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HomeMy WebLinkAbout014-1040-10-100 ~p ro It 0 3 0 o p es N ' N G N C ~ N O N i O 0 hl U C N Y I O O O v ° .n Z E LL c 0 L Q x 1 I 3 M Z 3: U Z . O Z G> d rn M w a m Z 0 c (9 O Z d c ,U ~ P 00 w O ry 2~' ~ ~ Z E `s N ~ I c E ~ o ~l d L s_ I C C Q U Z I- Z o N ~ 1 en d c N E L N 0 N i U ° ) i U ° Q) (L .0 0 C14 LO :3 E § 0 0 0 a Z° CL (L 0. U) m co ►+i~ a C m (D N N U ~ rn m (D LO o r m a 0 v frr N N d r Q co C ^ y N ~V °O O N W C C E N n I Q o 3 li a~~i a"i c a y N N lyl H o C C E w a ao 1 L~r V _ U (O - N o 5^ N yid Co N in fc0 E U LL ° =i U) • L~ o i 2 N cca ik w v v as m a a at ° a w • c~ a d d y c E c 0 la 0 :3 Ll V a 2 0 N V Parcel 014-1040-10-100 09/27/2007 04:29 PM PAGE 1 OF 1 Alt. Parcel 19.31.15.289A 014 - TOWN OF FOREST Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/03/2006 02/02/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - ROSEN, LONI J & KRISTIE D LONI J & KRISTIE D ROSEN 2256 320TH ST CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2078 270TH ST SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 19 T31 N R1 5W NE NE AND INC PARCEL IN Block/Condo Bldg: THE SE NE DESC IN QC 828070 EZ-U-1187/526 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 06/22/2006 828070 QC 11/03/2000 632957 1556/160 WD 07/23/1997 1177/270 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/12/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 174,900 189,900 NO AGRICULTURAL G4 36.880 3,500 0 3,500 NO UNDEVELOPED G5 2.000 200 0 200 NO Totals for 2007: General Property 40.880 18,700 174,900 193,600 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 t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ✓ ADDRESS J~ eT ci CO SUBDIVISION / CSM# LOT SECTIONT&E: N-R W, Town of Q,• ST. CROIX COUNTY, WISCONSIN -PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e /g~ ,©ws~ I J * / I V - r5c ~e - INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. { BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:, Liquid Capacity: /G?JQ Setback from: Well ~fb ' House / Other Pump: Manufacturer-Z--4 za Model#. q4F<_ Size it Float seperation 1~2 la Gallons/cycle: Alarm Location it ,,r,;, ,J' y,Z S iZXC/ fy SIB O~tP I SYSTEM Width: l Length 7 Number of trenches v~ Distance & Direction to nearest prop. line: Setback from: well: 416 House Other ELEVATIONS E Building Sewer ( ST Inlet. ST outlet PC inlet PC bottom ,(o~ Pump Off Header/Manifold 9 Bottom of system r p 97, jr6 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: V---- /411 -,0~0c& Z"C y ICENSE NUMBER: 2 73;7' +S PECTOR : 3/93:jt ' Wisconsin Department of 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 PAVI(derlyar0g~ ES ❑ City El Village © Town of: State Plan o'.: FLOIDEST CST BM Elev.: ~lAKL Insp. BM Elev.: BM Description: Parcel Tax No.: /h 'a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 't✓" Benchmark SO /l~•~v Dosing Aeration Bldg. Sewer 7 O~/'/ Holding St / Fit' inlet TANK SETBACK INFORMATION St/ h+f outlet TANK TO P / L WELL BLDG. Ae Intake ROAD Dt Inlet Y