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HomeMy WebLinkAbout004-1052-70-050Ut• Croix County Planning and Zoning Tuesday, October 24, 2006 at 12:33:52 PM Detail Sanitary Information Page 1 of I Computer #: 004-1052-70-050 Sub/Plat: >35 acres Section: 22 Parcel #: 22.28.15.351A Lot: TN/RNG: T28N R15W Municipality: Cady, Town of CSM: 1/4 1/4: NE 1/4 SE 1/4 Owner: Lamb, Charles 246 310th Street Wilson, WI 54027 State Permit: Issued: 06/12/2001 POWTS Dispersal: Mound Permit: Reconnection County Permit: 15 Installed: 06/12/2001 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Monev Owed Not determined NA Helgeson, Bennie $0.00 None Signed Off: No Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 6/12/2004 Owner: Gunderson, Donald & Frances 246 310th Street Wilson, WI 54027 State Permit: 199928 Issued: 11/04!1993 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 11/10/1993 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed Mary Jenkins Yes Helgeson, Bennie file 1993 permit with 2001 reconnection $0.00 Mary Jenkins Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/4/2002 5/27/2005 04/01 /2005 5/27/2008 Parcel #: 004-1052-70-050 10/24/2006 12:33 PM PAGE 1 OF 1 Alt. Parcel #: 22.28.15.351A 004 -TOWN OF CADY Current ',X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -LAMB, CHARLES D & BARBARA J LE CHARLES D & BARBARA J LE LAMB 246 310TH ST WILSON WI 54027 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 246 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 38.840 Plat: N/A-NOT AVAILABLE SEC 22 T28N R15W 40A NE SE EZ-U-1680/542 Block/Condo Bldg: FKA (351) 004-1052-70 EXC PT TO CSM 15/4149 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-15W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 09/25/2003 741237 2419/132 WD 08/10/2001 653537 1697/417 EZ-U 07/23/1997 1120/429 OC 07/23/1997 970/198 TI more... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations' Last Changed: 04/18/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.840 4,900 0 4,900 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 24,000 223,300 247,300 NO Totals for 2006: General Property 38.840 29,000 223,300 252,300 Woodland 0.000 0 0 Totals for 2005: General Property 38.840 28,700 223,300 252,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 568 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 /* wscor-sln'c)eparfinentofCommerce PRIVATE SEWAGE SYSTEM Safely and Bw'Idings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal infom~aUon you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Per it H 1 er' Name: ^ City ^ Villa a Town of: .am`~, ~~iar~es Cad9y ownship CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION . Manufacturer Demand Model Number GPM TDH Lift Lridion System TDH Ft Forcemai n Length Dia. Fi oist. To well L'Alr A~~A~~T~nl-1 ~V~TtwA Coun ~t. Croix Sanit1 y Permit No.: State Pbban ID No.: Parcel Tax No.: 004-1052-70-000 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/ Ht Inlet St/ Ht Outlet Dt Inlet Dt Bottom Header/ Man. Dist. Pipe Bot. System Final Grade r th id De Li BED /TRENCH 1 ENI width Length SYSTEM TO P / L No.Of Trenches BLDG WELL PIT DIMNI N LAKE /STREAM No. Of Pits LEACHING p qu Inside Dia. Manu acturer: SETBACK CHAMBER N INFORMATION Type O System: OR UNIT um er: Mo a r~~e~Tn~n~ ~T~A~r ['V['TC\^ V~J ~ ^~~YV ~ ~V~~ r ~ .I ~ r Header / Mani old .-• Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Oia. Length Dia. Spacing cnn rnv~a v Praccura Cvctpmc 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 r,cnnr inn Incna c+inn #7' / / COMMENTS: (Include code discrepancies, persons present, et-: - --"---- -- Location: 246 310th Street, Wilson, WI 54027 (NE 1/4 SE 1/4 22 T28N R15V1n - 222815351 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. Date Inspector's Signature Cert. No. SBD-6710 (R.3/97) O~I~ U2%U1 idON 12:38 F~l 71d 38d 4$Bd ST CRS (;tl ZCINING t3lX 939 7l X001 ' County Sanitary Permit Application a~.cROU000UNTYwtscoNSln In accord with 15.04 SL Croix County SaNtary Ordinance ZONING OFFICE Personal information you provide may ba used for second8ry purposes sT. GROIx COUN-rY GQV'ERNMENT CENTER „ _ _ ~ jPrivacy law. 5. 15.04(1)(m)1 1101 Garmlchael Road ~' ,"~ Hudson, wl '5401 b-7710 ~ {715)3864680 Fax 715 388-4686 Attach c4m Leto laps for the system on pa ~ e "tNian rS-Ttt x 11 lnchQS in Size. Ccunty SanuarY Permtt # ,~ ^ Chock If reviaus 2ppllCatloit , 00 l5 1. A ticatton Information • Please Print ail Information I~catlon: Properly Owner Name CQ ICE 114 SE 114, 9ec22 c7a CHARLES D. LAMB sr ~,.