767 RE: PLAN 596-40382 FEE RECEIVED: 180.00 FULTZ, CARL W1/2,SW,SE,14,30,15W COUNTY OF ST CROIX TOWN OF EMERALD w S 5 MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system isinased on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Si6rarrdd erely, M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SBDA-7997 (R. 10/94) RECEIVED MAY 1 6 1996 Private g&Q~~sfft Plan Index/Checklist S96-40382 Owncr's Name Plan' g a CARL FULTZ S96-40382 Address gal Description COUNTY ROAD G WISW4 , SE4 14 T 30 N, R 15 W not Cti ALD TOWNSHIP S CROIX Contents FCoiiitnents/,SSpecia1lnstructions Page H Included Two copies nccdcd too all plans l X Plot Plan Return by Mail 2 X Plan View/Lateral 3 X Cross Section ~ I,~tx Letter to (C~~unty) (Submitter) a "tank & Pump/ X Siphon information Circle One and Provide Fax ( ) 5 System Sizing (Public) a Call for Pick-Up: ( ) 6 F-1 Other Seal (if applicable) I, the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer License/Registration N BENNIE HELGESON MPRS 3215 cry _ ~~~----i Address W1229 770TH AVENUE, SPRING:'VALL~ Y Signature p,,, nl!,;c liseOnly Attachments: Application soil & site evaluation Fee y'4«'ltl Needed for Holding Tank Submittal:". One copy of notarized holding tank \~~b All W 4 4 agreement. (Originals to County) Needed for At-Grade Submittal: nffl, Original signed and notarized t ~ r Application for "Use of an At- ~C Grade" county on-site SBD-10268 (N.01/96) C•`~ One additional set of plans 1-4 - cease «t /00 v Pr t' 9.' pv n a 15° r~.c✓ ~01.`~A~ i G ~ Y7o\ 103-15 0 Ioo,oo Copp'a orb: R~~bc•~. y Sa8' o C ~ CL - - - t - Page Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe .A Sin's Q-'3, -1 o Medium Sand _ H G Topsoil F I D b IE7, % Slope Plowed Bed Of 2N- 2 %2 Force Main From Pump Layer Aggregate D J Ft. E ~Ft i 1 Cross Section Of A Mound System Using .75 Ft. A Bed For The Absorption Area F F Ft. A G Ft. H Ft. Signed: ~Yz B r Ft. K_Ft. License Number: ✓'Yf' . PL Ft Date: D Ft. T Ft. Force Main Ft. L Observation Pipe-,,\ F- 01 A I I i~--- Distribution Bed Of 2 - 2 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Perforated Plpe Detoll 0 End Vlew )Porforoled End Cop ° PVC Pipe oboe ~s Permanent End Markers Jot\ \orG s Holes Located on Bottom are Equally Spaced Q .a" PVC Force-Main * From Pump /P PVC ENO Monllold Pipe C N Pvc. Distribution... Plp• Lost Holm Should Be Next To End Cop Distribution Pipe Layout 1 P R S X Y Signed Hole Diameter Inch License Number: Lateral " Inch (es) Date: Manifold " Inches Force Main Inches . - Page, 0f------- COMBINATION SEPTIC TANK/PUMP CHAMBER 4" CI Vent Pipe with (No Approved cLockin Manhole Cover Approved Gap, +25' 9 From Buildings With Warning Label Attached Weatherproof Approved _ .Warning Label Junction Box Vent Cap 12 Minimum Final Grade 6" Minimum - 4" Minimum 6" Maximum 4" C.I. ~ Quick 18" Minimum 7 Insp. Pipe Disconnect I 1/4" Weep - Hole Baffles D LJ i . I Approved Joint A w/C.I. Pipe ' Extending 3' Alarm ~V B Approved Joint Onto Solid Soil On 6; w/C.I. Pipe i C Extending 3' ' Onto Solid Soi Off D Conc. Block 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/o -Doses:1l2.s- Gallons Volume of Backflow:....... + .Gallons } Total Dose Volume:........= i_ •~.i Gallons Tank Manufacturer: Tank Size-Septic/Pump : //-yy- Ga 1 ons Alarm Manufacturer: T F--( t •J S C ~-cr, 3 75-Gallons Model Number: Capacities: A /inches or Gallons Switch Type:- + B inches or__3_~ Pump Manufacturer: + C~ inches or 1ti ?s~allons Model Number: + Dp inches or llons Minimum Discharge Rate: . -1 Total _ i n c h e s or Gallons 3T Vertical Difference Between Pump Off and Distribution Pipe: j,~).