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St. Croix County Planning and Zoning tllandav, ,November 03, 2008 at 9:53:46 A.11 Detail Sanitary Information Page I of I Computer #: 006 - 1037 -40 -000 Sub /Plat: 40 acres Section: 17 Parcel #: 17.31.16.256 Lot: TN /RNG: T31N R16W Municipality: Cylon, Town of CSM: 1/4 1/4: SW 1/4 SW 1/4 Owner: Hepola & Popelka, Janice & Mary 2101 210th Avenue Deer Park, WI 54007 State Permit: 479258 Issued: 06/17/2005 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 08/16/2005 POWTS Detail: Infiltrator - Quick4 Std. 19.1 sq. Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Ryan Yarrington >4/1/00 - Not Required Gille, Dennis decided to move existing house to new location on $0.00 Ryan Yarrington Signed Offf Yes property - north of horse pasture. Installed new 1000 gal. septic tank to 2 cells, 17 chambers each. Maintenance Scheduled Pump Date Pumped 8/16/2008 10/11/2008 10/11 /2011 Owner: Rushton, Francis 2101 210th Avenue Deer Park, WI 54007 State Permit: 315934 Issued: 07/22/1998 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 07/23/1998 POWTS Detail: Infiltrator - High Capacity 16" Bedrooms: 2 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Rod Eslinger Yes Utgard, Brady Filed with 2005 permit - abandoned800 gal. tank $0.00 Rod Eslinger Signed Oft: Yes and 2 trenches to move house on property. Abandoned an existing tile to unknown discharge Maintenance Notification Scheduled Pump Date Pumped Notification 7/22/2001 7/27/2002 04/20/2006 04/20/2006 Request for Technical Assistance to Establish the RFE - Hepola Property, Ion Page 1 of .ti Jennifer Shillcox From: Jennifer Shillcox Sent: Monday, July 09, 2007 4:39 PM To: ' Lepak, Gary T - DNR' Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon OK, here's the dirt. I spoke with Jan Hepola and she told me that they moved their house closer to the river in 2005 (after obtaining a building permit from the Town of Cylon and a sanitary permit from the County... she did not apply for a land use permit from the County because she didn't think they were in the floodplain). Their mortgage was sold in the past year and now their new lender is requiring flood insurance... thus the need for the elevation certificate the the LOMA. Ms. Hepola said there is a steep drop off along the banks of the river and doesn't think there is any way they could be in the floodplain. I told her that unless you dig up an RFE in the archives or would be willing to do a site visit, there was nothing more we can do and she will have to do a study to determine the RFE. Thanks for your help ... let me know if you find anything in the archives or could visit the site! Jenny - - - -- Original Message---- - From: Lepak, Gary T - DNR [ mailto: Gary. Lepak @Wisconsin.gov] Sent: Friday, July 06, 2007 12:11 PM To: Jennifer Shillcox Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon That's why one doesn't ASSUME or give answers till you get all the facts. Being that the FP is about 550 ft wide on the west side of the Willow, "How did the County issue a permit in a mapped FP7 Over all, things seem pretty flat in the overbank till you get close to the existing development. I did check for DOT bridge data. Nothing on the two closest bridges, or at least nothing usable for a FP determination since it appears they were rebuilt in 1970. Did find Bridge data on STH 46 over the Willow River from 2000. Although 3/4 mile downstream is a bit too far to make any reasonable projections. Might be able to use to get some generalizations about the FP, but setting a RFE could be a stretch. Maybe your file will turn something up? I'll still do an Archive search next week. Later GTL From: Jennifer Shillcox [mailto: jennifers @co.saint- croix.wi.us] Sent: Friday, July 06, 2007 11:08 AM To: Lepak, Gary T - DNR Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Gary, 7/9/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 2 of 3 I am not sure what prompted her to submit the Elevation Certificate to FEMA ... it may have to do with flood insurance. I see on the completed certificate that she is requesting that the flood zone designation be removed from a residential structure built in 2005. The structure appears to be 381 feet from the OHWM. I left her a message to get more information, but I am assuming that she'll need an RFE. I'll let you know as soon as I hear anything from her. Thanks, Jenny - - - -- Original Message---- - From: Lepak, Gary T - DNR [ mailto: Gary. Lepak @Wisconsin.gov] Sent: Friday, July 06, 2007 9:48 AM To: Jennifer Shillcox Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Jenny Glad you contacted me before this went any further. I pulled up the Floodplain Map for this area. The FP is at least 700 ft off STH 46 & the development I see in the Hepola 40, is only 300 ft off STH 46. They shouldn't need a RFE /BFE based strictly on location. Have you compared the FEMA FP map with the best building location that you can arrive at? Do you come to the same conclusion that I have? If these are the facts, FEMA needs to be contacted to be informed that an RFE /BFE isn't required. From what I can see, the Elevation Certificate wasn't needed, but because it was submitted, FEMA wanted the BFE. Or am I missing some of the facts here, Like, they actually want to build something w/i the designated FP. If that is the case, then establishing a RFE will be required. There appears to be at least 4 possible options: 1. This is very near the Deer Park Waste Water facility. They may have done a H &H study to site the ponds. 2. This area looks familiar. Development in the NE of the SW of Sect 17 may have had a study done 10 -15 yrs ago. 3. Are the bridges on 210th Ave or 220th St relatively recent? By recent, I mean w/i the last 20 yrs the data may apply. 4. If nothing else is available & since it's a 40 acre parcel, the land owner is responsible for doing an H & H analysis. If an RFE is needed, I'll check my Archives next week & see if there was a study done like I seem to recall. Maybe you can check your property file on the development just upstream. My plat book has Gehrman listed. I'm not sure where to check for anything on the Deer Park WWTP. Will spend a little time on that if the Archive search turns up empty. Let me know if the "location" doesn't correct the problem & then we'll proceed to track down any data that may work. 7/9/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 3 of 3 Later GTL From: Jennifer Shillcox [mailto:jennifers @co.saint - croix.wi.us] Sent: Thursday, July 05, 2007 4:03 PM To: Lepak, Gary T - DNR Cc: Ellen Denzer; Kevin Grabau Subject: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Gary, We have a property owner, Janice Hepola, who owns a 40 -acre lot on Highway 46 adjacent to the Willow River, Parcel #17.31.16.256 located in the SW 1/4 of the SW 1/4 of Section 17, T31 N, R1 6W, Town of Cylon. Ms. Hepola has submitted an Elevation Certificate to FEMA, but the County Flood Hazard Boundary Map does not show a BFE /RFE along her property and FEMA will not process the request without this information. Ms. Hepola does not wish to do a cross - section or H & H model if at all possible. Do you have any floodplain data in your files in which a BFE /RFE may have been established in this area? Thanks in advance for your assistance, Jenny Shillcox Land Use Specialist St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, Wl 54016 Phone: 715- 386 -4682 Fax: 715- 386 -4686 lennifers " co.saint- croix.wi.us 7/9/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon age 1 of 3 r Jennifer Shillcox From: Lepak, Gary T - DNR [Gary.Lepak @Wisconsin.gov] Sent: Friday, July 06, 2007 12:11 PM To: Jennifer Shillcox Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon That's why one doesn't ASSUME or give answers till you get all the facts. Being that the FP is about 550 ft wide on the west side of the Willow, "How did the County issue a permit in a mapped FP7' Over all, things seem pretty flat in the overbank till you get close to the existing development. I did check for DOT bridge data. . Nothing on the two closest bridges,, or at least nothing usable for a FP determination since it appears they were rebuilt in 1970. Did find Bridge data on STH 46 over the Willow River from 2000. Although 3/4 mile downstream is a bit too far to make any reasonable projections. Might be able to use to get some generalizations about the FP, but setting a RFE could be a stretch. Maybe your file will turn something up? I'll still do an Archive search next week. Later GTL From: Jennifer Shillcox [mailto:jennifers @co.saint - croix.wi.us] Sent: Friday, July 06, 2007 11:08 AM To: Lepak, Gary T - DNR Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Gary, I am not sure what prompted her to submit the Elevation Certificate to FEMA ... it may have to do with flood insurance. I see on the completed certificate that she is requesting that the flood zone designation be removed from a residential structure built