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HomeMy WebLinkAbout030-2089-40-000 4. ° 3 0 o O 6 y s~ Cam. 0 0 ^y O y y x v ^v O y c ~a c N U o a o N C N 3 c U. C co O m Lo Q N ' d' O LLl Z N Z = o V £ L d d A F- z d m 10 of o Z b' c L) U ~ r O N _ O to F- N z C E .p 6 M N O m N CL ~ N O N C • O a - 0 m p 0 z co z a N Z E _ ~a ~ E ;v N is Y L C w a w 75 co Lq N 0 ,r N N N U v p I uo H I- H ~ O `.r- 0 0 0 3r I z • IL CL CL a g N '3 N Q N V1 -i U 2 m rn } O M CO -O lz :z p 64 0 O O 0 0 N M E N N tLil O O ~ O ~ NO O O U Sri 'v ~ Q m N w p } a~ ~l O ° 3 N c Y O E O O O! U N N D 0 (D 04 (D M 0 0 0 N O O O O yr 0 r O N Y Y D N N N N C C N O O = Lo try)' W (n a) N N N N C (n C,4 0 -3 Lo (D i..~ O' M C M 3 Z' r co V 7 Lo N co co U • y' O M Cn Q.' N O N rL Cn tQ - E N M IL xk Q L T CL u rrv~ i C C w ~1 A u a 2 O in 2 'o (3 a N STC - 104 AS BUILT SANITARY SYSTEM REPOR v t'Y iQ r C f'f r „ r i/~I OWNER ~~/5- ADDRESS. /7~~ ~s SUBDIVISION / CSM#LOT # SECTION T, Y/~ N-R W, Town of_,~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0 7r A A' ~1tBr+~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK ALTERNATE BM:.9~~~Jrl9,sbl~ia SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House, - -Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length ys Number of trenches , i Distance & Direction to nearest prop. line: ?7 Setback from: well: House Other ELEVATIONS Building Sewer 27Q1 ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9.C17 Existing Grade y~5-,01 Final grade 6~5;9 DATE OF INSTALLATION: - PLUMBER ON JOB: LICENSE NUMBER: ~s INSPECTOR: 3/93:jt Lab rardDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT SCI'. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State PI KUNiNHEIM, MIKE 1 `1 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~50 Benchmark /60. f Dosing W Aeration Bldg. Sewer 3 9 8 / ' ' Holding St/ Ht inlet ~L 94,7G TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic >aS r 3 as y , NA Dt Bottom Dosing NA Header / Man. 9y S3 , Aeration NA Dist. Pipe Holding Bot. System y'7 PUMP/ SIPHON INFORMATION Final Grade 3s" qj" Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head . Loss Forcemain Ler. Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a. ' 1J5 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of rlacj. CHAMBER Model Number: System: 3&12 2 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) ; x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length rd' I 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 `7 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. /JOSEPH 34.30.19W, NW, 5E, WALSH ROAD 4" r 45) h /Tf J `C'/i ~i~ rC 'vL~ "r✓ -C. F..d-;,.~..:Xr`yt,; r ~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date I pector'sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t ~ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water system: 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, W1 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit umber The information you provide may be used by other government agency programs ❑ Check if revision to previ s application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pope