~ T 28 N. R r w Property Owner's Mailing Address ,--', ~ r~ (- Qom, Lot'Number Block Number U'~k 246 310TH STREET `' -'r ;~ N/A N/A " City, State Zip Gode Phone "`r Tf ~F " ,`~ ,~' Subdivision Name tx CSM Number WILSON WI 54027 715 772-3287 "~"~ N A I p8 o Building: (ohe0k orte) CFity ^ Village Town of ~ 1 or 2 Fam;ly Dwelling - No, of Bedrooms: ~_ CADY G Public/Commeraal {describe u9e): G+ State•owned ~~ raTH~ TREET Check boa on line 8 ff applioable) on x on line A e of Permit: (Check onl il T l S . y yp . Parcel Tax Numbers) DOt~ .~ I dSa ~ 7d - A} t•0 Repair . ~ Reconnection 3 Non•plumbing 4. ^Rejuvenetion 22-28-15-351 ~S 2 ~`~ /`~ Sanitation ~ PermliNumber X s} 199928 ~ state Sanlta Permit was reviousl issued 199928 11 s04-93 N. Type of POYYf System: (Ghedc all that apply) G Non-pressurized In-ground ~ Mound ^ Sand Filter ^ Construoted Weaand i;: Pressurized In~round ^ Holding Tank ^ Single Pass ^ Grip Line At- rode ^ AprohlC Treatment Unit O ReClrcttiating ^ Other V, Dls ersallTreatment Area Information: 1. De3ign Flow (god) 2, Dispersal Area 3. piaporoal Arco 4. Soil Application Rafe 6. percolation Rats E. System Elevation T. Fin o Required Proposed (Gals.fdaylsq.R) (M~.lnch) Elevation 450 375 .375 .5 N/A 9.00 99.25 an n ormat On p n a one ~ o of tNanufaoturer Prefab t Site Con- t d t Stoel Fiber lass Phdstic New Existing Gallons Tanks e Conno rut e s g Tanks Tanks 000 000 1 IDWESTERN PREC © to ^ ~' 7 ^ ^ ^ ^ VII. Responslblilty Stntemtnt I, thG undrirt;ignod, astrump rot:ponsiGlNly for repair/reconnenction/rejuvenationlinstallatlon of non•plumbing for the POwTS shown on the atiar~led ptdns. A license is not re iced for terraliit r'6 air Or tilt Installation ofnon-plumbing satritatioll atom. Plumber's Name (print) Plumber' i nature (no stamps): g wtlP/MPRS No. Business Phone Number BENNIE HELGESON 220292 7 - Plumber's Atldress (Street, City, State, Zip Code} W1229 770TH AVENUE, SPRING VALLEY WI 54767 vul. coumy use only Disapproved Sgnitary Permit Fee Date laeuad Issuing Agent Signatr:ro (No sumps) Approved owner Given Ini6sl Adverse ~ 25 ~ ~Z ~~ ~ Oatsrminatian - roveUReesonsnfor Disa(p~pro-vat ~ ,n n 5 _ I r Q -~-~,~ IX. Conditlona of Aplp 'jgCQ, V1P.6tJ~C._ 5 [TAM '1~pi1 e ~ cs~w `-~ 'T O~wA~ l$ 'k-~ u~¢, r 1 r_ ~,~.. - „ate ,~Q „,,,, o~ ~ ~ ~w~ ~ 0,~.11WI.~ ono ~.t~- . -- ,~ A~. s.~-~n~-~-s DO O P, i 3`^'~ ~ ~b 6-" Q ~ ~ G F ~' ~ ~ ~ ~ b G CZ~ C7 p 4 C 7b o ~ fi~ P ~ ~ O ~" O ~ ~ (ll V\'CLJ ~ ~~ D ~ ~. rr, ~v ~ . -6 u ~ C 1~ ~. 1 ` ~~~~~~ ~1 _~ v\ ~1V ~c ...t., >Y V P~ ~ ~ o cr' ~-~ ~ do d ~ ~ ~ ~ ~° b ~~ . ~~ I i I ~a ~~ n ~ \Sp 4 o ~ ~• P CS 6 O ~ o ~ G ~~ RI s~ ~ } ~' -~, u v c c A ,~ ._~4 ~~ __ - ~ W ~c ~ r ~ ~ r~ ~s ~w r R' ,' ~" ~ ~~ 'U 1-- In O F G -t b G ~ \ ~+~~ n C 0 48'-0" ° VAULTED CEILING 10'-8" ° 8'-8" 0 10'-0" 0 5'-4" 0 13'-4" D OPT PATIO DOOR MINI-Al IND 0 N 0 0 14'$" 0 20'-0" 0 13'11" ACFS-44128X48 3BR CK 2B OT SH 1312 SQ. FT. t BRM VHD O ~ --- -' K 60' TUB -"~ -'="- ='-- G IAUNDRY O.W. "" "- : mss=:r:::s::~sx -::-.:t.:-. ._.-- ac.-? z.:..::-~}.>~'.:s.-.3"_o".~c;':~' OPF~i.::.'_`-_h-_=.: :•: ~-_-:'_-= - _~; =v:>__X __~- KITCHEN - =- OPT. 4260 = - - ---- __ - _- _ ~~ =fi ~ UTILITY=wk' : ooQg- -<x::::.:-- ~::`:_: :x == - - - _ --- - - - Dl lNG ~ - _ - _ --- _- ~ BEDROOMS - _ -_ _ _ -- -- -- - __~=i'.f.3 _aw~~_`___ ~:~"Y--stir- yy -.__ ii_ r M O R - ~^~{i~- +-+ ._-z - !iiJ .- _ S c~N''•.`' -c=mss-. -- - - - - - LL ~i Q: 0]-• tlr £~._ . ~ l-' O.O . © - _- _ _ - - - - _ _ _ - BLS __ - - JJ 2 LIN ~ O BEDROOM 1 LIVING la-a BEDROOM2 ~ ROOM yo ~ --_--- ' ~ K -- - ~ K MINI-BLIND G G -= MINI-BLIND ~ ~~ O ~~ ~'h~~5 s~ J 52'-0" o VAULTED CEILING I 1r-0" 0 5'-4" 0 10'$" o D3'~• o 10'$" b uINI.AI INn MINI-BLIND G ~~ 3060 BLS PT ~ O O W OPr CLO O ;:LAUNDRY: _=:~_?<~ w~=M.,,- D/N/NG ~ ~=K/TCHENn_soooR - < >_ _: : _: : >:_>>_:=::~ -=;_<:;-::-:: - _ - --- --- =ti ~'- =_i Q J, ROM - _ -_ - ------- - -_ - j WORK - - - : ==`oarae.:;-s>;=; = :`=:BRINK- SFRZR F ` ¢ -- '- __ - := • - - - - - - :yy_zv - -_::cr_ __-_ - ___ _ i -_- ~:"_ -- _ - a ~ . - - - - - 3 :~(NB-23 )-,:= LIN G.C. ® r BATH 2 BEDROOM 2 ROOM BEDROOM 1 "M °" oQ,~e -PP ~ ~ WALK _ - ~; IN MINI-BLIND = = K K M NI-BLINDS ~~ 0 12'-0" 0 18'$" o ACFS-443 28X52 3BR 2B SH 1421 SQ. FT. 13'x" 0 8'-0" o WINDOW SCHEDULE W/OTH X HEIGHT A 14X39 K 46x53 D 30 x 27 L 30 x 66 E 30 x 39 NORQONTAL Q 24 x 53 F 30x53 U 24x39 G 36 x 53 V 30 x 39 va<Rr+ru I 46x39 OC 22x22 acz~av EGRESS WINDOW. I 0 13'x" 0 V OPT STAIR PLAN FOR ACFS-443 J STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /~r'~t w r-C .s V `~~c~~-ci'~~''.