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HomeMy WebLinkAbout006-1039-50-200Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Stafsholt, Rob C Ion, Town of CST BM Elev: Insp. BM Elev: BM Description: /~ ~'3 GS i TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / f~~~~ 3 ~. ~ /~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 ~ ~ ~./1 /"t"' 29 / Z~ J Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Li Friction Loss System _ Ft Forcemain ngth Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 479412 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 18.31.16. STATION BS HI FS ELEV. Benchmark 3 , -~ /b3.7 /dZS Alt. BM F ~ 11-~,,,, osu.. b • ~ /03 . Bldg. Sewer 3.75 7 t1~ . ~f 5 SUHt Inlet , /. /a '7 ~ SUHt Outiet ~~S 99 ~ Z Dt Inlet Dt Bottom ~ ~ Header/Man. ~ '.7 ~~ Dist. Pipe ~ ~~ ~?. Bot. System '~~ Final Grade Z.~ i St Cover ~.,~~ Co O. 3 / Q 3 . y - ; 7 g~ . / -r' 7~$ 95, ~ BED/TRENCH Width / Length ~ No. Of Trenc h e s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~ - - ~ l '~ 1 fe.~Llr~~ ~' `_ _- ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: , (~+~ ~ INFORMATION CHAMBER OR 1 L ~ Q'j'tJ Type Of System• ~ ~ > Sb ~d 5 ~ ~ /~ /~" ) Q~ ~~/ l J UNIT Model Number: f v~,o~.~C.~ COht~ t(5 ~cw o a. g ~~ 111CTRIRI ITI(1N CVRTFM J l Pn.r 1,. G ~ _ 1h~~LaX_ Header/Manif ~d /~ Distribution x Hole Size x Hole Spacing Vent to Air take L~ ~ ` \ \ \ L ~ ~ z (1 r ,• Jf Dia ` Length Spacing Dia ength am 6, ~ 0111 CCIVFR ., o.e~~....e e..~•e.,,~ n.,i.. ..,. Mn~~n'1 nr Af_[:rada Svefpms Only Depth Over / / Depth Over xx Depth of xx Seeded/Sodded xx Mulched - Bed/Trench Center u ~ BedlTrench Edges Topsoil ~ Yes No ~~ YesJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 2094 215th Avenue Deer Park, WI 54007 (SE 1/4 NE 1/4 18 T31 N R16W) NA Lot 3 1.) Alt BM Description = 2.) Bldg sewer length = Z ~ / -amount of cover = Z ~ Plan revision Required? ~__i Yes No ~ 1 ~l ! 1 ~ ~ C.- t ~J ~ Use other side for additional information. L__ ~__ Date SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 18.31.16. ~ 3~ S-, Cert. No. ~ afety and Buildings Division l(b'i.,'Wl as ' gton Ave., P. County . /1 / l~ 11.. ` "~- a 5~ i, 537 - 71 ~~~~ isconsin ~ ~ ~ ~ ry Pe t Number (to be filled in by CoJ l < ~~~ I ~ ~~ ~ 2 , Department of Commerce ` ~UL7 S n LD Number Sanitary Permit Applicatio ersonal information you pr ide Code Adm Wi 83 21 i h C , p . s. . , t omm In accord w tnay be used for secondary purposes Privacy Law, s15.04(l)(m) ~'~, CR01~ ddres (if different than mailing address) NING FF I. Application Information -Please Print All Information !)~ 9 ~ ~` -- ~,11 Property Owner's Name ~ 2. ~ ~~---~ 'S ~ Parcel # Lot # Block # 3 ~_ Property O er's Mailing Address L 6 .r~• Property Location ~ ~'/.~1~n, Section City, State Zip Code ~ ~ Phone Number irc one ,~/j ~~ I. Type of Building (check all that apply) Q/~ ~ S ~ ~ s ~ CSM umber • Family Dwelling-Number of Bedrooms "~ 2 P. soz8) ~ o yep ^ Public/Commercial -Describe Use ^Villag ship of ^City ^ State Owned- Describe Use _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A_ System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - Plumber Owner IV. a of POWTS S stem: Check all that a 1 -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- ound ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter hing Cha ber ^ Drip Line ^ Gravel-less Pipe Other (explain) • V. Dis ersal/Treatment