Loading...
HomeMy WebLinkAbout006-1036-40-200 St. Croix County Planning and Zonin Wednesday, February 02, 2005 at 11:45:00 AM Detail Sanitary Information Page 1 of l Computer #: 006-1036/0-200 Sub /Plat: NA Section: 17 Parcel #: 17.31.16. 49A20 Lot: 2 TN /RNG: T31 N R18W Municipality: Cylon, Town o CSM: Vol. 18 Pg. 4718 114 114: SE 1/4 NE 1/4 Owner: Gehrman, Dean 2172 220t Street Deer Park, WI 54007 State Permit: 453109 Issued: 04 /21/2004 POWTS Dispersal: Non - Pressurized In -ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11 ") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other irements Additional Notes Money Owed Not determined NA Bird, Shaun C ck for accuracy of parcel number has his is remaining acreage (not labeled as Lot 2) $0.00 Signed Off: No et to be assigned by Real Properties as of after parcel split - Lot 1 is < 10 acres with an 5/24/04 existing house at 2150 220th St. Permit #262352 St. Croix County Planning and Zonin Tuesday, May 31, 2005 at 8:11:52 AM Detail Sanitary Information Page 1 oft Computer #: 006 - 1036 -40 -000 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249K Lot: TN /RNG: T31N R18W Municipality: Cylon, Town of CSM: 1/41/4: SE 1/4 NE 1/4 Owner: Gehrman, Dean 2172 220th Street Deer Park, WI 54007 State Permit: 453109 Issued: 04 /21/2004 POWTS Dispersal: Non - Pressurized In- ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11 ") (PSA) Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Ad ditional Notes Money Owed Not determined NA Bird, Shaun This is remaining acreage after parcel split in CSM $0.00 Signed Off: No 18/4718 - Lot 1 is < 10 acres with an existing house at 2150 220th St. Original sanitary Permit #262352 c c or accuracy of parcel number- has yet to be assigned by Real Properties as of 5/24/04 'J RECEIVED 3 e � 79223 VOL 79 PAGE 4950 KATHETU H. WALSH REGISTER OF DEEDS ST. CROIX CO. MI CERTIFIED _ E EV MAP RE FO 03fi30PM LOCATED IN PART C�I Y 1/4 OF THE NE1 /4 CERTIFIED SURVEY MAP OF SECTION 17, T31 N, R1 6W, TOWN OF CYLON REC FEE: 13.00 ST. CROIX COUNTY, WISCONSIN COPY FEE: 3.00 OWNER SURVEYOR PAGES: 2 DEAN GEHRMAN EDWIN C FLANUM 2150 220TH STREET NORTHLAND SURVEYING, INC. DEER PARK. WI 54007 P.O. BOX 14 ROBERTS, WI 54023 NE SECTION CORNER SCALE IN FEET 1" = 1 50' POSITIONED FROM WITNESS (� NE CORNER MONUMENTS OF RECORD. SECTION 17 MGt]PL,&,VVCEU dCQMD� BENCHMARK I O 1 SO TOP OF IRON PIPE t N89 "45 834.35 ELEVATION = 1046.60 - - I N E SEI / ' 3. NORTH LINE OF THE SE1 /4 OF THE NE1 /4 I il l LLjZ LOT 2 ��` I p ui 40 , 22.21 ACRES t TO THREAD OF RIVER w p w O 21.00 ACRES TO MEANDER LINE INC. R/W U I U uj 914,711 SO. FT. c') 20.12 ACRES TO MEANDER LINE EXC. R(W z X m C y 876,470 SO. FT. 33' 33 U N I N LOWEST BUILDING OPENING ELEVATION = 1052 c I� y I �o WATER ELEVATION = 1037 Z cm AVERAGE ELEVATION OF THE ORDINARY HIGH 0 I I 1 O WATER MARK = 1038.9 0 o- I FLOOD STUDY COMPLETED ON ADJOINING I Qo I } PROPERTY TO THE SOUTH SHOWS 100 YEAR FLOOD Of I 1 I ELEVATION AT AN AVERAGE OF 9 FEET ABOVE THE A ;En ELEVATION OF THE WATER AT THE TIME OF FLOOD STUDY, THIS INFORMATION WAS USED FOR SOIL TESTS N I I DETERMINING A LOWEST BUILDING OPENING ON THIS LOT (1038.9+9' +4' = 1051.9). - ;� g BENCHMARK m I 1 TOP OF REBAR : EXISTING I ELEVATION = 1049.90 _FIELD DRIVE 100' 4 �5. SETq q I I ro t ::::... a 756 E � —� s�FgoMOywM. w w w w 0.2 ACRES t TO 1 -4 1 + THREAD MEgN q �2 rT w w w W OF RIVER INC. -R/W OFRNER 0.2 OFRIVEREXC. HR 4 1 i 0.1I.W.M. ``OwR/ �q`S� Im — !I1E4N ER LINE �R \ nil LEGEND - :9� 587 °iris ^E'308.28' m MASONRY NAIL FOUND p _c� - - -- -- 275.19_ 33_� M O Qo_ M _ O.H.W,M. p 1 5/16" O.D. IRON PIPE FOUO l ���= i Z I+ 16.69 O • 1" O.D. IRON PIPE FOUND SO.O "27'1_8!