~ ADDRESS o? Y~, (,1,~ ~~ 31v~-ti ~' s o ... SUBDIVISION / CSM~ /(~ ~ ~T ~ SECTION . ~ ~ T ~ g N-R_~W , Town o f c~ ~,., ST. ~ OIX UNTY, WISCONSIN C"1 A/ PLAN VIEW WITHIN 100 FEET OF SYSTEM ~~,~ `' / ~ta.µ.~r G4.~.,-6~- ~. / i 3 a'`` ~~ ,~ ~ ,~' ~d,, ~y ~ ~~ ,.,~. _. $} ~'" i~o ~~~ ~~ ~, ~' ~ i`~~ 1:1 Provide setbac}: and elevation infor.mat_ion on reverse of '=1i~.s f"'`~'~ provide 2 dimensions to center of ~.~~1~Lic Lank manl~oie c:ovr~r. '~ Y' a .\ BENCfBrIARK' ~~[ ~ o.~ u ALTERNATE BM: /V W ECrvt ~t+r I QC?. ~'c.' SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION 1 II s~,-~ Manufacturer: ~~~t.t~~?6~Tlr~ ~~'~CaST Liquid Capacity:_ /Qdj) -7,~C -~t'~ ~ v Setback from: Well~~_House ~ ~ ~ Other Pump: Manufacture; ~rnc~/ ~ ~ Model~~ Size ~/ l ~~ Float seperation ga_. Gallons/cycle: j~`~.:3~j Alarm Location ,;~'.~ ~a ~ /.c ,~~-ti ~ __ M cw -dL SOIL ABSORPTION SYSTEM ~ ~~ width: .2.3 Length ~~ ~ Number of trenches `~ x ~ S ~~ Distance & Direction to nearest prop. line: -'~ ~~'~ ~ i Setback from: well: House Other ELEQATIONS Building Sewer / /. ~' ~ ST Inlet : 9~, ~3 ST outlet PC inlet ~~ ~ PC bottom G~ Pump Off "t~, Header/Manifold_~~ Bottom of system 1~Ob Existing Grade ~(o.©~ Final grade ~~.~""r~ DATE OF INSTALLATION: ~ I~ 'ri PI,UMf3ER ON JOf~: LICL'NSE NUMl31;R INSPECTOR: 3/93:jt ~~"~/~ ~a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ Yt~~-~~~~ ~- ~~h~~~ Mailing Address L ~•~- Property Address ~~~6 ~~" ~ ~ ~ ~' ~~ ~ ~ ' (Verification required from Planning Department for new construction) City/State ~U~ T-~-~~~~'~ ; ~.9~ +~~~ - Parcel Identification Number 7~~.- ~~ - ~~a' 3~ LEGAL DESCRIPTION ~~ Property Location ~~- ~ '/., ~ %<, Sec. ~~ T~~N-R~W, Town of l.~- Subdivision Certified Survey Map # Lot # Volume ,Page # Warranty Deed # ~ o`~~~ ~ ~ ,Volume /l oZ U ,Page # ~~ ~7 Spec house ^ yes C~ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE 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 a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departinent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of th three yea pirati n date. ~ ~ ~ ~ ~~ y SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop descr' d abo , by virtue of a warranty deed recorded in Register of Deeds Office. ? SIGNATURE OF APPLICANT DATE * * * * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of-Deeds office a copy of the certified survey map if reference is made in the warranty deed F~ t F ;'/ r,. ~, 4 DOClJP.9ENT NO. STATE P.AP. OF WISCONSIN FORM J-1982 ' G!JIT CLAIM DEED Frances A. Gunderson a single person quit-claims to Charles _D . Lamb and Barbara J . Lambs._ husband and wife as survivorship marital --~ Qp e r_ t ~---- the following described real estate in_ _ __~ } r'" O ~ X County, State of Wisconsin: The North half (NZ) of the Southeast quarter (SE4), Section Twenty-two (22}, Township Twenty-eight (28) North, Range Fifteen (15) West, St. Croix County, Wisconsin. 19~~,~. ~:, ~ j . "~. ~X~~ Fl~~ This., ~ ~ homestead property. $C (~is)~ -±~e~l- Dated this y~"~-/~~-~~da' of ;~ .Q 2A ~n e2" G( ~` b~.~hr ~,P~~Q~f1L(SEAL) Frances A. Gunderson (SEA:.) AUTHENTICATION Signature authenticated this day TITLE: MEMBER STATE BAR OF WISGONSIN 19 authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WA° DRAFT .D 6'. Francis X. Rivard _. Schembera, Rivard & Stewart Menomonie WI 54751 (Signatures may ne a:'trtnticated or ac~nov:l.dged. 9otl~ are not necessary.) - (SEAL) THIS SPACE RESERVED FOR RECORDING DATA ~T--~- - ~---~-.., ~,,: ST. C~tr'1,1.. . ~~ Ra;,~ ~~...:. MAY 5 1995 9:30 A.;,; ,'~A l6 6v r~ -Y ---' RETURN TO Y~-~'~ ~ Francis X. Rivard Schembera, Rivard _& S lax Parcel No: ACKNOWLEDGMENT STATE OF W ISCONSIN -(SEAL) ss. County. as ~iw I'arsnnaily came before me this _ _-day of _ /9 (J r i l , 19~the above named Frances A. Gunderson to me known to ~~ .the person who executed the foregoing instryment • $,~ rgyyledgethPSame. Nrtary t''ibl My Ccr.