Septic 1,4 NA Dt Bottom Dosing NA Header 3, a y8 Aeration NA Dist. Pipe Holding Bot. System PUMP /N INFORMATION Final Grade Manufacturer o ~ Demand , 17 99 3 3 Model Number GPM • _ .5 r 90 I 9C~, j5~ TDH Lift Friction Syesatem TDH Ft Forcemain Length Dia. HDist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN DIMENSIONS 'S LEA anufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION Type Of nj,,80-1R CHAMBER Model Number: r OR UNIT System:,'cr:U 00 DISTRIBUTION SYSTEM Header /#Asv o+d- Distribution Pipe(s), / x Hole Size x Hole S =To r Intake Length Dia- `f Length -5~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or A rade Sy 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: FORES749,31..15W,r NE, NE, 274TH ST Plan revision required? ❑ Yes Q Ilo Use other side for additional information. p SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. tlll~ ip`~~Ilrs Safety o and utildin g Water Division System: vi■rrGr• SANITARY PERMIT APPLICATION Bureau 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. T C • See reverse side for instructions for completing this application State Sanitary Permit Number -4 The information you provide may be used by other government agency programs ❑ Check ii revision to pre"viou"s ap Iication [Privacy Laws. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Liar l rs /~ar42ar/4 /I%gn /4, S / S T 3( , N, R S'€ (or~ Property Owner's Mailing Address Lot Number Block Number / oZ ~c f/2r wY~ R04 J X/. City, State Zip Code Phone Number , Subdivision Name or CSM Number e ~h . ss y c > ~c9 a/c II. TYPE F B ILDIN : (check one) E] State Owned C] ityy Nearest Road ❑ Village Public or 2 Family Dwelling- No. of bedrooms _3 wrl OF For~s7'~ _a 70 s III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 -__ystem ___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 12fi~g4eepage 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 Lr Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 7 S' -3 S-? o Feet ~j cl Feet VII. TANK Capacity gallons Total # of Prefab. site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank f C s e f ❑ El . 1:1 E] El Lift Pump Tank /Siphon Chamber J p F4 COf s w ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: F G~~" L s j~lectl~.~ , w- 6 Q Sy 7 ir- 6 1 s~~ 7 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Saary Pe it Fee (Includes Groundwater ate Issued Is uing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination X. 'CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety a Buihlings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years- 6_ If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal' description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served.. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the folio-;r.ing: 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. PLOT PLAN SCALE 1"=:10 ' S --C- jet, T P 1busE 'Vo %E ftT LQAST- ZS' FZAM 'nZ )IJC*eS • - ~~..L y as •t~ t. k /~`t SViL c: v,,e, 3 Tye` ewC hlfoase 3 De d roo r.. x.1.948 g.3 o j°°°l a Lo (j ~Oe ~!1 -~TL, X00.0 OIJ SPIk~ Z~• OL P1• ~"Q-~~T - IN% ti - ~kL R°s°_\~S t i S 00 ~s`'~wse et g~ - 0 `LZ-IA1~ 101/0 s l EL'i9_ S"W. S'nw. ~ I f .