{n(_ 327.47' 33.02 Q, O 3/4" X 18" IRON REBAR SET WEIGHING 62':t 889 °32'42'E 360.49' 1.50 LB& PER LINEAR FOOT EAST - WES 1/4 L INE • • • • • . • • • . BUILDING SETBACK LINE (AS SHOWN) ( `i1 GD L�LLaaG]D� El/4 CORNER SECTION 17 w WETLAND OUTLOT 1 IS INTENDED TO BE OWNED BY THE OWNERS OF LOT 1 OF CERTIFIED SURVEY THIS INSTRUMENT DRAFTED BY SAM ADAMS SHEET 1 OF 2 SHEETS MAP RECORDED IN VOL. 18, PG. 4718. JOB NO. 05-10 DATE 2 -15 -OS ' Vol. 19 Page 4950 Parcel #: 006 - 1036 -40 -075 06/06/2007 11:57 AM PAGE 1 OF 1 Alt. Parcel #: 17.31.16.249A -06 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/22/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KATZNER, ALAN L & LINDA C ALAN L & LINDA C KATZNER 2150 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 2172 220TH ST SC 0119 AMERY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 22.210 Plat: 4950 -CSM 19 -4950 006/05 SEC 17 T31 N R1 6W PT SE NE CSM 19 -4950 Block/Condo Bldg: LOT 002 LOT 2 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17-31N-16W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 04/06/2005 791452 2778/425 WD 03/22/2005 790223 19/4950 CSM 07/23/1997 1174/56 WD 07/23/1997 1174/55 WD more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 22.210 64,000 0 64,000 NO Totals for 2007: General Property 22.210 64,000 0 64,000 Woodland 0.000 0 0 Totals for 2006: General Property 22.210 64,000 0 64,000 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 Parcel #: 006 - 1036 -40 -060 06/06/2007 11:53 AM PAGE 1 OF 1 Alt. Parcel #: 17.31.16.249A -05 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/22/2005 00 0 Tax Address: I l Owner(s): O = Current Owner, C = Current Co - Owner D _HRMAN �( a�2,n,� O - GEHRMAN, DEAN A 2150 220TH ST DEER W DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 0119 AMERY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 14.410 Plat: N/A -NOT AVAILABLE SEC 17 T31 N R1 6W PT SE NE EZ -U- 1187/527 Block/Condo Bldg: EXC CSM 18 -4718 & EXC CSM 19/4950 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17-31N-16W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 03/22/2005 790223 19/4950 CSM 07/23/1997 1174/56 WD 07/23/1997 1174/55 WD 07/23/1997 1109/182 LC more 2007 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.410 1,500 0 1,500 NO AGRICULTURAL FOREST G5M 5.000 5,000 0 5,000 NO Totals for 2007: General Property 14.410 6,500 0 6,500 Woodland 0.000 0 0 Totals for 2006: General Property 14.410 6,500 0 6,500 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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453109 0 GENERAL INFORMATION (ATTACH TC�.PERMIT) State Plan ID No: Personal information you provide may be used for sec ndary purposes [Privacy Law, s.15.04 Permit Holder's Name: k 1 City Village X Township Parcel Tax No: Qehrniol 1, ' L3UC1[T - w2tw I C Ion Township 006 - 1036 -40 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 17.31.16.249 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Di ipe Holding pinalGrade m PUMP /SIPHON INFORMATION Manufacturer kpq n d St Cover Model Number TDH Lift Friction Loss Systek 1 j TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold I Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia j II-ength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [� Yes [N No � Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2172 220th Street Deer Park, WI 54007 (SE 1/4 NE 1/4 17 T31 N R1 8W) NA Lot 2 Parcel No: 17.31.16.249A20 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes Fj No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildin � �., 2 County 201 w it. adiso WI -7082 itary Permit Number (lo be nued in by Co.) Nv isconson ( 8) 261!6546 0 S3 D Department of Commerce S to Plan LD. Number Sanitary Permit Applica on you �x���cti in accord with Comm 83.21, Wis. Adm- Code, perso -( FF1 ojeci Address (if different than mailing address) may be used for secondary purposes Privacy Law, s 15. 