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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 02 ' S X 7f Tre.jc66.r S y°/pZ° C 4. f INDICATE NORTH ARRok` Provide setback and elevation information on reverse of this for-m- Provide 2 dimensions to center of septic tank manhole coves-- BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: /&.-a/We Liquid Capacity: %000 Setback from: Wel House Other Pump: Manufacturer Modelt Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: j Length_2.S- Number of trenches .2 Distance & Direction to nearest prop. line: 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: 3/93:jt FandH ment of Industry, PRIVATE REPORT SYSTEM County: 6-r. LROIX Sanitary Pe rmit No-: n Relations Safngs Division (ATTACH TO PERMIT) • State Pla GENERAL INFORMATION ❑ City ❑ Village QX Town o Permit Holder's Name:H®MES Parcel Tax No-: TWIN STAR BM Description: CST BM El V.: Insp. BM Elev.: / DO Ga ELEVATION DATA ELEV. TANK INFORMATION BS HI FS CAPACITY STATION TYPE MANUFACTURER iJ I Benchmark Septic 11JL/f Dosing Bldg. Sewer Aeration St Ht Inlet Holding St Ht Outlet TANK SETBACK INFORMATION vent to ROAD Dt Inle WELL BLDG. Air Intake w TANKTO P/L t NA Dt Bottom Septic -IQ 1r) NA Header / Man. Dosing NA Dist. Pipe g<p 9 y S~ GH• by Aeration Bot. System q7, 31l Holding Final Grade PUMP / SIPHON INFORMATION Demand Manufacturer GPM Model Number Lricti System TDH Ft TDH Lift H h Dia Dist. To Well Forcemain Le Liquid Depth No. Of Pits Inside Dia. SOIL ABSORPTION SYSTEM No. of Trenches PIT Width Length, , MMEN I N Manufacturer: BED / TRENCH Z_ LAKE/STREAM LEACHING DIMEN I N P / L BLDG WELL CHAMBER Mo a Num er: SYSTEM TO / h OR UNIT SETBACK 50 N Ct INFORMATION Type 0 nv system: x Hole spacing Vent To Air intake DISTRIBUTION SYSTEM x Hole size Header / Manifold Distribution Pipe(s) Dia Spacing Length . Length Dia. Systems Only x Pressure Systems Only xx Mound Or At-Grade Sy xx mulched xx Seeded / Sodded ~ Yes ❑ No SOIL COVER Depth thOf Yes C1 No ❑ Over xx Dep Topsoil es ~d Depth over n Bed /Trench Edo ; Bed /Trench center ancies, persons present, etc. COMMENTS: (Include code discrep TOWN OF SOMERSET LOCATION: SOMERSET.10.30.19, SE, NE, G^Plan revision required? ❑ Yes ❑ Cert_No. Ir~ Use other side for additional information. pe or s Signature Date SBD-6710 (R 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Jf Safety and Buildings Division Bureau of Building Water System: SANITARY PERMIT APPLICATION 201 E. Washington Ave. r~7Lfit~ P.O. Box 7969 In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ~J r 0i than 81/2 x 11 inches in size. State Sanitary Permit Number • See reverse side for instructions for completing this application E] Check if revision to previous application The information you provide may be used by other government agency programs State Check it I.D. Number Plan (Privacy Law, s. 15.04 (1) (m)]. IEProperrIty APPLICATION INFORMATI N - PLEASE PRINT ALL INFORMATlONocation /,0 T~~ r Nr R ! E (or)' 1/4 perty 1/4, S L Owner Name Pro Lot Number Block Number perty Ownes Mailing Address Zip Code Phone Number Subdivision Name or CSM Number , State ( f ) ❑ ity Nearest Road rf~e eta 0 1*1 A.1 11. TYPE BUILDING: (check one) ❑ State Owned Public r5t 1 or 2 F,--- Dwellin - No. of bedrooms - ❑ Vown of .So1ri e,.1-k5tv Parcel Tax Number(s) 111. BUILDING