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HomeMy WebLinkAbout030-2094-70-000 Q o (D o I o ta, d a rs, ~O I I' I o I 0 H ~ I C I ICI ~ I i z C ~ m I C LL a I I 3 I z ui rn Z o z £ °wl' am cr) c) y m N F- Z I' C O C C7 O z d c V Z 'o z (n P - ° m c E O N M W O N d O 7 N O N (n ~ N C N N • L "C O ry LL N }i o o d p " I O z F z o N Q z ; C O N N <pNE O - m N S ' a m m N w O M 0 to CL M C > W d i O 0 O 0 CL CO N L I O _O V_- p _ co N F- N O F F- 0 3 3 ° Zo ~ I =aaa S O N ~ rn rn O I v1 U 3 rn rn z O Cl) I > O N .a- O ° ~Y N a 2 y d d~ c1? m L I O p3 y N n C O y O O O = N O ~O O O H m O C C t LL O O V ° v, p N C 'N a> r N ❑ 'D O W N O O 12 c rl O' c+> O _ N cn O O • L. O N U) cG N O -~Q z z c r^ ik w E G! V m L a EL s I' a E c c A LO) a m o (A V ,t y . Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Dini~ 'h of Safety & Buildings ifac 8 . Wis. Adm. Code ~ COUNTY St. Croix lze.. PI t include, but PARCEL I.D. # Attach complete site plan on paper not less than e7; not limited to vertical and horizontal reference p~ of sl cale or IEWED BY DATE dimensioned, north arrow, and location and dist APPLICANT INFORMATION-PLEASE PRTI(If REV PROPERTY OWNER: ZONINGOFFlOE P LOT LOCATION NE 4 SW 1/4,S29 T 30 N,R 19 * (or) W Jo Ann Persico Bruce Peterson PROPERTY OWNER':S MAILING ADDRESS - # BLOCK # SUBD. NAME OR CSM # #328 Co. Rd. #F na Highland Hills phase II CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (TOWN NEAREST ROAD Hudson, WI. 54016 (715 386-8236 St. Joseph Co. Rd. #E New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 450 and Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpolft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate . 5 bed, gpolft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) 96.05 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial till 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 ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ❑ S ®U ❑ S M SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Tiench 1 0-11 10yr4/2 none 1 2msbk mfr gw 2f .5 l f .5 .6 <vY : a? 2 11-23 10yr4/4 none sil 2msbk mfr gw Ground 3 23-60 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 elev. 4 60-96 7.5yr4/6 none co s Osg ml na na .7 :.8 100.05 ft. Depth to limiting factor +96" Remarks: Boring # r 1 0-9 10yr4/2 none sl 2mgr mfr gw 2f 1.5 1.6 2 2 9-19 10yr4/4 none sl 2mgr mvfr 9w if 1.5 .6 3 119-32 7.5yr4/6 none s Osg ml 9w na .7 @.8 Ground elev. 4 32-96 7.5yr4/4 none sl 2msbk mfr na na .5 .6 100.02. Depth to limiting factor +96" F Remarks: CST Name _Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 20 th. Ave. , New Richmond, WI. 54017 Signature: Date: cstm 2298 T Number: 6-24-94 PROPERTYOWNER Persico/Peterson SOIL DESCRIPTION REPORT Page 2 ~_of 3 PARCEL I.D. # ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxnciary Roots GPD/ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed ITrerch "XI ? 1 0-9 10 r4 2 none 1 2msbk mfr crw 2f .5 .6 3 2 9-23 10yr4/4 none sil 2msbk mfr 9w if .5 .6 Ground 3 23-60 7.5yr4/4 none sl 2msbk mfr 9w na .5 j .6 elev. 99.05t. 4 60-89 7.5yr4/6 none co s Osg ml na na T 7 .8 Depth to limiting factor +89" Remarks: Boring # 1 0-11 10 r4/2 none 1 2msbk mfr 2f .5 .6 4 2 11-22 10yr4/4 none sil 2msbk mfr gw if .5 .6 MUM 3 22-80 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 96.95 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-8 10yr4/2 none 1 2msbk mfr gw 2f . 5 .6 S 2 8-23 7.5yr4/4 none scl 2msbk mfr gw if .4 '.5 3 23-78 7.5yr4/4 none sl 2msbk mfr na na .5 .6 Ground elev. 97.25 ft. Depth to limiting factor +78" Remarks: Boring # Ground elev. ft. i Depth to limiting factor Remarks: SBD-8330(8.05/92) { STEEL'S SOIL SERVICE Gary L. Steel Highland Hills phase II 1554 200th Ave. CSTM2298 lot #16 New Richmond, WI 54017 MPRSW 3254 NEgSW4 S29-T30N-R19W (715) 246-6200 t town of St. Joseph N 1"=40' BM.