Ar nformation: 2 3 • ~S Design Flow (gpd) Design Soi~ lication Rate(gp f) Dis rsal Qrea Required (sf) Dispgrsal Area Proposed (sf) Syslgm'Elevation VI. Tank Info Capacity in Total Number Manufacturer Concrete Constructed S I Glass Plastic Gallons Gallons of Units ter ( ~ _/op New Existing -~ ~', Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi d, assume responsibility for installation of the POWTS shown on the attached plans. Business Phone Number ~~ Plumber's Name (Print) Plum Signature MP/MPRS Number ~ ~>v ~~ ~ ZZ 6~ ~r~ -Z -~ Plus Address (Street, City, State, Zi d ~ 1 J VIII. Coun /De artment Use Onl ature (No Stamps) Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Si ; Approved ^ D' ed Surcharge Fee) _ Z S 760 7 ~ '`~'l( j st • ^ O ven Reason for D nial IX. Conditions Approv 1 SYSTEM OWNER: 1 Septic tank, effluent filter and ~ dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. ,.ar Lae khan Rl rz x r 1 inches in size SBD-6398 (R. 01/03) PROJECT Rob Stafsholt D SE 1/4 NE 1/4S 18 /T 31 6 COUNTY ST. CROIX MPRS Shaun Bird 226900 DATEB/16/05 BEDROOM 3 CONVENTIONAL XXX IN-GROU P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE LDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ENCHMARK V.R.P. TOp Of 1/2" pipe ~ ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL «H,R,p, Same as Benchmark c^ ~,~> SYSTEM ELEVATION 95.9/95.7 215th A ~----~ Scale is 1" = 40 unless otherwise noted Well is to meet all setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 150' Vent >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area B-2 100' 6' Long 11 " 34" Grade at System Elevation 0, Vents 2-3' X 69' cells with >3' Spacing 20 0 13~ ~" ~~ 0' 3% Slope 2 25' ST /~ 15~ Property Line SS 1402160th St. New Richmond W i 54017 TOWN Cylon Pro 3 Bedroom House PROJECT Rob Stafsholt D RESS 1402 160th St. New Richmond W i 54017 SE 1/4 NE 1/4S 18 /T 31 6 TOWN Cylon COUNTY ST.CROIX 8/16/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROU P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE LDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ENCHMARK V.R.P. Top Of 1/2" pipe .~ ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark c-^ SYSTEM ELEVATION 95.9/95.7 ~ 12 5 h A r---~ Scale is 1" = 40' unless otherwise noted Well is to meet all setbacks required by WDNR Vent >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 111„ 6' Long at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 150' 2-3' X 69' cells with >3' Spacing ,~' 25% ST 15 B-2 100' 0' Vents 20' - 20' ~~ ,~~ 0' 3% Slope Property Line Pro 3 Bedroom House nro~ off, o~~ Day'(. ~~/" Wisconsin Ddpaitment of Commerce ~ 51C111~ ~O1VI REPORT Division of Safety and Buildings ~ \ ""' ;: Page ~ of m acco ui ~.omm o~, vv~s. ram. ~, e r')nust lan on er not less than 8 c~h~s ~ si~e Attach com lete site a County - 5 ~~ ~>~ 1 p . p p p indude, but not limited to: vertical and horizontal re a ~°}}[~~t_(BMj, diredion and percent slope, scale or dimensions, north arrow, a d I i0 n `a 1t~ikt~?(ggj~-fa~arest oad. eI~ parcel I.D. v o ~3q~ ~~~U~} w ~ ~NiNi/ OFf=(~,`_ Please print all informs Re ' w y Date 1 ~ Personal iMorrnation you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). ~ O~0 ~ ~~ (~ ~ ~ S ~ Property Location Govt. Lot s~ 1 /4 ~ 1 /4 S 1 T 31 N R ~ E (o W Property er's Mailing Address (Jot # Blod< # Subd. Nam CS City fate Zip Code Phone Number ^ City ^ Village own Nearest R New Construdion Us esidential / Number of bedrooms Code derived design flow rate J~ GPD ^ Replacement ^ Public o m erdal -Des 'be: ________ ~ ___ ____,______ __ /v~I~ / Flood Plain elevation if applic Parent material OL General corrxrler>ts ft. able rU2~ and recommendations: ? ~' ~ t^j ~/~ ~ 1 ~ / "~ ~ ~~ / l / G~ ~~ y ~0~ Boring # Boring ~ _ </ ~ ~ ~ v [b t / pit Ground surface elev .