O ner Nam T roperty Location Zia SL5 1/4, S ,3L T , N, R E (or& Property Owner's ail ng dd ess Lot Number Block Number M Number City, S to Zip Code Phone Number SubdivMLL6 ! ( ) . TYP F BUILDING: (check one) ❑ State Owned II Nearest ad ❑ Vi age Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo ©-~o gg 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. Lg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System --------System Tank Only______________ Existing System _________E---------- 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 N 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. /l1 ch) Elevation Feet Feet VII. TANK Capaaty INFORMATION In gallons Total # of Prefab. Site Fiber- Plastic Exper. Gallons Tanks Manufacturer's Name Concrete con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ El ❑ El Lift Pump Tank /Siphon Chamber ❑ ~ ~ 1:1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for ins Ilati of a `nsite ewage system shown on the attached plans. ps) MP/MPRSW No.: Business Phone Number: Plu e s Name P / Plumbe s Si ature: M/ A-7 O - Plumber's Ad ress (StrCi , State, Zi de): JZ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitt ry Permit Fee (Includes Groundwater ate ssue Issui g Agent Signature (No Starn 0 Approved ❑OwnerGiven Initial ~j Surcharge Fee) Adverse Determination /7// X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) 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 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 the5tate 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 line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for.numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), . address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the 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. ~iq a?~?So 44 all 8 1 - ~,ce~MO aJ~:!l I~10 I I _ _1 a Wisco?-An Department of Industry, g SITE EVALUATION REPORT Page of Labor and Human Relati ons Division of Safety & Buildings in with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site pla aper not 1/2 x ches in size. Plan must include, but not limited to vertical an ont ce point (BM ction and % of slope, scale or PARCEL 1.. # dimensioned, north arro location 5sf to st road. APPLICANT INFORM N-PL T MINT A FORMATION REVIEWED BY DATE PROPERTY OWNE S CE ,L PROPERTY LOCATION GOVT. LOT Alj 1/4 1/4,S ,c T N,R X(or)* PROPERTY OWNER':S MAILING AD LOT # BLOCK # SUED. NAME OR CSM # Cl TATE ZIP CODE PHONE NUMBER ❑CITY VI LLAG OWN NEARS OAD / New Construction Use pQ Residential / Number of bedrooms [ ] Addition to existing building [ ] Replacement ( ] Public or commercial describe _ Code derived daily flow 1,M gpd Recommended design loading rate 1~bed, gpd/ft2~trnch, gpolft2 Absorption area required ;5-95S bed, ft2 trench, ft2 Maximum design loading rate . , bed, gpd/ft2_,,Y' _trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) s Additional design / site consideration Parent material - Flood plain elevation, if applicable - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem p s ❑ U MS ❑ U S❑ U RS ❑ U ❑ S 1~ U ❑ S ,!1 'JZ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Co