in 2005. The structure appears to be 381 feet from the OHWM. I left her a message to get more information, but I am assuming that she'll need an RFE. I'll let you know as soon as I hear anything from her. Thanks, Jenny - - - -- Original Message---- - From: Lepak, Gary T - DNR [ mailto: Gary. Lepak @Wisconsin.gov] Sent: Friday, July 06, 2007 9:48 AM To: Jennifer Shillcox Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon 7/6/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 2 of 3 y � Hi Jenny Glad you contacted me before this went any further. I pulled up the Floodplain Map for this area. The FP is at least 700 ft off STH 46 & the development I see in the Hepola 40, is only 300 ft off STH 46. They shouldn't need a RFE /BFE based strictly on location. Have you compared the FEMA FP map with the best building location that you can arrive at? Do you come to the same conclusion that I have? If these are the facts, FEMA needs to be contacted to be informed that an RFE /BFE isn't required. From what I can see, the Elevation Certificate wasn't needed, but because it was submitted, FEMA wanted the BFE. Or am I missing some of the facts here, Like, they actually want to build something w/i the designated FP. If that is the case, then establishing a RFE will be required. There appears to be at least 4 possible options: 1. This is very near the Deer Park Waste Water facility. They may have done a H &H study to site the ponds. 2. This area looks familiar. Development in the NE of the SW of Sect 17 may have had a study done 10 -15 yrs ago. 3. Are the bridges on 210th Ave or 220th St relatively recent? By recent, I mean w/i the last 20 yrs the data may apply. 4. If nothing else is available & since it's a 40 acre parcel, the land owner is responsible for doing an H & H analysis. If an RFE is needed, I'll check my Archives next week & see if there was a study done like I seem to recall. Maybe you can check your property file on the development just upstream. My plat book has Gehrman listed. I'm not sure where to check for anything on the Deer Park WWTP. Will spend a little time on that if the Archive search turns up empty. Let me know if the "location" doesn't correct the problem & then we'll proceed to track down any data that may work. Later GTL From: Jennifer Shillcox [mailto:jennifers @co.saint- croix.wi.us] Sent: Thursday, July 05, 2007 4:03 PM To: Lepak, Gary T - DNR Cc: Ellen Denzer; Kevin Grabau Subject: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Gary, We have a property owner, Janice Hepola, who owns a 40 -acre lot on Highway 46 adjacent to the Willow River, Parcel #17.31.16.256 located in the SW 1/4 of the SW 114 of Section 17, T31 N, R1 6W, Town of Cylon. Ms. Hepola has submitted an Elevation Certificate to FEMA, but the County Flood Hazard Boundary Map does not show a BFE /RFE along her property and FEMA will not process the request without this information. Ms. Hepola does not wish to do a cross - section or H & H 7/6/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 3 of 3 model if at all possible. Do you have any floodplain data in your files in which a BFE /RFE may have been established in this area? Thanks in advance for your assistance, Jenny Shillcox Land Use Specialist St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715- 386 -4682 Fax: 715- 386 -4686 je nnifers@co.saint- croix.wi.us 7/6/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 1 of 2 y �. Jennifer Shillcox From: Jennifer Shillcox Sent: Friday, July 06, 2007 11:08 AM To: ' Lepak, Gary T - DNR' Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Gary, I am not sure what prompted her to submit the Elevation Certificate to FEMA ... it may have to do with flood insurance. I see on the completed certificate that she is requesting that the flood zone designation be removed from a residential structure built in 2005. The structure appears to be 381 feet from the OHWM. I left her a message to get more information, but I am assuming that she'll need an RFE. I'll let you know as soon as I hear anything from her. Thanks, Jenny - - - -- Original Message---- - From: Lepak, Gary T - DNR [mailto: Gary. Lepak@Wisconsin.gov] Sent: Friday, July 06, 2007 9:48 AM To: Jennifer Shillcox Cc: Ellen Denzer; Kevin Grabau Subject: RE: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Jenny Glad you contacted me before this went any further. I pulled up the Floodplain Map for this area. The FP is at least 700 ft off STH 46 & the development I see in the Hepola 40, is only 300 ft off STH 46. They shouldn't need a RFE /BFE based strictly on location. Have you compared the FEMA FP map with the best building location that you can arrive at? Do you come to the same conclusion that I have? If these are the facts, FEMA needs to be contacted to be informed that an RFE /BFE isn't required. From what I can see, the Elevation Certificate wasn't needed, but because it was submitted, FEMA wanted the BFE. Or am I missing some of the facts here, Like, they actually want to build something w/i the designated FP. If that is the case, then establishing a RFE will be required. There appears to be at least 4 possible options: 1. This is very near the Deer Park Waste Water facility. They may have done a H &H study to site the ponds. 2. This area looks familiar. Development in the NE of the SW of Sect 17 may have had a study done 10 -15 yrs ago. 3. Are the bridges on 210th Ave or 220th St relatively recent? By recent, I mean w/i the last 20 yrs the data may apply. 4. If nothing else is available & since it's a 40 acre parcel, the land owner is responsible for doing an H & H analysis. If an RFE is needed, I'll check my Archives next week & see if there was a study done like I seem to recall. 7/6/2007 Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Page 2 of 2 Maybe you can check your property file on the development just upstream. My plat book has Gehrman listed. I'm not sure where to check for anything on the Deer Park WWTP. Will spend a little time on that if the Archive search turns up empty. Let me know if the "location" doesn't correct the problem & then we'll proceed to track down any data that may work. Later GTL From: Jennifer Shillcox [mailto:jennifers @co.saint- croix.wi.usJ Sent: Thursday, July 05, 2007 4:03 PM To: Lepak, Gary T - DNR Cc: Ellen Denzer; Kevin Grabau Subject: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Gary, We have a property owner, Janice Hepola, who owns a 40 -acre lot on Highway 46 adjacent to the Willow River, Parcel #17.31.16.256 located in the SW 1/4 of the SW 1/4 of Section 17, T31 N, R1 6W, Town of Cylon. Ms. Hepola has submitted an Elevation Certificate to FEMA, but the County Flood Hazard Boundary Map does not show a BFE /RFE along her property and FEMA will not process the request without this information. Ms. Hepola does not wish to do a cross - section or H & H model if at all possible. Do you have any floodplain data in your files in which a BFE /RFE may have been established in this area? Thanks in advance for your assistance, Jenny Shillcox Land Use Specialist St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715- 386 -4682 Fax: 715- 386 -4686 jennifers @ co.saint- croix.wi.us 7/6/2007 Jennifer Shillcox From: Jennifer Shillcox Sent: Thursday, July 05, 2007 4:03 PM To: Gary LePak (E -mail) Cc: Ellen Denzer; Kevin Grabau Subject: Request for Technical Assistance to Establish the RFE - Hepola Property, Town of Cylon Hi Gary, We have a property owner, Janice Hepola, who owns a 40 -acre lot on Highway 46 adjacent to the Willow River, Parcel # 17.31.16.256 located in the SW 114 of the SW 1/4 of Section 17, T31 N, R1 6W, Town of Cylon. Ms. Hepola has submitted an Elevation Certificate to FEMA, but the County Flood Hazard Boundary Map does not show a BFE /RFE along her property and FEMA will not process the request without this information. Ms. Hepola does not wish to do a cross - section or H & H model if at all possible. Do you have any floodplain data in your files in which a BFE /RFE may have been established in this area? Thanks in advance for your assistance, Jenny Shillcox Land Use Specialist St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715- 386 -4682 Fax: 715- 386 -4686 jennifers(a.co.saint- croix.wi.us i ArcIMS Viewer Page 1 of 1 1 4 .o 1 http: //72.21. 230. 