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030-1017-95-110
Q c m ° 0 ry " o ~ II o 0 o .c ~ O X (9 c O C f0 Q N co E 'a 0 c 0 y co C N (D d p •O N M ~p 7 U N N N d . E2 V I' p N C Z c m 3 CD ul 3 i LL c C O >N y O O L U 'O o a d y M > 71t L- Z N _T Lu Z O V O Z d d L H U) Iii d m o I O Z d U a~i Z d o z - a> '2 ~o Co. (1) m ^ N O. AI~ N U N U) N c • N IL O U co c O O O d C Z F- Z Z I CO y > 'C M N > d - d O. •w r~+ Y c CO CO O y d L J o O O O 0 a N N C) E :3 ca Z u7 f' H H U w N N 3r 3: ~r aa a~ z00 C) ~a Z a L C N y m ~ N 7 O V1 7 O (o (o O N co -i L) 2 rn rn } ti co o o 0 om 0 0 N N ' ml t LL O I' 2' .O N uNi tp G) 00 •p N d } iJx ~p U) 49 Ci O ~ 7 w C O O c '0 m c 3 (p p .o c E 04 Lo 0) a) CO t U N S N LL 0 O 0 0' E E N N N ^ _O of N _c a~ O d . Q of O N W di N L _ -O I- O O ^x)1 ~I N (6 co O _ U O N E U O L' O O U) I J -O N Cl z `1' Zi W ~ I EL a) 0 a .v m a t~ c 'I C t A 0 a~ 11 0 in 0 t a.K. rein; allu nullml neIauviw n Division of Safety & Buildings J $ ccord with 1LHR 83.05, Wis. Adm. Code Attach complete site paper han 11 inches in size. Plan must include, but St . Croix not limited to vertical oriz Ireinf(I, direction and % of slope, scale or I.D. # 99 a nc4lo-clearest road, pending oned, north and dimensi ED BY DATE FREE APPLICANT INFO T101~- ,4ERINTj4 INFORMATION PROPERTY OWNER: Vin, ' , PROPERTY LOCATION :9 (or) W J G T SW 114 NE 1/4,S % T 29 N,R , Dahlby SU. NAME OR CSM PROPERTY OWNER':S MAIL 'A„ 399 Brookes d CITY, STATE 1 ZIP CODE PHONE NUMBER {MOWN NEAREST ROAD Hudson WI. 54016 (715)386-0244 St. Joseph New Construction Use (X) Residential I Number of bedrooms 4 Addition to existing building Replacement Public or commercial describe Code derived daily now 600 gpd Recommended design loading rate . -5 bed. gpd/ft2_-,5 _trench, gpd/1112 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.25 starting el. It (as referred to site plan benchmark) Additional design/ site considerations step down trench spaced to code installed 3-91 tai ow surface Parent material pitted glacial drift Flood plain elevation, if applicable na ft -7 $ a Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ®S ❑ U MG o u ®S ❑ U ® S ❑ U Gas o u ❑ S [at SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 -9 10 r3 3 none .5 .6 2 -28 10yr4/4 none sil 2msbk Ground 3 8-60 7.5 r4/4 none elev. 91.85 It. - 4 0-84 7.5 r4 4 none MS nwfr na -ma- -7 i Depth to limiting factor +84° Remarks: Boring # mfr 1 10-11 10 r3 3 none, I 2 2 11- 8 10 r4 4 none -si I --2xasb3r,- fr. Ow if . 3 28-65 7.5yr4/4 none sl 2msbk na' Ground 97e125 It 4 5-84 7.5 r4/4 none is os mvfr n 8 Depth to limiting factor +84" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av New Riehmon W1 54017 Signature: Date: 9-12-96 CST Number mO2298 PROPERTY OWNER Ji.m Dahlby SOIL u t U U M f r I W N "r- V U n I r ayr. 2 S6 3 PARCELLD.f: pending Lot #5 Boring# Horizon Depth Dominant Color Mottles., Texture Sere gourv ay Roots GPD/ft In. Munsell Qu. Sz. Cont. Colo' Gr. Sz. Sh. Consistence Bed Trench 1 0-17 10 r 3 none Q-11 2c 1 mfr El 2 17-37 10 r4/4..- none sicl 2msbk mf r Ow if .4 .5" Grouim 3 137-49 7.5yr4/4 none sl 2msbk mfr na .5 .ti elev. 92.6gft Depth to t limiting l factor , , Remarks: Boring # 1 0-9 10 r3` 3 none s ! 2 9-28 10 r5 4 none sil 2 b mfr aw if .5 T.6' 3 128-58 7:5 r4 4. none . Ground elev. 4 158-82 7.5yr4/4 none is os mvfr na-'• na .7 i .8" 97.85ft. Depth to limiting facer +82" Remarks: Boring # 1 10-10 10yr5/3 none sil 2cp1 mfr caw 2f np .2 L'3 2 110-30 10yr4/4 none sit 2msbk mfr 9w if .5 .6 3 130-66 7.5yr4/4 none sl 2mgr mvfr gw na 5 .6 Ground elev. 4 166-84 7.5yr4/6 none is Osg mvfr na na .7 95.85 ft. Depth 10 Nmifing +84" i Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: I STEEL'S SOIL SERVICE Gary L. Steel Jim Dahlb 1554 200th Ave. MPRSW 3254 SWkNEk S5-T29N-R19W New Richmond, M 54017 town of St. Josph (715) 246-6200 1 lot #5-csm N 111=401 BM.