t. Color Gr. Sz. Sh. Bed Trench c'<. . Ground elev. ft. ) - Depth to limiting factor Remarks: Boring # J i Z62 < / / //1911 5rz1 17 i Ground / s s~ elev. - - ~~3 ft. Depth to limiting factor Remarks: CST Name:-Please Print f~ Phone: Address: Signature: Date: CST Number G_ ~ PROPERTY OWNER c SOIL DESCRIPTION REPORT Page+df PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cgnt. Color Gr. Sz. Sh. Bed Trench <:<: s 6,14 Ground r elev. Depth to limiting factor ~L- Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 141,- - Ice J i ya 0 I I ~ I i 7Y /iP~zr.E,o ~ M 'J DEPAFKWENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) FOCA ON:/ 1ITY: OT NO.: NO.: SION NAME: SE 1/4 34 /T30 N/R19 (or)W St. Joseph 17 n/a _ Y: OWNER'S/ AME: MAILINADDR SS: &-t C-fn `s' oix Steven & Norma Henning 665 Walsh Rd., Hudosn, WY. 54016 DATES OBSERVATIONS MADE USE PROFILE DES RIPTIONS: PER 0 ATION TESTS: NO.BEDRMS.: COMMERCIAL DESCRIPTION: esidence 3 n/a New ❑Replace 10-26-91 n/a RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: RUN D: IN-GROUND-PRESSURE: SYSTEM-INS-1: 11 LHOLDING TANK: RECOMMENDED SYSTEM: (optional) ® S ❑U S ❑U ®S ❑U ❑ S CCU ❑ S ~U conventimal dicate: Class DESIGN RATE: 2 I If any portion of the tested area is in the If Percolation Tests are NOT required under s. I LHR 83.09(5)(b)), in Floodplain indicate Floodplain elevation: n/a decinal' PROFILE DESCRIPTIONS page 42 0k1B BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHU ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.17 100.67 none >7.17 .83bl.1. 1.67bn.sil. 4.67 bn, l.s. &gr. B-2 7.97 100.90 none >7.97 1.00bl.l. 2.17bn.sil. .58bn.s.l. 3.67bn.l.s.&gr. B-3 7.74 100.60 none >7.74 .83bl.1. 1.83bn.sil. .75bn.s.l. 4.33bn.l.s.&gr. B-4 7.16 99.79 none >7.16 .83bl.1. 2.00bn.sil. .50bn.s.l. 3.83bn.c.s.&gr. B- 5 7.34 100.88 none >7.34 .92bl.1. 1.83bn.sil. .67bn.s.1. 3.92bn.c.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 P R P- P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sca s n . D s what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Sh the surface elevatio a rings an a 'on and percent of land slope. ^ o J SYSTEM ELEVATION 97.10 b 2~~ cA ~ - a - i - t Kok E , Tr- 3 T ti : i I J INSTRUCTIONS FOR COMPLETING FORM 115 - SET - 6335 To be a corn , A urate soil test, your report must inr1ude: 1. Complete legal, i; 2. The use section niust c rly in€licate this is a residence or commercial project; S, MAXIMUM number of bedloorns or ce = al use planned; 4. is this a new or re,_ =eat system; 5, Complete the su. ng boxes-' ',.)SUITABLE FOR A HOLDING TAN ONLY IF ALL OTHER SYST° E RULE( OUT E- ON SOIL CONDITIONS; B. PLEASE use t`te ~viat_ions shod.=r writing profile descriptions arid completing the plot flan; 7, MAKE A LEGIB diagram a£:cu.. `119 Your test locations. Dvr %,ving to scale is preferred. A separate sheet may used if desir B, Make sure your benchmark and v- ,n refer erice point are iwn, and are permanent; 9- Complete all appropriate boxes as to dates, names, addresses, flood plan data, percolation test exernp- tion, if appropriat 103 If the inforn1£?tiOr? 1g F~ as flood plain, elevation} does riot