178/ website/LRPortal/ARCIMS/MapFrame .asp ?PIN= 7/2/2007 St. Croix County Final Property Report Page I of I - St. Croix County 2007 Property Report Print Retort Generated: 7/2/2007 10:38:21 AM Data Updated: 7/2/2007 1:00:00 AM PARCEL COMPUTER NUMBER: 006 - 1037 -40 -000 PARCEL MAP NUMBER: 17.31.16.256 NOTICE: All payments received by County Treasurer will be posted the next day. 2002 2003 2004 2005 2006 2007 <-- Click on the year to select the annual record. (* & dark red = elin uent Property Description Billing Information Municipality: 006 - TOWN OF CYLON Name / Attn.: JANICE M HEPOLA Document Number: 585702 Address: 2102 210TH AVE l 9 Volume & Page: V1351, P92 s j Public Land Survey: SECTION 17 T31N R16W City, State, Zip: DEER PARK, WI 54007 Quarter: Country: USA QQ / Tract: Ownership Plat: NOT AVAILABLE Primary Owner: JANICE M HEPOLA Description: SEC 17 T31N R16W 40A SW SW Secondary Owner: POPELKA MARY A Total Acres: 40.00 ACRES Site Address: 2101 HWY 46 S Assessed Value Other Valuation Date 7/26/2005 Fair Market Value: 0 Assessment Type Acres Land Improved Total Assessment Ratio: 0.0000 Value Value Value Net Assess. Val. Rate: 0 G1 - RESIDENTIAL 4.00 30,000 77,000 107,000 School District: 0119 -AMERY G5 - UNDEVELOPED 22.00 27,500 0 27,500 G6 - PRODUCTIVE 14.00 33,600 0 33,600 l FORST LANDS Totals - -> 40.00 91,100 77,000 168,100 Tax Installment Dates Tax Detail Please pay Ist instailment to your municipal treasurer, 2nd Category Tax Paid Balance installment to the County, Amounts Due I . Period Pay To: Date Due Amount Real Estate Tax Due 0.00 1 MunL 0.00 Lottery Credit O 0.00 2 County 0.00 Net Property Tax 0.00 0.00 0.00 j Total Taxes - -> .0.00 Special Assessments 0.00 0.00 0.00 Tax Payment History Special Charges 0.00 0.00 0.00 Date Paid Receipt Number Amount Delinquent Charges 0.00 0.00 0.00 NONE Private Forest Crop 0.00 0.00 0.00 Specials Woodland Tax Law 0.00 0.00 0.00 Managed Forest Lands 0.00 0.00 0.00 Category Amount Penalties 0.00 0.00 NONE Interest 0.00 0.00 Totals - -> 0.00 0.00 0.00 i I http: //72.21. 230.178/ Website/ LRPortal /total__pi-ocess.asp ?IDValue= 006 - 1037 -40 -000 &new... 7/2/2007 4 ', Off"' \F� ° Federal Emergency Management Agency Washington, D.C. 20472 L gND S8G May 31, 2007 Ms. Janice Hepola IN REPLY REFER TO: 2102 21 Oth Avenue CASE NO: 07- 05 -4128A Deer Park, WI 54007 COMMUNITY: ST. CROIX COUNTY, WISCONSIN 7 I S -a to 9 ^ 5 (UNINCORPORATED AREAS) & COMMUNITY NO: 555578 216 -AD RE: 2102 210TH AVENUE -- PORTION OF SECTION 17, T3 IN, R 16 (WI) Dear Ms. Hepola: This is in response to your request for a Letter of Map Amendment for the property referenced above. The Federal Emergency Management Agency (FEMA) uses detailed application /certification forms for revision requests or amendments to the National Flood Insurance Program (NFIP) maps. The forms provide step -by -step instructions for requestors to follow, and are comprehensive, ensuring that the requestors' submissions are complete and more logically structured. Therefore, we can complete our review more quickly and at lower cost to the NFIR While completing the forms may seem burdensome, the advantages to requestors outweigh any inconvenience. The following forms or supporting data, which were omitted from your previous submittal, must be provided: - Please provide a copy of a general location map, such as a tax assessor's map, which shows the structure in question within parcel boundaries with respect to identifiable landmarks featured on the Flood Insurance Rate Map (FIRM). Such landmarks may be major road intersections; section, township, and range lines, bodies of water; or other significant points of reference. This map must include a scale and must accurately display the strucutre in question. IV - - --�_ -� � S - �7�f g - I � i � 102 - S7 The property for which you have applied for a Letter of M cated in an approximate Special Flood Hazard Area Zone A The Base Flood Elevation (BFE) as not been established by FEMA for the flooding source affecting the property. Additional information regarding BFEs is available in the FEMA publication "Managing Floodplain Development in Approximate Zone A Areas" and can be obtained by calling 1- 800 - 480 -2520. Please provide us with a BFE for the property referenced above on community letterhead with a signature from your Community Official in charge of Floodplain Management. Additional acceptable sources for obtaining a BFE for the property may be the local district of the U.S. Army Corps of Engineers, State /Commonwealth agencies (i.e. Department of Natural Resources, Department of Environmental Quality, Department of Transportation, etc.), or the local community's Engineering, Planning, or Building Department. Another option that may be used to determine a BFE includes submitting a detailed cross - section of your property and flooding source at the upstream edge of your property or structure. The cross- section must be completed by a licensed land surveyor or a registered professional engineer. A third option for obtaining a BFE includes having a registered professional engineer prepare a hydrologic and hydraulic model (e.g., HEC -RAS, HEC -2, Quick -2, or HEC-HMS) showing base flood conditions. This model would be subject to our review. Please note that if all of the required items are not submitted within 90 days of the date of this letter, any subsequent request will be treated as an original submittal and will be subject to all submittal procedures. When you write to us concerning your request, please include the case number referenced above in your letter. All required items and questions concerning your request are to be directed to LOMA Manager, FEMA LOMA Depot, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA 22304 -6439. If you have any questions concerning FEMA policy, or the NFIP in general, please contact the FEMA Map Assistance Center toll free at (877) 336 -2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 600, Alexandria, VA 22304 -6439. Sincerely, William R. Blanton Jr., CFM, Chief Engineering Management Section Mitigation Division em I-c.ct S ( (S 107 EAF3PiLUJCAT PARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY O .;KS NO. 1660-037 ISTRUCTURE O N FORM FOR SINGLE RESIDENTIAL LOT OR STRU AMENDMENTS TO Jane 30,207 NATIONAL FLOOD INSURANCE PROGRAM MAPS PAPERWORK REDUCTION ACT Public reporting burden for this form Is estimated to average 24 hours per response. The burden estimate irtckides the time for reviewing Instructions. search[ng exisflt[g dab sources, gathering and maintaining *a needed data, and completing, reviewing, and sing the form. You are not required to respond to this collection of information unless a vatl! ONE control number is dspWpd It the upper right corner of this form- Send comments regarding the accuracy of the burden estimate and any suggestions for reducing Ohio burden to: Ihfwmation Collections Management U.S. Department of homeland Security, Federal Emergency Management Agahcy, Epp C Street, S.W., Washington DC 28472, Paperwork Reduction Project (18604037). Submission of this form is required to obtain or retain benefNs under the National Flood Ins ProunurL This f orm sho uld be used to request that the Federal Emergency Management Agency (FEMAj rernave a single structure or legally recorded parcel of land or portions Vwmp& described by metes and bounds, certified by a registered proftesional sneer or from a designated ted Special Flood Hazard Area (SFHA), an area that w m of f be land surveyor. by having a 1 �6- dharrca oHhy equaled or exceeded in any given year Nose toodl, via Letter of limp Amendment (Li WM- It shall not be used for requests submitted by developers, for requests Involving multiple structures or lots, for property in alluvial fan areas or coastal high hazard areas (Y zones), or requests involving the placement of fill. PfaM Use XT-1 forms for such requestsj. Fill is delimad as material placed to raise the grade to or above the Base Flood Elevation (BFE). The aormmhwn construction practice of removing unsuitable existing n ftlat (topsoil) and bacldilling with select st udun t material is not considered the placement of No f the,prhtctice does net alter the existing (natural grade) elevator, which Is at or above the BFE. Also, fill that to placed before the date of the trst'Nationat Flood hmamea Program (NFIP) map showing the area in an SFHA ,la considered natural wade LOIIA: A letter from DHS - FEMA stating that an existing shuctum or parcel of land that has trot Oeerh elevated by fill would not be Inundated by the base flood. A — This section may be conhpleled by the property owner or by the property owner's agent 1. Has fill been placed on your property? No ❑ Yes — N Yes, STOPH — You must complete the MT-i application forms; visit htta-lhv rrw .fema_aovls)lantoreventifhmldi mt- I.shtm a cap the FEMA Map Assistance Center tolt free: (877 -FEMA MAP) (M-336-2627) 2- Legal description of Properly (Lot,. Block, Subdivision) and street address of the Property (if different frorn malting address): 3. Ara you requesting that the flood zone designation be removed from (check one): ❑ Your wOm legally recorded pro~ ❑ A Portion of your legally recorded property? (a metes and bounds description and map eel the area to be removed, cettMed by a registered professional engineer or liCartsed land surveyor are required) A structure onymn property? What i the date of (ruction C7 � All documents submitted In shrpport of this mivast are correct to the best of my knowledge. t urderstand that arty false statement Wray be punishable by tine of Imprisonmerrt under Titre 18 of the United States Code, Section 1001. Apptiarft ('tame , Company: j