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HomeMy WebLinkAbout030-2094-50-000 e h Q ~n y N a O a O X N O. cC Ol N O ,It y °O 0 `c o y ~ U p a Z N ~ m LL. c m O_ 0) O co z N rn E o z d d ° w a co N F Z O I C •p (6 O z c U p d' in N ° 0 z c E a .O v M j f6 N • ~ c c a O o 4) Q w Q o z m z z N LO rte., LO d N E 2 y O y d O Q O 1 (O .0 o ° 0 CL N C'4 O = fn (n (n I O N (1 w ~ ~VJ S O F~ H H O --1 4 z O O 0 0 0 0 a z • rtvv 3 a a a a N O O N (M to (n fn U j,, m rn Q) m U') N N co LO O O O .J M Y m N c d d Q ' O O C~ 7 O C ° c N c 0 E o 00 F- ? N w a rn o 0 y 00 0 N N cl In E 0) c) O a) v O O O 3 N N Wr O y C N FBI ` L L -0 N O O O^ N I- I- N I~ d' 6m co,)~ • y'7; O N U) w N O z N U) ~ d l0 ~ d a a W c E c c `~1 A U a 2 0 in ci STC - 10 4 „ate AS BUILT SANITARY SYSTEM REPORT' OWNER U C E ~ C (A.)D y r~ N ND ADDRESS (//G<<-✓ ~i'Z e: I SUBDIVISION / CSM# 14141~L LOT # SECTION T_N-R_Z~W, Town of S~ ~0 SGzP/-~ ST. CROIX COUNTY, WISCONSIN L L PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'b~D yk `~E izxsb r L D ax 70 6A~" ~L- ~0~~~ ~ =IU ~p ,SC GvEL`' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: C s ~D -f Coro nJc-lz AjI.J /0-40 4-o.4 Li-~- ALTERNATE BM: ~u t LSO uNQf} l-re~J /D Q SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: U C K _5 Liquid Capacity: Setback from: Well /U t-- House (0 r Other Pump: Manufacturer Model #,7S; 5, Size Float seperation p Gallons/cycle: Alarm Location b ASE ~E~-+ .SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: ~c7 Setback from: well:_,~-)4_ House other ELEVATIONS Building Sewer 3, / ST Inlet, ?(AA ST outlet PC inlet 5 PC bottom r31 Pump Off Header/Manifold Bottom of system 9 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: GL LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.: ECKLUND, BRUCE & CINDY l CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA g /5 y'S TYPE MANUFACTURER CAPACITY STATION ,+BS HI FS ELEV. Septic y., GJ Benchmark SOD Dosing r /V -,7, -3sK x0y Aeration Bldg. Sewer X 3 74 " Holding St/ Inlet TANKS-TBACK INFORMATION St /,K Outlet 3 / Vent to 1 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet f0, S~ Septic y r NA Dt Bottom 3, 3 BAY. 3/ Dosing SZj / ? NA Headers 6,0- Aeration A Dist. Pipe ' Holding Bot. System 7 30, 2/0 PUMP kSMOiINFORMATION Final Grade ' ?7.70' Manufacturer ~S Demand ' 6e. F`, 3 8rj'3, 3 a- Model Number SS n%' .~3 GPM TDH Lift G ,L, % Lriction System 4 TDH Ft Forcemain Length Dia. a " Dist. To Well SOIL ABSORPTION SYSTEM DEMENRENN H Width a , I Length No. Of Trenches PIT No. Of Pits Inside Dia. th DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING adurer: SETBACK INFORMATION Type Of e.~ 2 ~~v Moe Num e r: System: ecy^rf-~ DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) Hole Size x Hole S Vent To i ake Q Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-ycafle Systems Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Tc~nter Bed /Edges O 3 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH.29.30.19W, NE, SW, LOT 14,,HIGHLAND VIEW DRIVE (!LL( 7 Plan revision required? ❑ Yes ~q-o LZIFI/l/91 Use other side for additional information- SBD-6710(R 