Loading...
HomeMy WebLinkAbout042-1020-90-400 '0 0 O N O 3 0 O o 0 ~n N ti ti ti tl r i I N C Z 7 U. c C a Q 3 ~ N Z y Z 0 crn a 0 co IN- Z 0 E cu O Z 0 d Z M F r d Z S '2 N M N _ C f0 d C, ry N N d L O O Q Z co z 16 z w N _ ~ d c N m ( N d a - m o c o a` r) U) U) Flo zv>° ovFy) 00 5 5 a LL Z •N j~aaa 0) Cl) N O Y 7+~ N co ~O (D 7 N co Q m c a Lo L ~ N ~1 a) ~r 7 w G 1 0 N C E CO 04 (D a °o °o °o 0 Q °r° 3 r°n v H f~0 a N N N v oc~ o C, Cp 40, O C a N L d 7 co N Gp r N co N ~ In H c~~ N t M .d. C N • 0 co 0 N O Z c' L (n 0 ~ it d m a ~t a ` a • ce a d ;2 d d c rr~~ c a> ~1 A c°~a~ ov~iti Parcel 042-1020-90-400 07/11/2005 04:52 PM PAGE 1 OF 1 Alt. Parcel 08.29.18.118D 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BORGSTROM, JOHN W & ANNA M JOHN W & ANNA M BORGSTROM 1019 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1019 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.120 Plat: N/A-NOT AVAILABLE SEC 8 T29N R18W PT NW NW BEING LOT 4 OF Block/Condo Bldg: CSM 10/2802 2.12 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 08/07/1998 584662 1346/599 WD 07/23/1997 1186/14 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 37944 274,500 Valuations: Last Changed: 10/19/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.120 38,000 203,500 241,500 NO Totals for 2004: General Property 2.120 38,000 203,500 241,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.120 38,000 203,500 241,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 -Xisconsin 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. C °4 - / o 20 - ~y0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OWNER: PROPERTY LOCATION ,II G OT/ J lit) 1/4 l V I )l/4,S P T .217 N,R f 8 k(or) W I- 'A PROP RTY 0 ER, :S MAILING ADDRESS LOT # BL7T- CITY, K# SUBD. NAME CSM # IZ163 ~I. _ 33loN, (fob€rL~sS~, 4 ST E ZIP CODE PHONE NUMBER ITY VILLAGE EVOWN NEARESqT ROAD q "5"/ 0 7- z 5 ~ 11-~ y- k {q-J E 01 / New Construction Use [,I, Residential / Number of bedrooms 3 (j Addition to existing building (j Replacement ( j Public or commercial describe Code derived daily flow ~70 gpd Recommended design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required ~-~,3 bed, ft2 3 trench, ft2 Maximum design loading rate , 7 bed, gpd/ft21-9-trench, gpd/ft2 Recommended infiltration surface elevation(s) c/ 7 ° ft (as referred to site plan benchmark) Additional design / site considerations 42.4 Parent material Cb ,AJW A C~h Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT RADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 5n ❑ U MS ❑ U 5fl S❑ U J S ❑ U ❑ S aU ❑ S Q U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Barxfary Roots Bed Trench Ground 35 1, A) 0 C S 0 W q -7 8 elev. I u / y~Tt 5.88 D G% S 0 S M Nl~ "7 Depth to limiting factor Remarks: Boring # Ground l zttt , B& I0 r2 5i~ L ~a vU Depth to limiting factor Remarks: CST Name.-Please Print Phone: Address: W) 5 4 0 17 Signature: Date: CST Number: - h J°¢ ~5 Z Z-`j~9 PROPERTY OWNER ~lwncl 00ZP SOIL DESCRIPTION REPORT Page?-ofd PARCEL I.D. # O" f 2 /O Z U -I CU Depth DominantColor Mottles Structure I ! GPD/ft 'Boring# Horizon Texture Consistence IBourdary Roots Bed iTrench in. Munseil Ou. Sz. Cont. Color Gr. Sz. Sh. 7- A)n /0 Ground Z8 ~a iZ4/ 0 C S elev. e F i 00 "Tt. c 4 OCJ (i J C 1 / r Depth to limiting factor Remarks: Boring # 7d ` 7 24 to a 4/ ~ G S. I Z,n s,~i 71 3 'Z 41Q Ground elev. S~ o G S , Depth to limiting factor Remarks: Boring # /V 0 -j e-7 Ground 7J i~ 0 elev. 00 A /7 J . Depth to limiting factor Remarks: Boring # Ground elev. it. Depth to limiting factor