USE: (if building type is public, check all that apply) a43 ~ ' ,I d3 - 1 ❑ Apartment/ Condo ❑ onal Facility 2 El Assembly Hall 6 ❑ Medical Facility/ Nursing Home 1110 E] Restau Outdoor rant/Bar RecreatiDining 3 E] Campground 7 ❑ Merchandise: Sales/ Repairs 8 ❑ Mobile Home Park 12 C] Service Station/ Car Wash 4 ❑ Church /School 13 C] Other: specify 5 ❑ Hotel /Motel 9 ❑ Office/Factory IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. p Replacement of 4. E] Reconnection of 5. E] Repair of an Sy stem Tank Only Replacement 3. [3 Existing System S stem S Exlsti-n9 -----System Datelssued B) C] A Sanitary Permit was previously issued.. Permit Number V. TYPE OF SYSTEM: (Check only one) Experimental Other Non-Pressurized Distribution Pressurized Distribution 21 ❑ Mound 30 ❑ Specify Type 41 42 [:1 Pit Privy 110 Seepage Bed Holding Tank 12 0,Seepage Trench 22 ❑ In-Ground Pressure 43 C] Vault Privy 13 Seepage Pit 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: n 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Raft SMlnr~in hje 6. stem~Elev- 7. Final Grade Required (sq. ft.) Proposed (sq. ft-) (Gals/day/sq. ) ( 7~ Feet Elevatio Feet CapgaClty Site Gall Fiber- VII. TANK in i lions Total # of Tanks facturer s Name refab con steel lass Plastic App. INFORMATION ons Exper. New Existin Concrete strutted g P. Tanks Tanks ' cam. ~ ❑ Septic Tank or Holding Tank ❑ ❑ ❑ 171 ~ ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on th eat Phone N flans Plumber's Signature: o tamps) PRSW No.: Busiss Plumber's Name: (Print) /V t Plumber's Address (Street, City, State, Zip Code): 01 1q1_ - a IX. C UNTY / DEPARTMENT USE ONLY (Includes Groundwater ate slue Issuing gentsig ure(No amps Sanitary ❑ Disapproved San~ Permit Fee Surcharge fee) Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber cRD-6398 (R. 05/94) 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 an nevv \ Wisconsin Administrative Code will be applicable. Y criteria in the 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 s county prior to installation submitted to the 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed necessary, usually every 2 to 3 years. pumper whenever 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. lil. 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, reconnects V Type of system. Check appropriate box depending on system type. on, or repair. 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 8 112 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 effect groundwater. can The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. G v r S` 8 a ; REp ART TE ENJ ptV pY~4dm code courn`r st , Croix Sp11. pr10 S► *'s austnt• in accord with 1LHA 83.05, i 0• # mu PARGEI. DAB sent of In st in&de, but & DsPa laaos~s 18 !a of sat~Y ~uW~r►9$ than g 112 x 11 inches a of sbPe~~e or RE~iEV~~ BY ` not Well 8M), disect<oa~W site Plan on Pam retesence Pots't ( to I've load 30 t" lg Co an overnoa Owh dlocation and pa Nt ALL INFpRMA'fION P `OCAZfON 114510 30 14B " Attar no n~o ,north SION_PLEAgE GOY -1.01 SK#t,S g .NAME OR M# S'IROAD FORMA E APPLICAa? IN LOna Bn GE N NEAR68th• St• E CMNEA: Somerset g PATwin star xS MAS.ING RESS Pty NUMBE 5632 Edon to a-As" t PROPEF 209 Lane (6 208th.. ZIP~,ODE 753 ~ 3 ,99662 2 1971 6 C11Y , p[E 55011 member of be~r rate , 9 aerch. 