05/91) Date Inspector's Signat a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code _ y~- CA o i STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a40 71 8% x 11 inches in size. ❑ check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP OWNER PROPERTY LOCATION 4 C ` UA /4 S0/4, S T3 ON, R E (or PR ERTY OWNER'S MAILING ADDRESS LOT # BLOCK # V0 .,.j CLr_V-+-ems P ol CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER r NUj gn z z 60- #1,61q,14,410 c-~5' II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD E& or ❑ State Owned ❑ VILLAGE : ~ t~ 1 f.0 CA,w,-* Ad:cr D2 ❑ Public E& or 2 Fam. Dwelling-# of bedrooms PARCEL AX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) Q O Z D L5 1F] Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1o ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 96ew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # 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 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 (s q. ft.) (Gals/day/sq. ft.) (Min./inch) q([ ELEVATION ~J Q / f Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed -9 1 El I F1 I El Se tic Tank or Holding Tank Q>~D <tegD ~fZ~ Lift Pump Tank/Si hon Chamber if VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite ewage system shown on the attached plans. Plumber' ame (Print): Plumber' ignature: ps) MP/MPRG"o.: Business Phone Number: . 7 Asa Plumber's Address (Street, City, State, Zip Code): (-I A,~ IX. 90UNTYIDEPARTMENT USE ONLY ❑ Disapproved Sayary Permit Fee (includes Groundwater Date Issued Issuing Ag nt i nature ( tam Approved El Owner Given initial 40 Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I SBD-6398(R.08/93) 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 the 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. lll. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must: sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) l_ . LAN P ko ky I L l l V ~M~~k I! 6~c tiX 1 ~~cc~ p 2c V~ Q ~A, LG ~i°~~171 ~ PAGE OF CrrJSS Sec~lun o~ ~en Syst~e~ ~ Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Mash Hoy Or Synthetic Covering _ Mln 2" Aggregole Over Pipe OGaIDullon Over Pipe 0 0 0 0 j 6" Aggregate B o Perforated Pipe Below enooID Plpe o -Cowling Terminating At Bottom Of System p~~Pose~ ~1~1k' gr~,clc 5-Aco'A ton SOIL. FILL DISTRiBUTIOAI PIPE APPPDVED S4MIETIC COVER OR q" OF STRAW Z" OF l~6GREGATfi OR 1JARS" 1-IA~J 8 (o OF Y2-21/2 AGGREGATE 0 'ELEV. 0F21JFEET 33 3 DI•STRI91JTIOAI PIPE TO BE AT LEAST IUCHES BELOW ORIGINAL GRADE AME) AT LEASTZO INCHES BUT IJO MORE THAlJ 42 IMCNES BELOW FINAL GRADE MAXIMUM DEPTH OF EXEAVAT100 ROM 0R1&Nq4 6RADF- WILL BE M~NIMUM Mt-" of EXCAVATION fROM_ ORt411JAL 694DE WILL BE rIt SIGHED: LICEMSE DUMBER: DATE. 2 c ~L u • PAGE cF PUP'\P CHAMBER CROSS SECT 101,1 AtJG SPECIFICATIOUS VENT CAP `i~ C.I. V'E!