Remarks: S90-8330(6.05/92) STEEL'S SOIL SERVICE IJ-15,;1 z©o Gary L. Steel p e C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 IV u) % N Lt) V,4- 5 -f- z 9A/ 21e) 0 (715) 246-6200 40 co r? 25 "or Y" Y' A'1- a 42-1 i i © z~, 421 zoo' i Cc Fl-Y ~ . ~~G= ~ ~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER ' 1101 Carmichael Road F Hudson, WI 54016-7710 (715) 386-4680 June 11, 1998 Edina Realty Jason Bast 400 So. 2nd St. Hudson, WI 54016 RE: Existing septic system inspection for Paul and Laura Cicha, Lot 4 Legal: NW 1/a, NW %a, Sec. 8, T29N-R18W, Town of Warren, St. Croix County Dear Mr. Bast: On June 10, 1998, an inspection of the septic system on the Paul and Laura Cicha property, 1019 110th Ave., Roberts, Wisconsin, was conducted. At the time of the inspection, the septic system appeared to be functioning properly. No ponding of septic effluent was observed in the drain field vent. The septic system serving the Cicha property was installed on July 9, 1996, and was sized for a four bedroom house. A Weeks 1200 gallon septic tank discharges to a bed type drain field- 12 ft. by 72 ft. The system was inspected by staff from this office on July 9, 1996, and was installed as a code compliant system. To prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. This inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. The water test results will be forwarded to you as soon as..we receive them. Should you have any questions, please contact this office. Sincerely, Ow C: Rod Esr Assistant Zoning Administrator STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER J'V4(t e-'= C If ADDRESS 4 S 9 SUBDIVISION / CSM# LOT ~T SECTION T2f N-R /f W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~SL a INDICATE NO RROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: - /yof /4a'.D ALTERNATE BM: SEPTIC TANK / O O Manufacturer:---"Z-5 Liquid Capacity: /.ZOO' Setback from: Well T House_ fp ' Other Pump: er Model# Float seperation s C A cation :SOIL ABSORPTION SYSTEM Width: 2 Length Number of - Distance & Direction to nearest prop, line: Setback from: well: House //,f Other ELEVATIONS Building Sewer-///. v/~ 01 ST Inlet: ///_ST outlet 4r_ /D PC inlet m PC bottom Pump Off Header/Manifold , Bottom of system ~76 r ~,v0 ~ Existing Grade Final grade- G~ DATE OF INSTALLATION: 7 PLUMBER ON JOB: LICENSE NUMBERIr f INSPECTOR: r'~y C 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ~ Safety and Buildings Division ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 262382 Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: CICHA PAUL WARREN CST B Elez Insp. BM Elev.: BM Description: Parcel Tax No.: Q a S 0'' A9600190 TANK INFORMATION ELEVATION DATA U~ rj TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark V Dosing a 4a. i Aeration Bldg. Sewer O .57 Hold' g St /Inlet 1571 /07 TANK SETBACK INFORMATION St/,~K Outlet 16 7, 71 Vent TANK TO P/ L WELL BLDG. A irIto ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header_ 723 S~ Aeration N Dist. Pipe -7,3?' Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer 1 Demand 'P ' r Model Number GPM 3, 110~ TDH Lift Lriction Sys Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ D N cturer: SYSTEM TO P / L BLDG WELL LAKE/ STREAM -tEACIL.-NG SETBACK INFORMATION Type O ~y,~- CHA Mo erMurri System: e~it;/dcp(' f -o UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe,,, x Hole Size x Hol ing t To Air Intake Length Dia- Length~~ Dia. Spacing CO SOIL COVER x Pressure Systems Only xx Mound Or At-Gr a Onl Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Tjawh Center Bed 4J44weM Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN.8.29. 