= top of SW lot Stake C el. 100, n ~ 2 9 13' ~ ~l Qy Gary L. steel 9-12-96 Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. x , 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 ~~O l Y than 8 1/2 x 11 inches in size. - • See reverse side for instructions for completing this application State Sanitary Permit Number ,;26 g(~ P? The information you provide maybe used by other government a enc r rams ❑ Check it revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFOR TI E SE PRINT ALL FORMATION Property Owner Name Property Location 1/4 v4, S~ T 2g , N, R/9 E (or Property Owner's Mailing Address Lot Number Block Number a a City, State Phone Number Subdivision Name or CSM Number S yG 10 (tS)~ -.s6 c / /4 ' II. TYPE OF BUILDING: (check.one) State Owned ❑ city JNZ e st Road ❑ Village c'v Public 1 or 2 Family Dwelling - No. of bedrooms Town OF!;-LZdem114 Rd III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 aSO /017 - 9s- //0 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. oK 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-Fil I 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/da /sq. ft.) (Min-/inch) rr. 31, lev t' on ~-6 -7 S~ fir} r e~ q. ys Feet Feet VII. TANK Capacity site Prefab. Fiber- Exper. INFORMATION in gallons Galoltons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. New Existing structed Tanks Tanks Septic Tank or Holding Tank ~d f W i El El F1 E Lift Pump Tank /Siphon Chamber El 1 1:1 1 1:1 -1 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Si nature: (N Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code IX. UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Age t Sign' / (Aroved Surcharge Fee) / / ,may pp ❑ Owner Given Initial ~l/ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: BENCHMARK: .5 41.6 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ,yy~,'d~~s~~y Liquid Capacity: ,442 Setback from: Well'1'~~'~` /~~`House /3 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Z_ Length S Number of trenches Distance & Direction to nearest prop. line: /D Setback from: well:, House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: =-~lJ~ - LICENSE NUMBER: ,144 INSPECTOR: 7- 3/93:jt STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER-W,I,' e ct s S e- ADDRESS SUBDIVISION / CSM# LOT # SECTION 5- TAN-R/ 5rl_W, Town of 57- ` ::fffc/6:j ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v~ L r~ S I 0 5e '`t 3f ~v I I ' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER u 7 f? A CA S S Q. • MAILING ADDRESS I Lo S `~0~/~',6Q PROPERTY ADDRESS ~r~ (`p location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4,_ 1/4, Section T2S_N-R_Y ~_W 'GOWN OF _ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTUUDSURVEY MAPrb- Z 1 , VOLUME 0 , PAGE 3 , LOT NUMBER J 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. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 -o- e5 n n n 0 0 n 0 0 0 n n 6 0 WRA•-MCR C DISTRIBUTED BY WISCONSIN REALTORS ASSOCIATION WISCONSIN REALTORS ASSOCIATION 4801 Forest Run Road Madison, Wisconsin 53764 AMENDMENT TO READ. ESTATE CONDITION REPORT THIS AMENDMENT TO REAL ESTATE CONDITION REPORT AMENDS THE REAL ESTATE CONDITION REPORT PREPARED BY .1~0e_ 4,00 L~~~`fa Mare_4 (OWNER) ON - - 19 (DATE OF REPORT), CONCERNING THE REAL PROPERTY LOCATED AT 'U,r oglk 6-> (STREET ADDRESS), IN THE ( . V*6%GE) (TOWN) OF COUNTY OF _ Gv-o i-~_ STATE OF WISCONSIN. The owner is required by Section 709,035 of the Wisconsin Statutes to amend any original or amended Real Estate Condition Report if since completing the Report, but before the acceptance of an offer to purchase or option contract,' the owner obtains information or becomes aware of any condition which would change a response;.on