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HomeMy WebLinkAbout032-2074-30-000 O N g ° N y y m d o y O U O I O ~ c N ~ ~O a O N N O r ~ ~ tD fn 06 cC a o N C J ~ 3r I ~ z o ~ I i LL C o. o fn J Q O Cu Cl) Z y E N N r C ~ ~ L O Z r d d v Cl) Z a m 0 o z a~i Z a i ~ o I d ~ I ~ C I o 2 Z ~ O _ Z I c c d fn co m E E N c ~ . a I s i Y a a (/1 > y d N C O C m > O G a n c > c M N N U o O 0 0 0 0 Z a = a a a CL • mss: o 3 LO co y o N (1) fn J U ~ (3) 0) O c ID .c o U) Lo c) 0 C) 0~ N m ~ a U) a) v m Q in m Lo 0 c O ` C 0 ° w c ►~i1 O o U o o CO d f E LO m o rn l F- ccn a 0) o 0) ,e Im c 4 P.- c:5 y C C N C 7 r N r N C N O N ~O co N C D In u7 M h.y N E 2 co ti m ca L • O O U) CO N O Z c N • a m .2 4 a E E c c S' Parcel 032-2074-30-000 01/06/2005 09:44 AM PAGE 1 OF 1 Alt. Parcel M 14.30.20.785C 032 - TOWN OF SOMERSET 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 * SCRUTON, WILLIAM H & MARILYN R WILLIAM H & MARILYN R SCRUTON 1515 TWIN SPRINGS RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 1515 TWIN SPRINGS RD SC 5432 SCH D OF SOMERSET SP 1700 W ITC Legal Description: Acres: 1.720 Plat: N/A-NOT AVAILABLE SEC 14 T30N R20W 1.72A IN GI-2 LOT B OF Block/Condo Bldg: CSM VOL 1/254 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1085/518 WD 07/23/1997 1085/517 QC 07/23/1997 579/431 2004 SUMMARY Bill Fair Market Value: Assessed with: 11212 318,300 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.720 27,500 242,400 269,900 NO Totals for 2004: General Property 1.720 27,500 242,400 269,900 Woodland 0.000 0 0 Totals for 2003: General Property 1.720 27,500 242,400 269,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 109 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 SUR EYOR'S RE CjqT ORD CERTIFIED URVEY PLAT A6 C ~S oo / o \ ivdJ \ n • - Gl~l ~G zo 7 P• J ~ P• ~ .v~ ~ u `~o• i 2/ lk , 5 ~ C2 ~o 9a• top, Go 0 2 ~ ~ tiE \w. A ~ p. sa \ / ZZ Ae. 9O• P APPROVED ST. C OIX COUNlY COMPREHENSIVE PARKS PLANNING %3~iL; i~.2UGt/_ AND ZONG13' COMMITTEE APPROVAL OF 1, 40R SUBDIVISION DO =5 N 0 T ;v EA 11 A v. ,I_ FOR SEPTIC RJER TO H62.20 IAM 2 6 1976 ~ = Note: -9- Indicates Iron Pipe found in place. -o- Indicates Iron Pipe Set, Scale: 1 Inch equals 100 Feet. Bearings shown are recorded on the Plat of TWIN SPRINGS ADDITION. 333465 (see other side) tial 11 ~ Volume 1 page 254 F I t F D z,. Ju 9 1 76 W &M 0! CONNEtt r-.. O kold " it Dead° F; &OIX Qvvy, +1~11:ooao4o Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor aa ~-d Human Relations %visibl-15Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1 e iol i 'Pan must include, but not limited to vertical and horizontal reference poitSt erection 0 o" pe, scale or PARCEL I.D. # ~ \ q dimensioned, north arrow, and location and di ' c fo n re cad. _ APPLICANT INFORMATION-PLEASE rNT e'1`Oi p 10 RE EWED B DATE c ' PROPERTY OWNER: PROPERTY LOCATION r, ° Ct !taOV.!f. LOT 4 114,S T 30 N,R or W Wm. & Marilyn Scruton' T\IW F 1 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SU 4040 Restwood Rd. CITY, STATE ZIP CODE r CITY ❑VILLAGE [SOWN NEAREST ROAD Circle Pines MN. 55014 (6 9 Twin--Snrins Rd. 461 New Construction Use [ Residential ! Number of bedrooms 3 [ J Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft2.5 trench, gpd/ft2 Absorption area required 379 bed, ft2 -175 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 •5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94_q9 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material i i Mj-_f-nnP „ni anrj. Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S :~R U EkS ❑ U ❑ S RU ❑ S A-21 U ❑ S ®d1 ❑ S QdU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends l.v 1 0-10 10 r3 3 none sl lmsbk mfr cs 2f .4 .5 2 10-20 7.5 r4/4 none sl lmsbk mfr if .4 .5 Ground 3 20-27 7.5 r4/6 none sil lmsk mfr 9w if .4 .5 elev. 94-49 ft. 4 27-55 7.5yr4/4 none sicl lfsbk mfr gw na .2 .3 Depth to 5 55-75 10yr6/3 none fragm ted limestone na na np np limiting factor 551- Remarks: Boring # t 1 0-11 10 r3 3 none sl lmsbk mfr cs 2f .4 .5 2} 2 11-16 7.5 r4/4 none sl lmsbk mfr cry if .4 .5 Ground 3 16-28 7.5 r4/6 none scil lfsbk mfr CrW na .2 .3 elev. 4 28-60 •8 94.45 It. Depth to 5 60-75 10 r6 3 none fro ted limestone limiting factor 60" Remarks: H-4 contains many stones CST Name:-Please Print Phone: Gar L. Steel - - Address: Signature: Date: CST Number: PROPERTY OWNER Wm. Scruton SOIL DESCRIPTION REPORT Pages of 3 PARCEL I.D. # 032-2074-30 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Cont. Color Gr. Sz. Sh. Bed ITw& 3 1 0-10 10 r3 3 none sl lmsbk mfr gw 2f .4 .5 2 10-20 7.5yr4/4 none sl lmsbk mfr gw if .4 .5 Ground 3 20-24 7.5yr4/4 none sicl lfsbk mfr gw na .2 .3 elev. c2P y7.5yr5/2 ft. 4 24-41 7.5 r4/4 7.5 r5/8 sicl lfsbk mfr gw na .2 .3 Depth to 5 41-6 5yr3/4 none is Osg mvfr gw na .7 .8 limiting factor 6 60-75 10yr6/3 none fragm nted lime tone 24" Remarks: Boring # - 1 2msbk mfr C1w 2m .5 .6 4 ? 2 10-27 7.5yr4/4 none sl 2mgr mfr gw if .5 .6 3 27-41 7.5yr4/6 none sil lfsbk mfr gw if .4 .5 Ground elev. 4 41-62 7.5yr4/6 none sl w/ ragmented limestone 10yr /3 93-..45- ft. Depth to limiting factor 41" Remarks: Boring # 1 0-17 10yr3/3 none 1 2msbk mfr gw lm .5 .6 5 2 17-37 7.5yr4/4 none sl lmsbk mfr gw if .4 .5 3 37-64 7.5yr4/6 fld 7.5yr5/8 sicl lfsbk mfr gw na .2 .3 Ground elev. 4 64-72 10yr6/3 none fragmented limestone 94.95 ft. Depth to limiting factor 37" Remarks: Boring # Ground elev. ft. I Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th ~ve. Wm. & Marilyn Scruton CSTM2298 NW4SW4 S14-T30N-R20W New Richmond, WI 54 17 MPRSW 3254 town of Somerest (715) 246-6 00 lot #B csm vol.1-page 250 N 1"=40' BM= top of tel. ped bracket at el. 100' / drain area from culvert to be diverted away / from mound area. \ es. _ F v 1p rl- S ' Z.7 /8 17' /y Gary L. Steel 5-26-94 9 10 STC - 104 L9 AS BUILT SANITARY SYSTEM ORTRM AL t 2 2 996 OWNER C tai,, CpijN;Y --CkV!vut~FFtCE ADDRESS SUBDIVISION / CSMJ_ f+ i j LOT SECTION -T_W , Town of ST. CROIX COUNTY, WISCONSIN PLAN VIE SHOW EVERYTHING WITHIN 1 0 FEET OF SYSTEM ~l 3y~tSx so' ~ ~G scs~ 4 i i INDICATE NL02Zc1A9R0W Provide setback and elevation information on reverse of this for'Tl. Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK ALTERNATE BM:~~~A~~ ~C~ / SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: LE ~ Liquid Capacity: Setback from: Well HouseL-Other Pump: Manufacturer Model{ 5-6,Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM f r Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: 1A2 House _ Other ELEVATIONS Building Sewer P_i4v ST Inlet. ST outlet PC inlet PC bottom^ Pump Off Header/Manifold Bottom of system Existing Grade Final grade. X19 DATE OF INSTALLATION: PLUMBER ON JOB: - LICENSE NUMBER: INSPECTOR: 1 lz2 3/93:jt 4 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) SanitaryPerm itNo.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Pla SCRUTON, WILLIAM CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic {J / r Benchmark 3,17' /00. Dosing ao lX/`~s V i ao.ot) Aeration Bldg. Sewer /Sj 9{.99 Holding St/ Ht Inlet p 9 y ✓ 5 ` TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet 9_3/ 9 Air Intake •C Septic > 0 S - NA Dt Bottom /-2, 71' 9o Dosing w g - g r NA Header / Man. Aeration NA Dist. Pipe Z/,Q 16d. VY Holding Bot. System q. 7,51 4. PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number LF03 /Z (1/, GPM TDH Lift Lriction l I Systema5 TDHFt Forcemain Length Dia. u Dist. To We"I S., SOIL ABSORPTION SYSTEM BED/TRENCH Widt Lengt No. Of TrQnches PIT No. Of Pits Inside Dia. Depth DIMENSION C / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHIN nu acturer: SETBACK INFORMATION Type O CHA R Moe Number: System,;In.:,a_a .5. ~J 8 ` /U yr /L~~ w~l ~ UNIT DISTRIBUTION SYSTEM Headed Manifold Distribution Pipe(s) yy , x Hole Size, x Hole Spacing Vent To Air Intake Length Dia-1 Length Dia. Spacing A" 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: SOMERSET-14.30.20W, NW, SW, TWIN SPRINGS ROAD 's,~i U 1 z, `5,71 Plan revision required? ❑ Yes E] E No Use other side for additional information. 