1)(m); ZONING I. Application Information - Please Print All Information # 2 1 Z ZO) Parcel # -Lot Property owners N � �y,� > �, o ow.o � . �c • 9� Property Location Prope Owner's Mailia Address !� �7 o2 / c � g J (fy\ b �. /., Section city, State Zip Code y� Phone Number -3 T N R rc o le {O II. Type of Building (check all that apply) CSM Number r 2 Family Dwelling - Number of Bedrooms _ \ ✓•� p� FS 5 ❑ Public/Commercial - Describe Use ( /� \� ❑City ❑ViIL•t ' ownship ofC. ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. mplete line B if applicable) i O - =C. 2 A. w System ❑ Replacemctit System ❑ Trestment/Holding Tank Replacement Only ther Modification to List Previous Permit Number and Date issued B. C3 Permit Renewal ❑Permit Revision ❑ Change of ❑ Permit Transfer to New i I Before Expiration Plumber Owner s IV, Typ of POWTS System: Check all that 222W ❑Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter _P�u� In -Ground ❑ Mound >24 in. of suitable soil ❑ Constructed Wetland ❑ Pressurized In round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating El Sand Filter Recirculating Synthetic Media Filter hing Chamber 11 Drip Line ❑ Gravel -less Pipe El Other (explain) L V. Dis ersaLlTreatment Area nformation: rem Eleva 'on Design Flow (gpd) Design Soil Application Rate(gpdsfj Dis7l Area Required (sf) Dis Area Pr posed (sfj S ys S�� _7 Y VL Tank Info Capacity is Total Number Manufaetirrer Prefab Site S I Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment 11ait Dosing Chamber VII. Responsibility Statement- I, the undersigned, as a sponsibility for installation of the POWTS shown on the a ttached plans. Plumber's sine (Print) Plumber's Si MP/MPRS Number Business Phone Numb Plumber's Address (Street. City, State, Zip _�? �� 11 YO/ 2 VIII. tountyMepartment Use Onl Approved Disapproved Sanitary Permit Fee p es Lud Groundwater Dal; sued lss ing gent Signature o Stamps) Surcharge Fee) 2;� f 7l O ❑ Owner Given Reason for Denial IX. Conditions pprov al 3)t S �wuA.0 SYSTEM OWNER: �� p �� 1 0AX-1%. 9 Septic tank, effluent filter a dispersal cell must all be serviced t maintained as per management plan provided by plumber. 1 �pae_. > `f : D a out- t -u000� 2. All setback requirements must be maintained / as per applicable code /ordinances Attach complete plans (to the county only) for the systam on paper not less than Sl/2 : 11 inches in size _ h A 5 s be .0� II�QA SBD -6398 08102) P T PLAN PROJECT Dean G ehrman ADDRE 2150 220th St. Deer Park Wi 54007 SE 1/4 NE 1/4S 17 /T 31 W TOWN Cylon COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1/30/04 BEDROOM 3 CONVENTIONAL XXX IN- GROUND SURE CONVENTIONAL LIFT' HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA # of chambers 22 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.1/97.6 4' be l o w grade Alt. BM Top of 1/2" Pipe @ 99.0' 1320' Property Line Vent �» Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area Well is to meet all 6 11" setbacks required by Grade at System Elevatioi WDNR Pro 3 Bedroom House Plans Designed Using Conventional Powts Manual Version 2.0 30' N 50' 7 % ST Scale is 1" = 40' 700' Slope 20' 1 B- 0' unless otherwise 5 noted Vents 40' 75' Alt. * B. �,(� S `e 19�w� / 04 oa 5 5' B -3 1'�s i �9+�L.