9 ►oadn►9 ,red, 9t Cedar , Use Red cpmrt►eraa► dew Ngw ConsW~on Pubic R~mended des: loading too betc'arkl deter fled m site P ur te' lev g Rep►a0emer# 450 90 ench K laS reie low s f aca l~ d2ilY g p bed, ~g uh low r trench 3 aPPU pILL S1 Code detw Flood t sYS~"^ U required (s) trenc rPtlon"^ U rPtlonaW gu(I2t7e ep down QptESSURE ~ S D©V D S R~trun design r site ash Iw-s~NDt~U , GPp Add► outw p US RT Flood Bed Parentmated2J ~ ios tamue c S [3v S O DESCRIPTION pE4 Sh~c~re ~Sisten~ 8atcleN S:Su► ' SOIL . 1 U _ t+ 'texture Gr. Sx• Sh mfr if ..4 pominant Color pu. St• C Cdr sl 1msbK raf r 9v .5 DeP Wiunsell 1msbK na none sl Mvfr, na Boring H0fa°n in. # 1 0-26 105r3ry4 3 /4 none fs Osg . 2 26-49 ~ .none 1 ¢F 5Yr4/6 3 49-84 . Ground elew- 93.75-K• ro iml6nq if tats mf r 8411 sl 1mshK Mvf r na na a8marlcs: none f s Osg Boring # 1 0-11 10yr3/3 6 none 1~_g4 ~,5yr4/ 2 2 11 1 Gtotmd 000 925 tt O } to 246-620( cc ad` w Phone: -115- c tm O' 2 now 96 Remar Steel 54017 ass pot d , WI :_Pie New Ricon CSC Name PARCEL/C,~ "atar Homes Boring # soft. vEsC14/prl01V Horizon Dep. FleponT z in Dominant Color 3 1 0-16 Me Vell Mq 3.. P 10 2 Yr3/3 Cola re~cture Sb~ ~ 16 nona e , -g5 re ~GI~>vWd 7' SYr4/6 sl Gr. sz. re sh. 95.1 none l fs lmabk mf RoO~ GPOift Osg mvfr 9w Dom, to l f . T~ ~ na n • 5 5 a '185 .6 Boring # Remarks: 4 1 0-10 7.5 2 Sy,-314 10-7.7 7,5Yr3 none /4 none is lcsbk Ifs 1 csbk mvfr 9w 1 f mvfr . 7 8 h b na na J 'S .6 7„ ~ Remetks: 1 0-24 2 1pYr3/3 24-90 7• none 5Yr4/6 none sl 1m sbk Ifs mfr Osg ~ fr n5w 1 f • 4 • 5 na •5 .6 s: 1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: [3 City ❑ Village Town of: State Plan o.: TWIN STAR HOMES, INC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI ELEV. Septic Benc Ile ark Dosing Aeration Bld Holding St Ht I et TANK SETBACK INFORMATION t Outlet TANK TO P/ L WELL BLDG. ventto Dt I let Air Intake IiAe Septic NA Dt B ttom Dosing NA Header / Ma Aeration NA Dist. Pi Holding Bot. Sys PUMP/ SIPHON INFORMATION Final ade Manufacturer Demand Model Number GPM TDH Lift Friction st m TDH Ft ~j Forcemain Length Di Dist. To Well SOIL ABSORPTION YSTE BED/TRENCH Width L gth N ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P / L DG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model 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 To Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.10.30.19W, SE, NE, 68TH STREET Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 r Safety and Buildings Division v~•~rt.r. 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, WI 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. S / Ct 6 • 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 E] Checli ~ 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 1 e-~ m s ;5- 114A1,C,- 1/4, S T.-?o , N, R E (or)49 Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number e av YQ o, ) 7S. s~3 II. TYPE BUILDING: (check one) ❑ State Owned ❑ !tr Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms O VII age Town OF 5- ,me e-r 7'~e 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/Condo 3 2- 61 J' 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. 