~1T PIPE WEATHERPROOF APPROVED LOCKIAIG JUNCTION BOX MAWHOLE COVER - P-5' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE 4 MIN. I L__ IB"h11W. C0IJDUIT 18"MIN, ~ 11~ INLET PROVIDE AIRTIGHT SEAL I III A I III I I I I I I I ALARM D I II. I I O *APPROVED I 1 ON q JOINTS WITH I I ELEV. ("4T. APPROVED PIPE __j 3' ONTO PUMP OFF D SOLID SOIL COWCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL. SEPTIC E SPECIFICATIOU DOSE N TANKS MANUFACTURER: - I ) C. E r NUMBER OF DOSES: PER DAS TANK SIZE: _ 410-0 GALLONS DOSE VOLUME ALARM MANUFACTURER: `:LAAJK 17CC-tL-~ INCLUDING BACKFLOW: GALLONS MODEL IJUMBEK: CAPACITIES: A= 7o IWCHESOR GALLOWS SWITCH TYPE: B= - INCHES OR ~ GALLONS PUMP MANUFACTURER: ~ IF Y6-g'5 G=_1% INCHES OR I60 GALLONS MODEL NUMBER: SS /,-t t 3 D INCHES OR /100 GALLONS SWITCH TYPE: c.6 A- f WOTE: PUMP AMD ALARM ARE TO DE MWIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIIMIIMUM NETWORK SUPPLY PRESSURE . , . FEET + L~FEET OF FORCE MAIN X F/ppr,FRICTIOU FACTOR.. FEET TOTAL DyAJAMIC. HEAD = FEET INTERNAL DIMEIJSIOM& OF TANK: LF-M&TH _AYS, ;WIDTH ;LIQUID DEPTH. q5l u 1 J I i ~ L~ III i S25 SSM33 1/4 HP Submersible Sump Pump 1/3 1HP Submersible Sump & Effluent Pump VERSATII ITY FOR MANY LIGHT DUTY JOBS. DESIGNED FOR LIGHT APPLICATIONS. ■ Designed for drain water removal, or permanent ■ Removal of drainage water and light septic tank effluent. applications with small amounts of debris. ■ Automatic and manual operation models available. ■ UL (except proximity Switch model) and CSA listed, ■ UL, CSA and SSPMA listed. SSPMA approved. HE?VY DUTY RELIABILITY ?DURABLE MOTOR FOR YEARS OF SERVICE. ■ Oil-filled motor for maximum heat dissipation, continuous ■ Oil-filled motor for maximum heat dissipation, continuous bearing lubrication. bearing lubcation. ■ Recessed vortex impeller for free flow of liquids, solids. ■ Recessed vortex impeller for free flow of liquids, solids. ■ Thermal overload protection with auto reset. ■ Thermal overload protection with auto reset. MAINTENANCE-FREE OPERATION ■ Wide-angle mercury switch, or proximity switch for small 10" dia. sumps. PRODUCT CAPABILITIES PRODUCT CAPABIi.I'1'IES Capacities to 28 gpm (105 lpm) Capacities to 31 gpm (1171pm) Heads to 23 ff. (7 m) Heads to 23 ft. (7 m) Pump Down Range Pump Down Range' 7-10 in. (178-254 mm) (Switch Off-On) (Switch Off-On) OQI Switch 7 in. 178 mm) Solids Handling 1/4" dia. mm Proximity switch 4 in. ~ 101 mm) (6.4 ) Solids Handling 1/4" dia. (6.4 mm) Liquids Handling drainage effluent Liquids Handling drain water Intermittent Liq. Temp. to 150°F (660C) Intermittent Liq. Temp. to 140OF (600C) Motor 1/3 HP shaded pole Motor 1/4 HP shaded pole. 3000 rpm Electrical 115V, 7.5A. 10, 60 Hz. Electrical 115V, 9A. 10, 60 Hz. pH Range 6-9 pH Range 6-9 Discharge. NPr 1-1/2 in. (38.1 mm) Discharge. NPr 1-1/2 in. (38.1 min) Min. Sump Dia. 12 in. (304.8 mm) Min. Sump Dia. Housing heavy cast iron float Switch 18 in. (457 mm) Power Cord 10 H_ 16/3, STrO/SJTOW-A: Proximity Switch 10 in. (254 mm Housing cast iron Mechanical Seal type 6, carbon & ceramic automatic model only Volute Case thermoplastic Power Cord 10 ft., 16/3. SITO/SrrOW-A. 20 it., 16/3, SJOW/SJOW-A Mechanical Seal type 6. carbon 8 ceramic PERFORMANCE CURVE PERFORMANCE CURVE CAPACITY - LITERS PER MINUTE CAPACITY - LITERS PER MINUTE 15 30 45 so 75 eo 105 0 20 40 60 00 100 120 24 24 r 22 7 SSIM3 - zz 3 h HP - I.N~ 20 6 N W Ifi V n W LL 16 - - W 16 5 