apply, place <& in the appropriate box; 11. Sign the form your cur r ent address and your certification number; 12. Make legible cop a -stribute as required. ALL SOIL `BESTS FAUST E FILED WITH THE LOCAL AUTHOf I"l"HIN 30 DAYS OF COMPLETION, LVIAT1O1, = _ _ :ERTIFIED SOIL TESTE' Soil Sel -tes and Textures {ether i)bols st: aver 10"i BR r cob - f fe (3 - 10") SS e gr cler I3") LS I I GVs C's Perc is Blda ,r l3n *sil BI si fly y cl YCo~-x scl Sal L ;,iryi R F ; i sicC Loam mot Mot"es sc ~Iv J sic - Si if'f - fet. .t pt nTrrl early, 1 = rl .k d - distinct p promin "it HVVL - Hi-,r,„r'rvel, )0 'textulei: ;posal BM - B VRP Ver 16 nce Point 3.01 ACRES EL. = 931. S N i - S89°27'37"E 806.06' 638.06' 148.00' 411.42 ' 394.64' 1 i i in I LOT II LOT 14 Y M 136,241 SO. FT. ' M 130,681 SO. FT. e 3.13 ACRES 3.00 ACRES I EL 29.8: I ~ I t0 - S89°27637"E 806.03'- w 411.42' 0 3 394.61' N CID C N N M o I M 0 1 N Z 0 S89° 37'21"E N :17. 00' LOT 12 LOT 13 EL. 909.2 ro 130,679 SO. FT. M 130,680 S0. FT. I 3.00 ACRES 3.00 ACRES 33' NWI/4 OF THE SEI/4 411.420-swi/4 OF THE SEI/4 411.58' N 89 ° 27' 37 " W 823.00' N89°27'37" W 1287.34'- - ROAD - M - 823.00' M N890 27'37"W I 855.49' 3 O M N U cm -4 C4 M 0 LOT 3 LOT 2 O ° O o N I A PLAT OF ®EEeK`%FiEL® SECTION 34, 'T30N~, RI' ALL IN OF THE SEI/4 AND IN PART OF.THE`SWI/4 OF THE SEI/41• INCLUDING PART OF LOTS '2 OFFDICE; 4.017 CERTIFIED SUR' :DOCUMENT' N UMBEI LOCATED IN',THE NWI/4 TOWN OF -.ST. JOSEPH;.' ST. CROIX COUNTY, WISCONSIN; REGISTER OF DEEDS MAP.-RECORDED IN. VOLUME 7, PAGE 1989 AT THE, ST. CROIX COUNTY' yulun . uruu n~ CURVE DATA t AMC CMOOO r[_ uuE irf ONOAO r 1C~11E r + CHIT[ LOT' ASOIY1 CQIA1t our IS { [~an u..!e[r i Ne 10 uf, air Erw p. xu o) .ADO•u•p!t «vo 000«M W .rso'ug3K 1 1 3 u).oo sons•or nsna33s•r 30) : r Y/+37.1 000•!f'r0't• 0[CT,ION H ` 3 1 310.00• 60'33'07.' Aif•NIS3.Sq 364 q• . 1)3 11 • _ , _ . 41 Ss oo ss or i' y • 11 310.00• . 10.10 x13 /t Of'[' . p . 'al+ , 1 1 j$ 00 136.01- ' , r _ 1 1)10.00 f • 3S•01110• 43/•03 N•[1 ,+1; 3 a u' 1 . . ,3[0.00 . • lf•OS• U A07•f1 sis•[ 11.», 300.3P30•r tSOh3•!7.t :1[.00••'•'• p•33.07. f3S•3VS).s•1?.. 707.1s• 214.11. . am n ° "3p,p+ , 10.3SIS7• f3S•71•S3.!•r 1 363:33 - 371 fl 15047.3)•r t,00N3'30•r ' >w;" to 1 .64.64 • r i , 3 { moo '.Ix•x1'2r W- 43.1'Tl; w,s2' xOS 1T !4~ " t - fY! • ~ d2l » ~ 3 fn•:. a w ' '301 al. _ Tt ~ I ~1 `_UNpLATTED' LANDS [ lj w ol, al 0.1 i 33, w1 K11 «0117« L«IE OF TM fEW of SCCTIOA &a Do' ' • ' S89. 27'37'E 1321.14' saw' j:1 M MI ' se.oo' •a.oo• , I WI' W ' ' 39•..{' 3 bl TCM/O«AAv to FOOT RADIUS < V, _ ~•jl . . 145.00, ^ k t cv6-of-sAe [ I IN FE 3 ,l0 t g+ g & _ .1 I Oil "i 'SCAL R s_ f ` l LOT 8 I -J1 " o loo • 3'v I 131.147. SO. !T. - , t $ j « f CENTER 3,01' ACRES SAC ' L'OT 6 LOT. T / 4. i% CU6- 09 8 130.677 f0. /T, 9' - ACAtf ; % i . I 115.420 p. R 3.00 p, 3.12 ACRES \ • 1 ; - . I 1 • r • ' F AT _r. S 350.10' • •O+ t{~'M1i T'1 I I 1 ' ^ I ' 1--r LOT 9. ' ,4. 0. OM1'L 146.604 SO. rT. $ , I . 1• P" . 3,.U ACRES I w. . \ ai- - ,air LOT. 5 W.r/ » I Q{.=3T so n LOT 1011. w \ 3.13 ACACi 131.290 SO,,FT. IN' p m3•~~ ! t. -Z A•.'~ 3.01 ACME " I 3[•.Y 0; ,QI 9' AA, / / u.