~mi date: ''NameS of per SO n;, signing .n any capaary ~.tiouid De typed or orinled be~~w their signatures >f', {i :_'E~i Cuunty, Wls. '(If riot, 'state expiration Pl 1 ° ~;~~`~ S$3 NTF 0023 I,y;"' wa STATE ti P,~t OF W ISCONSIN QUIT CLAIM DEED FGRM No. 3-t'd82 Ne1COTax Forlns, P.O. Box'~208, Gre@^ Bay, W! 54:3J7-0208 pO~ ~/OS~ -7o-ao~ as • a~. ib ~ 3~/ HELGES N EXCAVATI N, Inc. SEWER AND WATER SPECIALISTS Plumber/CST Cert. #220292 BEN HELGESON Office (715) 772-3278 W. 1229 770th Ave. Home (715) 772-3127 Spring Valley, WI 54767 Fax (715) 772-3387 June 1, 2001 St. Croix County Zoning Office 1101 Carmichael Road Hudson, WI 54016 RE: CHARLES LAMB Dear Sirs: I have inspected the mound and the tank on this property and all appears to be in proper working order at this time. Sincerely, c_~ Bennie Helleson President BH:cb Enc. 1 "~ ~ " ~~c~~L~~ ,_.~, ~~ °s ~~~~~ ~ ~ ?~01 ~~ , SX e~x `;.~ r ~;: ;. +;~,I r"1~ 0 ~~ ~~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ r ~ .~ V ~ ~ ~-~r~~..s ADDRESS a ~~ ~, ~~n ~ L ~Iv.~ti ~-~ SUBDIVISION / CSM# ~ ~ LOT ~ SECTION . ~~' T ~ g N-R rs W, i own of__~~~ aa. ~g. rs. ST. CI20IX UNTY, WISCONSIN PLAIT VIER WITHIN 100 FEET OF SYSTEM ? S~ v ~ ~~.~ ~~ ~ ~ !yam . n ,.n' << $~ ~~ ~ ~~ ~ ~ INDICATE NORTH ARROW ~~ ~~ /" = yd ~ ---- ~~ Provide setbac}~ and elevation information on reverse of '..his for.-rn- Provide ?_ dimensions to center of ~eE~tic tank manhole cover. ~' Cr ~~ t BENCFB+fARR • ~s (~ O.~ o ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION 1 s~,-~.. Manufacturer: ~~~~~s~~t~--vim ~'~CasT Liquid Capacity: j~ j~ ~;ST~ ~t'~ ~ u r Setback from: Well_ House ~ Other ~"j' ,~ ~ ' 35~ . p,~,,,7,,, 8 Pump: Manufacturer C~~~/cQ~ Model#__~S ~ 1-Size y ~ f ~ ~~ Float seperation g1 Gallons/cycle: i~~. 3Fj Alarm Location .,~"... ~a ~. t-c ~~ti,..` - o~- -.dL SOIL ABSORPTION SYSTEM Width: ~:~ Length ~~~ Number of trenches Distance & Direction to nearest prop. line: -.;~~ ~7'S- i J i Setback from: well: ~~'3 House~~ Other $LEVATIOxs Building Sewer / ~ G' ST Inlet : ~~, g3 ST outlet g PC inlet ~ PC bottom •~ Pump Off ~~, Header/Manifold ~~, Bottom of system ~l,Ob Existing Grade ~~,©~ Final grade "~~.~-`~~ DATE OF INSTALLATION: ` I~-I 'c1 PLUMBER ON JOB: LICENSE NUMBER: _~i~,?/S"" INSPECTOR: -_-Ct ~° - --- ---- 3 93: t 7 L~C,'~'i~I~pari~~~f Ir~d~ser~8 .15.351 Labor and Human Relations PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT t. GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ~] Town of: ev.: nsp. BM E ev.: BM Description: TANK INFORMATION r Permit L9..94 an ID Nc ax No.: ~04- ~ ~ ELEVATION DATA A9300333 TYPE MANUFACTURER CAPACITY Septic ~~,i~ (~ ~- Dosing /~ ///'e. ~ =~~"~) ~~" -7So Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic > 1 ~ ~ i38' ~ ~!o " NA Dosing ~~ p s38 ~ y~ , > ~ p NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~ Demand Model Number ,j~ /j ~ ~~ GPM TDH Lift ~:~-~~', friction ~. System~r TDH~,I~b Ft ea Forcemain Length `'r,_,r Dia. ~ Dist. To well 7Fjo SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark D ~~ )~~ o /oa~I~t fpa . Bldg. Sewer ~- / ~- ~ ~b d9 St / Ht Inlet G( ~ 9 ~~$3 St/Ht outlet ~,by q~,Sq Dt Inlet ~,~ ~- ~ t•(, S % Dt Bottom /~ 9 ~ (. 0 a- Header /Man. Dist. Pipe ~, $;6 ~( ~, Bot. System j/ ~ ~f ?~ d / Final Grade ~ ~ ~•~~) BED /TRENCH Widt ~ ~ Lengt ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N 3 S ~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O ' ~ ~75 " r c ~ j ~ CHAMBER OR UNIT Model Number: System: 7 /'Z!. l3 ~ ?~ /( DISTRIBUTION SYSTEM Header /Manifold R ' ' Distribution Pipe{s) ~ I i I 1 . ~ ` 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 7`; Depth Over ~~ i xx Depth Of ,r ~ xx Seeded / Sid ~ xx Mulched Bed /Trench Center Bed /Trench Edges 1 p U Topsoil -~ Yes ^ No Q Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CADY 22.28.15.351 ~-, ~n ~j ~ ~.. ~-.t ~ I ~ r. ~/~ ~ r;... , ~~ `'- ' :r ~ / ©Gl:? 93 Plan revision required? ^ Yes j~No Use other side for additional information. ~ ~` ~~" ~ ~ ~ %~ ',~;;~ ' ~ ,~,; SBD-6710 (R 05/91) Date rf+sp cto s Signature Cert. No. ~-= _ _ SONITORY PFRIIAIT ePPLICOTIAN ' ~ O~LMR In accord with ILHR 83.05, Wis. Adm. Code couNTY Y,PERMj'~# STATE P~CyI -Attach complete plans (to the county copy only) for the system, on paper not less than ~ ~ )) (( ff ~- ~~// ]] ((`"' 8i4 x 11 inches in size. pp ~~ [[ QQ ''iiJJ ^ Check f r vision to previous applicatlon wee reverse side for instructions for completing this application. sTATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. 