►G2 - ~,~,.M T PA'"PmN 1N ~T1 Prc.. 11Z®v C1 S b~'T CZ►'1WE ~T1 iCEl ~t;~q=RUUS WT -Tkm -Vml;~ OF CON c l1N. rcirs~onsin bepertment of industry, SOIL AND SITE EVALUATION REPORT,, Page \ of 3 Laiior'and Humm Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code . COUNTY F~~> Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but. S C 1x not limited to vertical and horizontal reference pant (B10% direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVRF, ATE PROPERTY OWNER: PROPERTY LOCATION' e ~'t 1~2L~g `r~R2tr se~-tafi- tvF 1/4 E(oC@ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME. J CITY, STATE ZIP CODE PHONE NUMBER ❑CITY F VILLAGE [FOWN NEAREST ROAD 1_ 'h\r L.hlAvt~ MAJ. s S o4 3 (titZ) y 3 6, 6 (,a'1 1--o CZ ~TS't-- Z~ O 'T7t 'T'• Pq New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing bui&@ I ) Replacement [ ] Public or commercial describe Code derived dairy flow Ll S) gpd Recommended design loading rate - bed, gpolft2 o•'BUerxh, gpcW Absorption area required 6 `L3 bed, ft2 S 6 3 trench, ft2 Maximum design loading rate o bed, gfxW ° ` trench, WW Recommended infiltration surface elevation(s) seE NohT W ~ft 8 3 It (as referred to site plan benchmark) Additional design/ site considerations Z 1iZe')c Wei a r_-~\1 S 'x S -)'ri'" . - po s C .pv ih P ie. 'k~Qv 1(LeT> Parent material s 1, L:T4 oU t-V S e Gr. Flood plain elevation, if applicable - It r S = Suitable for system coNv noNAL MOUND IN GROUND PRESS AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors Stem ®S 11U ®S ❑U ®S ❑U URE INS ❑U ®S ❑U ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Motties Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bard3y Bed ranch y a - S l p`t2 zL-L - SI 1 Z'~Sb~t y 1 , a-S Z S-~3 l `2R V-1 - Sl 1 2'f S 1T ►~Vl_ R.S o_S o.6 Ground 3 ~S -6S S `m 3/y - 6b- l S ~ Sig C w o • ~ 0 8 VoX~ It. LJ bS 4b -S `f R_ 31y - S sg M 1 ` Depth to limiting facet r Q , Remarks: Boring # o-S 10 -R z.) _ S> I ZTSb>i: V"L fi, CL - a. S o. .13 3 1B=~S 7.S`tIZ 31Y ~S S wll - o.-I 0's Ground elev. l Depth b limiting i facto f Remarks: TNsne:-Please Print Arthur L. We erer Pine 715-425-0165 egerer S o i Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number: ~~-ao S-3-~(~ M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z•of. PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday. Roots ...-(dPD/ft in. Munsell Qu. Sz. Cont• Color Gr. Sz. Sh. Bed. Trey 3 1 0 - b o iZ / -Z. s 11 Z -3 b1j wi ~l- a-s o S. o. L Z 6-3y 71 .S12, I1 4!! Gres 0-5,bk V vjX_ _ C- S o.~ n•8 Ground 3 3y ~3 S`~2 3/Y ~S o S3 `n-il - 0-7 0,8 elev Q ~1 ft. Depth to limiting factor i Remarks: Boring # ~ S LO `t lZ Z Lz. - S l ~ ~ `F S b k tK'F Ir- a- S - o • S c~ . ~ Z S-~3 ti~~124/ - s~ Z~Q3~h my o.s 0.6 I' Ground -I. $ k rL 3! - S o 3') M 6--) 44 o ft. y ~l8-~3 Lo~2 s~L - 1 s o s w~ 1 ck, - o~ 8 Depth to limiting factor Remarks'f; Boring # a_~ ~~o~.~ 2c2 sal z~sbk m~'1- a-s - ~•s El 3 --t'L I.S \Z 3!y, - 6~ S~3 r-i 1 o o.