=top of NE lot stake at el. 100' JAI, 4 1b IBS, ` V &I I Ole' ~C}'I Gary L. Steel 6-24-94 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER z4ge ADDRESS -W/ SUBDIVISION / CSM (/I e*rl LOT SECTION 2-4 T3_N-R. W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ta.06 ~ LpTGOrAci' I'/Q7✓ vlr~ r o ` !o 302" e ~ • ~s use l/ pis lice ~.~m tt Weil S' 5k r. d ~~c~-~~s 5 x Bo N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: A/k 4>16c6yo. /V1 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~ tIES C:~ Liquid Capacity: Z" Setback from: Well ~Q6 • House ,,.7zZ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ,S Length Qo Number of trenches Z Distance & Direction to nearest prop. line: 68' 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: LICENSE NUMBER: INSPECTOR: C 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 n r-') AAA Permit Holder's Name: ❑ City ❑ Village pwn of: State Plan o.: i++tILBRAAiDT, DAVID CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type of CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No C] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH. 29.30.19W, NE, SW, HIGHLAND VIEW RD, ~d~Yr'1 `S N back Ito 0-yL y - Plan revision required? ❑ Yes ❑ No H_ I H Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division Bureau of Building Water System, r-■`■■■~ SANITARY PERMIT APPLICATION 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. 7 - ~4 NJU • See reverse side for instructions for completing this application State Sanitare `it mber ? 14 P 0? The information you provide may be used by other government agency programs E] Cheecckk it revision/to previi/us application (Privacy Law, s. 15.04 (1) (m)]- r tate Plan I.D- Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert y Owner Name Propert Location ( ly- 1/4 8,,11/4, S -Z4 T ® N, R lgk (010 Property Owner's Mailing Address Lot Number Block Number yy1 V City, tate Zip Code Phone Number Subdivision Name or CSM Numbe _ Nearest Road o/ f. ( 612 ) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cityage ` ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Vll Town of o'1 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ©3o o'er - ?D 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12;,Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade - ` Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) i) EI vation y / Feet Feet VII. TANK Caaa it in gallons Total # of Prefab- Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tanks ,o Septic Tank or Holding Tank j weeks < El El Lift Pump Tank /Siphon Chamber ❑ El ❑ ❑ 1:1 1 1:1 1:1 0 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI ber's Nam P ) Plu ber's Signature: o Stamps) MP/MPR Business Phone Number: yr f ~ w. -77 Z - 3Z Plum is Address (Street, City, State, Zip C de): 3 t, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sw/f/d ary Permit Fee (Includes Groundwater at ssue Issuing Agent Si No Stamps) J Approved E] Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBO-6396 (R. 0' 5/94) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4_ Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwii fling. 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, nu ur'c ,r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Cvriplete fc r ;rfi s: ptic, pump/siphon and holding tanks for this systern. Check experimental approval only if tanks receivpc experir.,ent d ;)roduct approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number v,iih approar )'i~ prefix (e.g. MP, etc-), address and phone number. Plumber must sign application form. 1X. County / Department Use Only- X. County / Department Use Only L . ; t' N.