593-41206 PROPERTY OWNER PROPERTY LOCATION FP.Ai~ICES GUl`IDE'RSOA1 ICE '/a SE %a, S 22 T 23, N, R 15 E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 246 [.7IL50hI ROAD (310TH STREET 1`I/A ~/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER t;:rILSOTI !:~I 54027 715 772-4532 AI/A 11. TYPE OF BUILDING: (Check one) ^ State Owned VILTMLAGE ~ NEAREST ROAD i . CADY 310TT~ STREET ^ Public ^X 1 or 2 Fam. Dwelling-# of bedrooms 3 PAR ELT NUMBERO 111. BUILDING USE: (If building type is public, check all that apply) 004-1052-70 1 ^ ApUCondo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ RestauranUBar/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 in line A. Check 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 # - 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 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 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 RE(~UIRED (sq. ft.) PROPOSED (sq. ft.) (Galsldaylsq. ft.) (Min./inch) ELEVATION 450 375 375 , 5 Td/A 97.00 Feet 99.25 Feet VII. TANK CAPACITY in allons Total # of ' Prefab. Site e Fiber- pl i Exper. INFORMATION New istin Gallons Tanks s Name. Manufacturer oncrete Con- structed Ste l glass ast c App. Tanks Tanks Se tic Tank orHoldin Tank 100 1000 1 I~?InGIESTERP? PRECAS LiftPum Tank/Si honChamber 750 750 1 iiID[yrESTEP.td PFECAS 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 Sta ps MP/MPRSW No.: Business Phone Number: I3ET1i~IE [tELGES0A1 3215 7_l5 772-3273 Plumber's Address (Street, City, State, Zip Cod []1229 770TT~I AVETIUE, ST'RIP1G VALLEY ~rTI 547 7 IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved Sanjtary Permit Fee (Includes Groundwater f Surcharge Fee) a e sue Issuing Agent Signature (N ~ mps) Approved ^ Owner Given Initial Q1 D~~ A vets De ermina i n ~ X: CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 the 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 pern-~it issuing authority. 4. Changes in ownership or plumber requrres 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. Thr„ •u •ptic tank(s) mint l>e 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 & Buildings Division, 608-266-3815.. To be complete and accurate this sanitary permit application must include: I. 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in#ormation. Provide a!! information requested in ~1 %. VII. Tarfii iif~?rmatian. Fill in the capa(;ity of ever•~ tv.~ ~;nL/or existing to ~k. 'ist the total gafions, number of tanks and manufacturer's narne. indicate p. r::-f~;t) or site constructed anti tank material. Complete for ail septic, p~u:rtp/siphon and holding tanks far tl,i:~ ~.t~.+t:ter?t. Check experi~~r:€~~i:1i approval only if tanks received experin~e,;t;ri ~~roduct appro.~ai trcrr DILHR. VIII. Respor,sibiiity statement. Installing; plumber is to fill in name, licensee e~y;rnber with appropriate prefix (e.g. MP, etc.), address and phone nur;ber. Plumber must sign appficati()n term. iX. County/Department-Use Oniy. X. County. Department Use Oniy. Comp~Fte ;:lane: and specification<, not smaller than 8',z x '' in(~I:~~~ r~~ust be submitted to the county: The ~tl~~ns mts-~s inc;ude; *het folicwing: A'; ;riot r~+;~n, c?rawr~ ;c sc•~ia~ _ ,~i~s +;ornplete ~~ ~e?~~~~^r,s; location of !"i.:i:llr 4 :._ ,i.~(c.} ':; P,t?;iC tank(S} Crrifl)G'r tr£:. `{:c~`t tan:•;s. bi~ti'':r;p :. , , WeliS; 4'M?::°.' '~'...+ S?'•N3ter sef`JICe; stre~.rns arty, lakes; pump or siphon tanks, dis~r~?~?~ation boxe4; a~,i+~•h~otrttion systerns replacement system c'lri.=~ -st'.tf~ :'?Fa location of the ~)Uil(airlg Sr"~t'e't-:i'' '.l `~Qf'ZOntu ;:,°''_,: .;.-'.r?iCa": ~:IP.VBEIr'tn i"t?fe''E-i~?CE'~ pf.~InLS; C} complete specifications for pumps and controts; dose volume; ~ievatiot, 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 sur~:t=.~~~(~¢._: (fr~es} for <, r;rmt~~r c{ regulated practices Which car: effect grc)undwater I I"kE: niOr,le3 (:'+lectecl tf~ro;lg'~ tt'.r;~:{? S.'e;ha' iE?5 N.lE~ ',sE.(n :~ r t: ~„ ,.'!;,' , ~~U'.!'(SWate', ;tr;iertd- Water COntanrl T?atlOn in VGSttgatlnnS angl F_'Stal'iisitn~r .; ~tc3 Fi~~rt~!.S. SBD-6398 (R.11/88) 59~:~ 4~20s ~~~~ ~L~~ 6i Drar~i' iy - zt~ -ti3 v~o A ~ ~'~~ ~. u h ~ SI~QC~ .Z ~orc-e. ~ V Ma..'v. ..,y ~ h SAFETt ,, p~bz~ ~ ~~ ~ ~. K G~fouY Elev y `. U~ N , y' Grw~.l:,,~ ~- ~~r; ~~d s~~. cbo© ~~~ S~,~E~~ ' ~c~v~r"~ ~ ~0Z Mob~,1-~ ~~.-t.. gC, ~~r e ~Q~-w. ~ :~ t. ' k,ti ?,. ' ,1 Q.1~ o-v•R.~ (t~C1.0U $~~bw• o~ ~~usQ~S,d~aS tAV.~sn~~n ~~,~,~ 11-a~1~1~ l i ~~ riH cam ~r ct, ~. ~ ~•e1 ~ ~1 t-~ ~ ".~r~~+~~cE~ ~ ~ ~' au~~rt;u FicL17101l5 ~`! (c r 0 _..~ 3 pry.: 'i,'~ , .. ; :•e. .. `, ~ ~ ~ L ~ r, 3 Cross Section Of ;A Mound Using A'Trench For The Absorption Area H ~/~ ~ . `~ ~. G. 3 Medium Sand .Fill ,~ _~ F -~--6 Toosoi g~ E I T -- -.