� t � t 500' J O 4 4 Ven > B - 1a �, to GO V 2 -3' X 69' Cells with >3' Spacing P g PQOT PLAN PROJECT Dean Gehrman ADDRE 2150 220th St. Deer Park Wi 54007 SE 1/4 NE vas 17 /r 31 w Tp Cylon COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1/30/04 BEDROOM 3 CONVENTIONAL XXX IN- GROUND SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA # of chambers 22 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter Zabel A -10C ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.1/97.6 4 be l o w a rad e Alt. BM Top of 1/2" Pipe @ 99.0' 1320' Property Line A Vent Standard Biodiffuser AL Leaching Chamber with 3 1. 1 ft2 of Area Well is to meet a ll Grade at S setbacks required b stem Elevation Y WDNR Pro 3 Bedroom House Plans Designed Using v� Conventional Powts Manual Version 2.0 30' 50' N 7% ST Scale is 1" = 40' 700' Slope 20 ' 10' B- 50 , unless otherwise noted Vents 40' Alt. *B S 5 5' o�- 1 500' O � r Vents B -2 ' o °- 2-3' X 69' Cells with >3' Spacing Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. e ' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` 0 � /z /� Property . c �+ ca io I �` j � ' Govt. Lot 1/4 A,1,4 /4 S 1 31 N R � E ( ) Property Owner's Mailing Address A �qt # Block Subd. Name or CSM# x 20 4- - State Zip Code Phone Nu r liage Wown Nearest Road LIL rir., r�U vv v�U ( ) c7 New Construction Use: ' Residential / Number of bedrooms 3 Code derived design flow rate J t7 GPD ❑ Replacement ❑ Public r mmercial - Describe: K �7 �f c Parent material /G/�,✓ � Flood Plain elevation if applicable _ rte ft. General continents and recommendations:sy Boring Ce&L AAZN Oo-I FEB.Ztb4 Baring IZI # pit Ground surface elev. ft. Depth to limiting factor � in. Soil Application Rate y (� r�Q . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff A-1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Z/ Z- 3 - f S s yr /.' FT] Ong # Boring a I Pit Ground surface elev. 03 1 ` ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 el Ila , 3/z Q a,� ✓ - �— - Z ` Effluent #1 = BOD > 30 < < 220 mg/L and TSS >30 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - - ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address , Date Evaluation Conducted Telephone Number 1 008 192nd Ave, New Richmond, WI 54015 `= -- 715 - 246 -4516 Property Owner _ Parcel ID # Page F731 ❑ Boring Boring # (� Pit Ground surface elev. � 2- ft. Depth to limiting factor A� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z y- 2 S 0 s F-1 Boring # E] Boring E] pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgll_ ' Effluent #2 = BOD 130 mg/- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SOD -8330 (R.6=) Soil Test Plot Plan Project Name Dean Gehrman Shau Address 2150 220th St. Deer Park Wi 54007 M #226900 Lot ----- Subdivision ---- --- Date 1/30/04 SE 1/4 NE 1/4S 17 T 31 N/R 16 W Township Cylon Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft . _- Top of 1/2" Pipe g,,,,,7� ( System Elevation 98.1/97.6 *HRpSame as Benchmark A t. BM Top of 1/2" Pipe @ 99.0' 1320' Property Line Scale is 1" = 40' unless otherwise noted Pro 3 Bedroom House 101' o N 0' 102' N 7% 700' Slope 20 ' 10' B -1 40' Flood Plain Alt. 75 elevation was B. established by surveyor -3 see attached map. 500' JIF -2 N5 SxYo�- CIO Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Fem ' cy Plan n #1 If system fails, determine cause of failure, use alternate area and install new in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option #3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC MAINTENANCE AGREEMENT` AND OWNERSHIP