3~ ~0 6 SBD-6710 (R 05/91) Date I ector's signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: x J ~ ry~ c, ;T L SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY R IT # -Attach complete plans (to the county copy only) for the system, on paper not less than p9 9F 8% x 11 inches in size. ❑ Check if revision to p evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE TY OWNE PROPERTY LOCATION '/a, S T , N, (or A" ilk I I;e PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY T ZIP DE PHONE NUMBER SBD VISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY N ARE ROAD : ❑ State Owned 0 VILLAGE OF: ❑ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms PARCELTAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 20 Assembly Hall 60 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. PQ New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5.E1 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 El Seepage Bed 21 Z1 Mound 30 ❑ Specify Type 41 El Holdin9Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 Feet Feet _17 7~ VII. TANK CAPACITY Prefab. Site Fiber- Exper. in allons Total # of Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION LNe xist in Gallons Tanks structed s Tanks Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber. S Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe s Na a (PrintPlumber's ignature: {No mps) MP/MPRSW No.: Business Phone Number: r Plu ber' Address treat, City, fate, Zip de : IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee (includes Groundwater ate ssue Iss 'ng Agent Signat re o Stamps) Surcharge Fee) 0 Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 41 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. III. 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) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 27, 1995 2226 Rose Street La. Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 308 MIDPINE CT STAR PRAIRIE WI 54026 RE: PLAN S95-40276 FEE RECEIVED: 180.00 SCRUTON, WILLIAM NW,SW,14,30,20W TOWN OF SOMERSET COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Since . y, ' erard M. wim Plan Reviewer Section of Private Sewage (608) 785-9348 8232R/ 1 SUDA-7987(8. 18M) Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Laborand Human Relations REVIEW APPLICATION Bureau of Building Water Systems r ~ Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave 1340 E Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or hav995-462fo e os onhat inmatiosubmit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Appoint ent Date Reviewer Nam Plan Identification Number - / - - - 1, 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Proje t Name City E]Village @ Town Of: County k k~l ) Protect Location ~E or v GOVT. LOT v 111/4,5 T. ~ N ,R 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 ......../lam A At-Grade 1,501 - 2,500 gallon septic tank $120.00 H Holding Tank 2,501 - 5,000 gallon septic tank $160.00 . M Mound 5,001 - 9,000 gallon septic tank $ 200.00 N F Non-Pressurized In-Ground (conventional) 9,001 -15,000 gallon septic tank $ 300.00 . P n Pressurized In-Ground Over 15,000 gallon septic tank $500.00 O ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 yo - 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 . 