~ Ground elev. 9~- o ft. Depth to limiting ' factor ` Remarks: Boring # f 1 i Ground ' elev. ft. Depth to limiting factor Remarks: SBO 9330(R 05/92) PLOT PLAN Page 3 of 3 SCALE Vbus~ to aE PT LAST" Zs' FRAM I ~t948 8~ 1 - ~l . 10 .0 wi s PlhZ b i\ s R ~'C1Z 4vt~1F 'Rv21v C~}~ S 4 \ _ s-q b L'1 9ot°_\~S ' b' a.5 ZOO # tj S' o ~S" mouse o.Z n. { Sj et, cl-) - 0 ~ 101. C1. ga _ ~~1 OV jL ( LW L 1 lJ Arl. 1^1ZQV CO Y Tl~ ~`r ,z►~ wE ~ chi V ?UPS f~T -T)ME of cwv S " c ( A q6-8o S -3-qb (715 ) 42A-016S M00576 CST Signature Date Signed Telephone No. CST # SEPTIC TANK &*PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS r 4" CI VENT PIPE 12" MIN. ABOVE GRADE F WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK ~ FINISHED GRADE 4" CI RLSER WARNING LABEL 7 6" MIN . -4" MIN. ABOVE GRADE 18" IN. 6„ MAX. • INLET ' I' . WATER TIGHT SEALS GAS- TIGHT i 4" T BAFFLE A SEAL APPROVED -A- i JOINTS W/ CI CI PIPE B ON PIPE 31 ONTO 3 ONTO i SOLID SOIL SOLID C I SOIL PUMP OFF ELEV . 7FT. IPJ OFF RISER EXIT D PERMITTED ONL) IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER : NUMBER DOSES PER DAY : TANK SIZES:. SEPTIC loco GAL. DOSE VOLUME INCLUDING DOSE GAL* _ FLOWBACK:__ GAL. ALARM MANUFACTURER: ss c-c{ CAPACITIES: A INCHES = 3i AL. MODEL NUMBER: ~rs~ GAG. SWITCH TYPE: B = 2 INCHES = PUMP MANUFACTURER: _ z c Le.- C = I..2'(z INCHES = 2 y. Z--"GAL. MODEL NUMBER:- S SWITCH TYPE: D = t/ INCHES = D`i,_)b GAL. rF y REQUIRED DISCHARGE RATE GPM PUMP ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . -2-;r-& FEET +FEET FORCEMAIN X T/100 FT. FRICTION FACTOR'. III I FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH' /2 SL, e tT , r SIGNED: 1 u 1~~ L LICENSE NUMBER: DATE: HEAD CAPACITY CURVE 3 7/8 6 1 /4 - 30 MODEL "98" 4 5/8 - 0 ~ j 8 9 2 ® 3 5/8 = 6- 0 15 4 4 10 2 \ 5 1 112-11 112 NPi 0 U.S. GALLONS 10 20 30 40 50 60 70 10 LITERS 80 160 240 0 FLOW PER MINUTE - TOTAL DYNAMIC HEADIFLOW PER MINUTE - EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 A 3/16 20 6.10 25 95 Lock Valve 23' SKI'02 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback variable level float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1/z H.P. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.4 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4) N98 115 1 Non 9.4 2 or 2 8 6 3 or 4 8 5 float system. D98 230 1 Auto 4.7 1 or 1 & 7 - 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak', for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All Installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable Level Switches, FMO477; Electrical Alternator, FM0486; Mechanical Altema- licensed electrician. All electrical and safety codes should be followed Including the tor, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, most recent National Electric Code (NEC) and the Occupational Safety and Health Act FM0732. (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWK 70: P.O. BOX 16347 Loulsville, KY 402W-M7 MenuFachlrersol, . 