CERTIFICATION FORM i wnerA3u O er Y Mailing Address d Property Address (Verification required from Planning Department for new construction Identification Number city /State P • 2 `F�) LEGAL DESCRIPTION Property Location N - Town of ' /,, 1 /•, Sec. T Lot # Subdivision Volume Page # Certified Survey Map # �— , ----- —, P . S S� e Page Warranty Deed # Volume — 5 — L Spec house D ye n° Lot lines identifiable q t] no SYSTEM ENANCE y system could result its prem ature failure to handle wastes. Proper maintenance Improper use and maintenance of our septic s in a licensed pumper. What You put into the system consists of pumping out the septic tank every three years or sooner, if needed by P can affect the function of the septic tank as a treatment stage in the waste disposal system D a certification form, signed by the owner and by a Th property owner agrees to submit to St. Croix Zoning p lumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system masterplumber, journeymanp the s tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), eP Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards on set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. 1 wi thin 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. / DATE SiGNA "1'iJRE OF APPLICANT OWNER CERTIFICATION nts on this form are true to the best of my (our) knowledge. 1(we) am (are) the owner(s) of I (we) certify that all stateme the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. i DATE SIGNATURE OF APPLICANT * * * * * *, A Formation that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a copy of the d survey map Reg map if reference made in the warranty deed a copy o Proposed new home floor plan for: Dean and Peggy Gehrman 2150 220 Street Deer Park, W 1 54007 (715) 269 -5606 dpt@amerytel.net F - 7 . . -..._i Brea kfast '.' 7 X0115 2 WWSW r suitt 1 Vaulted Family Room R r Kitchen - M Both _. Foyer `far ng Roam B�wn 3 w FLUOR PL spy but 2�S I� n Hd� -7r St. Croix County Zoning Monday, May 24, 2004 at 10.47.40 AM Detail Sanitary Information Page 2 oft Computer #: 006-1036-40-100 Sub/Plat: NA Section: 17 Parcel #: 17.31.16.24A10 Lot: 1 TNIRNG: T31N R16W Municipality: Cylon Township CSM: Vol. 18 Pg. 4718 1/4114: SE 1/4 NE 1/4 . .......... . Owner: Gehrman, Dean 2150 220th St Deer Park, WI 54007 State Permit: 262352 Issued: 06/11/1996 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 07/25/1996 POWTS Detail: Bed Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspecto As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as-built (not likely at this time) and Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No new parcel number after CSM#757505 in Utgard. Note on inspection report that an as-built 2004 - this is now Lot 1 was needed and report unsigned. No as-built apparently was submitted by Utgard Plumbing for this mound. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 7/25/1999 Notes Inspecto As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as-built (not likely at this time) and Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No new parcel number after CSM#757505 in Utgard. Note on inspection report that an as-built 2004 - this is now Lot 1 was needed and report unsigned. No as-built apparently was submitted by Utgard Plumbing for this mound. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 7/25/1999 - — — — — — — — — — — — --- — - -- -- -- — — — — — — — — — — — — — — — — — — — — — — — — — — — — -- — — — — — — — — — — — — - r Slate liar of Wisconsin Furl) '_ - 19112 WARRANTY DEED .:..... ....._... f DOCUMENT NO 56 Jean Ann Doth, a single person -_ _ APR 24 1996 - - � 11:00 A. conso, and s%arrants it) Dean A. Gehrman, a single person THIS ,PACE Ali ERVEn rr)R RE +N . DATA NAME AND RETURN AC DRESS p a -he following described real estate in _-St _- Croix County. State of Wisconsin: 006 - 1036- 30/ -_40_ (Parcel Identification Number) The South Half of the Northeast Quarter (S2 NE Section 17 31 - 16, St. C ix County, Wisconsin. .�-- �- I CS � -4 L sn�` TRA �- � is not Thi; - homestead property. (is) (is not) Ex,eption to warranties: municipal and zoning ordinances of record and ' recorded easements restrictions and reservations. Dated this 22nd da of - -- - April 96 ilt`.� s • �', � r - II ' - (SEAL) __-Jean _ Ann Do - -- - -- _ - -- -- - - (SEAL) - - - ------ - - (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN - - - IS -. - - P olk County. t authenticated this day of _ __ __ . 19 Personally came before me this - _??nd__ —_.� day of - - April - - --- _ -- 19 the above named .jean Ann Doth TI - rLE: 'MEMBER STATE BAR OF WISCONSIN -------- - -__._ - _. - -_ -- -- . _ - (If not. - x authorized by §706.06. Wis. Stats.) to me known to be the person ___ _ _ __.__.___- who execated the f ( ego ¢ instrume nd )wlcdge�the,sa ne. " THIS INSTRUMENT WAS CRAFTED BV e,3j r6tF 1 Bert D. Petersen, Attorney. - ,, Clear Lake, WI 54005 No �1 P ubl i c _ Pd k -- -- -- _ ._ Count%. Wis. (Sienetures ma_v be autbentica A or acknuwledged.I re rlrt'V� � � mmisslon is permanen t. if not, state expiration date: necessary 1 -r v�i3�'` = jt -11, 1 - - - 19c) 'l," .1 tee h..,dd N rva rrn•h lh.lau lkeee \y- f+,):a �•° bANN:% \fy UF.6U of %f)`K:\RUF yyt (O \1t\ %NiSconSin:egal Blank Co. I ^I: _ FUN %1 \n. 1 - I49! Afdwaukee. L'in 3 N CERTIFIED SU MAP OWNER DEAN GERRMAN LOCATED IN PART OF THE SEI M OF HE NE1 SECTION 17, T31 N, 7 F R16W, TOWN OF CYLON, ST. C OIX COON WISCONSIN ACRE TO M ER UNE mS RA E ELEVATION OF TH_ 0RD;.ARY NJGK NSIN OEERPAR.� %154007 O o SURVEYOR EDNIN FLANUM A = OF OT 1 �- I U v 0f NORTHLAND SUR�YI..%r. cv 1 z f y - 3.1 ARE + - TO TH OF FEVER ,;ATE. ELEVATION = t437 P.O. eox 14 °i < , ROBERTS, W. 54023 1 x © LEGEND 10 .859 SO. Vr'ATEA'MRK = 1038.9 �J x Sr. CROIX COUNTY SECTION CORNER POSED N C5 2.43 A _ TO cAN R UNE EXC. RWV FL003 STUOY COMPLETED 0 ADJO:N' NG " FROM WITNESS MONUMENTS OF RECORD j gF 106, 9 FT. PP. OP zRIYTOTHESOUTHSNtJ1'151WYEPRFL !..1SCNRYNA!LFOQND J I u�5 ELEVATION AT AN AVERAGE OF 9 FEET ABOVE TF1= Q ELEVAT.ON OF THE WATER AT THE TItME OF FLOOD O ' x 19' :RON PIPE SET 1W'EIGFING f1� STUDY. THIS INFORMATION Ws AS USED FOR 1.13 LSS �I1. . PER LINEAR FOOT a I D v DETER MINING A LOWEST 61.11 NG OPENING ON C THiSLfiT(1038.9 +9' +C= 105t.9�. . 1OU ROADWAY SETBACK LINE 2 n tc EXISUNG FFRNCE �r`- l Ul 1030.8 \ / _' G7 1036.8 fD - - - - -�-- - -- X SPOT ELEVATION 1041.6 =x_. X ® =u NE CORNER I �L 1036.8 TFiAt? OF 1036:5 ' f v ® 5EPTIC SECTION 17 x� i 4 c + - 1036.8 �.za � _� - W= 1037.2 47 _ 0 UTf_ITYBox upi r�j1 Ln W-100 . � �'� L.B.O. = 1052 w�, � � a LOWEST BJIIDING 7� o I '�"�� �p 6 \ OPENING ELEVATION FI Z I_ T � i = i^ X '� IA' ' C s i. s I 8 '38 X� _ G77 ro � I i N 7-'S E 28j 76 `� O.Hyi!M 3 ' t1 •, .8 0 F I v G1 N v1 _ 6• CD < I to I} I j 0 SAO% X �� ' O �� NO I O I I } I W 0 4' �•�� I - __ 1039.3 1039.9 1 7.9 I Qi 104.7 1054.1 X t0 d.1104�6.6 ` � ?$ ` +` N 1052 .4 ` I L]I / X 103 2 Ir i C I S I ^ SFED `t852.6 1052.8 ` G,I 0 .3 , H EJ p • SB 32'42 ^E 360.49 I <i I o 1 x �i 31 C / ♦ GARAGE 327.4T 1041.1 (t �I c�@! Z U tOs�8.2LB. . =1052 a`o' Qom I I 32 42'1Y 4348 _ 862,C4 - ~ - ' —_ _ .