0 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 410 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) Elevation `r TOO 4 5 ,U'ex- d Feet S Feet VII. TANK Capacity INFORMATION in gallons Total # of 's Name Prefab. Site Fiber- Ex per- New Existin Gallons Tanks Manufacturer Concrete Con- Steel glass Plastic App structed Tanks Tanks Septic Tank or Holding Tank Q &1.05-7'er t1 ~ ❑ ❑ ❑ ❑ `C+ I I I I Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No Stamps) MPRSW No.: Business Phone Number: /<a~ tTl2 S 3 8'G - 3<2 / Plumber's Address (Street, City, State, Zip Code): [1 "S"G U Po- 1 l IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved San pry Permit Fee (Includes Groundwater Elssued Iss ing Agent Signature (No Stamps) 4Approved Surcharge Fee) ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever . necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815.. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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. 1X. 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. ' ~J, T v a rn e r~,U G S~ t, 7370 ~Oin eS~ S c lyv~ IV s a~ S3 I 3 u a .W ~7 N s T ~ , El, W1 consin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and H uma n Relations 3 Division o; safety & euiksrxrs in accord with ILHR ~.0is. Adm. Code • ' COUNTY ST C Z.11~ X Attach complete site plan on paper not less than 8 z'11 inches in size. P44n t include, but not limited to vertical and horizontal reference poi ($f0), direction and % of s'id a or PARCEL I.D. # dimensioned, north arrow, and location and dist neartst road. x REVIEWED BY DATE APPLICANT INFORMATION-PLEASE P f~T(ALL INFORYATI PROPERTY OWNER: PRO LOCATION _rW L k3 la tI''Z 'Pml`'] 1/4 N E 1/4,S T !~Q N,R 1 q E ("K PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUED. NAME OR CSM # °111 Zoa `nt. l PrvF - CITY, STATE ZIP CODE PHON ITY []VILLAGE DOWN NEAREST ROAD C.Np plat 1~1 N S S A 11 ( 614 S p 1"'1 S 65. Ttt ST New Construction Use [ Residential / Number of bedrooms Zb [ ] Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow L1S0 gpd Recommended design loading rate o• 5 bed, gpd/ft2 6 trench, gpd1ft2 Absorption area required 90 O bed, ft2 -150 trench, ft2 Maximum design loading rate 0 - S bed, gpd/ft2 U trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations ~'L` Y_ Ut3,j11Wki,' l3t.-b ctf'~%N S~ Kjfmb a►y Parent material S pir.,0y o V T w f is H Flood plain elevation, if applicable - ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitablefors stem LAS OU ®S ❑U 9S OU 9S ❑u OR OU DS R)U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bandary Roots Bed Tmnch SL ii.4'x':v 4F, o-V3 1 S l13) sb1( )'A\3 ~S - o•'~ o-`S }__.4' pL•i f-R Z -1S ~.S Yp-31Y 1~S ~CSb1~ MU`~ Ground elev. j 9 ft. Depth to limiting factor 4 Remarks: Boring # x 1 -10 SHtt3) 1s lcSbk Vnv~l- Z 10 -80 Z. S `i R 3l CS ~ o- S ' o. lO Z" »s k wt v , Ground elev. , loo . 9 ft Depth to limiting factor Remarks: CST Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: l• Date: CST Number: lip`` q5-33`~ 11 -L[- ~S M00576 f ` 7 PROPERTY OWNER-Zw~k) SIV~Z k-~t1"t* SOIL DESCRIPTION REPORT Page xr of 3 PARCEL I.D. #E Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o- °t 1-S LiVL-5 - ~S ~cs'b YAV cS - 0.'1 0.a Z a-8,6.~•s BIZ V/t, `FS o s r,1 - o. s v. Ground elev. lo_~ ft. Depth to limiting factor 8S" -2 Remarks: Boring # s O-~ -1•S`lR3iy 1TS ~CSb~t YnU`F1^^ El Z g- ~.S Lr~yl6 _ 'Fs o s9 rn 1 - o.s `0,6 Ground elev. 1\-%• loft. Depth to limiting factor ? Cal 0 Remarks: Boring # Ground elev. W4.5 ft. Depth to limiting factor Remarks: Boring # n Sao 1~ u ~ 5 0 M A O ~ ~ ~t-S C-O~ Z jv Lev 17 O.