8W NW NW 110TH S A1n_revt required-7.J Yes Q-Nd- Use other side for additional information. 1-7 bK 1 1,21 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ✓ SANITARY PERMIT NUMBER: R .1 SANITARY PERMIT APPLICATION Safety and BuildingsDivisi System! Bureau of Building Water 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 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary PPer~it!N~ummbeerr The information you provide may be used by other government agency programs ❑ Check ifr6vi§ion to previous- `pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 10 Property Owner Name Property Location 1/4 W 1/4,S 9 T .Z , N, R E (or)gp dz e- to G Property Owner's Mailing Address Lot Number Block Number i Cit State Zip Code Phone Number 5trbdivi5+ert-Name or CSM Number q p II. TYPE F BUILDING: (check one) ❑ State Owned 071ty Nearest Road C] Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF W RF /O ST. Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) a 1 ❑ Apartment/ Condo a e zD o - 4~~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. Z 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 110 Seepage Bed 210 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) Elevation 0 q0 x57 9' -P 91 6 .7 .7 Feet . P Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the site sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps PRSW No.: Business Phone Number: I, A r 31py 7 - tGSL Plumber's Address (Street, City, State, Zi Code): t? P6ffgT/Z 7711 W IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanita Permit Fee (includes Groundwater ate Issued Issuing Agent Si nature (No Stamps) Sur Approved ❑ Owner Given Initial /a Adverse Determination X. CONDITIONS OF APPROVAL / REASON FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divmion, Owner, Plumber f e 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.j, 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. 7 nYO,#~-- i I l0eA,"a . J 7Y r I. 3d/-/a71 0 ~SF I qu ScstGE = s-° ~ 1 SD d = BM ~ Sti~vc/oe f i'r~E. L oT C O P~tl i~ , 14,5-p w ,OO o X = To~r'w~ s = f'Uaivr~ CoT u„z,v~,c .ti~ p~~-~.~=-may x X 1 EL6d = 97. r}c7' i 4 n -04 N tl1 Z C to R'~ i r ~ ~ p1 v vJisconsinDepartment of Indus", 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 c-5-/U X 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. n4a_ /0;_>0_90 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OWNER: PROPERTY LOCATION 11 Z2f GOVT. LOTnJ 1/4 (U 1/4,S P T Zy N,R ) 8 f(or) W PROP RTY 0 ER':S MA!I_ING ADDRESS LOT # JBLC5K # SUED. NAME CSM # I )zI io c j , 336N lobcrL~s_4, 4 CITY, STATE ZIP CODE PHONE NUMBER []CITY VILLAGE MOWN NEAREST ROAD J4 New Construction Use (;?J, Residential / Number of bedrooms 3 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow t;_D gpd R`ftign loading rate 1 7 bed, gpd/ft2 8 trench, gpolft2 r Absorption area required ('~3 bed, ft2 (0 3 tren axirnudWgR°Id ving rate gibed, gpd/ft 2 trench, gpd/ft2 Recommended infiltration surface elevation(s) itJ9~referred to site plan benchmark) Additional design / site considerations ' Parent material m L Flooo.-O n elevation, if applicable 0 ft S =Suitable for system CONVENTIONAL MO PjfT: t . '1N UN PR S,Y11 AT ~RADE❑ U O S IN FuILL HOL S NT uK U = Unsuitable fors stem ~'S ❑ U ® 7 U JS S01 O'€SCRIO ORT GPD/ft Depth Dominant Color 9~°" ' I Structure Boring # Horizon in. Munsell Qu. Sz. Cont Coto) - tGre Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 011,~77 16 e,. 