~ ft. Depth to limiting factor in. Soli lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# 'Eff#2 Z s--zs~ l s' e ~ ct~ 9S.q~ ~D/9~ Boring # BO"~ pit Ground surface elev~~. Depth to limiting fador ~ ~ ~ in. Soil lica6on 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 o~l o /b i~1~ ~-~--- S ~, -' _____- _ ~ °~r. 4 ~rq 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 'Effluent #2 = BOD < 30 mglL and T55 < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~/~-~J J 715-246-4516 ~o~? ~~ Property Owner _ Parcel ID # Page of 3 Boring Boring # Pit Ground surface elev. ~' ft. Depth to limiting factor _~___7,~ in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d `'~ ~ ~lz ----' S ~ ~ ~'.~ ~ ~ . O s" e s ~ z ~ ~-~ -S S /y/ ~/ ~~ a ~r;ng # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lica6on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~~ # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icatron Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 • Effluent #1 = BODE > 30 < 720 mglL and TSS >30 < 150 mglL • Effluent #2 =GODS < 30 mglL and TSS < 30 mglL 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. SB0.8JJ0 (8.6/00) ' Soil Test Plot Plan Project game Rob Stafsholt Shaun Address 1402 160th St. New Richmond Wi 54017 Lot ------ Subdivision -------- Date CS SE 1/4 NE 1/4S 18 T 31 N/R16 W Township Cylon Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. County ST. CROIX Top of 1 /2" pipe System Elevation 95.9/95.7 *HRpSame as Benchmark ~~ Parcel #: 006-1039-50-000 06/28/2005 12:28 PM PAGE 1 OF 1 Alt. Parcel #: 18.31.16.265A 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 'SWETLIK, CASEY J &HEIDI J CASEY J & HEIDI J SWETLIK 2154 HWY 46 DEER PARK WI 54007 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 2154 HWY 46 SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 8.090 Plat: N/A-NOT AVAILABLE SEC 18 T31 N R16W PT SE NE BEING LOT 1 OF Block/Condo Bldg: CSM 10/2771 8.09 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31 N-16W Notes: Parcel History: Date Doc # Vol/Page Type 05/06/2005 794339 2798/327 PR 07/23/1997 1149/14 WD 07/23/1997 1072/632 LC 9nn~ cl IMMARV Bill #: Fair Market Value: Assessed with: 0 Vaiuations: Description Class RESIDENTIAL G1 Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland Acres 8.090 Last Changed: 09/08/2004 Land Improve Total State Reason 35,000 92,100 127,100 NO 8.090 35,000 92,100 127,100 0.000 0 0 8.090 35,000 92,100 127,100 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 ,9 ~' i ..~. 51'61`7 iE~ Ls~ ~ U.Z7 :~ v Ott Q .