4,001 - 8,000 gallon dose chamber $120.00 D ® Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 . P Public Building Over 12,000 gallon dose chamber $160.00 S State-Owned Building Up To 5,000 gallon holding tank $ 60.00 5,001 -10,000 gallon holding tank $100.00 . Code Derived Daily Flow gpd Over 10,000gaIIon hold in r~~o.... $150.00 Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00 . Revisions To Approved PlaAPR.2 $ 60.00 . Petition For Varianc jj~/~ $ 100.00 Petition For Variance rte vARM, . $225.00 Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00 . (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: Priority Review: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 1= 5. SUBMITTING PARTY INFORMATION Telephone No (include area code & extension) Company me - VConac, erso No. & Street Ad-dress Or P Box City, Town or Village, S te, Zip code Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually The information you provide may be used by other government agency programs 1Privacy Law, s 15.04 (1) (m)l. SBDW-6748 (R. 09/94) OVER "'+Jd1U1n"""""""'Ur JUIL AIVU 51 I t tVALUA I IUIV Hth'UH 1 rage 1 0l 3 abt,; and Human Relations Division•of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or _ PARCEL I.D. u dimensioned, north arrow, and location and distance to nearest a V s I~r ~s 0 3 2 - 2 0 7 4 - 3 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFOMTIOTf L Vl REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Wm. & Marilyn Scruton GOVT. LOT NW 1/4 SW 1/4,514 T 30 N,R 20 xfc(or) W PROPERTY OWNER':S MAILING ADDRESS LOT x BLOCK SUED. NAME OR CSM # 4040 Restwood Rd. B na csm vol 1 page 250 CITY, ircTATE Pines, MN. ZIP S8D 4 Pi ONE y,fep ,99 []CITY []VILLAGDCUOWN NEAREST ROAD t0~ (1 622) / 4 Somerset Twin Springs Rd. (xJ New Construction Use [ )q Residential / Number of bedrooms 3 [ J Addition to existing building j J Replacement ( J Public or commercial describe Cain derived daily flow 450 god Recommended design loading rate • 5 bed, g. d • _6 trench, gpd/R2 Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate .5. bed, gpd/ft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.85 ft (as referred to site plan benchmark) Additional design / site considerations contour line 97.85 Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK u U= Unsuitable fors stem O S ® U ( as OIL; O S E1 ❑ S 91~U C 3S [3U ❑ S IN SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BOIIxlary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. I Bed ITrench 0-12 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 v 1 ,Jii; S 2 12-22 10yr3/3 none sil 2msbk mfr gw if .5 .6 Ground 3 22-31 7.5yr4/4 none sil 2msbk mfr gw na .5 .6 elev. c1d 4 31-65 10yr5/4 98.55 ft, 7.5yr5/6 sicl 2msbk mfr gw na .2 .3 Depth to 5 65-72 10yr7/6 fractured limestone limiting factor 311, Remarks: Boring At 1 0-12 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 ~X 2 2 12-27 10yr3/3 none sit 2msbk mfr gw if .5 .6 3 7-41 10yr4/4 c p7.5yr5/6 sil 2msbk mfr gw na .5 .6 Ground elev. 4 1-70 10yr5/4 c2p 7.5yr5/8 sicl M na I na, np i .2 98.55 ft. 5 70+ 10yr7/6 fractured limestone Depth to limiting r: factor 271, Remarks: CST Name-Please Print Gary L. Steel Phone: 715=246-6200 Address. 1554 24th. Ave., New hmond Wt. 54017 Signature: Date CST Number PROPERTY OWNER Wm. Scruton SOIL DESCRIPTION REPORT Page'Q of- }j 032-2074-30 PARCEL I.D. x S . J pw - 40"27 6' - c Boring # Horizon Depth Dominant Color Motfies (Texture Structure Consistence Boundary Roots GPD/ft2 2c;:in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed (Tram s€ 1 0-13 10 r2 2 none 1 2msbk mfr 2f .5 1.6 3 2 13-26 10yr4/4 none sil 2msbk mfr gw if .5 1.6 i Ground 3 126-41 7.5yr4/4 c2p 7.5yr5/6 sil 2msbk mfr gw na .5 j.6 37.25 ft. 4 141-64 10yr5/4 c2p 7.5yr5/8 sil M na na na np .2 Depth to limiting factor 26" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ms Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. I ft. i ~ I Depth to limiting factor Remarks: SBD-8330(8.05/92) S95-40276 STEEL'S SOIL SERVICE Gary L. Steel Wm. Scruton 1554 200th Ave. CSTM2298 NW4SW4 S14-T30N-R20N New Richmond, WI 54017 MPRSW-3254 town of Somerset (715) 246-6200 1 N 1"=40' BM.