~-1 D Trench Of ?~" - .2~" Aggregate, ~ ~~"'`~ `~6' °~" Plowed Layer f'~6'~-~e~-.o~~,~$~~'~over~d.~Wi'th D I Ft. `-~ ~tra~C% Mar~h Hay 0~ %Synthetic Fabric ~~,~ tik, ~y ~ ,~ F ,.`~~ Ft. N l,b Ft. ~1 ~ ~~ - ~3 1 Y lfi ~-, { 1'_, p )~~~S~I~~~ ~~ ~~~ t, ~t-~P~ati`'~fieW Oit bound Using A Trench For The Absorption Area G~'j Force Main I W I Trench Of ~ - 2~ Aggregate ~ Distribution Pipe ~ PermanentH~Markers Observation Pipe A o ---------------- - -----------------. ~' 6 N N a ~~t 8-0~ K ~ L J ~ A s ~t. I -10.`7 Ft. K /(~.~ Ft. W~ Ft. Q `7S Ft. J 7,~ Ft. L ,~~ Ft. Y t s,.. ~~ Si ned: ~ `~ License 9 ~ Number: ~ ~~l ~ Date: %(; -~c~ -~; ~, ;~~~. • _~,ltyner' ~rQ~ecs C~'c.ti.e~ewsov~ D~-tom`, l ~ -a.~ - ~3 ?V~. C'1PE / // /// ~ ~Uv Chi / (v .4`r` r LL / ,~ ' Wit' .c~s,• `( `~~'~~16 i I <=1~J5TALL 1'~Et'~HA1J~- r,~.r~--•ti .4T CU~J OF ~I~C1= LtiT`~tAL -~uD tiLP. }4ot.ES LU~h-? J oU ~'u ~ , ~ r, o~ _.P1.PE Rup F~R~ ~~Ufi,`_'~`1 SpA::.t`. . PLACE LRST ltO~.E_ 1JExT ~ Eu•~ CRP 'P'VC" ' LA'T~~ALS ,~ pV C .4---~pRGE F'i A ~ -J ' FRAt'1 111 M P ~J~S~'.R1$u7]OIJ: P1PE .1J~`.~r~~i_T_=--• r a i~~ , ~~ q ~T" ~~. .....,, a .~ ~~ '4.. '~~`d~: _,_,a i'~~ / ~.r.,.., (1~,..1.~ ~.///ry~~ ti a rr'.l I~ ~`~ ~ ~ 4 jY sa ,~q'C kh" "~$' n f r~ ~ r .x r ~ ,.. ~, n ~•- f , (r>> t" i S~k~~,,~111 ~~. ~ I r ~ : J i~P~_f~TiL1+~sJ .3~~. ~`l ~ll 3..41 t 1 L u~. r.:\.V J~® ~~G~~ ~°~°~~ OG,` ti~ S ~~~, b~L~ ~F~ py~ . s FT. ~( ~tN. Y a .y ~~. ~~~ U1AncT=Tc_... ~pRCE Y1 R )tJ ~ ~~ OF l-~vLES/P 1 P~ 11.1V, EI..EV. OF L°.TE' . ~ \TJ . / ~ ~~ ~_ _ .. i_3 ~ ~S 9 7, ~. 3 'FT. FR.or1 T~ w17N Su cc-E~""D1~1 G 1~~Es ~T.~~ ~f l !J"i'~•v+~ t-~ : -- pL:~ c E 1sT N'U ~ l ~ - LAcST H~O~-E TO ~~ I~fEXT•' ?D ~E E~JD ChP- ~~l~rl ~r2H C~5 ~Vc-~.h.C~~rSOu- PL1hiP CHAMBtR CRU55 SEC~IO;J y~ C.I. V E'~;T PIPE ~ 25~ = RO.^'1 DOOR, WINDOW OR FRESH AIR INTAKE IB"MIDI. ~~~~ ' ~3. 3~ INLET APPROVED JOIIJT W~C.I. PIPE EXTEAlDI1JG 3' OWTO SOLID SOIL ELEV. ~~ FT. VENT CAP WEATHERPROOF JUNCTION BOX 12"M I U. I GRADE I I COIJDUIT ~-- MA~;j COPE 1'~. 4'~ MIIJ. -- 18" MIIJ. v ~ \ _ PROVIDE I ~~4~~~.v5:....,.,Pd..~,~'.~ i 1., I, ...._ ~ .._ Y~~ D .. ... __ ....... ........~.... ~ CONCRETE pIOCK Ijl ill ~~~ I ~ I ALARM I~ I OAJ , I OFF V APPROVED JC1~;*_ W/C.I. PIPE EXTE-JDlur; 3' OIJTO SOLID SOIL 3.. "U~~"«` EXS•« RISER EXIT PERMITTED OIJLy IF TA K MAAIUFACTUR R HAS SUCH APPROVAL ~ I ` ~j-a- I ~~ SEPTIC E SPEGIFI~GATIOAJS DOSE 1 L TAAJKS MAWUFACTURER: ~~uJc~;~~t'-PU~h ~e-C~C'1 IJUMBER OF DOSES: -3 PER DAy TAIJK SIZE:- ~~~"~ ~ GALLOIJS DOSE VOLUME /SY. y~ ALARM MAAIUFACTU~CR: -~.~~ E:<~rr ~-IrC~ ~C~ S~.et,~_I0.ICLUDIAl6 6AGK~~FI~~.OW: GAE~oNS '~ MODEL IJUMBER: I ~ ~ ~~ CAPACITIES: A =..~IAICNES OR 00 GALLOAIS SWITCH TYPE: ~~r ~ g = ~ IIJCHES OR .~~ GALLO-.1S PUMP MAFJUFACTURCR:_~Q C= ~.IIJCHES OR !J ~~ GAl.t.0~.15 MODEL NUMDER: ~~`7_~ D=-f J~ INCHES oR~S-3'~`~~ALIONS SWITCH TYPE: ~~'+~• 'r .1~LP4-(~Ci~l-~eclrr NOTE: PUMP At\ID ALARM ARE TO pE MIIJIMUM DISCHARGE RATE ~ l GPM /INS{T~ALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFEREI~ICE 6ETWECAI PUMP. OFF AWD DISTRIBUTIOIJ PIPE....S~"~ FEET -~ MII~IIMUM AIETWORK SUPPLY PRESSURTT,,E/~, 2.5 FEET ~- ~ b FEET OF FORCE MAIIJ X ~'~~~" F/TOO tr.FRICTIOAI FACTOR..a_~.1L FEET = TOTAL Oy1JAMIC HEAD = /~.Y.~Z_ FE_ET > ~ ~ I !7 IIJTERNAL. OIMEIJSION= OF TANK: LE'.~L.TH ~~ ;WIGTH ~~~; LIQUID DEPTH ~` C S 0 3 412.0 6~~.F - - - A-~1G SPECIE I~'!. I IG~!`: _.IF® SIGIJED: -gyp LICE.h]EE LIUMBER: L~~ll~ _ UATE: IL ~~~~i~ . . , . ~`_ I• ~r.isn~~eS ~l._1,~~t ~e~r Sol, Subm C ~ -°~re` '~ ~~~~ MODEL: 3871 e S e SIZE. 3/4 SOLIDS Effluent Pum RPM:1550 ~ ~ ~~ ~ ~ ~# _1.2 H P: 0.4 ~6 METERS FEET 8 7 O a w g V ~ 5 ;a Z p 4 J Fa- O 3 H 2 1 ~~ -- -- ---- -- 1- -~ --___ 1 .~__--- I _ ._.. --- - ----~..--- __._I ~~, _..._..- .~ ---- -.___ - ~4 - -- -- --- --- --- ---t - 0~ 25 20 15 10 5 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY GOULDS PUMPS.INC. SEFECA FiN.L~i FEW YORK (3148 ~/`~~® ~~G ,L~~ ~~*1• OLD ~aGZ~ b~ ~P~~~ ~" O t 988 Goulds Pumps, Inc. ~t Effective October, 1988 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County o w N E R/ B U Y E R F1;ANCES GUNDERSON ROUTE/BOX NUMBER 246 [dILSON ROAD Fire Number 246 CITY/STATE L~/ILSON, LdISC~NSIN '1. [P 54027 PROPERTY LOCATION: NE Z, SE ~, Section 22 T •28 N, R 15^-W, Town of CAT1Y , St. Croix County, Subdivision N/A Lot number Pd/A Improper use and maintenance .of your septic rsystc~m could result in its premature failure to handle wastes. Proper