~i ~~rn~o/~~ri CERTIFIED SURVEY MAP, ST. CROIX COUNTY, WISCONSIN Part of the S.E. 1/9 of the N.E. 1/4 of Section 18 T31N R16W, Town of Cylon. I, Steven J. Johnson, Registered Land Surveyor, 5-1287, do hereby certify that to the best of my knowledge and belief, this plat is a true and correct representation of that part of the S.E. 1/4 of the N.E. 1/4 of Section 18 T31N R16W, Town of Cylon, described as follows: Commencing •at the east 1/4 corner of said Section 18 THENCE N87o17'04"W 86.11 FEET; THENCE NOlo02'OS"E 33.01 FEET to the point of beginning of the land to be described. THENCE NOlo02'OS"E 165.61 FEET; THENCE N88o57'55"W 10.00 FEET; THENCE NUlo02'OS"E 269.42 FEET; THENCE N87o17'04"W 801.67 FEET; THENCE S02o27'23"W 434.55 FEET; THENCE S87o17'04"E 822.46 FEET to the point of beginning. I certify that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and St. Croix County Ordinances in surveying and dividing the same. This survey was made at the request of Herb Gust Sr. ~ /~I~ ZU' S~~7 The bearings on this map assume the east line of the NORTHEAST CORNER N.E. 1/4 of Section 18 bears NOOo00' 00"E. SECTION 18 NOTE: The parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriat~\ "' Town Board for advice. a Ir. N ~ ~ Steven J J nson FILED R.L.S. 1287 9 ~ I;,~ v~ 1220 Wickre Dr . JUN ~ 1994 'O ~ I ~ Cumberland, Wis. 54829 ~ JAMEBp'CaNNEU. ~ ~ / / f ~ c~a~c ca., rrr I • Z o UNPLATTED LAND w N ~ ~I N 87' 17'04' ~ 8or.67• .-. ~• y W ° li ° i ~~' : ~~, w 3 ~ '• ~ ro j~ ~ ~. ,ii tp i 0 ~ 3 ~ o N^ d-Iw •xst ~~ ~-~ LOT J _ ~ a ~~ • ~• ~~w d~ m cv in 352362 SQ. FT. ~ ~ ~j ~ i ~ v-QO to ;yz N ~ ~ n 'r? 8.09 ACRES 1 ~ N °° ' I N. : 3...~ tyj ^ N M EXCLUDING R/W I ° z =~ o-• ~z ~ ~ N ~ ^ ~'-I Ott1; ZF- ~ i ~ `~ _ H 1 GHWAY SETBACK LINE °REEN NousE ~}, oaRaoE ~ I Z ~o. ~ ti AREA IN R/W 215TH AVE.- '"' CRY-., SEPTIC $ TO 1/4 LINE 27155 SO FT .a ~ _ ~~s 0.62 ACRES o~-~.. .. •..•~~~5463_44' S 87 17'04' 822.46' ~~~® HOUSE II „N, 87.17 ;04'W 215TH AVE .-- - ~O5'E 33.01---~; 70' I ~ 80' .. ...... ru s e9• se • - ----- f~bb WEST I /4 CORNER 32•E 5549.x2• •••• ................ 5549 :55~ EAST I /4 CORNER SECTION 18 ~,,,,.~~~..,,,~ 86. I ! ' ; SECTION 18 0 2' ALUMINUM MONUMENT - I N CONCRETE FOUND srEVEH ~• - o I' IRON PIPE FOUND _` ~ Y • 3/4' X 24' REBAR PLACED. ~= s"~~7 ^ Y O 100 200 300 400 WT. 1.50 LBS./FT. ~~. SCALE I ' - 200' =; ~ ~ ; x~ • ,;~ Q.. , RA - RECORDED AS - y .,, ~~. ~ SCALE I N FEET .~ VOLUN~E 10 PAGE 2771 ~~ ~ ~ ',~ ~~~ ~, At ~ ~ a :~ `~ '~ o Parcel #: 006-1039-60-100 06/28/2005 11:54 AM PAGE 1 OF 1 Alt. Parcel #: 18.31.16.2650 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 "HEMAUER, THOMAS E & BARBARA J THOMAS E & BARBARA J HEMAUER 2058 215TH AVE DEER PARK WI 54007 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description n ~~ ( T SC 0119 AMERY ~ ~ SP 1700 WITC Legal Description: - 27.290 Plat: N/A-NOT AVAILABLE SE R1 W $€-NE~5CC1CSM 2/372 & Block/Condo Bldg: E CSM 10/27 - ~~ ~ n 1 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) - Kv 18-31 N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1216/592 W D 07/23/1997 1072/632 LC ~nn~ ci innnneQV Bill #: Fair Market Value: Assessed with: ---- --------- Use Value Assessment Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 23.000 3,800 0 3,800 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANC G6 3.290 9,000 0 9,000 NO Totals for 2005: General Property 27.290 12,900 0 12,900 Woodland 0.000 0 0 Totals for 2004: General Property 27.290 12,900 0 12,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 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 end/ Plan Option #1~f 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 OwnerBuyer Mai~g Addy S~ ~~U~ D 9 f new ~l ~ p~psrty Address De artmerit or - ~ : {Verification required from Planning P _ parcel Identification Number ~ty/State LEGAL D~CgfpTiON ~ i ~ T~N-__ ~~ W, Town of I.,ocation~ 