• a. n saf•xr T[ 0 '0 „ 1u.oci 1 ] 1 JI u/.o{ X SECTION 3 ° sn•xT 3T•E 1 a .{ft. ZI O1 1 I g~ X1 Z, ; in , L® LOT .4 LOT 14 or LOT I I $O. PIT. .130.670 SO R • - 111 f0. %T. 300. ACRES COU«Tr a ! 3.00 ACM{ U{. n - CAP rot) 3.93 ACRES , w . w 1 d • . r .O 1' A 30' N i.0 -~fw•x7'37'L f0{.Of'-~ •d' , p f.4• 7.37 E • O 3... ' . _ I A- , O 390.34.1,..x• f Z 1 ' r. 1 I g.p A1fT .Y I 8 ))r.oo' i I. 10* wlc TO LOT 1 . T 13 ;YT[A LOT 12 LOT 3 - g 130. w So. ► w [ltvATl 110,670 So. FT. » 3.0 ACRES 11 f3' I „ CA J 3.AASN' S0 /T ^ - 3.00 ACRES . 130.679 y r .-).a -t 1.00 ACRES , I I-•r , n " t I 33.133' ►AOM Rdi -0-1 sit . t_1 it -I «sf•:r 3r•w ROAD a1 wl 8 -WALSH rrss•x7 3r•w 1x.:.3.'~~. { 3 1 1~[ 66 Co. j~ R s..3•• N89. 2T'37'w. I 8SS 48 >1 del 1_1 Inl.. tal k ' ~a' 1..1 1 -'r Q31 S r 01 FYI;., 17 j STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER u. 144-o 17 i~~ MAILING ADDRESS (r, I(#',, Said i:7j- . ANot sr A tu PROPERTY ADDRESS 4, L (locati n of septic s stem) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATIONAIL)l _ 1/4, 17 1/4, Section 3 , '1'N-R_2 _W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION (c, 4.4 LOT NUMBER f~ 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 three year expiration date. SIGNED: DATE: c St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i s T C - loo This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when j. the property is sold and submitted to this office with the appropriate deed recording. ---------------------------T--------------------------------------- Owner of property; Location of property_Al tL'-~ 1/4 _1/4, Section q _,T n&R_4~_W Township !St ~SP ~ L Mailing address Gin Sq [j Address of site Subdivision name Lot no. 13 1 other homes on property? Yes L/ No Previous owner of property Total size of property ? Ac-'-4-8 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , 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. gnature of Applicant Co-App'icant nrlt~s of Sionnfii- (lat'P f Sirinntiira • State Bar of Wisconsin Form 2 - 19U f 529206 WARRANTY DEED VOL •v 1~- - P►rG1S~'t;~S GF~ i°~;~ 1 DOCUMENT NO. 112 -1 - ST CRUCJ.•''il i peed for P. t . MAY 2 2 1995 lwsband andfP at 10:00 A• pi O&L conveys and warrants to Michael J. Runnheim and Joan O. _ ~ d00 Runnheim husband and wife THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS t. roix the following described real estate in County, State of Wisconsin: (Parcel identification Number) Lot 13, Plat -of Deerfield in the Town of St. Joseph, St. c; roix County, Wisconsin. lbia is not homestead property. X1K (is not) Exception to warranties Easements s restrictions and rights-of-way of record, _ if any. I . t9 95 day or Dated this may )/J (SEAL) (SEAL) Donald E. Noxell. - (SEAL) (SEAL) Beatrice s^^ Nnrail AUTHENTICATION ACHNOWLEDGMENT STATE OF WISCONSIN sa. Signature(s) St. Croix County. r1.tr day of , 19 personally came before me this 95 named authenticated this day of 19 the above Duna E. Noxell aid Beatrice Alm TITLE: MEMBER STATE BAR OF WISCONSIN we tnown to be the person (If not. authorized by §706.06, Wis. Stats.) -hg instrument and acknowledge t I THIS INSTRUMENT WAS DRAFTED By `r.i.M ~Pf~~ tie ~ ~