~ ~ ~ U t~'1 ~ l ~ Zo v Ground elev. ft. 17 S_.:- - Depth to limiting factor - Remarks: ^Rn-R33nrR (15ro?~ PLOT PLAN Page 3 of 3 SCALE 1"= 3 Of '~3?~1 -LTL. 1.00 0►.1 S►>ltzk y' I~SUU~ 6►Z[lu+.~fl b tN b' D►R- G 0 y e. i r1i O .r Ir.~LT►r~t_ R~vp Po~►yT" ~l~Z~tt'fE®g s . S 8°!0 !OV S jc Lsl.l%72 _ -_l I fit. too b 3 :-lip- E VIT _ L~sT : 4 ~y O• W . Lt►v 3-1, z• ccft S - 6 c6, ~Ttt 5-7 C-~ ~ ~Ir 1l ~S (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # -61/09/96 10:13 $ COUNTY CLERK 2002/002 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER T~~. 5+ A rz H c M z MAILING ADDRESS 1`171 A o 8 T L.~ /V, w . C_ is Aiz /`'1 •y S`5 o i I PROPERTY ADDRESS 6 9 8 6 8 T6 S4. (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 'Al i' 1/4, Section i -0, T 3 o N-R 19,_W TOWN OF 60 -n L rt,s Z + , ST. CROIX COUNTY, WI SUBDIVISION Ha I c- o ~ ,n b LOT NUMBER CERTIFICEDSURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failute 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 properly 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 113 full of sludge and scum. 1/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: I - 9 - y 6 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 o f property T,,,,, 5 4 A 2 ho M t j .I ,,.c Location of property SE 1/4.&/- 71/4, Section _/,~r, TAN-R_Z~P_W Township 0-,o Se- Mailing address Address of site Subdivision name C S Lot no. Other homes on property? Yes x No Previous owner of property CX a r`r c T68.r/5' ~;~c~ Total size of property Total size of parcel Ll a fJ~c- s Date parcel was created Qe c ~7.3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? At Yes X_No Volume and Page Number 2 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. Signature of Applic Co-Applicant 1(~ )Q- . 17 - y 5 ate of Signature Date of Signature State Bar of Wisconsin Form 2 - 1982 ~I 538202 : i' WARRANTY DEED / DOCUMENT NO. V0 i "AGE 39? - Claire M. Toensing, a single person, - JAN 5 1996 I 9:30 A.~~ conveys and warrants to Twin Star Homes ' THIS SPACE RESERVED FOR RECORDING DATA - NAME AND RETURN ADDRESS Attorney Kristina Ogland it - - S t Cr01 X - . following described real estate in - Hudson, WIC the 54015 CotuitV. State of Wisconsin: 032-2037-40 (Parcel Identification Number) I I Part of SE1/4 of NE1/4 of Section 10-30-19 described as follows: l iCommencing on the NE corner of said Section 10; thence S860581W on N line of said Section 10, 683.03 feet; thence S1025'E on centerline of proposed Town Road 1644.1 feet; thence S880481E 33.03 feet to point of beginning; thence S10251E on Ely line of said proposed Town Road 357.57 feet; thence SEly on NEly line of i said proposed Town Road on 100 foot radius curve, concave NEly, bearing S490541E 149.75 feet; thence N810361401IE on Nly line of said proposed Town Road 372.95 feet; thence N2006'E 389.16 feet; l thence N880481W 504.3 feet more or less to the point of beginning. 'I This is not homestead property. l MX(is not) ii Exception to warranties: Easements, restrictions and rights-of-way of record, if any. i 2d Dated this day of October I9 --95 (SEAL) (SEAL) it 'i Claire M. Toensing (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ____Cl-aireM. Toensing STATE OF WISCONSIN ss. County. October ,0 95 --1'-f--- ate., ,C r C . 