Melling Address: i�dL a V Daytime Telephone No.: E -mail address: Fax No.: Y SignaEure of Applicant (re"kaM Dale c� 3-30-07 ErulAf Secfkorn A , OHS - FEMA Form 81-82, DEC 05 MT-EZ Form Page 1 of 3 3 B – This section must be completed by a registered professional engineer or lkensed land surveyor. NOTE= if an NFIP Elevation Certificate has already been completed for this property, it may be submitted in addition to this form: APjIIRe" Rafuf The regulations pertaining to LOMAs are presented in the National Food Insurance Program (NFIP) regulations under Tale 41, Chapter 1, Parts 70 and 72, Code of Federal Regulations. The purpose of Part 70 is to provide an motive procedure whereby DHS - FEMA will review information submitted by an owner or lessee of property who believes that his or her property has beery madvertentiy included in a designated SRiA_ The necessity of Part 70 is clue in pmt to the tecfrrical difficulty of accurately delineating the SFHA boundary on an NFIP map. Part 70 procedures shall not apply if the topography has been altered since the effective date of the first NFIP map [e -g -, a Rood Insurance Rate Map (FIRM) or Food Hazard Boundary Map (FHBM)j showing the property to be within the SFHA. Basle of Determination DHS - FEMA 7s deternimation as to whether a structure or legally recorded parcel of lark!, or portions thereof, described by metes and boards, may be removed from the SFHA will be based upon a comparison of the Base ^annual- chance) Flood Elevation (BFE) with certain elevation information. For Zone A, with no BFE determined, refer to Afroging Fbodpkw Development in Approximate Zone A Arees, A Grade for Obtaining and Developing Base (100 -Year) Flood Ekwahom The elevation inomrafion required is dependent on whether a structure, or a lejaliy recorded parcel of land, is to be removed from the SFHA. Item to be Removed from the SFHA: check one Elevation Information Required: (complete Item jd Structure located on natural grade (LOMA) Lowest A4acerd Grade to the structure (the elevation of the lowest ground touching the structure including attached decks or garage) ❑ Undeveloped legally recorded parcel of land ( LOAM) Elevation of tte lowest grand on the parcel or within the portion of land to be removed from tte SFHA (skip to item 2) ; t; •• r- 1- What is the type of construction (check one) 13 crawl space ❑ slab on grade 1] other (explain) 2. BUILDING INFORMATION Building Street Address (including ApL Unit, Suite, ardlor Bldg- No -): Property Description (Lot and Block Number, Tax Parcel Nanber, Legal Description, etc -): 0 0 (v -- 1 0 - 4L -- 0 CU 1 % en_ � % 3; J J lZ la : - 7;, , ✓ 3. GEOGRAPH C COORDINATE DATA - Please provide the Latitude and Longitude of the most upstream edge of the structure (n decimal degrees) 1nacaW NADW p NAD27 �;rs_fL <r,3 Let Z .� ang Please provide the Latitude and Longitude of the most upstream edge of the property (m dedmal degrees) kidicale Datw¢ IX Wmes Q NAD274_ 10rJ`1, LaL-j L, ZZ „ ft$ Log. 4. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION NRP Community Number S Panel Nu rrdw Base Food Beireton (BFE): Source of BFE: 78.13 , + - © 8. ELEVATION I PORMATNXt (&URVEY RE WRED)j Ef PrTN0 C��.T_ • Lowest Adjaeft Graft (LAO) to the structure j D Sly 7 0 ( • Elevation of the lowest grade on the properly; or, metes and botinds area 6c3 2;7 (0 (m) C g • lndKote the data (an n d dathurn conversion d dillerent from NGVD 29 or NAND 88) NGm 29 X ny NlV® Co MescmeF a Ha FM WOW fib tin a sum to MW wMMna of uW 13Y@4 J& No e 1# Y@§, W hm is alts do Of ft Olf om 9 This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or arduTect authorized by low to Cerny elevetion edcxrrralio n. Al l documents suubm>iifed an support of this request are correct to the hest of my k nowWo - 1 understand that any false statement may be punishable by fee or irtrhent under Title 18 of the United States Code, Section 1001- CerCufer's Name: License No,: Expiration Date- Company Name: Telephone No.: Fax No.: Seal (tea) D &A a� �-`- T- 74`+ - 1 -718 J_5 -79 -171 y z - C (See atdeched address fisting for LOMAQ DNS - FEMA Form 8142, DEC 06 MT-EZ Form Page 2 of 3 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008 Federal Emergency Management Agency Exoires February 28. 2009 National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Janice Hepola Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No_) or P_O. Route and Box No. Company NAIC Number 2102 21& Avenue City Deer Parts State WI ZIP Code 54007 A3. Property Description (Lot and Block Numbers. Tax Parcel Number, Legal Description, etc.) 006- 1037 -40-000 Sw114- SW1 14, Section 17, T31N, R16W, Town of Cylon, St Croix County, Wisconsin AC Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) residential A5. Latitude/Longitude: Let 45 10 03.13 Long. 9222 57? Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Budding Diagram Number Z A8. For a building with a dawn space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl spade or enclosure(s) OR sq ft a) Square footage of attached garage sq it b) No. of permanent flood openings in the crawl spade or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade (I wags within 1.0 god above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total not area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name &Community Number B2. County Name B3. State SL Croix Co., WI 5555788 St Croix WI -.- - -- - B4. Map/Panel Number B5. Suffix FIRM Index B7. FIRM Panel B8. Flood B9: Base Flood Elevagon(s) (Zone Date Effectiva Revised Data Zone(s) AO, use base flood depth) H & 1.04 April 27, 1973 March 26,1976 A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined D Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the building located in a Coastal Barrier Resounm System (CBRS) area or Otherwise Protected Area (OPA)t 0Yes 040 Designation Date ❑ CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REWRED) Cl. Building elevations are used am ❑ Construction Drawings' ❑ Building Under Constriction* ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations- Zones Al -A30, AE, AH, A (with BFEL VF_ V1 X30, V (witty BFE). AR, ARIA, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete harns C2.a -g below according to the budding diagram specified in Item AT Benchmark Utilized Vertical Datum Con Check the measurement used. a) Top of bottom floor (indudkng basemen, crawl space, or enclosure floor) 1482,15 IN feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 01 61 . +/- ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones orgy) ❑ feet ❑ meters (Puerto Rico only) d ) Attached garage (top of slab) O feet ❑ meters (Puerto Rico only) e) Lowest elevation of mad*ory or equipment servicing the budding ❑ feet ❑ureters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) 1051.M ® feet ❑ meters (Puerto Rico only) g ) Highest adjacent (finished) Made (HAG) im 30 ® feet ❑ meters (Puerto Rico orgy) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer or architect authorized by law to certify elevation Information. I certify that the infomrafior► on this Cer6ficate represents my best efforts to interpret the data available. ri . I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. \� 4`'• a� �gCONS j , 4., • �. •! '% ® Check here f comments are provided on back of form. r Z 37 rNIW(N C. Certifier's Name Edwin C. Flamm License Number S-2487 4$7 Title President Company Name NorthLand Surveying AMERY .: WIS Address P.O. Box 14 City Roberts StateWl ZIP Code 54023 'y d •...� s aS�' r Signature � - C� Date � /Z 0 , 7 Telephone 715.749 -1718 FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number '+ 2102 21d Avenue City Deer Park State WI ZIP Code 54007 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Building is approximaty 380 feet west of the river. Approximate ordinary high water mark location of the river directly west of the building is at an elevation of 10327 feet Budding has one door at the walk out level on the south side of the house. Signature ate ® Check two if atladenen s SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zomes AO and A (without BFE), complete items E1-E5. Kthe Certiwate Is inlernded to support a LOMA or LOMB F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement t used. In Puerto Rico only, entermifts. E1. Provide elevation information for the following and check the appropriate boxes to stow whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor 0XILIdmg basement, crawl space, or enclosure) is 7-M ® feet ❑ meters ❑ above or ® below the HAG. b) Top of bottom floor fig basement, crawl space, or enclosure) is , % ® feet ❑ meters ® above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the rKod higher floor (elevation C2. b in the diagrams) of the building is X ± / ® feet ❑ met ® above or ❑ below the HAG. E3. Attached garage (top of slam) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: if no flood depth nwnber is available, is the top of the bottom floor elevated is accordance with