maintenance ce,n- siste of pumping out the septic tank every three years or sooner, if needed, by a l.lcensed septic tank pumper. Wliat you ptit into the system can affect the function of ttre septic tank as a tre;rt- ment..stage,in the waste disposal system. St. Croix County residents maw a maximum of 601.' of the cost of which was in operation prior to accepted this program in August owners of all new systems agree maintained. be elii;ib.le to replacement o July 1, 1978. of 1980, with to keep their receive a grant fc~r f a failing system, St. Croix County the requlrement that systems properly The property owner agrees to submit to St. Croix County 7.onini; a certification form, signed by tl~e owner and b.y a master plumher, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on=tiite wastewater disposal system is in proper operating condition and (2) after inspection. and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersiKned, have read tl~e above requirements and al;ree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Der.lrt- ment of Natural Resources. Certification form mast be completed and returned to tl~e St. Croix County %oning Off.i,ce within 30 d;iy~: of the tFsree year expiration date. SIGNED ~~' UA'1'1s_ / l1l_~..~ St. Croix County Zoning Office P.O. Dox 9S Hammond, WI 54015 715-796-223n or 715-4,25-8363 Sign, date and return to above address. ' ~ APPLICATION FOR SANITARY PERMIT STC- 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 an~d'submitted to this office with the appropriate deed recording. '; Owner~of..ProperCy ~ FRANCES GUNDERSON ;Location:•of Property N_ E ~ SE '~, Section 22 _ , T 2f3 N-R_].5_ W Township CADY Mailing Address 246 6dILS0i1 ROAD • WILSON, ~dI 54027 Address of Site. . ..Subdivision Name. N/A Lot. Number' N/A Previous" Owner . of property ~~~~~ Z .Total:; Size of Parcel _ l'(f' Date Parcel was'Created ~~/ ~ /~ 'ire all corners and lot lines identifiable? /~ Yes _ No Is this property being developed for resale (spec house) ? _ Yes ~ _ No Volume' ~(~~ 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 refer- ences.to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY 0(UNER CERTIFICATION 7 { we) eex,#,i. ~ y ~h.at a.?..Z a ~atemen~a o n ~h,ia ~ a~un cute ~c.ue ~a ~1~. e b ea ~ o b m y ( a un PznowQedge; ~h~t I (wet am {~.e1 ~he• awnen(a) ob the pnopenty deae~c,i.bed .~n ~h.i,~ .in~a~unccti,on ~a~rm, 'by v.vitue a~ a wa~vcant d ne onded ~.n ~1~.e ~~~,i.ee o~ the Caunty Reg.ca~eh. o~ ~eeda as Daeumewt Na. ~~~~; and ghat I Iwe1 pneaen~2y a e di,s a~ d ahem { an 1 (weI ~ have ab~ai.ned an own ~h.e pnopod ed a.cte ion the a ew g, p y eaaeme-tit, ~o nun•w.i~h ~h.e above dedc~u.bed pnapenty, ion ~h.e eoris~'ic.ucti,an o~ aatid .ays~em, and the berme had been du.2y neeanded .gin the C{~~~.ee o~ the CaurLty Reg.c~s~en ob ~eeda, as ~acwnerLt Na. ~ 1. ~ . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER ('IF APPLICABLE) PATE SIGNED DATE SIGNED X88808 VOL v 70PA6E 1.98 STATE OF WISCONSIN, CIRCUIT COURT, IN THE MATTER OF THE ESTATE OF `DONALD H. GUNDERSON Under oath, I state that: File No. ST. CROIX COUNTY PETITION AND CERTIFICATE • TERMINATING JOINT TENANCY • TERMINATING LIFE ESTATE • VESTING SURVIVORSHIP MARITAL PROPERTY 92 PR 74 F ~ 13 14~ Y' - 1. The above person died on October 20 , 1990 domiciled in St. Croix whose post office address was Route 1, Box 190 , tiVilson , L11I 54027 County, Wisconsin, 2. At the lima of death tha decedeni had the following interest(s): • Describe property (including recording data, if any). • Designate type of property interest (Joint Tenancy, Life Estate, Survivorship Marital Property). • Give name of surviving owner(s). The following property held in joint tenancy with Frances Gunderson by Administrator's Deed dated November 9 , 1959 , recorded November 11, 1959 in volume 363 of records on page 92 as Document #259998 conveys The North Half of the Southeast Quarter (N~ of SE4) of Section Twenty-two (22) , Township Twenty-eight (28) North , Range Fifteen (15 ) West. Assessed value = $57, 530.00 Estimated Fair Market Value = $58 600 O~ECj1SrERt ^ See attached. S OF ST. CROIX CO., Recd for Record J ~ `~ ~' 11992 I ask that a Certificate of Terminationl~cii~tte~pt~ be issued. at 11:45 A: Subscribed and sworn to before me m C~ ~ on August 5 , '1' 79 9 2 Re ~ster of Deeds 2~~1 ~~~ - ~~c-~~F C , 'j-1 ~ Signature of Petltioner _e E. Blegen taryPublic,Wisconsin Frances A. Gunderson Name Typed ti~'r cormission expires: August 21, ~ 994 August 5 , 1992 Robert J. Richardson Name of Attorney Richardson Law Office Sa 3 McKay Avenue Address Spring Valley, Vti'I 54767 -'~`•J~..:r..t~~1~2F tt~ 1:0C!