z to 5 ti - - - a z 14 z a 14 z 12 a a 'z 4 a = 4 W W fo 3 x 10 3 a e a o - - o s z o ~ e o 4 ~ 6 - - 2 r 2 4 1 0o s fo n m z5 w 20 5 10 15 20 25 30 35 4 CAPACITY - GALLONS PER MINUTE CAPACITY - GALLONS PER MINUTE Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor-and Human Relations Division pt safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION uo Ann Pers ico Bruce Peterson GOVT. LOT NE 114 SW 1/4,S29 T 30 N,R 19 ~dqor) W PROPERTY OWNER':S MAILING ADDRESS LOT # ?LOCK# SUBD. NAME OR CSM # #328 Co. Rd. #F 14 na Highland Hills phase II CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EFOWN NEAREST ROAD Hudson, wI. 54016 (715 386-5347 St. Joseph CO. Rd. #E [:4 New Construction Use [q Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450gpd Recommended design loading rate ' 7 bed, gpd$ '8 trench, gpolft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • _7 bed, gpd/ft2 - 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.39 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND 7 TINGSOUND PRESSURE AT•GRADE FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ®S ❑ U ❑ U EIS ❑ U ❑ S AU ❑ S ElU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bou'tdary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trencft 1 0-11 10yr4/2 none 1 fill na cs na np np 2 11-29 7.5yr4/4 none sl lfsbk mfr 9w if .4 .5 3 29-88 7.5yr4/6 non 1 0~ Osg mvfr na na .7 .8 Ground elev. 98.64 ft.~, Depth to limiting factor v +88" Remarks: Boring # 1 0-13 10yr3/3 none 1 fill na cs na np `np 2 2 13-8 7.5yr4/6 none S Osg mvfr : na na .7 .8 ct' bt:733\C.':A Ground elev. 97.64ft. Depth to limiting factor +82" Remarks: CST Name:-Please Print Gar L. Steel Phone. 715-246-6200 Address: 1554 20 Ave. Richmond WI. 54017 Signature: ~ Date: CST Number: C/x 6-23-94 PROPERTYOWNER Persico/Peterson SOIL DESCRIPTION REPORT Page 2, of 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 3 1 0-9 10 r3/2 none 1 fill na cs na np ; np 2 9-80 10yr4/4 none co s Osg ml na na .7 ~.8 Ground elev. 96.64 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-9 10yr4/3 none 1 2msbk mfr 9w if .5 .6 2 9-16 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 16-80 10yr4/4 none co s Osg ml nay na .7 .8 Ground elev. 95.64 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-9 10yr3/3 none 1 fill na yw na np np 5 2 9-24 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 4-30a 7.5yr4/4 none sl 2msbk mfr 9w if .5 .6 Ground elev. 4 0-78 7.5yr4/6 none co s Osg ml na na .7 .8 95.64 ft. Depth to limiting factor +78" Remarks: 36'x10 sil. lens at 63" non-contiguous in boring Boring # Ground elev. ft. Depth to limiting factor i Remarks: SBD-8330(R.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Highland Hills phase 11 1554 200th Ave. CSTM2298 lot #14 New Richmond, WI 54017 MPRSW 3254 NE4SW4 S29-T30N-R19W (715) 246-6200 town of St. Joseph N 1"=40' BM= top ofNW lot stake at el. 100' C Y~ -73i ~o Gary L. Steel 6-23-94 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE I ( W 6gLr4N D 5W6 - PROPERTY LOCATION N 0 1/4.5 1/4, Section, T 30 N-R TOWN OR Aosq ST. CROIX COUNTY, WI j SUBDIVISION t 1.. V3 N LOT NUMBER CERTIFIED