the commun s inance? ❑ Yes ❑ No ❑ Unknown. The local official must dY floodplarn management ord certify ills infornratlon in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S CERTIFICATION The property owner or owner's authorized represerdatnre who completes Sections A. B. and E for Zone A (without a FEMA or community-Issued BFE) or Z one AO must sign hoe. The statements in Sections A, A and E are correct to the best of my knowledge. Property Owners or Owners Authorized Representative s Name Janice Hepola Address 2102 210'" Avenue City Door Pads State WI ZIP Code 54007 Signaturo rte- Date t*Z—C Telephone 715-2699.6149 Cormnents ❑ ChecLb= if anaMm SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's Moodplaih marragernsht ordinance can complete Sections A. B. C (or E), and G of this Elavation Cerffinete. Complete the appliceble tlem(s) and sign below. Check the meash wwrt used in items G8. and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a ticentsed surveyor, engineer, or arc hike t who Is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E fora bulling located in Zane A (without a FEMA- issued or communky4ssued BFE) or Zone AO. G3. ❑ The fallowing idormation (items G4. -39.) is provided for community fbodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compfiartce/Oocupancy Issued G7. This permit ties been issued for: ❑ New Construction ❑ Substantial Improvernetd G8. Elevation of as-built lowest floor (including basement) of the buldrrg: J] feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature — -- Date Comments ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions ATTACHMENT " A " EL= 1059.30 EL= 1056.33 : --BLDG CDR CLEAN OUT EL= 1054,28 BLDG COR •. CLEAN OUT EL= 1054,26 APPROXIMATE ORDINARY 1 ST FLOOR -{+ � • • •SEPTIC VENTEL= 1053.91 HIGH WATER MARK• ., . BLDG C❑R •.•..• EL 1052.15 •-SEPTIC VENT EL= 1054,23 EL= 1054.28 ----------------------- - - - - -- 381' ±---- ----------- ► ® ❑HWM ` ~BLDG CDR EL= 1052,82 EL= 1032.67 GROUND "BLDG CDR EL= 1052.02 W EL= 1051.20 WELL•• • • SEPTIC VENT EL= 1050.52 EL= 1054.33 x '• •••�•� • •SEPTIC VENT EL= 1050,60 GROUND-.' EL= 1051,33 SCALE 1 " = 60' St. Croix County Planning and Zoning Wednesday, A'onember 07, 20017 at 10:09:43 AM Detail Sanitary Information Page 1 of 1 Computer #: 006 - 1037 -40 -000 Sub /Plat: 40 acres Section: 17 Parcel #: 17.31.16.256 Lot: TN /RNG: T31N R16W Municipality: Cylon, Town of CSM: 1/4 1/4: SW 1/4 SW 1/4 Owner: Popelka, Mary 2101 Highway 46 Deer Park, WI 54007 State Permit: 479258 Issued: 06/17/2005 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 08/16/2005 POWTS Detail: Infiltrator - Quick4 Std. 19.1 sq. Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Buil Plumber Other Requirements Additional Notes Money Owed Ryan Yarrington >4/1/00 - Not Required Gille, Dennis decided to move existing house to new location on $0.00 Ryan Yarrington Yes property - north of horse pasture. Installed new 1000 gal. septic tank to 2 cells, 17 chambers each. Maintenance Scheduled Pump Date.Punped 8/16/2008 Owner: Rushton, Francis 2101 Highway 46 Deer Park, WI 54007 State Permit: 315934 Issued: 07/22/1998 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 07/23/1998 POWTS Detail: Infiltrator - High Capacity 16" Bedrooms: 2 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Rod Eslinger Yes Utgard, Brady Filed with 2005 permit - abandoned800 gal. tank $0.00 Rod Eslinger J, Yes and 2 trenches to move house on property. Abandoned an existing the to unknown discharge Maintenance N; Wication Scheduled Pump Date Pum Notification 7/22/2001 7/27/2002 04/20/2006 7/27/2005 04/20/2006 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479258 0 GENERAL I NFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Po elks, Mary C Ion, Town of 006 - 1037 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: /y� Section/Town /Range /Map No: /b Z , ta 13 1 � 1 z, �..J 17.31.16.256 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � �2 Benchmark Z • C rO y � �d� � Alt. B F,` 11. Aeration Bldg. Sewer // Cq \ I Cf Holding St/Ht Inlet 7.1 c l'T •b9 TANK SETBACK INFORMATION St/Ht Outlet 7.33 c l 7. S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt inlet Septic -7 / ®�/ r O2— i �/ ! r— Dt Bottom Dosing Header /Man. 7, 5 0 1 Aeration Dist. Pipe 7 Q 7 ' Holding Bot. System I aAj Final Grade jj�� A% 9 -7 PUMP /SIPHON INFORMATION T. z Manufacturer Demand St Cover,\\ JW Z3 GPM 1 1{�. J Model umber i I $95 `60 Z TDH Lift Friction Loss System Hea TDH Ft 9,-7 , 75 1 7 Forcemain Length Dist. to Well JJ �, T d SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - 1 (� SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturers � INFORMATION CHAMBER OR d f Type Of System: /M .5 _+ J r UNIT Model Number: 1,f..v� 1 1 a � 7 J � < 4 DISTRIBUTION SYSTEM 'r( j— 1 - 7 3 T d2-•� Header /Manifold IDistribution Hole Size x Hole acing V to Ai ntar 7 / / pipe(s) � \ y� Length Dia �f Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth f eded /S dded xx Mulched Bed/Trench Center /1 �"T Bed/Trench Edges \ Topsoil xx Se Yes ` j No Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2101 Highway 46 Deer Park, WI 54007 (SW 1/4 SW 1/4 117 I T31N R16W) 40 acres Lot Parcel No: 17.31.16.256 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = Plan revision Required? 1 Yes 0 ' i I Use other side for additional informs ion. _ _— — —I - — Date Insepctor's Signatu Cert. No. SBD -6710 (R.3/97) %ely and Buildings Division County r W W ington . Box 7082 S , scons jn o ) I 3707 {� �� �� etmit Number (to be filled in by Co.) Department of Commerce 154 9 ZS' Sanitary Permit Applica State an I.D. Num In accord with Comm 83.21, Wis. Adm. Code, personal informatio ybu provide 1 5 20 may be used for secondary purposes Privacy Law, s 15.04( )(m) ST CROIX COON Projec Address (if different than mailing address) I. Application Information — Please Print All Information ProDerty Owner's Name Parcel # Lot # Block # 06 -/031- V o - oe a Z`JCO Property O s Mailin ddress Property Location City, State / Zip Code Phone Number J w V`, S W �`, Section -er taleA 1 7/.5- ��9•S�S�9 / (circle ) T I N; I �10 E o II. Type of Building (check all that apply) 6k Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use dS�� a,-\_ ❑ State Owned -Describe Use Z "J - Ge.LI W 4-) ❑City ❑Village T ownship of _ C /a n III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ys sk Replacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System R. ❑ Permit Renewal ❑ Permit Revision Change of El Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl t&Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ RQcircul4ting, c 7 Sand Filltt'er�' -_ Yn Recirculating Synthetic Media Filter chin Chamber ❑ Drip Line El Gravel-less Pipe 11 7 Other (explain) 3 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (so Dispersal Area Proposed (sf) i System Elevation / "/sV .7 (05/3 1c y7 L.3 7 ✓/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Z. L. Tanks Tanks Sept or Holding Tank /0 Aerobic Treatment Unit W Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for insta of the POWTS shown on the attached plans. Plumber's Name (Print) Pl Signatu MP P umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) SZ / y o V ST A In GL Syov VI!LCounty /De artment Use Onl Approved isapprov Sanitary Permit Fee (includes Groundwater Date Issu Z777Si Surcharge Fee) 3 QQ f!7 6 ❑ Owner rven Reaso ial IX. Conditions of Approval/Reasons for Disapproval n I L C/ SYSTEM OWNER: 3) O LL &O \S S�s mot.,.- 1. ` Septic tank, effluent filter and C-V a.n �d A_ed0 G GC O (�t�Lt �� �� CA V_ dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as Der i licablP code /ordinances. Attach complete plans (to the County only) for the system on paper less than 8112 x 11 inches In size SBD -6398 (R. 08/02) l �Q,� 57 Ole 1 6� /�� ��i1 Zz ' 4 9 E w w o J w 3y 957'7 I it , /o ac.. g OWPLIt ,�geo �2 /off, X09 L� Z2 CO PY s A O Eta cv �7'T3 ,J �tR /� w 3 � 4/t 96.3 9s7 i 01 yo l��f B L� gou l7' L� Z ®g "� C� • y 0 i 3 4b A oA0p paD • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I 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 in include, but not limited to: vertical and horizontal reference pc nt (B I arcel I.D. —f percent slope, scale or dimensions, north arrow, and location and distance o nearest road. !� (o • 17 r �f'� bQD Please print all information JUN 005 Q 1 e ' we Date Personal information you provide may be used for secondary purpose (Privacy Law, s. 15.04 ( • /� Property Owner ST. C "LlIa 'on MO.'r o e lkc-. S I T 3 1 N R E(o W Property Own is Mailing Address Lot # I Block # I Subd. Name or CSM# a 14 V I Y� - S. Ci State Zip Code Phone Number E3 City ❑ Village % Town Nearest Road 6eev- D IJ O 14 JG. ❑ New Construction Use: PEr Residential / Number of bedrooms Code derived design flow rate. S GPD ®' Replacement ❑ Public or comm al - S Describe: Parent material ___0_ L _�.2 G4 o P o ` ain elevation if applicable 1. General comments � 5u 55�s1' a - - t re " G1 -,� C -) Fo +k; s (e Q t�.c�. M�"' and recommendations: . T � � 94.36 . Boring # n Boring i J 61 pit Ground surface elev. �a • b ft. Depth to limiting factor 10 _ in. Soil licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 o -1 l o O a s 4 - aFS b K rnFr Qw (� . 