1~4~~~ /', Sec ~l._.._-- property Lot # ~-. Subdivision ~ ~ page # 5~ 01 ~ . ~o ~ ~~ 1 Volume ____~~-- C~eraf ~ Surve~ # 213 3505_ Volume ~-~-----' page # 'Warrant3' Deed # [] no Lot lines identifiab e spec houses ^ no ~~~NANCE rernature failure to handle wastes. proper mamtc~~ SYS~M maintenance of your septic system could re ~ n~~ by a licensed pumper- W1~t Y°u put into thz m Improper use and ears or soon waste ~sposal syste1II- consists ~ p~p~g out the septic tank every three y can affect the function of the septic tank as a treatment stage in b ~ owner ~ by a artment a cextif' .ieation form, sigma y system a to submit to St. Croix Zoning DeP r verifying ~ t (1) the on-site waste~l~~ loge. The prope1ty °~e1 €~ restrictedPlumber or a licensedpumpe septic tank is less than niasterPlumber, j lumber, lion and pump g if nGre~'), is in proper operating condition and/or (2) after inspee in ( wig the standards fain the private sewage ~rtificatioa ements and agi~ to main of Natural Resourcxs, State of Wilco Office within. 30 ~~ .~ undersigns have read the above requir to the St. Croix County Zoning ent of Commerce acid the Departure set forth, herein, ~ set by themDePar~ ~~,~~ must be completed and returned stag that your ~~c x~pirafion date. days of the y / 1 ~ _ DA TURF OF APPLICANT our knowledge. I (we) am (are) the owner(s) 01 OWI~IER CERTIFICA'I`IOI~I i (we) ceitifY that all statements on this formdeedrecorded in Registmer of Deeds Office. the grope cubed above, by virtue of a warranty ~ ~ ,b r DATE OF APPLICANT nt. **~`~ SIGNATU~ , rmit being revoked by the Zoning DeP~e ~,y ~fonnation that is mil-represented may result in the sanitary Pe ~~~.~:.: wairantl' deed from the Register of Deeds office is Include with this application: a ~pdthe certified survey map if reference is made m the ~~~' dCed ST CROIX COUNTYG~E~N,I, SEPTIC TANK 1~SAINT~xD O~ggSHIp CERTIFICATION FORM U 2867 P 213 State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Numbcr h Document Name THIS DEED, made between Casev J. Swetlik and Heidi J. Swetlik, husband and wife ("Grantor," whether one or more), and Robert Stafsholt ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): That part of SE '/. NE '/. Sec. 18-T31N-R16W being part of Lot 1 of Certified Survey Map recorded in Vol. 10, page 2771 as Doc. No. 517617 described as follows: Lot 3 of Certified Survey Map recorded in Vol. 20 of Certified Survey Maps, page 5028 as Doc. No. 801481. St. Croix County, Wisconsin. 603~ta15 \, KATHLEEN H. MALSH REGISTER GF DEEDS ST. CROIx CO.. NI RECEIVED FOR RECORD 08/15/2085 02:95PM MARRAHTY DEED i:~fE1~T REC PEE: 11.00 TRANS FEE: 90.00 COPY FEE: CC FEE: PAGES: 1 Recording Area ~-"t0. David J: Estreen ~ aG ~ ~ 304 Locust Street Hudson, W15401 ~ (P ~ ~; Exceptions to wa~rantie/s: Easements, restrictions and rights-of--way of record, if any. Dated ~ ~[ /T ~I ~~ ~, '~ Lr *Casey J. Swetlik AUTHENTICATION Signature(s) Caste J. Swetlik and Heidi J. Swetli husband and wife authenticated on _ _ 1 I *Kristina Oaland TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Parcel identification Number (PIN) This is not homestead property. (is) (is not) ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on , the above-named to me known to be the person{s)-who executed the foregoing instrument and acknowledged the same. Attorney Kristina OQland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 * Type name below signatures. INFO-PROTM Legal Forma 800-655-2021 www.intoprotorms.com ;~ ` ;? 