%'S Feet Minimum Required Supply Pressure: + - Feet f-;(` Feet of Force Main x l < Friction Factor/100Feet: + -,Feet _Inch Diameter Force Main Total Dynamic Head:...= 1q,3 Feet Internal Tank Dimensions: Length; Width; Liquid Depth Al, X. Si gnat e_ - License Number S Date u-r_~ _ - / u erssi 1e E "fluent Performance Curves , , Pumps METERS FEET 90 MODEL 3885 25 80 SIZE 3/4" Solids WE15H 70 Z 20 WE10H a 60 WE07H f- 15 50 40 PEO 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 0 10 20 30 m'/h CAPACITY ~GOULDS PUMPS, INC. SEW-CA FALLS NEW YORK 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/a" Solids 110 rE15HH I \T 100 30 90 25 80 70 u~ I 20 J H 60 0 ~ WE05HH 15 50 T_ I a 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 D I L H R in accord with ILHR 83.05. Wis. Adm. Code COUNTY y ttach.complala site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELI.O. N • dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY aNNER: PROPERTY LOCATION 'W sc v C~ j^ ~.~05 Q>°y'') $ , GOYLOT GJZ S(Jl/4 s1/4,S/ T 30 N,R 11(oc PROPERTY OWNER'S MAILING ADDRESS ' : 21. To B~~ SUBO. NAME OR CSM S . 3 SOX /OZ XI CITY, STATE ZIP CODE E NU • ~R >c p, VILLAGE N NEAREST ROAD L Y' s, New Construction UseA ResidentiA ber of bedrooiii ' j J Replacement I I Public or 0cial deWt'be Code derived dairy flow - gpd gn loading rate •'V bed, gl~ ' tr ench. 9P Absorption area required bed, ft2 1t2; ° _ i rv sign loading rate 5 bed, gpd/ft2 ' 4 trench, gpd/ft2 Recommended infiltration surface elevation(s) - it (as referred to site plan benchmark) Additional design I site considerations _ /O Z : ~S Parent material t AIC i a ::ti Flood plain elevation, if applicable IVA ft S = Suitable for system CONVENTIONAL MOUND INGROUNDPRESSURE AT-GRADE SYSTEM N FILL HOLDING TANK U= Unsuitable fors stem ❑ S I8 U A] S0 U ❑ S nil ❑ S A U ❑ S J' U ❑ S ,N U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Moores Texture Structure Consistence Bwxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trend ~ r o- / 5 J /0y 33 ltloje El 2,,~ Qs CT •S .1 Ground 3 5-AR.- elev. e s/ . S~K Gw . y /01,-/Sft. 3$ 59 5Y,? Z/ 7. g R .5/f /"7 G s~t ryl~r C, U) • Depth to 5 59-21 5 X9 Y, I `l /a XR s c In K C 0 ' • limiting factor 7/='75 5 7.5 -5' .5,0-/ .2 /n s' k .5 , Remark's. Boring # RL / D-F /0 >.R 3 3 A16 0 2 s.'l 2r>7s~ /-;'q as C-C •s 1,6 2-46 7, 5'Yfl Ale ti e Ground 3 24-410 sYR glAl Ale vi .SI-r r '1'ns CA) •rl 51 S~ y 'S le s ' sc, ZmS ' • 4 ' 5 Depth to - 4miting factor - Z-/o F-1 Remarks: CST Name:-Please Ptiint' Phone: Address2?'0 /vC l r\ J/l BO NC-0 Y~ `,V 1 1 1 11 Signature- Dale: '7 CST Numboc Boring # Fiorizo Depth Dominant Color Mottles Structure Pp 111 1~1 Texture Consistence rr in. _ Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Y Roots o- Trcrr; / /p 3 j si / 2 s QS • 5~•~ ` Z 17-Z9 Ala4e Ground z9 3 jYR - y /v0~? /S /"~S~ Ci M.) y s Jr ioi-5n. YR C y:•.~ 6~rtu6fhngto `f:5~ sy,' s 7~5` s Sc ZmS~ o factor 37 Remarks: Boring # Ground elev. . ft Depth to limiting factor Remarks: Boring # Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. IL Depth to limiting t factor Remarks: rr~ • STC-105 SEPTIC TANK MAINTENANCE AGREENT St. Croix County OWNER/BUYER . CARL & MELISSA FULTZ MAILING ADDRESS 408 W 18TH ST, HASTINGS MN 55033 PROPERTY ADDRESS ~j-'30 G (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION W1 SW 1 SE A, Section 14 T 30 N-R 16 W TOWN OF EMERALD ST. CROIX COUNTY, WI - SUBDIVISION • LOT NUMBER CERTIFIED SURVEY MAP_ . VOLUME, PAGE-------_., LOTNUM13ER 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%0 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: ,s- 46, St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 a ~ STC - loo 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 CARL & MELISSA FULTZ Location of property W2SW 1/4 SE 1/4, Section 14 T 30 N-R Township EMERALD --16 --W Mailing address 408 W 18TH ST HASTINGS MN 55033 n Address of site_ yet" Subdivision name Lot no. Other homes on property? Yes r No Previous owner of property SW,e~.t i°m S fOr.'Dt S Total size of property. O_a~r,~ S Total size of parcel - Date parcel was created Are all corners and lot lines identifiable? des No Is this property being developed for (spec house) ? y y s' Jib No Volume No ~o- and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process.- If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY I (we) certify that allstatementsCERTIFICATION onthis fo best of my (our) knowledge that I we am (are) th are true to the property described in this information form, by w virtue oof ha warranty deed recorded in the office of the County Register of Deeds as Document No. own the proposed site for the sewage ~disposal tsystem ) orpsntl r I e(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. S '4a t u ~ of licant Co-Applicant Date of Sianature D~t_P of Sinnat„rr, DOCUMENT NO. WARRANTY [SEES THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 517955 ~ 1og Q L3 YOL 3PiGE 83~ Sween Brother Farms, a' General Partnership ~I RWd1brRt-id - - . . - by Paul V. Sween, General Partner, said - - - i! Partnership a/k/a Sween Bros. Farm a - JUN 16 1994 Partnership . . I 12: 0 P1. conveys and warrants to --Carl j'. Fultz and Melissa M. - - - 11 - -.Fultz.,__husband. and- wife_,.-_hol_ding__a.s---------------- surui-vor_ship.-mar_ital_.-property---_ - I i; RETURN TO li _ . the following described real estate in . --St..___Cro-1X------- ---------------County, - - State of Wisconsin: Tag Parcel No- Southwest Quarter of Southwest Quarter (SW4 of SW4) of Section Fourteen (14), and the West Half of the Southeast Quarter of the Southwest Quarter (W2 of SE4 of SW4) of Section Fourteen (14), all in Township Thirty North (T30N), Range Sixteen West (R16W), St. Croix County, Wisconsin. !T This ----15 -riot-___-___ homestead property. XTQ~X(is not) Exception to warranties: Easements and restrictions of record. Dated this _ day of ..T6! BROTHER 'F GENERAL PARTNERSHIP: - (SEAL) by - - - - (SEAL) - ' - - Paul V . Swe (SEAL) by_:_ -(SEAL) - - I AUTHENTICATION ACKNOWLEDGMENT t c;~.,ar„rorzl STATE OF WISCONSIN ST. CROIX COUNTY WISCONSIN ZONING OFFICE I r r r r u r n■ I MMMM~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - Hudson, WI 54016-7710 (715) 386-4680 November 18, 1996 VIA FAX: (612) 513-0561 Linda Winker North Coast Mortgage 5353 Wayzata Boulevard Suite 200 St. Louis Park, MN 55416 RE: SEPTIC INSPECTION FOR CARL FULTZ PROPERTY LOCATED AT 2530 COUNTY HIGHWAY G IN THE TOWN OF EMERALD Dear Linda: An inspection of the septic system for the above referenced address was conducted on July 3, 1996. This property is located in the W2 of the SE%9 of the SW%, of Section 14, T30N-R16W in the Town of Emerald. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions or if we can be of further assistance, please give our office a call. Sincerely, Mary J Je kins Assistant Zoning Administrator St. Croix County, Wisconsin db 1-05" FQ r S /03 q 83 Al, yss9iZ_ a2 ~ O 77,5 39" ai 36 /00, o Bi - ~a3,i5 BZ scc, B3 -/oi•9j oN ~i6 ~ SwAy sw% W Z 5 F ~ S~'`~~