SURVEY MAP , VOLUME I I + i, PAGE 6J5: LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: a DATE: Z Z' 1 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 s • S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property b8upe Location of pro\perty_&Lrl/46Q) 1/4, Section 7T ON-ROB Township J`'~. J©~eyl~ Mailing address qqj bd,~ ~~L~o~~,~le OLD y Address of site 4161~LA-AJb V/L-w p~ ftd u1-4gAj _VP0 Subdivision name Lot no. Other homes on property? Yes__,Z_No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _--k1-Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number Las-- as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded the office of the County Register of Deeds as Document No. r Z 6 w6,6 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ar" C Signature of-Applicant Co-Applic nt 7-~Z'lS~ ? a~- yS Date of Signature Date of Signature / \ H W Z w 1- ` w 0: r w p • LL OC W J J N 0 0. p W lf)Cp / , ' cn W0 p~ Q N ~a~r O 0 J in Z ~J M M °zI m o` I w 1 DRAINAGE EASEMENT I~ OD I in S00034 57 E 504.99' 0 267.55' 1 237.44' 0 : 1 50. , M v 1 (D o : tD I o o a N 0 M tl DRAINAGE O M EASEMENT- I 33' 33' o W w 11.1--- - - - - I 0 0 o m o ° W m d ? Z p. M (n N LL I W N N M V O 1 a O1 0 0 0 O o 1 J MIN 3 J M M i - N C\j 0 I ~ Nt 0 N O N o ! (p 0 I I 1r - N01°34'2YE 302• 57' 630,29 I 327.72' I •s7T Slate Bar of Wisconsin Form 2 - 198'- . : ' 526$6 WARRANTY DEED REGISTER'S OFFICE DOCUMENT NO. VOL 4PAiE5Q5 ST CROIX CO.. V.1 = Reed for Rec ^ r l Hihland Hills, a Partnership consisting Of MAR 2 0 1995 I , Ain Persico3 Ro eon r Ruelin argil Bruce_ ?etc son - 11:00 ` A.(,i I Bruce A Ecklund and C~,mthia L• Roglater of Dee ~3 cr~rtveys and,warra,nts to hu as survivo-&-r and wife E marital property. THIS SPACE RESERVED FOR RECORDING DATA = i - NAME AND RETURN ADDRESS the following described real husband st. Croix estate in County, State of Wisconsin: (Parcel Identification Number) I ~i Lot 14, Highland Hills First Addition in the Town of St. Joseph, St. Croix III County, Wisconsin. i' II V!t F-- This is not homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. i~ March . 19 95 Dated this day of t Highland Hills, a Partnership By: (SEAL) (SEAL) I. BPD Tir<t~ I~ JoAnn Persico o e~ r Rueli-n I (SEAL) B .Bruce Peterson • i ACKNOWLEDGMENT AUTHENTICATION I STATE OF WISCONSIN ss. Signature(s) St. Croix County. . i l9- Personally came before me this day of p authenticated this day of MSrCh 19-95- the above named Tnonn P raicn RnflPr knvli*+ artr~ ~ Rrttcp___P_~tQr~on_ ~ • TITLE: MEMBER STATE BAR OF WISCONSIN NOR" P"W (If not, who executed the i I authorized by §706.06, Wis. Stats.) to me known to be theaI ~A foregoing instrument cknowle the sam . THIS INSTRUMENT WAS DRAFTED BY '=•-1L1-=- !i Kristina land Attorne at law Notary Public . county, WIs I y-- - - a commission is (Signatures may be authenticated or ack~iowledged. Both are not My erman~nt.(If ncN, state expiration date. j -necessary.) ' •42nn" of persons signing in any capwity +Mwud be typed or printed below their - 4nmt.tes Wisconsin Legal Blank Co.. Inc. STATE BAR OF wgyCONSIN WARRANTY DEED Milwaukee. Wis ~ FOR %l DL. 2 -Hal