2 '11-a-5 /)0 C 3,/ .Z m 5, low Ground ~~5 ,2 `f/4 G S ©s J elev. I u 88 V (9 ~i A) o 6= s a s 114 Depth to limiting factor Remarks: Boring # J Yo0 10 o S~ 7-M5,© (0 C~) 1 5 2 3/+ Aj)o s S c n1 ~+4'c~ O Ground G aU • I elev. v.La BCC / 2 5/,9 C) 0 ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: / _ Z Z-0 0 Address: /5y- I j 4 d/ 7 Signature: Date: CST Number: jj~ lz>~( - - LnSf Z Z`- ~9 ;;111 L PROPERTYOWNER dt4n1v^A SOIL DESCRIPTION REPORT Page'r?-of PARCEL I.D. # D"L - /G z U 9U Depth Dominant Color I Mottles Structure GPD/ft Boring # Horizon in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. I Consistence IBoundary I Roots Bed ITrench l 3/z- G-- J zms13 i~ _~Z 4r~4~ ZmSG r~ t ~5~r Ground - Z8 J tv/" '4/ 0 YA) C S 5 v 0, , 17 R elev. 8 1 z6 go ~Zj Depth to limiting factor Remarks: Boring # l Z z4 )o rc 4/4 7L E S, l Zm s~i ~'r~ , 5 . Ground ' 'Z 41 elev. D G Q s Depth to limiting factor 7- go,, Remarks: Boring # l 6-5 0 2 3/v z SQi-~ cd a 5 Ground J - A 0 2 N D G 2° S li, .'7 . elev. /DO --/f7 . Depth to limiting factor 79V Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE zoo* c Gary L. Steel 9WIVS • e C.S.T. 2298 too-, '0 New Richmond, WI 54 17 MPRSW-3254 /vO % N i lk S •6 + z 9,M-1216u) (715) 246-6208 40 CO r7 ~Y- Y' S Ke- loo ` ~zq 4 2- o~ ®r 5 qo A2, 5 47 zdd' CERTIFIED SURVEY MAP Located in part of the NWha of the NW-1-4, Section 8, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. _ I I I LEI I G N co=ca y 01- II=1~G SUh `JLY MAP i 7 N N N ~/O! . 4-7- , hG. 11-78-- 110TH A`JcrJUC Cr CD -h 7 Z 7 North line of the NW} of the NWJ of Section 8 0 W o o eo m N88056101"W - 913.00' m o 001 L" 0 200.00' w s ME o m N 240.00 t ' N 200.001 N89022 1 2711W V HMO, r2 z z o IL 0 0 0 o I~ O N iT~ CC) 90- LOT 3 LOT .4 D I> 2.56 Acres Inc. R/W m O1 I~ v+ = 111,422 Sq. Ft. Inc. R/W 2.12 Acres Inc. R/W M -P' 41 fD n' 2.40 Acres Exc. R/W 92+513 Sq. Ft. Inc.R/W W IC'1 a M z co - 104,596 Sq. Ft. Exc. R/W ~ N 2.00 Acres Exc. R/W N If- rt M 87,164 Sq. Ft. Exc. R/W - .p IT> n w rn Imo' (J) a o T - .r d r ■ z 0 co w i cn 240.001 200.00 CIO S89022'27"E 440.00' !Jr P'"A i i rE D L A"JD8 C LEGENDp1q0V S-'4407 } Humbird Land Corporation Aluminum County Section ,,),fl p;^^sQ- a..; I A;~^ , 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 ~/}Lt L ~scR Location of property,&p&/_1/4,414.4J 1/4, Section w Township e4-~A-l Mailing address Wiz;- -.T Address of site ~~fJ^ ljp ittric . ,/?a~E2f~. r~JL Sy©Z6 Subdivision name CS Lot no. _ Other homes on property? Yes_&e-" No Previous owner of property /&&zA4xzZ,~~z4f 6yR2 Total size of property .7,> • !f r Total size of parcel & 44cXKs' Date parcel was created Are all corners and lot lines identifiable? i/ Yes No Is this property being developed for (spec house)? Yes -1,~_No Cs Vol me /o and Page Number 02 as recorded with the Register o~Effeds~ Bt- / Y 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. Y-115-76V , 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 ys' 7 6 Signature of Applica t Co-Applicant STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS ZZ& DSO rti z'o_Z 1'Y©/g PROPERTY ADDRESS 6'V'V-z3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1V u/ 1/4, /V&,~ 1/4, Section T -z 7 N-R /P W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP 10y , VOLUME_L, PAGE.z 8'dt, 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 ye xpiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. - STATE. BAR- OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 545764 VOL 1186PAGE. 14 REGISTER'S OFFICE- - - - - This Deed, made between ST.CROIXCTY., VV' HUmb.ird-Land-Corgorati.on.,_a._ Minnesota-Corporation-_---- Redd for Re=d Grantor, JUN 2 1 19961 and.. Paul- _ - Cicha_- and. Laura --L.