the:prevlously completed Report. The amendment must tie submitted to the prospective buyer, alOng'with a copy of the previously completed report if not already submitted, no later than 10 days after the acceptance of the offer or option. This amendment is not a warranty of any kind by the owner or any agents representing any principal In this transaction and is not a substitute for any Inspections or warranties that the principals may wish to obtain. OWNER'S AMENDED RESPONSE Item Number of Property See Condition Statement Affected by Expert's New Information or Condition Yes No N/A Report -r- Owner's explanation of any "yes" responses: Q d-di, A 1al-T, a~OLC? C 1; ; Seim I "A3 R 1 4- . 1CyYr N Q/l.t,. c l U t't.e a26L p . /Lit i~SJ % QYl'Q .pri, /a - 10 _ 9 OWNER'S (CATION: The owner certifies that the information In this amendment is true and correct to th f the own is k wledge as of the date on which the owner signs this report. Owner Date G - i I-99 owner Date _ _ q q Owner Date Owner Date BUYER'S ACKNOWLEDGMENT: The undersigned acknowledges receipt of a copy of this amendment, Prospective Buyer Date G u- 11 Prospective Buyer Date . L - I - 9 q Prospective Buyer Date Prospective Buyer Date C,vffoht t 998 by Wacusin REALTORS' AnocWilon Dmtwd by. Datua Peumn Conrad No rep- *Akion is made as b 00 Iogw vafloily of any provision or ft adoduacy of any provision in any speodlc uansadkm e I i ~ r- ~ J ti 13 f M r3 o~~o 00 7 2 O 1447PAGE 14 EXISTING SEPTIC 605059 SYSTEM AFFIDAVIT KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI Name & Return Address : RECEIVED FOR RECORD Mark A and Denise J And rso 458 River Road 48-04-1999 2:45 PM Hudson, WI 54016 AFFIDAVIT EXEMPT 8 CERT COPY FEE: 05,29,19,76A-10 COPY FEE: 2.00 TRANSFER FEE: Parcel I . D . Number RECORDING FEE: 10.00 PAGES: 1 030-1017-95-110 Computer I.D. Number The existing septic system which serves the dwelling being added on to must be verified by an acceptable soil report or be inspected by a licensed soil tester for compliance with high groundwater and/or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2) WI. Adm. Code. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is properly functioning, an addition may be added to the dwelling without updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1) Property Owner(s) Mark A and Denise J Anderson Property Mailing Address: 458 River Road Hudson, WI 54016 Property Legal Description: Lot # 5 CSM/Subdivision \401. ( t 31(0'1 D)29b,550, SW NE 5 29 19 St. Joseph Sec. , T N-R W, Town of Comments: The existing septic system was sized and installed for a three bedroom dwelling and was installed by William Schumaker on 12-10-1996. I, as the owner of the above described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Signed:L LL6L_Q C1C(Shn Notary Public Subscribed and sworn to before me on this date: Date: -~t gg g/,~f 99 Zoning Deplyttmeennt n commissio xp3,3e ~2~t( Approval: e~) J g ` eDate: 'cQ o S ~`y i . l o g STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i) Gam' c c ADDRESS ~`c% S G~.~✓ SUBDIVISION / CSM# Cl LOT # SECTION T :?-/N-R_ZJ/'_W, Town of ~5; ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM co e 4,1 v~ ' (T Z V i v ~s INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: s„ ~t It 11_6 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 4J Liquid Capacity:~~~2,~)' Setback from: Well House /5 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length S Number of trenches Distance & Direction to nearest prop. line: /Q Setback from: well:' House -3 d Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB:i LICENSE NUMBER: 144,,e2 ~ INSPECTOR: 7 3/93:jt wiscoosin 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 268699 Permit Holder's Name: ❑ City Village Town of: State Plan ID No.: LACASSE, R. W. ST JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA O 6 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G/ ~c~4r,-y~ 6L Benchmark ~43S 166,0 Dosing 1 P4 1-m , 4~ '1. j6t) , W Aeration Bldg. Sewer (o (aft S; (,:2-2 Holdi St/ Inlet rtANK SETBACK INFORMATION St/)A Outlet 7. VZ_ gy, 7,1 Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic NA Dt Bottom Dosi ng NA Header tL"_F111 /7 Aeration A Dist. Pipe 9o3io/ f,3, 'D mg Bot. System 9 •9~"Z , ZQ ' PUMP/ INFORMATION Final Grade d Manuf !!!;M Mo el Number TDH Li Lriction System TDH Ft Head Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT , No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D I M E N I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA M r' SETBACK INFORMATION Type O P_•,,..- 3v r ~ CH R UNITR Mo el Number: System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 4,/ Length/ Dia. `t Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst 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.)" LOCyA},}~~TION: ST JOSEPH.5.29.19W, SW, NE, RIVER RD E ..[-ice: • } " . d ' ^j."'~" 111A, 57 4•,.l Plan revision required? ❑ Yes No Use other side for additional information. /a 9 u- SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH p SANITARY PERMIT NUMBER: " 3.9 "ns- 36 17:.6 _ i01XTY SANITARY PERMIT R!InHR C°""` TRANSFER/RENEWAL . UNIFomm PERMrr M (Pl8 67-T) - z 9 lRMIt pENEWAL QATII: p AN FE A f' t~INAI E MI? ISSUAN E AT S AT PLAN t.G. NUM6ER, PmoPEk?Y LOCA► ION Al E- k,S J TR:f N,R /-5 TD OS h L~7 , VM LO K NUMBER SUBL~IVIS'ON N MEar? W ' . NEAR OAD,' KEOPLLANDMARK• _ - PREVIOUS "NOTARY PERMIT MOLDER (IF CHANGED) SANITARY PERMIT TRANSFERRED TO. A v {N PHG E NU• EA DD RS IE AD -t S - the undersi4ried, heraby aSSume r*s _ pons,hi)iiy for installation of the prira:e sewage system :hat rras RrOpe'iy. Prev'*U$ly been approvetl #cr tnrs L 6` A c:/ ' ~ PRcV:}~~ VL::MBE~S "JA!vI,E.~(I CNANG 1°1UMBEPi S ADDRESS. ` , PREVIOUS, Sy sEa ~ ADD~SS NUMBER HON !`UMBER: ~ ~ ~ 3 1 PRSVr NUMB:R PHOnIE NtJMBlfe. S,^",IATU - O t OF I A A P V 0 I DISTRIBUTIOl4, 0•IQjnai - county Coot • Burtsu of Pluembing 3BL~.6399 ,R, 518T? Copy . A•wrno. i ~w SANITARY PERMIT APPLICATION Safety and Buildings Division Bureau of Building Water Systems 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 ) s cr©' Y than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 14 114, S~ T 2g , N, RIq E (or Id, Property Owner's Mailing Address Lot Number Block Number 2 a D ~r1 od City, State Zip Code Phone Number Subdivision Name or CSM Number .s y (~s>3 -.s6 4 II. TYPE BUILDING: (check one) State Owned ❑ City Nearest Road ❑ village T ,Se GJAX w Sam/ Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town of Rd III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo c SO lO 17 _ " ~57^ 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. K_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/da /sq. ft.) (Min./inch) 8'$• 3S Elev tion .75-0 t_r% F 9. yS Feet 9/' Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing Gallons structed Tanks Tanks Septic Tank or Holding Tank PC I ~,/o '7`l~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Si nature: (N Stamps) P PRSW No.: Business Phone Number: `d ~3 7! .S ^ 3p ti //2 P umber's Address (Street, City, State, Zip Code /0 7d S~C_o IX. UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ~ Date Issue I suing Age t Sign Surcharge Fee) 2 16 9 Approved E] Owner Given Initial Adverse Determination ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Dive ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any ne 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 only one on Fine 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 isto 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 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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. . C__ r- C' 1 X • See reverse side for instructions for completing this application State Sanitary Permit Number r The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location SGJI /4 t /4, S:5- T .29 , N, R / e~7 E (orYIV Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number IL TYPE F BUILDING: (check one) R State Owned o vita a Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF S" T die X` r` r,,, 111. 