�_ _ EMTNR'r �i. tY — - _ o 33.02 EAST - '.VEST l;e L!NE NSW32'4 W 885.06' E114 CORNER IN FEET 1• = 100' o - - .,„gin o ! SECTION 17 id 9 HpA�� -- � --- -- --- -- - - - - -- i ------ - - - - -- Tt-IS INSTP:U : ".ENT DRAFTED BY FOWL N FLANI,M f 33133 0 100 JOB NO.04 -14 LATE 1.30 -04 I I 1 • �5 1 �Y� bl ti 1047.4 A ' � K 1.0 1048.5 i 62 N x 63 CONCEPT 1 LOT C.S.M. LOCATED IN PART OF THE SE1 /4 OF THE NE1 /4, SECTION 17, T31 N, R1 6W, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN. 1047.7 X OWNER 1036.8 3.47 ACRES TO THE CENTER OF DEAN GEHRMAN 1041.1 STREAM ALL THE WAY TO THE ROAD 2150 220TH STREET 64 1041.6 DEER PARK, WI 54007 94 X 3.01 ACRES WITH PAN HANDLE N , SURVEYOR No 1036.5 EDWIN FLANUM 1036.8 _ + 1036.8 rHRt gD OF RVER NORTHLAND SURVEYING - 96 P.O. BOX 14 �o + X O H Iy��� 1034.9 ROBERTS, WI 54023 r W.M. W �r - 9a 1-042.6 RIVER MEAND 1039.1 39 LEGEND S80 °18 '39 "F2 97 L 1tL43.4 1038.8 9 X ST. CROIX COUNTY SECTION CORNER POSIT NED FROM WITNESS MONUMENTS OF RECORD \ _ j0Aj 1040.4 ro- 103 .2 MASONRY NAIL FOUND w 1.054.1 10 X 0 1054.1 S'oo423"2s93 95 0 ��2 $ 1039.3 1039.9 103 10 4 oi Q 1" X 18" IRON PIPE SET WEIGHING r- N X 00 X r — — - i _S89 °3 d4F 2Z' o., _ . _ _ . B oo... 1.13 LBS. PER LINEAR FOOT o 1052.6 z° 10 g 8.3 9 °3242 "E 360.49' 0 93 • — 100' ROADWAY SETBACK LINE 327 47' ° ® 1041.1 0 33.02' a o rn rn� — X EXISTING FENCE QS 522.00' 83 o m ° ® 1058.2 _ _ _ _ - cn rev L.02' 14 m 1 8 4 _ 0) 1036. — — — — — — — 852.04' X ELEVATION m °' N89 °32'42'W 885.06' 1O Q9 ° � fly Q� ` N CERTIFIED SURVEY MAP OWNER DEAN GEHRMAN a� LOCATED IN PART OF THE SE1/4 OF THE NE1 /4, SECTION 17, T31 N 2150220TH STREET Asa y , DEER PARK, WI 54007 w w •. 142 R16W, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN. �(f Luz '= " p- O SURVEYOR W a cr . m � cn oa sm 0 CL EDWIN FLANUM w80002 cn•"m w 0 rn NORTHLAND SURVEYING AREA OF LOT 1 N p ' tv "A W •• W N uj Z 3.1 ACRES +/- TO THREAD OF RIVER WATER ELEVATION = 1037 P.O. BOX 14 W O W N "W W w ROBERTS, WI 54023 E-a a cs. w rs. •• co cn��"•r �I; cn w ° LEGEND --I �-" W N I- ;+w of x Z 2.48 ACRES TO MEANDER LINE AVERAGE ELEVATION OF THE ORDINARY HIGH -i F GJ t1 � r� t� 0. C7 w O Y 107,859 SQ. FT. WATER MARK = 1038.9 O< W m w m w W O< o� m m X ST. CROIX COUNTY SECTION CORNER POSITIONED r �xa�n �tac�a QUO FROM WITNESS MONUMENTS OF RECORD c 2.43 ACRES TO MEANDER LINE EXC. R/W FLOOD STUDY COMPLETED ON ADJOINING g w z 105,679 SQ. FT. PROPERTY TO THE SOUTH SHOWS 100 YEAR FLOOD MASONRY NAIL FOUND i� ELEVATION AT AN AVERAGE OF 9 FEET ABOVE THE m ELEVATION OF THE WATER AT THE TIME OF FLOOD O 1'X 18" IRON PIPE SET WEIGHING STUDY. THIS INFORMATION WAS USED FOR 1.13 LBS. PER LINEAR FOOT DETERMINING A LOWEST BUILDING OPENING ON N THIS LOT (1038.9' +9' +4' = 1051.9). . 1 00' ROADWAY SETBACK LINE Rill I W I LY MG PRAVVIED dLp�GJD� OO rC�1i UY1L D �'l p�Q ( C�sG �--n— EXISTING FENCE O = 1036.8 1036.8 I X SPOT ELEVATION '31 N ao -- 1041.6 on N n \ X ® WELL NE CORNER -r IL 1036.8 niR SECTION 17 w 0 1 0 a EAD OF RIV 1036.x' ;\ ` OO SEPTIC w I O ar w I r a + _ 1036.8 _, _ _ - - W= 1037.2 Itij 0 UTILITY BOX N LL I 1 1 y +, c -:t- s I �! 1O 6 ___ W =103. �owRNFR L.B.O. = 1052 LOWEST BUILDING wl O w Qo I r» ui ? s o ° t 0° I 1 Z���� - _ 6 :� OPENING ELEVATION �I I z I W o > . _, .• I = a N c I S$ o "`' LIN X ° = `' 0 1$ � 3 we 28 - - -��4 o.H 1 '�.1o3s.s 6 � NI 1 � N x c 3 ro 1 I N 75 S� 1" -g� , -1 a lb I R G - p1 �-I— 1 OM O.H. CL U c � �° � c Q I o d l r 1043.3 - ..W.I14•� ♦�` �� - � �� I 49 ^' a �! I N X 1053.0. O ° 0��� -10 ```� 1039.3 1 37.9 I W 10547 1054.1 1048.6 1039.9 Q 1 00 1 _ . X ° c I 105 1052.4 ?S �� �� �Q ------- - - - - -- -_ - I = I Q� r X,. S SQ X ' X �r.R 9 3y�� --x !