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HomeMy WebLinkAbout032-1013-95-025 ~0 00 C c 3 0 (D M O GG I, Q N N 0 CO C X Er ~ I C co N O U C Z aa) - N O m LL c N o0 Q o I M aa) Z y rn ~ ~ •E o Z L a a m Lo IM- U) I O z d c U a o N m Z d c N H r m a c y~ _ N O 0) a fl Q C y a) O O O FrJ Cn L (6 N • 0 LO O aa) Q N p o Z M Z C> O Z LO N o ~y ~ Os Y CL N a . w N 5 N E d i a C o c o a o ' a 0 C O O O •w,, Qaaa CL U fA J N ~ ~ } It (0 N p j?5 X 0 0 o 0 4) M Z?5 f` - N N N 12 m o o qz m M co 2z i 4 'C m n C7S O O t!') Co N O LM d Q } G' 06 7 w c N LO y C Q N C 04 o E N n a) o p° Q o y l m c co 0 :1 o 0 0 0 o N N N N O f6 Y C 'D Y CF co O M O y -7 N N :3 M M V 1• N a) o t' Li i N d. N G N C'4 M =^x!i E N 0 ~ O O U) Z N O N CA ..w C/j m m a 3 n i a CL d V d U O N ~ 3 w O A 0 CL 2 0 U) 0 RECEIVED ' 3 8`;D 307'g VOL KATVO PAGE 5040 11wu~ REGISTER OF DEEDS ST. Co, WI RECEIVEDXFOR.RECORD N ST. CROIX COUNTY 08110/2005 04:00PM o zZ Z SLWA(EYOR'S RECORD C ERTIFIED SURVEY MAP REC FEE: C THE SOUTH UNE OF THE SE1/4 OF SECTION COPY FEE: 3.00 REFERENCE 4 THEESTSCROIX COUNTY SCOORDINAATE SYSTEM PAGES: 2 s 0 IN PG. ---__O_L_ 6 1568 Nm 6' _R LOT 1 C.S.M._- N \ 8g 69~ 51 (S5'39'36"E 943.24') C N E °~~Z 504'0522"E 942.82 - w 8 $ p BgZ~ ~Z,S i fax - > 14 V! P, ~p Z m ~ N N ? v v ~ Os ~p NZ $02 'S1 `w 6 2.29' ~1 R~1 ~ • 669.48 # ~ - .gy 61 CAI a na 1=2 3 ~ N ill --i Rt CA -4 ~v Sig Mirig N fir ~bc m N~0 o~ Icn ~ZOC M I' o J 26.73' L m LOT 8 N03-13.54"E 1,302.7 4' I EAST UNE OF - ("0339'21 "E l 1302.71') LOT '7 THE SwI/4 of DEER RUN ESTATES - THE SE7/4 - -T----------- m o Z N v N 5121 fL2 al '41 L 2 ~ Z °z ~ Z 1~t1 ' cm v o mod 0 70 r+ 11"1 _ . o° IT! c~ z O rn CIO N CNl~ -1 JD " - SHEET 1 OF 2 SHEETS Vol 20 Page 5040 1~ 8 STC - 104 Cb i AS BUILT SANITARY SYSTEM REPORT OWNER - ' x 01- ADDRESS ZCGNIK'(iO~FtGG 'a 1 jj' SUBDIVISION / CSM# LOT # SECTION---,::L T N-R1y W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s • ~ , BENCHMARK: ZZ",O ALTERNATE BM:. SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: h2a. ~ Liquid Capacity: Setback from: Well House 2,2 -Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: L2 Length -.5'y Number of trenches Distance & Direction to nearest prop. line: ~mQ Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet :1~,, ST outlet 2Z Z2 PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - - PLUMBER ON JOB: l LICENSE NUMBER: INSPECTOR: 3/93:jt f BENCHMARR : ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 7 ~ Liquid Capacity: -z Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: L2 Length _-5/ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet; 2•,5) ST outlet 9Z 42 PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - PLUMBER ON JOB: - l LICENSE NUMBER: INSPECTOR : ~~r l 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX -Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: P S NJ 1M & BARB ❑ City ❑ Village R Town of: State Plan o.: SRT CST BM Elev.: Insp. BM Elev.: BM Description: 7C Parcel Tax No.: ZOO a,,-, C -d-". A9600139 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer' ~r Holding St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Verit TANK TO P/ L WELL BLDG. AirrIto ntake ROAD Dt Inlet A Septic >a~` 3 NA Dt Bottom Dosing NA Header/Man. 9S?,3 Aeration NA Dist. Pipe s Holding Bot. System b , qA~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ` ` t F 5 ' Model Number GPM TDH Lift Lricti System TDH Ft Forcemain Len Dia. Ff Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: "0'tJ U ' 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 `r Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges- I,7- Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.5.31.19W, SE, SW, 230TH ST 1-i1#/ -(3 7y_ f- l~.~vc_s~ l ~h ~a r_ 1 r Plan revision required? ❑ Yes No n _ Use other side for additional information. j h SBD-6710 (R 05/91) Date - 6AP( efor's Signature Cert No. J J z~ Sey/ sB~ l }1~0 /7' to ~ ® bar' I~ / s / le r y Safety and Buildings Division ~~■`r■r. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P-0 _ 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. • See reverse side for instructions for completing this application state san-;?itarryyy 7 ;Z rrmittNNummherk The information you provide may be used by other government agency programs ❑ Checkit rev`isio'n to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Propert Owner Na Property Location a 1/4 c 1/4, S T , N, R E (orW Property Owner's Mailing ddres Lot Number / Block Nu r cit State Zip Code Phone Number Subdivision Name or CSM Number ( ) Y 117. TYPE F B LDING: (check one) ❑ State Owned City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ° ran OF - T' III. 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 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- pg New 2. ❑ Replacement 3.,E] 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 P 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Mi ./inch) Elevation Feet Feet VII. ANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel Plastic p New Existing structed glass App. Tanks Tanks 11 1 Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT I, th ndersigned, assume responsibility for inst ation of th site sewage system shown on the attached plans- Plum e ' Name: Plumb s Si ture: a s, )V' No.: Business Phone Number: 1 - S~ Plum er's A dress (Steet, C ty, State, Zi de): 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater Date Issue Iss g Agent Signa re (No Stamps) XApproved ❑ Surcharge Fee) Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-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 nev 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-6-3i99) to be submitted to the county priorto 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. 