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 S ❑ 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. X_New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System______________TankOnly Existing System _________ExistingSystem 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 22E] In-Ground Pressure 42E] Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) og. 3S Elevation ? 56 P y S Feet Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- Ex per. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App strutted Tank Tanks Septic Tank or Holding Tank 00 /;/"AV f • ❑ ❑ ❑ ❑ ❑ ~.s'7C'( Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ -1 1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N.Q 5 amps) P PRSW No.: Business Phone Number: amt' a.." -3~rG' ,r'r2 Plumber's Address (Street, City, State-, Zip Code IX. UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Age t Sign p~)- Approved ❑ Owner Given Initial A SurcnargeFee) , Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: _ SBD-6398.(R. 05/94) DISTRIBUTION: Original to Counly, 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, 608-266-381-5. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 1J -A o..casS ,SuJ y iUF% S T iP/9GJ oT S D F Tow,r~ F S-EZ,5-velm~ lb i ~ OW «d co . •s ypT~ G r 85 s F s a:2 Ala a 5 PJ i =:77EFQ3 R S ANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE SANITARY/ PE IT # -Attach complete plans (to the county copy only) for the system, on paper not less than -7(08'~R 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION R.W. LaCasse %4 NE Y4, S 5 T 29, N, R 19 for) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1220 Oakwood Ln. 5 na CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson, WI. 54016 715 11549-5693 csm vol. 11 nacre 1167 111. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned VILLAGE ; St. Joseph River Rd. ❑ Public ❑ 1 or 2 Fam. Dwelling~# of bedrooms 3 PIwo ARCEL A UM R( ) III. BUILDING USE: (If building type is public, check all that apply) D 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 450 750 750 .6 94.25 Feet 97.85 Feet VII. TANK CAPACITY Site in as Ions Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank X 1000 1 Lift Pump Tank/Si hon Chamber Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' I ure: (No S P r325,, PRSW No.: Business Phone Number: Gary L. Steel 715 246-6200 Plumber's Address (Street, City, State, Zip Code : 1554 200th. Ave., New Richmond, WI. 54017 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ry Permit Fee (Includes Groundwater a e Issued Issuing Age t Signature (No m ) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination l X. CONDITIONS OF APP~L/'~ NS FOR DISAPPROVAL: Cam- SBD-6398 (formerly Plb-67) (R. 11/88) 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 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 permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (ScD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) mtjst 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 ad^(nistrator or the State of Wisconsin, Safety & 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 numbers 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 Fam'~;y Dwelling. III. 