-- and Wife, - at 11 :55 ,M Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... Register of Deeds / conveys to Grantee the following described real estate in _..$ta.. Cr9.1X....._.__... RETURN TO County, State of Wisconsin: Part of NW 1/4 of NW 1/4 of Section 8, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Tax Parcel No: f yoo Wisconsin described as follows: Lot 4 of Certified Survey Map filed August 16, 1994 in Volume 10 of Certified Survey Maps, Page 2802 as Document No. 520266. 0 ER TANff $ This 7 S - nOt--------- homestead property. (p}~ (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And------------ - - - - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Easements, restf•ictions and rights-of-way of record, if any and will warrant and defend the same. Dated this -18th------------------- day of --June 19-.96. - --.(SEAL) HUMBI-RD..LAND-CORPORATION. . ------..(SEAL) - Austin J. Baillon, Its President -----------..........(SEAL) - --------(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF NUIXONX)O ( M I NNES TA ss Rae ms . --y--•-••-------- --------County authenticated this day of___________________________ 19 Personally came before me this ! $th-__day of June 19..96. the above named ---.Austi n J. Baillon'Presi ent fiumbi_cd_.Land__CQrposti.ojl.......................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. Stats.) to me known to be the perso n. foregoing inst~~nt and ac the 4~ AM. A. SAILL L r THIS INSTRUMENT WAS DRAFTED BY flIOTARY PUBLIC-MIPJN Humbi rd Land CorP - oration-WASNINfa'iON CO Paul A. Bai l ion My Comm. - Notary Public Wash1n9tQn un vn. 3 (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ------.January 319.... -_-..__.;(t- QQ•Q) - - - • •Namee of persona Signing in any capacity should be typed or printed beinw their Signatures., 4 WARRANTY DEED STATE BAR OF WISCONSIN wivnmin T.egal Blank Co. for. FOI281 No. 1-1982 Mil'-'kec. Wis. - .r 9,04C-9/98 TUE 10:04 FAX 715 386 4686 ST CRX CO ZONING a 16002 ST. CROIX COUNTY WISCONSIN ZONING OFFICE sr. cAOiXCOUNTY GOVEANMENt CENTER 1101 Carmichael Road Hudson, WI 54016-7710 SEPTIC INSPEOTrON (715) 386-4680 / Please WATER TEST REQUEST FOIE specify desired application. Outside test(s) & remit winter months, Makin water lines are appropriate fee arrangements 3 access to often turned with with this office to the home necessary. off during insure that entry please make Y can be gained, 0 Water (VOC's) i~ Water {Nitrate Water & $acteria) $185.00 (Lead Coneentration)'"`"45.00 septic $50.00 Q Nitrate Owner: 21.00 & bacteria PAIL s~ BRA G retest Address, t~HA Requested by: V s. (if~ST relephoneP S Address: 1?x'oPex'ty address Telephone :.ZZP Ss~Oi~ :Location: (Fire to & Street) sec. f! l/DTH Realt j T s w Y firm: F16I'll q ,Town of O ; Lock Box Co _yco mbo: Closing Date; 7'08- aq I8./3,/qs .i'ROVIDE A SKETCH OF E COMPLETED $y p HOUSE & ROPERTY OWNER ' ~.ter sam SEPTIC SYSTEM ON s the dwelli location: K~bfw► REVERSE OF THIS FORM* f` vacant, dates currently occupi a K 3e of Septic last occupied; Yes Q No '1?tic tank Ias~Ystem'~- o't ~q 1 `evious Owner' pumped by: ~y s Name(s): •'e an CAIf4 OU.W Date: N/A ❑Y yNf the follow. Slow draina 9 been observed? Cy SN Sews - from house. dY Sewage dischaP into dwelling, qY ~N Foul ge to ground odors, surface or road ditch. O `i~r comments relative to system Operation! I ""rtifp that bf of MY knowl age bOVe infortaation is complete and true to the OWNERS SIGNATUpX: C~ 1 DATE : L//ol* ,,0$(09/98 TUE 10:04 FAX 715 386 4686 ST CRX CO ZONING Z003 r OWNERS DRAWING F NOUS & SEPTIC SYSTEM LOCATION 0R IN © tiv fl PIK QRR/A/ Ff" o)DPr E&T oh-)4 To BE COMPLETED BY INSPECTION AGENCY System design &/or permit ~on, file,? , `Oyes ❑No Soil series per SCS Soil.