~:f'3_ t _ Spec-ifi at:.)i`.S not Sma X 1 it?Ci, . su_ lty_ -{le plans must r~vv! tg~Ul ldn, araN'r v1 di Corr, _.'I°S1tt'. ding tcink(s), septic ti0 :CS pUrrrp or sips on tar ;i' Drption the handing served; Jn ti~s~_ section '2 1; 'i t yc i)SO I <<iu,red Hy ng infonration. GROUNDWATER SURCHARGE i ,98'? W t 10 included the creation o surcharges (i'ees) for r,1z,#, fated pr.:i wvnich can effect grcxunclvva~.<.>r. Tire (TIC) E CJ it '`.eG througH 0o-se _,i1?cllii(i t'S e used for nvesti,jabons and esta`,I,s~ c,f standards JOB TIMM EXCAVATING 2 OF Z SHEET NO. Route 1 Box 192 6' WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE r c...... . . s < G 4 o LL 1 ' PRODUCT 205-1 ~ Inc., Groton, Mass.01471. To Order PHONE TOLL FREE 1.600-225-6960 ' r TIMM EXCAVATING JOB SHEET NO. OF z Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .........i ..:..........:......................i........ jYo ?y zg . . n....................... It t j 83 , • t, r \ 1 _ IHa s oed !1_ TZ / - PRODUCT 205-1 ~ Inc.,Groton,Mass. 01471, To Order PHONE TOLL FREE I-800.2256380 Wjscaisih rtment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY fs Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Cr x 34 ".~'"'p ^Ts'► 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. 630-2094-10"' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE ED BY' E PROPERTY OWNER: PROPERTY LOCATION David Milbrandt GOVT. LOT NE 1/4 SW 1/4,S ~0 ,N,R: j9_ PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR 2718 Sylvan St. 16. na Highland Hrls phase IV- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Little Canada, M. 55117 (612) 437-0896 St. Joseph Co. Rd. #E [ New Construction Use [ xJ Residential ! Number of bedrooms 3 [ J Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2 .5 trench, gpd/ft2 Absorption area required 900 bed, ft2 900 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevatio1s arg 1n97.00 step down ft (as referred to site plan benchmark) Additional design / site considerations trench' s 3.33 ' below surface spaced to code 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 for s stem tkS ❑ U ❑ S ®U 7E2S ❑ U ❑ S ® U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 10yr4/2 none 1 2msbk mfr gw 2f .5 .6 1 2 8-23 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 Ground 3 23-78 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 elev. 100.2$t. Depth to limiting factor +78" Remarks: Boring # 1 0-16 10yr3/3 none 1 2msbk mfr 9W 2f 1.5 .6 ...2.`€ 2 116-40 10yr4/6 none sicl lfsbk mfr gw if .2 .3 3 140-86 7.5yr4/4 none sl 2cabk mfr gw na .5 .6 Ground elev. 101.1 ft. Depth to limiting factor +86" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., New Richmond, WI. 54017 Signature: Date: CST Number: 5-7-96 cstm 02298 PROPERTY OWNER David Milbrandt SOIL DESCRIPTION REPORT Pagjj!_ of„-1-- PARCEL I.D.# 030-2094-70 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 10yr3/3 none 1 2msbk mfr 2f .5 .6 2 9-24 7.5yr4/4 none scl 2msbk mfr gw if .4 .5 Ground 3 24-82 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 elev. 97.6 ft. Depth to limiting factor +82" Remarks: Boring # 1 -12 10yr3/3 none 1 2msbk mfr gw 2f . .6 :F 4., 2 12-40 10yr/4/4 none sicl lfsbk mfr 9w if .2 .3 3 0-84 7.5yr4/4 none sl 2csbk mfr na na .5 .6 Ground elev. 94.00 ft. Depth to limiting factor +84" Remarks: Boring # % 1 -11 10yr3/3 none 1 2cpl mfr cs 2f np .2 5 2 1-26 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 6-88 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 Ground elev. 94.5 ft. Depth to limiting factor +88" Remarks: Boring # xV ~'vv tiff Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 David Mi-T30N-tR19W New Richmond WI 54017 MPRSW 3254 NE4SbV4 S29T30N town of St. Joseph (715) 246-6200 4 lot #16-Highland Hills phase II I N 1"=40' BM.