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 information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallo,7s, 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 `.:anks 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% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainsvater 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; (Jose volume; elevation differences; fric ion 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 5 STEEL'S SOIL SERVICE Gary L. Steel R.W. LaCaSSE 1554 200th Ave. MPRSW 3254 SW44 S5-T29N-R19W New Richmond, WI 54017 town of St. Joseph (715) 246-6200 lot #5-CSM N 1"=40' BM.= top of SW lot stake C el. 100' ~{5d I2, to 18~ ~ 73 A 70, zA' 5rJ` ,bra , z5 .50 12dcK , 94, I Gary L. Steel 10-15-96 1 North ~ LOfi Sw'/y ~I E Yo ar I9 St ~o Se ~ ~ owe Gov ~ v Go . LoGsse- 14o" ~ a~-o oA~v.~oad L t cJ y9- I~ $py /64 as , ~a lob N q i Z1 a b M 380~~ Wisconsin Human n Relations tindustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 labs! and Hu Oiviss9n of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan m 1 ltd f~" p' St. Croix EL I. D. # not limited to vertical and horizontal reference point (BM), direction and % of slo o Qs or dimensioned, north arrow, and location and distance to nearest road. pending was.. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION h ' R D BY DATE PROPERTY OWNER: R PERTY A114Of>t Jim Dahl LOT 114 NE ti4 T 29 N,R l~ 76(or)W PROPERTY OWNER':S MAILING ADDRESS L C 'SUBD. NA CSM # ME, 399 Brookwood Dr. na c * CITY, STATE ZIP CODE PHONE NUMBER []CITY' []VILLAGE MTOWN- NEAREST ROAD Hudson WI. 54016 (715)385-0244 St'J 'h River Road 14 New Construction Use [x] Residential/ Number of bedrooms 4 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.25 starting el. ft (as referred to site plan benchmark) Additional design/ site considerations step down trench spaced to code installed 3.5' below surfar-P Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem M S ❑ U M ❑ U ®S ❑ U ®S ❑ U 62S ❑ U ❑ S CCU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-9 10 r3/3 none .5 .6 jC4 2 -28 10yr4/4 none sil 2msbk mfr aw 1f .2 .1 Ground 3 68-60 7.5 r4/4 none sl elev. 91.85 ft. 4 0-84 7.5 r4/4 none m Depth to limiting factor +84" _71 Remarks: Boring # 0-11 10 r3 3 non mfr ?mqbk 2f .5 i-6 e CS ' 2 2 11-28 10 r4 4 f .2 i.3 LU Ground 3 28-65 7.5yr4/4 none sl 2msbk mvfr na .5 .6 elev. 4 65-84 7.5yr4/4 none is os mvfr na na .7 .8 97.25 ft. Depth to limiting factor +84" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av New Richmond. WI ' 54017 Signature: - Date: 9-12-96 CST Number: m02298 Jim Dahlb( SOIL DESUWP r IUN rttrUn l rdy°? U1 3 PROPERTY OWNER PARCELI.D.# pending Lot #5 N Structure Bourci3y Roots GPD/ft Boring # Horizon Depth Dominant Color Mottles Texture Consistence Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. :ryrvt 1 0-17 10 r5 3 2c 1 mfr cs 2f n .2 4.•h 4:i: 4 if .4 .5 v n2 17-37 10yr4/4 none sicl 2msbk mfr cfw Ground 3 37-7? 7.5yr4/4 none sl 2msbk mfr CTW na .5 .6 elev. 92.65ft. Depth to limiting factor +79-" Remarks: Boring # :<,1 0-9 10 r3/3 none sil 2ms 2 9-28 10 r5/4 none sil 2msbk mfr if .5 .6 5 3 28-58 7.5 r4/4 none sl 2 Ground elev. 4 58-82 7.5yr4/4 none is os mvfr na na .7 .8 97.85ft. Depth to limiting factor +82" Remarks: Boring # 1 0-10 10yr5/3 none sil 2cpl mfr 9w 2f np .2 3 2 10-30 l 0yr4/4 none s i l 2msbk mfr gw if .5 .6 3 30-66 7.5yr4/4 none sl 2mgr mvfr gw na .5 .6 Ground mvfr na na .7 .8 elev. 4 66-84 7.5yr4/6 none is Osg 95.85 ft. Depth to limiting fa+84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Jim Dahlby 1554 200th Ave. CSTM2298 SW4NE4 S5-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of St. Josph (715) 246-6200 lot #5-csm I N 1"=40' BM.= top of SW lot Stake C el. 100' 1110 r 1~. 