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. r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of - Labor and Human Relations Division 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 must include, but 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPS TY OWNER: PROPERTY LOCATION I e22 j _ GOVT. LOT _ 114 j 1/4,S T,_ N,R E j(or& PROPERTY OWNER': M LING ADSS LOT BLOC # SUBD. N ME OR CSM # C7, STATE ZIP CODE PHONE NUMBER CITY ❑VILLAGE 2f0 N NEAREST ROAD New Construction Use Residential / Number of bedrooms _ ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow :ZfZn gpd Recommended design loading rate 7 bed, gpd/ft2-•Strench, gpd/ft2 Absorption area required bed, ft2 5'-Z s trench, ft2 Maximum design loading rate -,--7 bed, gpd1ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) &2 ft (as referred to site plan benchmark) Additional design / site considerations j s' 3 Parent material Flood plain elevation, if applicable A///I- ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM I FILL HOLDING TANK U= Unsuitable fors stem S❑ U MS ❑ U S❑ U a S ❑ U ❑ S U ❑ S 21 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 Tmr>ch s Ground elev. ;j ft. - - Depth to limiting factor Remarks: Boring # ~::•:::v f. ? 1 Ground elev. ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: _ Address: p Signature: f Date: CST Number: ✓ PROPERTYOWNER SOIL DESCRIPTION REPORT Page,,Zef PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1-U '2 Ground h ' L11, 71.9 elev. / ft. _ Depth to limiting factor .Zll~ Remarks: Boring # Ground elev. _ xULi- ,Jt~ ft. Depth to limiting factor Remarks: Boring # ~e A4 Z, r Ground / elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) J, ~^I ~w-~ ~ ~.~~i .~,Cs~1 s,~ ~ sa J s,EC s'' T~~/r,✓ ~/9 ~J Qsc~©~ `~,1' ~Q~3 ,~,~n~"s////~('~t'- off'/s1,~,~~~~or~ • ~~I C~ ~ ~ 36 41 ~ i ,r t As, /60 6 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix C unty O WNER/BUYER MAILING ADDRESS PROPERTY ADDRESS S ~i^'~ry». (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION S~-_ 1/4, U,) 1/4, Section, T_=2j _N-R_22 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 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. 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 (late. SIGNED: DATE: Vk St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C 100 • ~ y 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 - i j Location of property_5Z_1/4, S-L 1/4, Section :S- , TAN-R_22_W Township Mailing address . J l Address of site Subdivision name _ Lot no. _ other homes on property? Yes XNo Previous owner of property Total size of property a-C-4-t.S 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 ,~N o 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. S. iature of Applicant Co-Applicant \ OL 'Ack (.0 Date of Signature Date of Signature WARRAINT'Y DEED ` 543947 VOL Document Number 1179-~=001' ,I?et . Address ' MAY 2 1 1996 THE RIVER BANK 9:30 A V4 0 Parc-.1 I.D. Number: 0324013-95; 032-1013-70 Donald M. Potting and Debra Potting, husband and wife, conveys and warrants to James A. Nelson and Barbara L. Nelson, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: That part of the Southeast Quarter of Southwest Quarter (SEI/4 of SWI/4) and Southwest Quarter of Southeast Quarter (SWI/4 of SEI/4), Section Fite (5)~ Township Thirty-one (31) North of Range Nineteen (19) West, lying East of Certified Survey Map filed August 20, 1985, in Volume 6 of Certified Survey Maps on page 1568 as Document No. 404467; Somerset Township, in St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this S- f 7 / day of May, 1996. (SEAL) SEAL Donald M. Potting Debra Potting ( ) ACKNOWLEDGMENT STATE OF WISCONSIN TRAJV EER ss iY' COUNTY ) Personally came before me this 1-/4, day of 1996, the above named Donald M. Potting and Debra Potting, husband and wife, to me know to be the person(s) who executed the foregoing instrume and acknowledge the same. Notary Public n County, W1 - Diane M. Barron ty~ Notary Public My commission expires 1-- rq State of Wisconsin THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 Parcel 032-1013-95-025 04/04/2007 10:44 AM PAGE 1 OF 1 Alt. Parcel 5.31.19.79A 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/10/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NELSON, JAMES A & BARBARA L JAMES A & BARBARA L NELSON 2028 DUEHOLM DR MILLTOWN WI 54850-2301 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 352 230TH AVE SC 4165 OSCEOLA SP 1700 WITC 1~{' Legal Description: Acres: 12.580 Plat: 5040-CSM 20-5040 032-05 SEC 5 T31 N R1 9W PT SW SE & PT SE SW CSM Block/Condo Bldg: LOT 01 20-5040 LOT 1 (12.580 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 08/10/2005 803078 20/5040 CSM 07/23/1997 1179/01 WD 07/23/1997 932/135 07/23/1997 716/362 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/05/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.580 95,900 148,000 243,900 NO Totals for 2007: General Property 12.580 95,900 148,000 243,900 Woodland 0.000 0 0 Totals for 2006: General Property 12.580 95,900 148,000 243,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00