�i ((�� 103 .2 I 1 N SHED 108.3 HODS & 1.052.6 1052.6 -- ` `' S89 2'42 "E 360.4 _ _ _ _ � - - W ° 0' X t0_ ` I I GARA I O 327.4T w 33.02' N II<7 I c O LOT. , ,04,., ,'0 cv - OI o i N� � a o s L.B.O. - 1052 �n �b q 416 I O I Z ® g8.2 l T ' - _ _ _ _ _ _ �_ _ EXISTIN DRIVEWAY X o ` N8 9 °32'4 43 48.35' — _ _ _ v 852.04' - ' - — - - — 33.02 O I WE T 1 0 W7/4 CORNER EAST S /4 LINE N89 32 42'W 885.06' N I SECTION 17 E1 /4 CORNER SECTION 17 SCALE IN FEET 1"= 100 UHFe) p44CED R - Mn_D@ O It 1C D OO �'1[nIC G°3� ----------------- THIS INSTRUMENT DRAFTED BY EDWIN FLANUM 33 1 33 100 0 100 JOB NO. 04-14 DATE 1 -30 -04 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17:50 AM Detail Sanitary Information Page 1 of 6 Computer #: 006 - 1036-40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31N R16W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 1/4 1/4: SE 1/4 NE 1/4 Owner: Gehrman, Dean 2150 220th St Deer Park, WI 54007 State Permit: 262352 Issued: 06/11/1996 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 08/02/1996 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17.50 AM Detail Sanitary Information Page 2 of 6 Computer #: 006 - 1036 -40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31 N R1 6W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 1/4 1/4: SE 1/4 NE 1/4 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17 :50 AM Detail Sanitary Information Page 3 of 6 Computer #: 006 - 1036 -40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 114 114: SE 1/4 NE 1/4 Owner: Gehrman, Dean 2150 220th St Deer Park, WI 54007 State Permit: 262352 Issued: 06/11/1996 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 08102/1996 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17.50 AM Detail Sanitary Information Page 4 of 6 Computer #: 006 - 1036 -40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31NR16W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 1141/4: SE 1/4 NE 1/4 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17:50 AM Detail Sanitary Information Page 5 of 6 Computer #: 006 - 1036 -40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 1/4 1/4: SE 1/4 NE 1/4 Owner: Gehrman, Dean 2150 220th St Deer Park, WI 54007 State Permit: 262352 Issued: 06/11/1996 POWTS Dispersal: Mound 24" or more suitable soi Permit: New County Permit: 0 Installed: 08102/1996 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25196 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM#757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006 St. Croix County Planning and Zonin Monday, June 20, 2005 at 11:17.50 AM Detail Sanitary Information Page 6 of 6 Computer #: 006 - 1036 -40 -100 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.249A10 Lot: 1 TN /RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 18 Pg. 4718 1/41/4: SE 1/4 NE 1/4 Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Fogerty, Dave Owner changed to Utgard Plumbing $0.00 Signed Off: No Mary Jenkins No Utgard, Brady needs as -built (not likely at this time) a Change of plumber on 07/25/96 from Fogerty to $0.00 Signed Off: No Utgard. Note on inspection report that an as -built was needed and report unsigned. No as -built apparently was submitted by Utgard Plumbing for this mound. new parcel number after CSM #757505 in 2004 1000 Huffcutt septic tank to 1000 gal. Dose tank to 6'x 63' mound cell Pam Quinn NA Utgard, Brady This parcel became Lot 1 of CSM 18/4718 in 2004; $0.00 Signed Off: No contains <10 acres with remaining 40 for another house site in Gehrman's name. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/21/2000 4/8/2000 4/8/2003 7/21/2003 7/21/2006