16 L O ~ SHIP LoTO. 3280 Old uisville, KY 40Md Lane PUMP !O. (502)778.2731.1(800)926-PUMP Q~~~rrPuuvs SNCE /939" FAX(502)774.3624 ' ~-.".L`t~,~.'~ k j+4.w riitid ~N. ~ t ~,i'•''~? <S}~` tY~~1~. x ~ t. ,sr ~ h } - w t sZYy e(.~ it v,. F 1 ~ 3 w!N 21 ,1 + , j,~T~' ~ Ir 4 r °~X K~ 7~ i b 1 •l 7 ~5 'M Y. / F nl ~ 1~ F X -Sy K ♦ KY / \ tik~r5 key ~ # > lr 8 1 ? jr k ~ f / < 1_.~. as k "fir pp 160 ~1, CATi0ws CAPACITY: 1000'1500.GALLON . ' CONCRETE STRENGTH: 5000 PSI REINFORCEMENT ~ t `r COVER #4 REBAR TANK .6x6110 GA. WIRE MESH DIMENSIONS: WALL: 21/2 LENGTH: 1101, BOTTOM: 3" WIDTH: 93" COVER: 5" BELOW INLET: 57" ' HEIGHT: 73" MANHOLE: 24" I.D. INLET AND OUTLET: BORE WITH STOP FOR TYSEAL OR FERNCO GASKET } INLET AND OUTLET,BAFFLES: J, P.V.C. "MEETS WI. D.I.I.H.R. AND r`€ MN. M.P.C.A. SPECIFICATIONS M>~° LIQUID CAPACITY: a; 19.65 GAUINCH (SEPTIC) 1000 GAL. 9.94 GAL/INCH (PUMP) 500 GAL. WEIGHT: 12,400 POUNDS MODEL WCT-1500 10001500 Combination Tank MIENER CunuRm I Rt. 2 (Hy 10) Maiden Rock, WI 54750-(715)647.2311 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C b C(,(' L e S L"j i/ l a m e k-P 1 ~ Y-Y R /R MAIIdNG ADDRESS; (-A 0 -J, Z` v e cv- e S (Z (7 J PROPERTY ADDRESS 2 0 -7 70 , (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~c3 r E' S l PROPERTY LOCATION _ 1/4, _ 1/4, Section We57, TOWN OF Fore - 7L- ST. CROIX COUNTY, WI SUBDIVISION ► tOY1-- , LOT NUMBER CERTIFIEDSURVEY MAP VOLUMEILZ2,PAGE 70 , 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. Re IGNED: S DATE: / z o St. Croix County Zoning Office Government Center f 1101 Carmichael Road f a °l Hudson, WI 54016 r / V 11/93 0 Li 8TC- 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 C howl e ; I i u m 1-1 a r e Location of property_&_E1/4VF- 1/4, Section T Township moo.- c s Mailing address f~ ,3 J of r c r 'r Address of site ~i, U 7 g -7G I Subdivision name Lot no. other homes on property? Yes__,~_No Previous owner of property C u r e Y\ c e 0. e -4 V e Total size of property '-I I a Q-r 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 __.,Xr_No Volume 1177 and Page Number -26 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. 0 , and that I (we) presently - 5-4L)7 own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant I /O 9 6 Date o signature Date of Signature _ 32' 0 - 15 2 C-2424 C-2424 ~D C-2424-2 C-2416 y n ~ w r_ m a < 7C -1 SCISSOR TRUSS fl w m a N a v A so O nl . N = N o Om om 2-6 °-o as 0 N SCISSOR TRUSS q I o w n 3E N b z z C-3222 C-3222 C-3222 9' 0' 14' 6' f B' OWNER: CHI,. HARE PAGE: MAIN LEVEL SCALE: 1/4 DRAWN BY: LAMPERTS-gh ~ a t 32- 0- B' 0' - 15' 10- a 16' 2' C-4036 oSZ~ 2 ~ ~ X to a 2X10 JDISTS m C 2x10 JOISTS ~ ( r = r r 1 n m 11 B* 0, ~ BEARING WALL N 1 g 177777- Z BEARING WALL G7 1 g m ~c m _ m o £ z .9 p m m N = > r > r 1 r - r C-3216 C-3216 >o ❑VNER: CHUCK HARE PAGE: FOUNDATION LEVEL SCALE: 1/4 DRAVN BY: LAMPERTS-gh YGL 11 1 7PAGE 270 `ore ~V 5~ 350 WARRANTY DEED /"2d 3 ~ Document Number Jr'✓lD~~ Return Address Si6ddforMa A MAY 91996 1:30. P, J t m Parcel I.D. Number: 014-1040-10 fir bl`i Clarence O. Rothe and Vergil J. Rothe, husband and wife, conveys and