= top of NW lot stake @ el. 100' o` y ~(h If S Z~ 170 i I 1 Z d7d Gary L. Steel 5-7-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County p I L6 K-fl1`5~~. OWNERIBUYI~_ J 1 MAILING ADDRESS d 7l b S,41,4, 15r G,WZe ~G s ty f c S.~//~ PROPERTY ADDRESS f f/ (location of Sept' system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION -1/4, S&&) 1/4, Section Zf , T 3~Z N-RI_W TOWN OFt /L ST. CROIX COUNTY, RR SUBDIVISION - LOT NUMBER Ag, CERTIFIED SURVEY MAP ------,VOLUME , PAGE , 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 thr ear expiratio d te. SIGNE DATE: 6-- 7- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property A; I ~IV Y Location of property_ji& 1/4 $C~ 1/4, Section ,2,9,T 3d N-R19 W Township 60( Mailing address Address of site t. , Subdivision name ee-j Lot no. Other homes on proper y? Yes No Previous owner of property Total size of property Total size of parcel a~ ~CrgS Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? PC Yes -K ,,__No Volume 73 and Page Number Y?T 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 'n the office of the County Register of Deeds as Document No. 9--~5 , 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. s Signature of Applicant Co-Applicant Date of ignature Date of Signature ~ o \N-4 LOT 17 o LOT 18 DS ACRES 4.42 ACRES m 3.15 S \ 192,500 SQ. FT. 137,265 SQ. FT. .p .p .P o O 01 O_ EL.= 940.4 )50 .00' - - N89°16'22"E- 422.00 - - - - 25 _~76~47,27 N89016' 22" E 772.00 6 10p.00• E JD - - - 7 S89°16'22"W 722.00' 4 - - -S89°16'22"W 322.00' 450.00 N7s 47 - 1 ~ 1. . loo. 00, W- I 1.. .....1 75' • - - 1 50' 1 L -DRAINAGE I EASEMENT 1 w LOT 2 Ll N/ i N J 3, LOT 16 ° I O 132' " OD O 3.29 ACRES 143,254 SQ. FT. o W A D N w . fTl \ EL.=951.0 S 89°16' 22" W N89°16'22"E 422.94' / o Ll LOT 3 (D 3.( - CD I 131, _O Q) _ w N J - N J LOT 12 ~ o~ W 3.06 ACRES LOT 4 133,250 SQ. FT. - 0 N / 18 THE S64o / 3 \ J 20 / 2q F / / EL =951.0 : WARRANTY DEED SX25 ~ r . - Document Number APR 22 1996 3:00 P.~• Return Address Parcel I.D. Number U 3 _ 2,o V Highland Hills, a Partnership, conveys and warrants to David Allen Milbrandt and Rebecca Sue Milbrandt, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of'Wisconsin: Lot 16, Highland Hills First Addition to the Town of St. Joseph, St. Croix County, Wisconsin. This deed is given in fulfillment of that certain Land Contract between the parties hereto dated October 5, 1997, recorded October 9, 1995, in Vol. 1143, Page 306, as Doc. No. 534741, in the Office of the Register of Deeds for St. Croix Couiity, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of April, 1996. FEi: Highland Hills, a Partnership EXEMPT 'f'~-c'Lo (SEAL) oAnn Persico, individually and as Power of Attorney for Roger Ruelin and Bruce Peterson ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss . C y C"( x COUNTY ) Personally came before me this Din c( day of 111 p r 1996, the above named JoAnn Persico, individually and as Power of Attorney for Roger Ruelin and Brace Peterson, to me known to be the person s) who executed the forego' g instrument and acknowledge the same. ItaD' public ~a'O r County, Wis. E ` , . l~.y c61imission expires 5-~ Y- 9X THIS INSTRUMENT WAS DRAFTED BY: r ~ ~ r~ ~~v C 7 E ~ r ~ d c ~ ~ ~ r ~ r ~ p U i ~ 1~ ` ~r i ~ i 10 ~ ~