3 D J ; 4 Z2 rr L HI`11T ^L H f, C Ca 4 .1 (7- tI C-1 c: V. .~1 f)QCUMENT NO. STATE -BAR OF ,WISCONSIN-FORM 1 • B:`~1~ 5 6 ~~^f`~c'~ WARRANTY DEED.. THIS SPACC RrSgRVkD FOR RECONDINGeDAI*! THIS DEED. made between LV= R, Gamache and Yvonne A. Gamaohe REGISTERS ST C>FF~GE~s ~ husband an wife,, as joint tenants CROIX CO Wis.14 Rec'd for Record this_ 21,s X11 day Grantor li and Gordon E. Toer and Claire M. Toen?s>, husband and wife "`D- ------A.D.19?3 gjQlnt tenants M. {~c .w......._. _ Grantee, ,:.,yes 0!ConneLl, W i t n e s e e t h, That the said Grantor for a valuable consideration n"" Hof _ e-- f De~ , l Deno ii conveys to Grantee the following described real estate in.., St. Croix County, RETUR 7 l~ State of Wisconsin:. Part of Southeast Quarter of Northeast Quarter (S of NET a of Section 10, Township 30 North, Range 19 West described i{ as follows: Commencing on the Northeast corner of said Tay. Key # Section 10; thence S 86058' W on North line of said Section 10: This is not homestead property. ;f 683.03 feet; thence S i 1:125' M on cent*rlin-e-c f p opoeetl- T - .--..~,r Road 1644.1 feet; thence S 88048' E 33.03 feet to Point of Beginning; thence S T6o 5' E ors Easterly line of said proposed Town Road 357.57 feet; thence Southeasterly on Northeaster]. 1 line of said proposed Town Road on 100 foot radius curve, concav6 Northeasterlyy bearing ! S 49054t E 149.75 feet; thence N 81036'40" E on Northerly line of said proposed Town Road 372.95 feet; thence N 2006' E 389.16 feet; thence N 88045, W 504.3 feet more or less to i~ the point of Beginning. TRANSFER Ii FEE. f Together with all and singular the hereditaments and appurtenances thereunto belon u1g or in any wise appert*kdn f And R. Gamaohe and ivorine A. Gamache, i8 wife warrants that the title is good, indefeasible in fee simple and free and clear of encumbragces except I i! I~ and will warrant and defend the same. Executed at Hudson thisday of Degemb_g:r , lq~ SIGNED AND SEALED IN PRESENCE OF $;Z72~~~~~SEA4L) the jf (SEAL) fi I ~I - Yvonne A_ uamaohe (SEAL) I. f (SEAL) ~I L R. Gramache and Yvonne A. Gama husband and Wife Signatures of Yin 41 authenticated this day of !g ~i ilex S. Kosa Titlt: MCmbtz Stott Her of Wisconsin dEJPtXM=jW 11 Authorized under Sec. 706.06 viz. I~ !1. t Somerset, WT property Kevin Taaffe, home tele. (612) 426-7615 work tele. (612) 481-2087 work fax (612) 481-2022 Directions: 35 North to Somerset, take a right onto Spring Rd, bear right onto Sonrise, 1.2 miles to 170` take a left, .6 miles to 68`h St. take a right, ,4 miles to property on the left side (corner lot). Pine trees (double row) to open field, oaks on back of lot. Kevin Taaffe is representing his mother-inlaw in the sale of the property. 77rl T w Y•+W '17tt 4 5- 1, , i , t Y' t y f 6y, _y_.~ g yt, r • t 4 ~0, i. ~ ~ ~ 6 Z. 5.9wyti P 5 R~~ 9• s >S. i. ]r f j r r 71, 4.1 x L~ ~.r t • pia s i;r Y S? 3 f ' h 5;. a y ~ & ~ Y s tt; `^c *~t~ w 4 } ' ¢i i tY• r E 31 ~1 }i1`. N t L 'i 't, t• 3.M r R R''`"`d j..; 1~, IFS i. aa;'i X 1't t } t8.i n o Y <q ar t,% ' ; i .'fi't ~ ~ - 1 • , ~ ~~~~v, ,,,x-.~ ? r*~,` yfi`! N ~ 7AT~ f~ Y ~y,P `ter ~ 5 J d 3 ' i~ y Ff• 'k wy H r a`~ ; '15,~ T 8 ~;R~f.~' ~ 3 +Y ~ -4i~. a~. 1 . ~ •f i Y5 51 ~ P Y't . L h { w t 1.l ,5:9yk ~ r ~ Jar fi* ~t~.$~'~ . ~4~~-z R 3 , 3 V 'p9~y ~ J 'R •iJ11 R TT~.'-y y i ~S ~j4 itv~ p.