=top of SE lot stake st el. 100' 100 + ~o ~s~o P ~ q 3 i ~jv: ,'~Aa~~G ®5 ~ 13' 8 M Gary L. Steel 10-19-94 WORKSHEET - MOUND SYSTEM DESIGN 895 -40P,,76 PROBLEM: Design a mound system for aRe ..ust The site characteristics area: Depth to groundwater or bedrock in. Landslope % Percolation rate Distance from dose chamber to distribution system. ft. Elevation difference between Dump and distribution systern ft. Step 1. WASTEWATER LOAD = BF'- 1L gal Step 2. SIZE THE ABSORPTION AREA A) Area required = sq. ft. B) 6E;d or trench length (B) ■ ft. C) Bed or trench width (A) _ ft. - D) Trench spicing (C) _ xJ} Wastewa ter load .24 coal/f 2 ■ / r t /day B ft. tr 'i ems Step 3. MOUND HEIGHT A) Fill depth (D) ft. B) Fill depth (E) D slope A)+P) r/ ft. f va (8~ x 1,16 C) Bed or trench depth (F) _ ;t• D) Cap and topsoil depth (G) = ...1... ft. E) Cap and topsoil depth '(H) _ ft. ,~iRn• Licenue Nu: of lp X95-4 27 6 Step 4. MOUND LENGTH A) End slope (K) ■ + F + H x 3 . ,(,Qc,-?_ ft. 2n9th 4 1--5)- 12. IeL2S B) Total d (L) ■ B + 2(K) . ft. Step 5. MOUND WIDTH Al) Upslope correction factor = « LLZ A2) Upslope width (J) (D + F + G)(3)(factor) ^$1--) ft. 7, W BI) Downslope correction factor ■ B2) Downslope width (I) ■ (E + F + G)(3)(factor) ft. CI) Total mound width (W) for bed ■ J + A + I . 8f 8~ =s'~ 7,-'2 C2) Total mound width (W) for trenches , J + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA ' A) Infiltrative capacity of natural soil ■ B) Basal area required ■ wastewater flow : natural soil infiltrdt e•capacity ■ sq. ft. CI) Basal area available for bed for sloping sites ■ 3;~' L? Y(gt9-6) C2) Bas areay avail le for trench for sloping sites glA~ B W_ CJ+A 'A „ sq, ft. C3) Basal area available for trench or bed for level, S Sign: sq. ft. License 1"U: Data: *zq~~ Step 7. DISTRIBUTION SYSTEM S95-40276 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = /,J in. 2) Hole spacing in. 3) Distribution pipe length 4) Distribution pipe diameter ■ _ in. 5) Spacing between distribution pipes in. 6) Distance from sidewall to distribution pipe = in: 76) DISTRIBUTION PIPE DISCHARGE RATE .i ft. 1) Number of holes per pipe 2) Flow per pipe = XBGPM, 7C) SIZE MANIFOLD 1) Manifold iscentral/ end 2) Manifold length = ft. 3) Number of distribution lines = 4) Manifold diameter = in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = GPM 2) Force main diameter r / in. 3) Friction loss = 1• / ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = 42 ft. 2) Friction loss = , 4 J ft. 3) System head 2.5 ft. _ 2, S_ ft. Total dynamic head _ 13•G ft. Ucergo: ~ Date : S Pvt.. ~ o P /Q S4541°40276 kd"-S'~ew~ 7F) PUMP SELECTION 1) Pump selected will discharge GPM at ft. total dynamic head. 2) Pump model and manufacturer A/ 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal./cycle 2) Daily wastewater volume 4 doses/24 hrs. _ gal./cycle 3) Minimum dose volume = 1;~ gal./cycle 7H) DOSE CHAMBER 1) Minimum capacity required = s`z~a- 75zYf9/ &t~ gal. sign: Licvnoo "u:• Date: . rja o/ ea0k) E S ~D ~Sf-P'n c 7s d too, OPR moo' Page-(-Of--40- t rh SCyt9UJ~N y ~ 9.5-402Z6 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G ILS's ` 9 Topsoil - F _-31 E D co? $ Slope Force Main Plowed Layer Bed of Y`21S" Aggregate Cross Section of a Mound System Using A Bed For The Absorption Area D~ 46 Ft. ~Ft. F R4 Ft. AFt. G f, D Ft. $ Ft. HFt. Signed: - K Ft. L l 7. S' Ft. License ~9 I ~ 6 Ft. SAGE SYSTEM Date : qs- nallY C0p1ditto O ~fl~ REV► ~AAN -AM501ok Position of E PENCE Force Main"- $E I L I J Observation Pipe Imo--- K Fj B r-----.