-Survey sheet Type of soil absorption system: $low gr ❑At-Grd ❑Mound: Approx. size 'X ❑ av C1Dose OPressuriZed N Ft.= ❑Bed- OTrench '❑Dry Well Molding, Tank ❑Outfall pipe.'----.. OBSERVED.DEFICrENCIES DOther ❑Unknown Septic tgnk-jq, Setbacks: [House [Well OProp: line OOther Dose tank Setbacks: OHouse ❑Weli []Prop. line OOther [Locking cover-:: : OWarning 1abe1 . ❑Pum p/Ploats DAl'arm ❑Elec: ..wiring . Soil Absortition System Setbacks: OHouse DWell ❑Prop.,Iine OOther ❑Pondn g:.:,. _ [Discharge: Genera] comments; INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title ST. CROIX COUNTY WISCONSIN G ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER e N a n w n A 7 1101 Carmichael Road wwwwb • Hudson, WI 54016-7710 ~F lot (715) 386-4680 June 11, 1998 Edina Realty Jason Bast 400 So. 2nd St. Hudson, WI 54016 RE: Existing septic system inspection for Paul and Laura Cicha, Lot 4 Leal: NW %4, NW %4, Sec. 8, T29N-R18W, Town of Warren, St. Croix County Dear Mr. Bast: On June 10, 1998, an inspection of the septic system on the Paul and Laura Cicha property, 1019 110th Ave., Roberts, Wisconsin, was conducted. At the time of the inspection, the septic system appeared to be functioning properly. No ponding of septic effluent was observed in the drain field vent. The septic system serving the Cicha property was installed on July 9, 1996, and was sized for a four bedroom house. A Weeks 1200 gallon septic tank discharges to a bed type drain field- 12 ft. by 72 ft. The system was inspected by staff from this office on July 9, 1996, and was installed as a code compliant system. To prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. This inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. The water test results will be forwarded to you as soon as, we receive them. Should you have any questions, please contact this office. Sincerely, -Cod Rod Eslinger Assistant Zoning Administrator ST. CROIX COUNTY WISCONSIN ZONING OFFICE ` - IN p N u ST. CROIX COUNTY GOVERNMENT CENTER ■+■+4 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 18, 1998 Jason Bast Edina Realty 400 S. Second Street Hudson, WI 54016 RE: Water Test Results for Paul & Linda Cicha located at 1019 110th Street, Tn of Warren, St. Croix County, Wisconsin Dear Mr. Bast: Enclosed are the original water test results from Commercial Testing Laboratory for a water sample that was taken at the above referenced property. If you have any questions regarding this, please call our office at (715) 386-4680. Sincere) , r eo~ ew Rod Eslinger Assistant Zoning Administrator Enclosure sm Y COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800-962-5227 FAX - 715-962-4030 ST. CROIX COUNTY ZONING OFFICE REPORT NO.. 65285/01 PAGE 1 ST.CROIX CTY GOV.CTR REPORT DATE! 6/16/98 1101 CARMICHAEL'ROAD DATE RECEIVED: 6/11/98 HUDSON, WI 54016 ATTN2 JIM THOMPSON OWNER*, Pau! 6 Linda Cicha LOCATION: 1019 110th Ave., Roberts COLLECTOR: Rod Esiinger DATE COLLECTED: 6-10-98 TIME COLLECTED44 3:30pm SOURCE OF SAMPLE' Outside faucet DATE ANALYZED:6-11-98 TIME ANALYZED. 2:00pm COLIFORM,MiFCC1 0 /100 ml INTERPRETATIOW Bacterioiogicaliy SAFE NITRATE-N: 10 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 si Nitrate-Nitrogen, mg/L LAB TECHNICIAN. Pam Gam WI Approved Lab No. 19 : deans "LESS THAN" DetectaLie Levei Approved by2