1, l, awlgyiZ Mfr- ► l� I,D 5 -;q 7- 5 yRy/ t-5 -: �^^ L w ,t 1. Co Fs,4 k mf r c., w - 1 t Pr ® Boring # Boring /p� r I Pit Ground surface elev. _ ' 1 D ft. Depth to limiting factor ;L in. Soil Application 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 K 1,0 Sc.L njtbP4 rv+ �_LV ) y (p 3 - 7.S yl,2Y /y 6 L d Fhb V- `I -1 7. Y Y y a Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) l � Signature CST Number 7 Address LJ Date Evaluation Conducted Telephone Number � 74P '0 -� ` 18- 3 3 - os IS -aS8 �Q-ry Property OwnerN pe.Lk C Parcel ID # _ Page C� _ of 3 Boring # Boring r a [ Pit . Ground surface elev. 1 D 01 D ( ft. Depth to limiting factor � A Q in. —'— Soil Application 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 0 - $ OID 3 2 -- ------ 5 L �5� k rh Q�,d Q • 10 I • b • S Iil`y 3 —V -`fi -1 .Sy/2` S L- 11 FS5 hifi- w JF , 4 . y -i� 7 SYQ� S t�.s '�" 5 5 c -s Boring # ❑ Boring , F ® Pit Ground surface elev. D a • C 7 ft. Depth to limiting factor �� in. Soil Application 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 I `Eff#2 d-(a (m i -31 - S L a F tt bfr- Qw a F 1. -I •SyR`i 1_ a?>nsLJu r�i _r' w F a�7SIP -" s tM t�T, W J . A tvs L 07 �. 7 s Boring # ❑ Boring El Pit Ground surface elev. _ ft. Depth to limiting factor in. =Soil Application 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 mg /L ' Effluent #2 = BOD, < 30 mg /L 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. SBD -8330 (R.6/00) Ce o is °" '`�•. icy, h W t I k� r6 s zm 1 ---li rte' S tj Nc- ..� V _ X t-+ 4 �► � �n IQ- i 1 Cross Section of a Two Cell Inground Component ! Using Leaching Chambers 3 £ i t i , 1 i ' Fintshed Gjracie = 1 D2. Finished Grade I al Grady = �'' ; may }��,, �..�' ; ;v; Grade - -F-��- -- x > >'f i > >> f f f Too of Chamber =17 � , y, � � �, Tod cif Chamber = ? LL f System Elev. � .��..: a � � Treatp ersai LL�11Q+ " # �.. V `{ d p }. +. {4 + 6 . _ - • .+ t Lim. A aV 41 3 t a v . I 2 i Observa - done Vent pipes to be coustueted and capped with approved. matexiats � ©r tie particular use. •� s i { • 1 i f 7 __ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A &A4 Mailing Address 2 r wl o Property Addres (Verification required from Planning Department for new construction) City/State Parcel Identification Number 40ln - /a 3 7- S/4 LEGAL DESCRIPTION Property Location S�V 1 /4, Sec. , T 3 N -RAW, Town of �o Subdivision Lot # Certified Survey Map # . Volume , Page # Warranty Deed 0 !5@p - M2— . Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE 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 a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the thr year piration date. QQ�� / /W SI NA APPLI ANT D� OWNER CERTIFICATION I (we) 'fy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of A thep per ty d c 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. FA DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ��!+t�k�� �'�: �i1C#f {':f� i�F �Cf:1:vi:•Ps: �'C }�f`,'1 '� �tIB�. • , ` .. it M.TX » ,. AM cv v tHS 'V's;a.4)C ,�fef7lSti#S Ftt . + Ywial .n�1�P,i�e� .A#�i • F ";: X " •�r , , :. ` .. v: a .- a. .— .:._...w:e.:...•�...- .. -a.,_. v..<: a>.. n. w.+. a...+..:.. an rona .:...:...: �,�..v....:...+.,.. .:�m:n� -.. .+, r, «.,.... OU • ... 7 '�ti$ ,vti{'.fA.aC'. .t•S!' » e.�R' _�. .....n,..:........>.. . m.,_<t a._...,-..«-.>,- �- 4�rw_.. y_..., n�Y•. C•:.::... a:.-,.,:,•+,,, rn :....w•m•.,..x..�.��- ni•,�,»._ _ • .- � .. _ ... .. ..... .. . �..ry + '� _ ... _ .. - .,...,, � ........:..:: ro....._ uv- n.,,•........ ca_.a..�.a.� ^..�.....n.:...^: -� -:ate: a...,.. �. ... ... . � a}t#� �fix3§e���4 i'�{�c#'.f}S3'•`c'� real fz � - . ,'n.> [J!• itltezti�'1- Ali`�at2!}eg.. i ut+ '"7..'43 y: .L`'� .�.'� 1 '+ a. - 0. 0: .r .. fi3'�F... :,�� 'Ti1E�E�3 a.,w. .... .. �, .. .:' w , W. AUTO WAT!ON aui3acriticaxzz3 t.1�t ,� ' ..' .;. c.rivt 1tYi i:3zia _......._..........ntz f1ikR1 -z[ '�Y 0 .. �� 'Fl:iditr. r f h{ �3s°A3'3a SAR OF VVIS :k�S1SA �_._.._.._,_..._,. »..,:,..., .. ._.._.,. N _- ..... ,..._.,..._.__ ..... g �• rart:#a%ititia3 by §:(1fo.Cits, t�-I %<_., Scut: to tt�e k.tneatr sa Lk, Fir.' ChC prt r" ....:......:... who i -xe :fxtr::.i the k�tt} .fSek 3 375zi i*r:krtarw- titw, the atsikc. ,•." "4's t;a #@ti•ii•'�FCLMd: :'ha"z VVM? CsR.AIA [:'I' . . . ....................... ................ . . . . ..... ...........- . . _ . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . -- ......._...._....,......_... _....__. ....... .... .............._..._..... A Viii ...... ..:....... ._.._......:........, app ! _.... ....._....._........_...- ...... ._............._..............., .,...__................... -._.. La, t S - __.... . •:.�.� •... i > a.xl" i1"i: #= :1!:541`. `^a'pl"'tF. #��i: ?[.S�Y. il.Rti k ^'•C e44 }'� :: iYS4k11ik{6.iP:1Y"; -... #:!c'.t'ttii:t:: ;itklt�_ l�� , i• - c.?i 35 - d3�:` �'.li.• N:lEt.ia.'F.1 #k'C': xl$.l i� i :.'• ._. +r :ai.c ::a3 , t •� :;.E:c .. "d1::. ;.. �..y lAii:'. it.fp` tl F W`i:?G.A0!4::it'w :'r.•caa',.ac� i.a�?; f?ia:'n :'2: .:s.: 0527/2005 16:08 7152483588 SUPERIOR AUTOMOTIVE PAGE 01 M tsln Department of Commerce SOIL EVALUATION REPORT Page „j_ of Dhrislon of Safety and Buildings in accordance with Comm 85, Wks. Adm. Code count ,T. C Ro ►Y. Attach oompiste site plan on paper not less than B 112 x 11 Inches in size. Plan must Inc ude, but not limited to: vertical and horizontal reference point (SM), direction and Parcel I.D. go -DOD percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ( (� / Please print aril Information. Reviewed by Date Personal Information you provide may De used for secondary purposes (Privacy Lew, a. 15.04 ( (o+)) Property Owner Property Location P op le 1 Govt. Lot 50 114!SW114 S rl T 31 N R E (o Property Own f s Mailing Address Lot # [ ti4c* - !r Subd. Name or CSM# ;� I4 Ckl State Zkp oda Phone Number ❑ City ❑ Village R Town Nearest Rea;•t n Oe e ,r k, r 51007 I ( 9 -5► rJ ❑ Nefw Construction Use: ®' Reskdantlal 1 Number of bedrooms 3 Code derived design flow rate _ $ GPD Replacement ❑ Public or commercial - Describe; — Parent material _ Q ! �„? -�, ...., Flood Plain eievation if applicable General comments r 51 . rG.+al -r�s �.� Igo r +h:s re kz 4- and recommendations; J:�. Z • Y a t 95.73') Boring 1 Boring # Ground surface elev. l off . b 1 it. Depth to limiting factor ao _ in. E� i Pit $oil A lication Rate H Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf In. Munsell Qu, $z Cont. Color Gr. Sz. Sh. 'Eff# - Effil#2 A FS K ro Fr- Qw rl -� '7, 51AY/ a yyy it Mf r Boring # E Boring I t� � r , Pit Ground surface elev. _ ' Q ft. Depth to l imiting factor i _ n. Soil Application Rate Horizon i Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP()M t in, Munsetl Qu, Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 r b - -1 5 L � �, F, w a F - - 4, ! . . -t N 7.5 Y Y t_. aF W Yv► F I a ,; 7. `1e2y e- 5a u f e- K 1 J F Ix Yoe CS Effluent #1 = 800 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 a BOO < 30 mg& and TSS s 30 mglL Name (Please Print Signature CST Number !�+ L Q:L g - 4, � ;t I Address �.�� Date Evaluation Cohducted Telephone Number wa' 35g 05;27/2005 16:08 7152483588 SUPERIOR AUTOMOTIVE PAGE 03 �11G�r Property Owner P a 0 &L Paroal ID # -- - - - -- Page _ Of !� Boring t Boring # -- Pit around surfaaa elev. LD1 D ( it. Depth to limiting factor / in. Soil llcation Rata Hcrizai Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 0 011#2 D D r--- -----� Is 1... f'I+r Q o� (s, I. L7 M Boring # ❑Boring Q� . lI"I pit Gtound surface elev. 1 p a •! g ft, Depth 10 limiting factor !� in. Soil Application Rate Horizon Depth Dominant Color Redox Dewiption Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff #2 - L w, r ; .A -a S1 rv+ —" r • 1.Ia - - Borng # F1 Boring — ❑ pit Ground suMace elev. _,_,,, ft. Depth to limiting factor in. Soil &VIcation Rate Horizon Depth Dominant Color Redox Description Texture Strurture Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. `Eff #1 'Eff#2 { Effluent #1 = BOD > 30 < Z20 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = 800, . 5 30 mg/L and TSS 5 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. BBD -8330 (RAM) 05Y27/2005 16:08 7152483588 SUPERIOR AUTOMOTIVE PAGE 02 0 0 w►'J�y 50 ' /y� Set,. l7 T X PJ� Ails LO 1 I(( 40 ,. .... ..... .. .. . of ! t ox - . A I � QQ j a ham .c. '..:_ a r. C6 _ a CO tt .