----- 1 0 I A-X x A I W IO Distribution Pipe Bed of V -2Y' Aggregate Observation I Pipe Permanent Marker Plan View of Mound Using a Bed For the Absorption Area P49e .z Of,1C1 Sc ei to S95-402 Perforated Pipe Detall n nd vi•et Perforated End Cap • PVC Pipe d,,►~ Holes Located On Bottom, J Are Equally Spaced J Q PVC Forte Main i .7 Q PVC Mordtold Pipe Alternate Position Of Distribution Force Main Pipe Lost Hole Should Be Next To End Cap End Cop Distribution Pipe Layout P - S Ft. R S y8„ X Inches Y 7L Inches Signed: Hole Diameter IX/ Inch Lateral 0 Inch(es) License Number: Manifold inches Date: Force Main " Inches „ 01 1 # of holes/pipe .5,01u4hvert Elevation of sIWQ.V Ft. ~s 5~ G0 E~~ b w ~e V A b A 4J 44 y=- r r r r r ' w IV rrrr W 4) A W rrr - - - - r - - 1 rrr - r - r - r ► - r'r rr-rrf O C~` My J N - , N a w ~ O o~ 43 N O w a°~ p I o ~ n a c a PA E OF PUMP CHAMBER CR055 SECTION A►JO SPECIFICATIONS ScrCu VENT CAP S95-40276 `i• C.Z. VENT P I P C WEATHER PROOF APPROVED LOCKING JUWCTIOU BOX MAWHOLE COVER ~ 25' FRAM DOOR, WIQDOW OK f RCSH 12~MIU, AIR INTAKE GRADE I y~ MAJ. 18' MI lJ. CONDUIT Ell INLET PROVIDE I l P nditto~ A IGHT SEAL I i I( V I APPROVED JOIIJ'f A® SID Z ( i APPROVED JOIAITS W/C.I. PIPE RE~p o* I III W/C.X. PIPE EXTENDIU(s 3 >k ~ I I EXTENDIUG 3 ALARM 50s OQTO SOLID $01L B NY 6 I II ONTO SOLID SOIL. I I C b ONVi~ • PUMP OFF 0 CONCRETE BLOCK RISER EXIT PERMITTED OQLy IF 'TANK MAIJLWACTURZP HAS SUCH APPROVAL SPEC,IFICAT IOIJS i:P71C AND _ ,)SL TANKS MAIJUF'ACTURER: (DUMBER OF DOSES: PER DAy TAKJK LIZE: ~~_t5 GALLOIJS DOSC VOLUME: GALL0IQS~ ~ ALARM MANUFACTURER: CAPACITIES: A= IUCHES OR --<_Y_/ GALLOQ5 MODEL NUMBER: B= 7 IkJCHE5 OR 29GALLOU5 SWITCH TYPE: C=I"HES OR -L?-? GALLONS PUMP MANUFACTURER: On IQLHES OR 71'_ GALLOU5 MCMEL NUMBER'. l~/eOT WOTE', PUMP AND ALARM ARE TO BE bWIICH TJPE: 4EL IU5TALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RA'T'E GPM 1Sr VERTICAL,DII,FERENCE bETWEEN PUMP OFF AND DISTRIBUTION PIPE_ e,r- FEET + MINIMUM NETWORK SUPPLY PR~~E$G$URE 2.5 FEET + ~ FEET OF FORCE MAIN X .,ZL.L-„F/oo iLFRICTION FACTOR., FEET TOTAL 0y1JAMIC HEAD = FEET 87 IQTERIJAL DIMEW 10Nf► OF TAUK: LE►JGTH ;WIDTH -;LIQUID DEPTH 91GJJEDt LICEUSE UUMBERt - ~,L DATE:yZ y p h~6,~ /~i ~f ~G RI ~ ~ M JFy y ~.V 1G' 1: Performance.' blr~ Curves Pumps METERS FEET S 9 t 4 0- ~ 7 MODEL 3885 3~s 25 80 SIZE 3/4" Solids WE15H 70 20 WE10H 60 ~ - WE07H 15 50 W EOSH 40 10- 0 WE03M 20 WE031 5 10 0 0 0 10 20 30 40 50 80 70 80 90 100 110 120 GPM 0 10 20 30 mom CAPACITY u GOU LDS PUMPS, INC. 56*cA Falls Pew rocM 1310; METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/4tt Solids 100 30 90 25 80 20 70 60 O 50 WE05HH 15 40 10 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i 0 10 20 30 W/h CAPACITY 01985 Goulds Pumps, Inc. Etfectiye Juty, 1985 1,aol VVl5QUf1Yl wvrMlullwllluilli wu uy' ,UIL ANU 511 t IZVALUA I IUN hk=IJUM I rage 1 or 3 Lab' •arlNuman Relations Dwision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St . Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 3 2 - 2 0 7 4 - 3 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Wm. & Marilyn Scruton GOVT. LOT NW 1/4 SW 1/4,SL4 T 30 N,R 20 xk(or) W PROPERTY OWNER':S MA!I.ING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 4040 Restwood Rd. B na csm vol 1 page 250 CITY, STATE Pines, M. ZI5C0~ 4 PHONE yllM~E4199 CITY OVILLAGD C JfOWN NEAREST ROAD g8 DE 62)7/8 Somerset Twin Springs Rd. [x] New Construction Use (xj Residential I Number of bedrooms 3 [ ] Addition to existing building [ j Replacement [ ] Public or commercial describe Cede derived daily flow 450 god Recommended design loading rate • 5 bed, gpd/112 •6 trench, gpd/ft2 Absorption area required 375 bed, 112 375 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 - 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.85 ft (as referred to site plan benchmark) Additional design / site considerations contour line 97.85 Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0S O U as O U 13S DU O S nu O S [aU O S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rertdi 1 0-12 10yr2/2 none 1 2msbk mfr gw 2f .5 .6 1 2 12-22 10yr3/3 none sil 2msbk mfr gw if .5 .6 Ground 3 22-31 7.5yr4/4 none sil 2msbk mfr gw na .5 .6 98! 