8 0 1 4 8 1 VOLAL~O~PAGE 5028 REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 07/26/2005 02:20P11 CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP PAGES: LOCATED IN THE SE1/4 OF THE NEi/4 OF SECTION 16, T31N, R16W, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN, BEING A DIVISION OF LOT 1 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 10. PAGE 2771 AS DOCUMENT NO. 517617. BEARINGS REFERENCED TO THE EAST-NEST 1/4 SECTION LINE OF SECTION 18, ASSUMED TO BEAR SB9°07'35"E, PREVIOUSLY RECORDED AS NB7°17'04"N. LEG61m -N- - INDICATES SECTION GARNER ( AS NOTED ) ~ - INDICATES i" ( OUTSIDE DIAMETER ) IRON PIPE FOUND AT POSITION. • - INDICATES 3/4" STEEL RE-BAR FOUND AT POSITION. -A - INDICATES 1.25" X 24" IRON PIPE 1 WEIGHING 1.68 LBS. PER LINEAR FOOT SET AT POSTION. (R) - INDICATES PREVIOUSLY RECORDED INFORMATION. -.~---+F- - INDICATES FENCE -INDICATES U/VP/~4jjED( /~/NDS R Y . IVEWA D \ ~ ~ - NB9°07 52'w 801 J6 ( R N87°17'04'w 801.67 OWNER / SUBDIVIDER ~~~ 549 WEST 5TH STREET NEW RICHMOND, WI. 54017 NE CORDER, SECTION 18 ( ESTA9LISHED FROM TIES OF RECORD ) N ~'1 N N ,~,. n ~~ z $O I I o ~'~ Z I ¢ I I ~Inl ~ - ~ w 3 _' I ~I~I ~ ~ S89°04'03'E 230.18' m ~ ~ I I~I Q~ LOT3 .• S o Q ~g~ F'I I ~I I 106 SOU T LOT L '" ° o ~ y I ICI ~ ~ ACRES ) ~ 87.120 SQUARE FEET: ~ ~ ° ~Ic~il)"" N ~ (2.000 ACRES) ¢ ~'~~ I eo• I I r'~I~I Q c o sr~: ¢ m I I ~I~I ~ ° 'Nn © ~ ~V I ~~"~' I ~I ~- ST. CROIX COUNTY 100' BUILDING SET LINE `~ _ ~+E~LiNG c~ -- ~,., I ql o ( R S87°17 '04 "E 622.46' ) ° chi- I y~~~ I ~I i~ m EAST-WEST 1/4 SEP7 is ` ~ a ~ o ~ g ~ ~ l ° m SECTION LIME SB9°07'35'E 822.49' ~ ~ ~ o $~ I ~I - - ~ 522.49 m 300.00. wE~~ O ^aj ¢'" ~ V ~ I - 523.33' a 300'00' i° 86.11' w I- ~--. :~' 215TH s69°o7'35•'E 823.33 • /4 vCIIIUE ~ I ses 07.35 °E UlVPLA7TFD LAMAS I ~ ao • I 4640.38' ~ ~~ I Wi/4 CORNER, SECTION 18 ~bL~" ( 1.25" IRON PIPE FOUND ) T~ PREVIOUS CERTIFIED SURVEY MAP AS PLATTED IN VOLUME 10, PAGE 2771 DOES NOT INC]_UDE ANY PORTION OF THE RIGHTS-WAY FOR 215TH AVENUE OR STATE TRUNK HIGHWAY "46". BECAUSE IT WAS NOT INCLUDED ON THE PREVIOUS CERTIFIED SURVEY MAP IT WAS NOT INCLUDED ON THIS MAP. IT IS APPARENT THAT THE RIGHT-OF-WAY FOR 215TH HAS NOT TRANSFERED OMMEAr9-IIP- TFE RIGHT-OF-WAY FOFi FMY. '46" IS APPARENTLY OWMED FEE SIMPLE BY THE STATE. NOTE: THIS PARCEL IS LOCATED IN AN AGRICULTURAL AREA ONMERS OF THIS PARCEL MAY EXPEPoENCE EXTENDED HOURS OF FARM EQUIPMENT OPERATKNi DURING VARKx1S TIMES OF THE YEAR OR MAY EXPEPoENCE ODERS ASSOC:tATEO WITH LIVESTOCK. SCALE IN FEET i" 150' O' 75~ 150 ~ 300 ~ gG N~7~ 7 A. * ERO * Pi~iVZEO 6Y: N~ RK:HMOND V/W ~D~RV ~SM~/~I~~~ YC7II ~V /I ~Li. 1296 C T.Fi. 'E' ~~itr~ ...«~'"..lC~ ~D~ NEV1/RICF~MOND,WI.64017 Vol 20 Page 5028 S`t. Croix County Planning and Zonin Thursday, December 01, 2005 at 8:49:50 AM Detail Sanitary Information Page 1 of I Computer #: Sub/Plat: NA Section: 18 Parcel #: 18.31.16. Lot: 3 TN/RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 20 Pg. 5028 1/4 1/4: SE 1/4 NE 1/4 Owner: Stafsholt, Rob 2094 215th Avenue Deer Park, WI 54007 State Permit: 479412 Issued: 08/25/2005 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Leaching Chamber Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Insaector As Built Plumber Other Reouirements Additional Notes Monev Owed Not determined NA Bird, Shaun $0.00 Signed Off: No