� t W PROJECT: BY: DESCRIPTION: DATE: WAUSAU CONCRETE COMPANY, INC. PROJECT #: SHEET #: OF 240 HWY 29 WEST PO BOX 130 MARATHON, WI 54448 -0130 PHONE 715 - 443 -6162 FAX 715- 443 -2318 TOLL FREE 888 - 443 -6162 NOTE: y2- I �,�• ' Q �/ i I i [ I I I I I i I i I i St. Croix County Planning and Zonin Wednesday, June IS, 2005 at 12:31:01 PM Detail Sanitary Information Page I of I Computer #: 006 - 1037 -40 -000 Sub /Plat: NA Section: 17 Parcel #: 17.31.16.256 Lot: TN /RNG: T31 N R1 6W Municipality: Cylon, Town of CSM: 1/4 1/4: SW 1/4 SW 1/4 Owner: Rushton, Francis 2101 Hwy 46 Deer Park, WI 54007 State Permit: 315934 Issued: 07/22/1998 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 07/23/1998 POWTS Detail: Infiltrator - High Capacity Bedrooms: 0 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Rod Eslinger Yes Utgard, Brady $0.00 Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 7/22/2001 7/27/2002 04/15/2002 7/26/2005 7/27/2005 Parcel #: 006- 1037 - 40-000 06115/2005 12:31 PM PAGE 1 OF 1 Alt. Parcel #: 17.31.16.256 006 - TOWN OF CYLON 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 * HEPOLA, JANICE M JANICE M HEPOLA POPELKA MARY A POPELKA MARY A 2101 HWY 46 DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description *2101 HWY 46S SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 17 T31 N RI 6W 40A SW SW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 08/24/1998 585702 1351/92 WD 07/23/1997 999/53 WD 07/23/1997 830/582 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 69,400 84,400 NO UNDEVELOPED G5 24.000 30,000 0 30,000 NO PRODUCTIVE FORST LANC G6 14.000 33,600 0 33,600 NO Totals for 2005: General Property 40.000 78,600 69,400 148,000 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 78,600 69,400 148,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPART, 7! 8 !` AS BUILT SANITARY REPORT Owner rR q YOC 1 S /'S u4 +o r\ Address A / y / Sf N to 1,99 r City /State ^�r�- of Legal Description: (? Lot Block Subdivision/CSM # t /a dLt r A /4 5h✓ Sec. Q, T 31 N -RAW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer LULa-�� Size ST/PC �_ Setback from: House Y,� P/L Pump manufacturer - Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYS TEM: Type of system: Width -- / Length 1 l.o� Number of Trenches Setback from: House _ W ell 1,25 P /L �` Vent to fresh air intake — — ELEVATIONS Description of benchmark -j-, Elevation Description of alternate benchdiark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines O O ( ) Bottom of System ( ) ( ) ( ) Final Grade O O ( ) Date of installation / / Permit number State plan number Plumber's signature License number A/ Date // / Inspector /l Complete plot plan � NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. LAN VIEW 3q p 1b0� Y 3� -363 r a' #uUAA INDICATI NORTH ARROW 08 /18/9 8 09:5 FAX 715 263 2 685 F& M BANK -CLEAR LAKE Q001 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY. REP )RT r r� "FaxNo it" 476,171 f � Owner f R p roG i S Iq (t69 +0 v� Address A 1 b l S.- N w� City /State t ��, 2 C.�J , rw # Legal Description: Fax # # Lot Block Subdivision/CSM # _ '/` Sec. , T N -R W, Town of YIN # _ SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION Wank manufacturer � Size ST /PC &a Setback from: House Well P/L Pump manufacturer Model Alau n location (HOLDING WANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line _ Meter location Alarm location SOIL ABSORPTION SYS n p �ra�r5 Type of system: Width Length i Ls Number of Trenches Setback from: House _ Well J,25 PIL - 75 0 � Vent to fresh air intake — — FLFvATIONS Descrption of benchmark A-W, Elevation Description of alternate bent ark Elevation Building Sewer ST/HT inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System () () ( ) Final Grade () () ( ) Date of installation / / Permit number State plan number Plumber's signature License number A Date /! / Inspector Complete plot plan r 08/18 09:53 FAX 715 263 2685 F &M BANK -CLEAR LAKE INO2 NO'T'ICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. LAN VIEW 3� - 363 Y r MDICAT NORTH ARROW /� ST. CROIX COUNTY WISCONSIN ZONING OFFICE I N - INN N - �_ ST. CROIX COUNTY GOVERNMENT CENTER 11111111 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 August 18 1998 Landmark Community Bank Attn: Barb Robertson 5909 167th Avenue NW Ramsey, MN 55303 RE: Septic Inspection for Francis Rushton located at 2101 Highway 46, Town of Cylon, St. Croix County, Wisconsin Dear Ms. Robertson A septic inspection of the above referenced property was conducted on July 23, 1998. This property is located in the SW' /a of the SWYa of Section 17, T31N -R16W, Town of Cylon, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a two (2) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sin ely, Rod Eslinger Assistant Zoning Administrator /sm v Wisconsin Department of Commerce E PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315934 Permit Holder's Name: ❑ Cit ❑ Village Town of: State Plan ID No.: RUSHTON, FRANCIS CRON CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: I /O<D 3/ " C 006- 1037 -40 -000 Pv TANK INFORMATION ELEVATION DATA A9800319 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. — re ptic e2 S Bench k 0 Dosing Aeration Bldg. Sewer S Holding St /W Inlet 7.0 TANK SETBACK INFORMATION St /e Outlet TANK TO P/ L WELL BLDG. Air ntake ROAD Dt Inlet eptic' NA Dt Bottom Dosing NA Header / Man. Aeratio A Dist. Pipe �$ G Holding Bot. System 943 qS/ 07 95 PUMP/ SIPHON INFORMATION Final Grade �.3 .S Manufacturer De nd 8, 37" g3 Mod m er GPM e H Lift Friction System Ft oss Force Len t Id. H Dist. To wen SOIL ABSORPTION SYSTEM BEDO T Width Length i No. Of Trenches PIT No. Of Pits ia. DImtxsr6N DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA ING Manufacturer: CH 4 INFORMATION Type L (� t� /_v'f �` OR HAM UNIT a Number: .y tP DISTRIBUTION SYSTEM Header/Manifold „ Distribution Pipe(s)� , x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length &m. Spacing �j �� f�(Q �r �� �Q� kAw 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CYLON 17.31.16.256,SW,SW 2101 HWY 46 fv a Ob RJ I i s kU wap►' Plan revision required? ❑ Yes El c Use other side for additional information. I II I le I I I at SBD 6710 (R.3/97) Date Inspe 's Signature ct ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: III �.. Lints nv :DI _ b. �M ........ a F Id AW ( 4 m i m e. e .m. E l o s � E s . F . . � I o t E } i 9 � i ( f . .aa e �. .... �.. M m _ P � 5 J SANITARY PERMIT APPLICATION 201 afety and E. WashnigtonnAve. Division . A h wonsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7%9 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Nu ber The information you provide may be used by other government agency programs E] Chec k I revision'to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner 4 me Property Location F _W1 /4a 1/4,S 1 T 3 �E 1 , N, R I Ca 0 X Property Owner's Mailing Address Lot Number Block Number a101 — City, Stat zip Code Phone Number Subdivision Name or CSM Number 5 UO ( 115) 2(,p9 -55 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road ❑ Village Public M 1 or 2 Family Dwelling - No. of bedrooms 6_ Town OF L' III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/Condo 0 4 co - 1031 — NU 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. ❑ New 2 ag Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System k l stem Existing S Exi sting System ------ -------- ------------- -------------- -- - ----- -------- --- --------- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 IX Seepage Trencha - IBCho. mbar 22 ❑ In Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit - C 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 M) 0D , IF 60 q 15 Feet Feet VII Capacit TANK in allo s Total # of Prefab. Site Fiber- . Exper. INFORMATION New Existing st Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App Tanks Tanks Septic Tank o $00 — 800 1 1A ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW N Business Phone Number: U 7� 76--W- j09qj5 Plumber's Address (S eet, City, State, Zip Code): 0 -1/2- N l i. 5 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued I nt Signature (No Stamps) Approved ❑ Owner Given Initial QZ ®% 00 urchargeFee) - i Adverse Determination VV o ` X. OND TION OF APPROVAL / REASONS FOR DISAPP OVAL: . O 3 a4- T�t SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed - 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 81/2 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. i i ��� �� � �ti� � � � ; yc �� 1 � `�' �-. � - ��� �x �� x ��- �: ��- ��.5. /S � ' �� �- ,.,-lk ����,� �`� � � I'� '��3�j`1 ��y �''� Wisconsin Department of Industry, r` ^ •' A "^ t%- IT c E i i AT I O N REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings �v nG� Wis. Adm. Code w ( [ COUNTY Attach complete site plan on paper not an must include, but St. Croix not limited to vertical and horizontal ref slope, scale or PARCEL I.D. # dimensioned, north arrow, and locatior 006- 1037 -40 APPLICANT INFORMATION -PLE R W ��o�� Y DATE PROPERTY OWNER: PROPERTY LOCATION Francis Rushton GOVT. LOT SW 1/4 SW 1/4,S 17 T 31 ,N,R 16 EAO W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 2101 St. Hy. 346 na na na CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD Deer Park, WI. 54007 (715) 269 -5524 Cylon I St. Hy. #46 [ ] New Construction Use [ xJ Residential / Number of bedrooms 3 [ ] Addition to existing building jxj Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate __,5 — bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 95.15 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I $] S ❑ U _1 S ❑ U 1 MS ❑ U EIS ®U ❑ S ®U [I R7 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <' 1 0 -11 10yr3/3 none sil 2msbk mfr Qw 2f .5 .6 1 2 11 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 32-90 7.5yr4/4 none lfs 2csbk mvfr na na .5 .6 elev. 9 9.15 ft. Depth to limiting factor +90" Remarks: Boring # 1 0 -8 10yr3 /3 none sil 2msbk mfr cs 2f .5 .6 2 2 8 -19 10 y r4/4 none sici lcsbk mfr gw if .2 .3 3 19 -28 10yr4 /4 c2d 7.5yr5/6 sicl lcsbk mfr if .2 .3 Ground ` _. elev. 4 28 -78 7.5yr4/4 none sl 2mgr , t�� . 