13' b 7 n' g.2 Gary L. steel 9-12-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER~ • MAILING ADDRESS I Z 2p et) a SWei 6 PROPERTY ADDRESS t J 6_e C, C{ ye location of septic system) Please obtain from -the Planning Dept. CITY/STAT> SQL PROPERTY LOCATION -S tO _ 1/4, WE 1/4, Section __6-T _J_H-R_L2_W 'SOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP/b- 2 I , VOLUME l I , PAGE 31 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. SIGNED: DATE: Zg St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i 8TC-loo This application form is to be completed in full and signed by the j owner(s) of the propert 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 f rm should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property S Location of property j6Lo_1/4A 1/4, Section To_N-R W Township S ~_7ts ~A Mailing address jaao j:!:,eK4 5^e)d Mad u)T_ e, v o i Address of site 5 s© S'~ Subdivision name Lot no. other homes on property? Yes l~ No Previous owner of property Total size of property r----t Total size of parcel Date parcel was created Are all corners and lot lines identifiable? t/ Yes No Is this property being de eloped for (spec house)? Yes V No Volume 120 and Page Nu ber as recorded with the Register of Deeds. INCLUDE WITH HIS 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. PROPE TY 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 his information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 11 5r-7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signatur llie~Applicant Co-Applicant hat-p of Sirrnifii-rl f Sirinat-iin- i S 9 _ FILED OCT 0 2 1996 0, 10 KATHLEEN H. WALSH Register of Deeds SL Croix Co., WI 5502;0 CERTIFIED SURVEY MAP Located in part of the SWj of the NE* of Section 5, T29N, R19W, Town of st. Joseph, St. Croix County, Wisconsin. N Le end Aluminum County Section Monument Found 0 ^ OWNER • 1" Iron Pipe Found .a Ln Jim Dahlb 0 1"x24" Iron Pipe set, weighing 1.13lbs 0.0 399 Brookwood Drive per linear foot .I.1 ~ n ? Hudson, WI 54016 100' Roadway Setback Line c N 0 ->E-r- Existing Fencel i ne L o 0010 0 z ( ) Previously recorded bearing and/or distance 4- 4) U_NPLAI TED LANDS I LCT I - - - C. S. M. IN G NORTH LINE OF THE SW 114 OF THE NE 1/4 V 9 270 V) y*' N 589°39'18"E 782.14' °1 0 v 391.07' r- 3: 0 r= I" IRON PIPE FOUND 391.07' T to a H N53°50'13"W, 3.62' 3.0' n O1 lV N Q CC 4) m FROM COMPUTED POSITION. LOT 6 N UNPLAi TEQ LOT 5 LANDS 6.01 Acres 8.81 Acres 261,966 Sq. Ft. 383,765 Sq, Ft. - M M PROVED LCT Z N N 1 c, a Cn LC I Ni N S. M. I N M- Z OCT 0 2 0' r c0t w m S.T. CROIXCOIINTY ,r V. I , PG. 250 ; (Se9°4318"~ CO tV .ompraheffsive Ftaw* N89°45'19"W N ' ZOfling and 91.27' c ' S89°45'18"E 306,47' Parks Catttrr*U00 ^ Z~ 22 F~ LOT z 240.47' 66.00' _ N 2.O' ° - !f not recorded . c"'1 ~ Y F- 0ni ~ LLT W W v; lthin 30 day's Of 00 w CO aQl trov at date o ~l W LOT 7 4 Ico w '•pproval shah be rri~ VI J. 00 n N8a045 8 'W . 380.13' N co 00 f" IRON PIPE FOUND 00 N02001'33"W, 0.92' M C14 U) 1~ _r - ¢ L C I I I FROM COMPUTED POSITION. M 0 0 O- Z NW Ln 3 ~.~.r~•!~ LOT 4 N V 2, PG. 586 I oe~t0~eaoA,w W A e VOL 1202PA 446 550599 WARRANTY DEED Document Number i I REGISTER'S OFFICE ; ST. CROIX CO., WI Reed to Rxod Return Address 'OCT 8 1996 at 11:00 .A M *XA.,. -R it fek. PAqWwOlDuft Parcel I.D. Number: James E. Dahlby, a single person, conveys and warrants to Richard W. LaCasse and Grace J. LaCasse, husband and wife, as survivorship martial property, the following described real estate in St. Croix County, State of Wisconsin: Part of SWU4 of NEU4 of Section 5, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 5 of Certified Survey Map filed October 2, 1996, in Vol. "11 Page 3167, Doc. No. 550270. Together with the right of ingress and egress over Private Road Easement as shown on said Certified Survey Map. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of October, 1996. TRANo,FER (SEAL) es E. Dahlby 19 AUTHENTICATION Signature(s) James E. Dahlby, a single person,