warrants to Charles W. Hare the following described real estate in St. Croix County, State of Wisconsin: NEIA of NEIA of Section 19, Township 31 North, Range 15 West, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this G74 day of May, 1996. T " ~~I . R o-~ (SEAL) (SEAL) Clarence O. Rothe Vergil . Rothe ACKNOWLEDGMENT STATE OF WISCONSIN ) a7 ) ss COUNTY ) Personally came before me this day of 1996, the above named Clarence O. Rothe and Vergil J. Rothe, husband and wife, to me known to be the person(s) who executed the foregoing wledge the same. kpo instrument and ac No ublic S ounty, WI 1VQTARY . PUBi_1C My commission expires TrATE OTT WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 Parcel 014-1040-10-200 02/14i2008 08:18 AM PAGE 10F1 Alt. Parcel 19.31.15.289C 014 - TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/02/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - LINDEN, TY T & TAMARA D TY T & TAMARA D LINDEN 2078 270TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2078 270TH ST SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Axr~ Legal Description: Acres: 10.580 Plat: 5352-CSM 22-5352 014-07 SEC 19 T31 N R1 5W PT NE NE; BEING CSM Block/Condo Bldg: LOT 02 22-5352 ('07) LOT 2 (10.58AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 19-31N-15W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 05/09/2007 850243 WD 02/02/2007 843772 22/5352 COC 06/22/2006 828070 11/03/2000 632957 1556/160 mWD ore 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/13/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: 0 0 General Property 0.000 0 0 Woodland 0.000 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 RECEIVED FILE NUMBER JUN 3 0 2006 L D 0 0 8 7 ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED IN THE NE % OF THE NE Y4 AND THE SE % OF THE NE % OF SECTION 19, T31N, R15W, TOWN OF FOREST, ST. CROIX COUNTY, WISCONSIN o~ I JOSEPH W. % o LEGEND * G G 2295 1 INDICATES SECTION CORNER MONUMENT NEW RICHMOND . o ¢ (AS NOTED) WI INDICATES 1' X 18 (OUTSIDE DIAMETER) Q O IRON PIPE WEIGHING 1.13 LBSI LIN. FT. SET _ 50' ST. CROIX COUNTY BUILDING SETBACK LINE $ UFt`~ w Q o UNPLA7°GD LANDS NE CORNER, SECTION 19, NYt CORNER SECTION 19, 210TH AVENUE NORTH LINE OF THE NE Y, (ALUMINUM CAP FOUND) L_ ~ ( ALUMINIUM CAP FOUND)_ -~-N89' 8'18"E 1348.09 N8 *IZ%'E 1 ' 674.0 30 r- 637. 32.07 71' , N89°06'57"E 1311.74' \ \ 50' WIDE RLIINE OF DRAINAGEEASBAENT( DRAINAGE( SWALE) OF LOT 1 I \ 461,910 SQ. FT. \ (10.60 ACRES) \ \ INCLUDING R/W i \ 418,253 SQ. FT. \ ( 9.6 ACRES) \ \ oo~~ EXCLUDING RNV \ i•S MANMADE/ Sol \ \ \ INTERMI l IENI SOIL 80itINGS POND ERING 4= 0: O I LL%JJ (WAT g to \ \ HOLE FOR 0 I ~I \ \ CATTLE) Lu I W o \ \ N89°35'35W 672.47 l y l Q ~I o 636.38' _l 3604' SOIL BORINGS 1 0 I a ` roil LOT 2 f ~I $ I (1100.58 ACRES) ; W \ \ INCLUDING RNV f' I I LOT 3 r3 \ > 435,789 SQ. FT. 8 z^I S (off 905,028 SQ. FT 8 (10.00 ACRES) `o g I~ (20.78 ACRES) N EXCLUDING RNV INCLUDING RNV ( o I \ 884,099 SQ. FT. 1( 20.30 ACRES) L + w ` 3 EXCLUDING RAN 6 EXISTING I Z \ I I J \V DWELLING I