5 .6 9 `a 5 78 -90 7.5yr4/4 none co s 0sg r�,tdl c,�� na, .7 .8 Depth to �. limiting - -. 9$ _ factor +90" "' �' Y Cgco .. Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6 Address: 1554 200th. Axe., New Richmond, W 4017 Signature: Date: 7 -7 -98 CST Number: m02298 PROPERTYOWNER Francis Rushton SOIL DESCRIPTION REPORT Page 2 of 3. PARCEL I.D. # 006- 1037 -30 Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -12 10yr3 /3 none sil 2msbk mfr cs 2f .5 .6 3 2 12 -32 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 32 -80 7.5yr4/4 none sl 2csbk mvfr na na .5 .6 elev. 9 Depth to limiting factor +80 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) a STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW -3254 Francis Rushton (715) 246 -6200 SW4SW4 S17- T31N -R16W twon of Cylon 0� N 1 " =40' BM.= top of 1 pvc pipe C el. 100' Alt. BM.= top of ROW post @ el. 104.05 �p0 � z' po\e' _ Q 0"0 GAry L. Steel 7 -7 -98 L"/&4&� STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT SL Croix County OWNEWUUYER �� fy ' - 7 MAJLING ADDRESS PROPERTY ADDRESS ' / I (location of septic system) Please obtain from Ilse Planning Dept. ` CITY /STAT> J�L PROPERTY LOCATION �2 `' -0 1 /4. 114, Section L7 , Z � � - R ��n i W TOWN Of ST. CROIX COUN{y, W, SUBDMSION LOT NUMMER CERTIFIEDSURYEY MAP � VOLUME ~~ PACE ` LOT NUMMER \ Improper use and maiatenar&e of wastes- Pr your septic w system could result "n its premature failure to handle Proper maintenance �vrtsisis of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pampa. What you put into the system cart affect lire function of the septic tank as a treatment stage in the waste disposal system. St. Croix County r+esideats may be eligible to of replacement of a fal receive a grant for a Maximum of 60% of the cost i system, which was in operation prior to July August 1, 1973. St- Croix County acce this ProgramProgram in lt of 19150 with the roquireatecK that owners of all new systems agree to keep their system properly maintained . The property owner agrees to submit to St. Croix Zoning a cert and by a mater plumber, j ifitation forth, signed by the owner the on ourneyman plumber, restricted plumber or a licensed pumper verifying that (b) -site wastewater disposal system is in Pumping (if necesu Proper operating condition and (I) after tnspectian and ry)• tht saps+,. tank is Icss than 1 full of sludge and scum LAVe• the un have read the above requi disposal system in acc ordance accordance w rements and agree to ncaintain the private sewage ith the st>rrdartls set lorih. Certification stating that Your septic has been maintained ust beompt c ompleted arid and by the isconsin CD oR Coun Zoning office" %vift. 30 days of the three must year axpstuion dare SIG DATC Sc Croix Count- T.oncng Office Gnve"Inicnt ('eruct Snt�i hael Road flu +Jsai LYt )�tJlf 6 TC- 108 • This application form is to be completed in full and signed by the owners) 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. ---------------- ------------------------------ -------------------- - � 7 Ownerof Location of pi operty ___' °i %4 X 1 /4, Section ,TAN -R Township flailing address i Address of site c5? %/ �. Subdivision name Lot no. Other homes on property? YesNv Previous owner of property _ /, Quit O Son Total size of property _ Z � 2 zL a �' Total size of parcel Date parcel was created z� Are all corners and lot lines identifiable? ,, Yes _ No Is this property being developed for (spec house) ? --„Yes �Nv Volume and Page Number _as recorded with the Register Of Deeds. ------------------ --------------------------------------------- IMCLDDN WITH 2818 hPPLICATZOSC Tiff lOLLOWING: A KARRAf�iTY DEED which includes a DOCt MENT M MBLR, VOLMft AND PAGE NMBER AND THE SEAL, EG OF THE RISTER of DEEDS, certified survey, if available In addition, a delays , would be helpful so as to avoid es the reviewing prOCess. references to a Certified Surve If the deed description shall also be required. y Map• the Certified Survey Map I (we) c PROP"ry OWNER CZRTIrICATZON best Of my (our) certify that all statements on this form are true to the know Property described ewe that I (wel an (are) the owner (s) of the warrant In this information form. by virtue of a Y deed recorded in the office of the Count Deeds as in No. Own the Proposed and that I Y R egister of obtained an site for the sewage dis (we) presently c onstruction of said id ste n Lhe above described system or I (we) the office of the Count and the same has been duly, recorded y Register of Deeds as Document No. Signa ure of Applicant Co - Appl icant —__ " DOCUMENT Nn, WARRAJM OEM 7"16 SPACE RESERVED FOR REC'"Q04411 DATA STATE BAR OF WISCION8131 MM 2 -1f0 . 9 9 n UWA 53 .. .Walter. C.. Olson-iod. Myrtle M. Olson,- as-bLa-ad fe ----_---- . ............ ........................... . . . . . .............. ReedletRaKwd' ................ ...................... . .............. .......................... MAR 2 9 M ............................. ........................ .............. I •••................. . t ... F.V.wK.4# _j,_Rus a conveys and warrants ............ ...... ljeUbag.. babuld. Amd. vife aa. Awv1v.armh1V - ------- _..•...... 0 ...... WXUALKWaty .............................................. ------- - - — ------------- ........... ............................................ ........................ - ------- . .......... . ..................................................................................... -- — -- - - ------------- ................................. ............................... ................ _•- INCTUR14 To ......... ............................................................................ -- — ------------------ . ........................... ............................... ...... .................... •..... the following deser2ad real estate In . . ........ State of Wisconsin: Tax Parcel No. _...00.(k1Q32:.A0 Sec. 17-T31N-R16W. $ • Em This deed is given in fulfillment of a certain Lind contract between the parties dated January 1, 1989, recorded January 4, 1989 In Vol. 830, page 582 as Doc. No. 414275. This ....... Is.-not --------- homestead property. *A (is not) Exception to warranties: Existing highways, easements and rights of way of record. Dated this ------ ---------- it . A1 )94 eAo' ........... ............•••. day of ........ ...... ........................... ........ ....................................................... __ .......... (SEAL) �_ ....(SEAL) * ------------------------------------------------------------------ -Walter _C-.01son. ...................... .......... .. ...................................... .................. ---....(SEAL) X.W?Vzr&'P7. (SEAL) • .......................................................•....• .•... � &._M_Olson .... ............. .... ......... AUTHRNTICATION ACKNOWLSDOMUNT Signature(s) ---- ------ -- --- -- • . .. ... ...................•...... ------- STATS OF j"W - ------------------------- - ---------------------------------------------------- authenticated ' — - - ---- -- •------- ----- County. this ........ 4 W day ot .......................... 19 ...... Personally came before me is ... ............ day of this — - S — -------- ---------------- _ 19.93 .. the ibove named ................................................ . ............................. ..•... ------------------------------------------------------------- --aw-VI-fe, ............................................. TITLE: MEMBER STATE BAR OF WISCONSI . . . . ..........•.......•........•.••................................. - ---- - ------------ ..................................... ............. ------------ rived o S L ire - to be the person S_.....__.. who executed the r& instrument &nd sianowledge the same. THIS INSTRUMENT WAS DRAFTED BY t 1AC ---- A ttorney _David _J!_.Estreen - ------------- .. ........ ------ ......... ..•........... ............. ON ....... -- ---------- ----- Second 4 . 3 ....... ---------- St.. Hudson. ..................... ......................... .......... . . . ...... unly, im• AK y Commmmiss perm t I ot, state (Signatures may be authenticated or ma t ot, state expiratio" Sp not nece3sary.) ............................. • N ' &-ft of Pw-ons oltab2s 131 isms cawlty sboW4 be typed or Printed below tMir sAftrM.N�tay— WA23U NW DR" STATE SAM OF WLSCkM9M Wisconsin Legal Blank Co. Inc. FORM No. *• ISM M Wisconsin