5ev. 5 ft. 4 31-65 10yr5/4 c1d7.5yr5/6 sicl 2msbk mfr gw na .2 .3 Depth to 5 65-72 10yr7/6 fractured limestone limiting factor 311, Remarks: Boring # 1 0-12 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 2 2 12-27 10yr3/3 none sil 2msbk mfr gw if .5 .6 c 3 7-41 10yr4/4 7.5yr5/6 sil 2msbk mfr gw na .5 .6 p Ground elev. 4 1-70 10yr5/4 c2p 7.5yr5/8 sicl M na - np •2 98.55 ft 5 70+ 10yr7/6 fractured 1' estone ` 4 21, Depth to limiting L~7 10 factor I } j 27" Remarks: rk: a 9 CST Name:-Please Print Gary L. Steel Phone. 71=24C-62 Address: 1554 2 th. Ave., New hmond Wt. 54017 Signature: Date: T CST Number: M 10-19-94 cstm 02298 PROPERTY OWNER Wm. Scruton SOIL DESCRIPTION REPORT Page 1 of 3 PARCELI.D.# 032-2074-30 Boring # Horizon Depth Dominant Color Mottles Texture I Structure Consistence Barr{ary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh Bed ITrench . 3 w 1 0-13 10 r2/2 none 1 2msbk mfr 2f .5 1.6 «v' 2 13-26 10yr4/4 none sil 2msbk mfr gw if .5 i.6 Ground 3 26-41 7.5yr4/4 c2p 7.5yr5/6 sil 2msbk mfr 9w na .5 ~.6 97.25' ft 4 41-64 10yr5/4 c2p 7.5yr5/8 sil M na na na np .2 Depth to limiting factor 26" Remarks: Boring # ~4~~i} iir:• Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. ~ I Depth to limiting factor Remarks: SBD-8330(R.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Wm. Scruton 1554 200th Ave. CSTM2298 Nw4Sw4 S14-T30N-R20N New Richmond, Wl 54017 MPRSW 3254 town of Somerset (715) 246-6200 1 N 1"=40' BM.=top of SE lot stake st el. 100' 108 -f- 8.2. s{ 8" 171 13 $ A4 Gary L. Steel 10-19-94 4 G) CERTIFIED UR EY PLAT zo 7Q ~ b 5 90 • ~ IS'l r E s9 'joo•°' w J. 7-e vo • SB ~ APPROVED ST. C;,OIX COUNTY COMPREHCN;'iIVE pARY.`> PIANNIN AND ZON1 l 0 COMMITTEE APPROVAL ►i 1012 SUBDIVISION ' DC?'.;'NC?1 ' :v. l F SEPTIC i1A. 1~1=~K I i-I62.20 Note: Indicates Iron Pipe found in place. -o- Indicates Iron Pipe Set. Scale: 1 Tnch equnls 100 Peet. E3earinE,s shown are recorded on tEio E'1a t of `j,WIN SPRINGS ADDITION. -c -L w una -et;uuii snail not oe aiscloseo to'otners unless, in the insured in litigation in which any third party asserts a claim adverse to the title reasonable judgment Of the Company, it is necessary in the administration of irnntinned nn inside hark rnver 1 ST. 48 CNTY. 109 PROP. 4 IRAN. 101A Re-Issue Liability: ORT FORM 402 ALTA OWNER'S 10-17-92 PREMIUM: $50.00 ORDER NO. S 941184 H POL ICY NO. SV2386143 AMOUNT $35,500.00 SCHEDULE. A 1. POLICY DATE: July 6, 1994 AT 9:15 A. M. 2. THE INSURED HEREUNDER, IN WHOM TITLE TO THE FEE SIMPLE ESTATE IS VESTED, AT DATE HEREOF, IS: William H. Scrr_tton and Marilyn R. Srrr..tton, husband ,and wife 3. THE LAND REFERRED TO IN THIS POLICY IS DESCRIBED AS FOLLOWS- PARCEL 1: Part of government Lot in Section 14, fown~>f~iA 30, Range ,_'0 described as follows: Lot "B of the Certified Sr_trvey Map recorded June 9, 1976 in Volume 1 of Certifier! Si_trvey Maps, Page 254 as Document No. 333465, St. Croix County, Wisconsin. Together, with a non-exclusive roadway easement for Ingress and Egress 66 feet in width as shown on the above Certified Survey Map. PARCEL 2: Lots 59, GO and that part of Lot 61, Twin Springs. ftddition in the Town of Somerset, described as follows-. Beginninq at the West corner of Lot 61, thenre '3 feet Northeasterly along roadway, thence Easterly along the renter of a gully to the East corner of said Lot, thence Southwesterly 11710 feet to the South corner of said Lot, thence Northwesterly 150 feet to place of beginning, St. Croix County, Wiscar►Nin. IIIIIIIIIIIIIIIIIII «OLDREPUI3LC 1 Till* ORT Form 3M ` • '99 7s s7 800 7880 (I lop ~j~ p 07 n~ 6Za ~3 2 6A I 87 J a "8/O. r ai~p T Pa 7g! 78 lyl4p 198.55 zsu 6 H e ap 3` lop 3 ~Z@. 