~fT?Sf3f I~ v ,, >Y.c: •i ~ ci;c~ ,d i• i -: -' -i~ ~C 4. .. t .-NJ.i k~~, * . ~, ~' <. - l • - ~` ~~ ,~ :Y~~? CERTIFICATE Based on the petition, the court certifies the date of death and ownership interests of the decedent, and terminates/vests that interest. The Department of Revenue's Certificate Determin- ing Inheritance Tax, if required, is on file with the court. BY THE COURT: Signature of Circuit Judge C. A. Richards Name Typed PR-t426, 4/90 - (PR-1427, 43A,44A) PETITION AND CERTIFICATE TERMINATING JOINT TENANCY/ TERMINATING LIFE ESTATENESTING SURVIVORSHIP MARITai PRCIPFPTV S Stock No. 25464 10/26/93 09:02 $ COtiNTY CLERK X002/003 i ., , 10/26/93 09:03 $ COUNTY CLERK f~ 003/003 Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations nivisinn of Safwty R Ruildinns Page ~ of :3 _ - _ 111 4VVVIV ~~~LII ILI 11 ~ VV.VV, ~~~J• /14~~~• \/VVV COUNTY ~7 ~ ® ~ but Plan must include er not less than 8 1/2 x 11 inches in size lete site lan on a Attach com , . p p p p not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. C5C3'~ - l0 ~ .~, - 7 U APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: t~-~o~,v, Gcs ~~'^ ~~ ~ so,~ PROPERTY LOCATION GOVT. LOT ~~ 1!4 SE 1/4,S '~T a $~ ,N,R 9 ~ E (or'VI\ PROPER ~OWNER L~NG ADD R E$S :S Ids I LOT,#~I BL0~1~ # SU ED. NAME Q~ CSM # S ( ~ ~ '/ , CITY, STATE ZIP CODE PHONE NUMBER 3~ ` ^CITY ^~ ~GE OWN NEAf~$T ROAD ~ ( ~rST ?7~ - YS lr~ r [ ~ e n ~ 4o Z ( ~ ~ r~ cl [ ew Construction Use [ ~-]Residential / Number of bedrooms _ ~ _ [ ] Addition to existing building (]Replacement [ ] Public or commercial describe Code derived daily flow yea gpd Recommended design loading rate : ~ bed, gpd/ft2 , ~ trench, gpd/ft2 Absorption area required yGa bed, ft2 ~ trench, ft2 Maximum design loading rate 5'~ bed, gpd/ft2 , ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~>. Oo Q°~ 0 1~ ° ~~ ft (as referred to site plan benchmark) Additional design /site considerations ~' s~.wd~ ~,.y.,~..e v- Lp non e . t= ~~ ~ S ~~S ~ Lac ~-- Parent material ~/~ ~~eY `~ Y 1 Flood plain elevation, if applicable /l~'f~ ft S =Suitable for system CONVENTI~ON~e ^ S L~J'U M~OUya~ C9'S ^ U IN-GROUNDPR~SSURE ^ S ©~l7 A^T- S DE S^YSS IN FIL H^0 SING TANK U =Unsuitable fors stem SOIL DESCRIPTION REPORT Boring # tk° ~...:::,h~ ! ~` ?~X~._> ~~ <>~ Ground elev. ft. Depth to limiting factr=~ Ebb- t~,C,.U~ Boring # Ground elev. y~ ft. Depth to limiting fact~r~ y ~'~I- ra ~ ~ ~ 1 Depth Dominant Color Mottles re T xt Structure Consistence Ba rtdar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color u e Gr. Sz. Sh. . y Bed Trer>ch -~ /d ~ - sal ~ bk >. ~`' ,. s,~ ~ --~3 ! o ~ - ~ l+~ct i. ~J u ~ 5 . ~ ~~ ~ o ~ ~ - vw S b ~' w.~ i. c~ J S ~I~ Remarks: a -~ o O ~- `- s ~) ~ ~~ b ~ ~- c~ /~ S ~ ~ I O -~(~ t D l2 ~` - ~ w. S b r c.J u ~ S -~ o O ~ ~3iP . S ~- /d 4tp S ~ C S b~ Vv. v ~ S~ rn ~~ ~ c;, Remarks: '-~U~~rY ~~~~ CST Name:-Please Print ~ Ph e: 7~~-ti. ~ 7~ ~ cdO~ ~ Address: ' ` ~- r~~ ~,~. l~ ~ ~ I Signature: ~at~; CST Number: ~ `' c ~- a .~ ~ p PROPERTY OWNER ~ra~.s,~< ~'~,,.~ ~SO,~.- SOIL DESCRIPTION REPORT Page a of 3 PARCEL I.D. ~ ©~ ~ ' i t3 ~~ - -? d Boring # 4'v :•4:ti i"•:ti 4 3 >: »{ .. Ground elev. ~ (~ ft. Depth to limiting fact ~ 1 ESQ- ~.G.ur Boring # kvv: x::.:v++'~yii: t:? ~ vii tiv is ti~i .~~~~.w :.: Ground elev. ft. Depth to limiting factor~,~ ~s"f 1~'G. U% Boring # 44 Xi1•M1:.}y}.:.:.:.. :v:.•.y y..: x.~:}: 4"• ~:: Ground elev. ft. Depth to limiting factor ~s~t~w Boring # 4kv~::~•inv ;~: ::iSt :}: ti? \i y:';: f'~ Ground elev. ft. Depth to limiting factor Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD'Ift Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 3~ / ~ ~`~ 5 - o ~ ~~ ~~- c t~ ~s . ~~ (- ii' ~ i ~ y ~ 5' _~ - ~ -~ If ~ ~r1, ,S ~ Remarks: I a~ ~0 3- s ~l ~ ~ s6~ (~~~ ~ i~f ,~ S-, ~ ~ ~-i ~~ y s' 1 ~ w. sbk ~r ,u~ , 5 ~ ~ Remarks: d-I p ~ ~ ~ ~~ (~ ~ Cc. S a~f f ' ~ s s a o~ o ~ av"S~k ~~ :~ ~~ ~s~. 3 ~ o y- _~ -C ~ u ~ S 0_y o '~ -rr3cl S ~ 7. s ~ 5 ~ v~ sbk w~~~ ~ `~ Remarks: Remarks: SBD-8330(8.05/92) ~5 + k r .~ 3~t~ __. ~' .5.`i" -~~.~-~ - ~~'vy--- X309 Y _ s, s~,~~ei ~- :, ~~o ~~ ~ ,5iop ` ~ ` /, ~' B2 "~~~os~~ ---rt- ___ ._,---- G~t i -_-_ ate` ~ ~, ~.M. ~ 1~,~.~. iOC~.ac_~ - ~ E,c~~.~~-,BLLS Sev~-« Ta(~~~C , _ ~~ ~s~ N ~~-,;~t Gam, . Ex.c~,p~