815 n 7+ ! y/ ( %.)k 93 D - L ¢ r Ja a6 etn~ y 4~ `o~is 786)4-10 68 786 A 7s3 8 ~ GOVERNMENT LOT 3 F 785 8 _ f/ f CsM 766 C OVE-- ENT LOT ? 4 785 a ~ se v4 _ s Gy v4 Ar y^ e 791 30 _ -20 o C~bi-Y R/IiF,p 796 8 ! tNT 4~T IZO 14 t 83p pq E L. 344 19 _ 846 785 p AAA _s. ~4.' " 84¢ 845 7 A 796 spa . $41 ~2. C s /K MC. Bac A / ~ ~ . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT 1 St. Croix County OWNER/BUYER c l't. Ml LWc I K, MAILING ADDRESS Llo40 A,'P-AEc eec1 ~,,OaA C~ r -le FL4 PROPERTY ADDRESS I ~W)A& 1 ~-df (location of septic system) P1 e obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION _ 1/4, Sk) 1/4, Section i T_,3 0_N-R 2,0 W TOWN of ST. CROIX COUNTY, WI B SUBDIVISION LOT NUM 3ER (QC CERTIFIED SURVEY MAP VOLUME_ PAGE 5q, LOT NUMBER 333 ~S- 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 yeaf--e~x~iration te. SIGNED: y 1,,-, DATE: h~ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 Y 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. 1 ( y Owner of property Location of property_4&) 1/4 Sl~l/4 , Section ~x `i~N-IC_W Township Mailing address Address of site Subdivision name Lot- no. Other homes on property? Yes _-No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _-Yes No Is this property being developed for (spec house)? -Yes < No Volume M,§, and Page Number - 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 informati.on form, by virtue of a warranty deed recorded in the office of- the County Register of Deeds as Document No. 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 Deed; as Document No. Signature of Applicant Co Applic nt Date of Signature Date of Signature Y ~ GJC_UMENT No. WARRANTY DEED 7W5 'FA'.E R-:iCRVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 - 1982 y,~~ 1G~ ~ra~F51•8 r_ Bonnie J. Stone a single person, JUL 6 1994 _ . conveys rrants to William H. Scruton and Maril -R. wa - . . Marilyn / 9:15 t~cruton husband and-wife ~ y . - . I~ I ti.' following described real estate in St....CrO1X.- County, - - - State of Wisconsin: Tax Parcel No: Part of Government 2 in Section 14, Township 30, Range 20, described as follows: Lot "B" of the Certified Survey Map recorded June 9, 1976, in Volume 1 of Certified Survey Maps, page 254, as Document No. 333465, St. Croix County, Wisconsin. Together with a non-exclusive roadway easement for Ingress and Egress 66 feet in width as shown on the above Certified Survey Map. Lots 59, 60 and that part of Lot 61, Twin Springs Addition in Town of Somerset described as follows:. Commencing on West corner of said Lot 61; thence NEly on roadway 23 feet; thence Ely in centerline of gully to Ely corner of said Lot 61; thence SWly 100 feet to S corner of said Lot 61; thence NWly 150 feet to Place of Beginning. The consideration is paid to an accommodator as part of a 51031 exchange. A is not This homestead prcperty. ;yt (is)@'u~Y' I Exception to warranties: Easements, restrictions and rights-of-way of record, if any. [gated thisA 15Pim day o: _ J Uvl 19 94 . (SEAL) (SEAL) ~I it I (SEAL) _ (SEAL.I i! ACKNOWLEDGMENT i FLORIDA Signature(s) .!4'!.!~c STATE OF Bonnie J: "Stone Ss. 'I tS County. authenticated this 3.1-day o*--._-_- ne__..._..• 199-q Po-son'nVy , rn;c before nnn this 1.1y o° June - l9_ _ 94 - the above named Bonnie J. Stone... i to me known to be the peron - - who executed the fore * g instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina 0 land 9......................... , RANDAtt {C. IERNR - ---------Attorney at Law Prot. Count}, w;r. at, (Signatures may be authenticated or acknowledged. Both 31~ ommission .Is.'-Perniana nLl ([f no state expiration are not necessary.) - t )ersons signing in any capacity should he type.l or printed below thrir sigi. L::1,1". ~ J TY DEED STATE BAR OF WISCONSIN Wssconsln Legal Blank Co. Inc FORM No. 2 - tv,142 Milwaukee. WKConSin