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HomeMy WebLinkAbout038-1132-10-500 ~ v °o I C c~ 3: oq o as (D M M O GC Cam, N In ` c ya a) [0 - J m x 4} _N zo C U O E c CO w to LO :3 0 a z (L _ c ~ ~ m LL c c m o O ol c o0 0 Q I CV V (D 3 z E o = o v z I CL co co P z l c c t9 -o o z c _ m z m c z U) N 7 E O M a 0) N ~ y N U) cc c ~y o •y LO_ c c 0 Z H z o z N LO cd w.~ 00 E C~ N U N N E m N co d 3 0. 'u > c ca O N N a) i a) C O O z 0 0 m (n C, Q O a fA fA to O w O -2 H F- _ 4 ~Ny z U7 > m 3: 3: 3: 2 0 ~i 0 0 0 2 z 0 • wui m a a a a ~ N g ~ C In U-) N }ice O y tq J U rn rn B o r y o o o E :3 p o m a p V) N y o Q > m m hl O ~ 1~ N N r~ 0 3 CO - N c ~l o CQ, ° ~ a c c 4 rn °o V M(t6 V N N a) N O I'W 2 C r CA r -14 co CD (:b c! m co z • y' O M to I, U- N O :z N Cn y d m a r, a L a • a d (D c E i C c 3 0.4 `~1 A 0 at 0UL) ~ STC - 104 10 AS BUILT SANITARY SYSTEM RE w OWNER Herbert & Sharon Fouks 2 19~ ADDRESS 876 Lincoln Ave Tw ce ki \ Amer WI 54001` b~~'co SUBDIVISION / CSMf Vol 10 Page 2859 LOT 95 SECTION___a2 _T_3j_N-R__I__Wr Town of S tar Prai ri P ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM L C6v~c.YG' re FFc v-r 2 . a ~aw5 G dq I L N U I CA`1'E tJORTH :.!'•!:0~' I Provide setback and elevation information on reverse of tlhi~, form. Provide 2 dimensions to center of septic tank m(3ntiolce. BENCHMARK: top of steel fence post with red ribbon, 100 feet ALTERNATE BM: top of vent pipe, end of trench, 97 feet SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Huffcut Liquid Capacity: 1000 gal Setback from: Well 60' 6" House 1116" Other n/a Pump: Manufacturer n/a ModelV n/a Size n/a Float seperation n/a Gallons/cycle: n/a Alarm Location n/a SOIL ABSORPTION SYSTEM Width: 5' Length 75' Number of trenches 1 Distance & Direction to nearest prop. line: 20' Setback from: well: 15516" House 101'6"Other n/a ELEVATIONS Building Sewer 97' ST Inlet.96.25' ST outlet 96.00' PC inlet n/a PC bottom n/a pump off n/a Header/Manifold 93.40' Bottom of system 92.85' Existing Grade 98' to 97' Final grade 98' to 97' DATE OF INSTALLATION: PLUMBER ON JOB: Vaughn D Monson LICENSE NUMBER: MP6567 INSPECTOR: S~_~ 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Liborand`Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State Pla FOUKS, HERBERT & SHARON X CST BM Elev.: Insp. BM Elev.: BM Description: Star rekirle Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G( e / dL )d jl_~ Benchmark 6,w Dosing Aeration Bldg. Sewer Holding- St/yt Inlet u/, TANK SETBACK INFORMATION St/ i;K Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. q Z 9 7 Aeration Dist. Pipe 9 3 S~ qq, 7 ' Holding,_._. Bot. System od S~ y1, PUMP/ SIPHON INFORMATION Final Grade 7, ?-~k Maplufacturer 1 :!7 and Model Number GPM TDH Lift Loss Iction System TDH Ft Force I n Length Dia. Dist. To Well H SOIL ABSORPTION SYSTEM ISJD-/TRENCH Width I Length _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I SYSTEM TO P / L BLDG WELL LAKE /STREAM L G Manufacturer: SETBACK CHAMBER Mode Num erINFORMATION Type Off? t.t c . System: p ,:.,cl J c 0 /o/ SS' X 9Q- OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over a Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center r~o Bed/ Trench Edges Topsoil E] Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Pralrie.32.31.18W, NW, SW, Lot 5 fi G1 ~7 7~ U c -7/q 0j 0t, Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1951- SBD-6710 (R 05/91) { 1 Date sped is Signature Cert. No. /r: e if S ~ ; , - 37 Z 1 Ul u - 5 ~ >¢n i ~y /27/ - ~ Q ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: / a r 9 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ST .Croix Count STATE SA ITARY ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ (j a5 63 ~ 8% X 11 inches in size. Check if revision to pre ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Herbert & Sharon Fouks NW '/4 SW '/4, S 32 T 31, N, R 18 or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 876 Lincoln Av. 5 NA CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Amery 154001 1(715 68-8324 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD /8'f0 &),; t d, ❑ State Owned ❑ VILLAGE ; Star P r a i r i ❑ Public 01 or 2 Fam. Dwelling-# of bedrooms 2 PARCEL AX M ER III. BUILDING USE: (If building type is public, check all that apply) _30? 3, g y~ E. 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. © New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 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 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 300 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION j75 375 .8 NA 92.85 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 1 1000 1 Huffcutt Inc. Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum er' Signatur : (No Stamps) MP/ PRSW No.: Business Phone Number: Vaughn D. Monson S6 2 (715 h63-3017 Plumber's Address (Street, City, State, Zip Code): 3 3rd Av. Clear Lake Wi 54005 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanit Permit Fee (Includes Groundwater Date Issued I Agent Signature (No Sta/mpg)_ Surcharge Fee) lit- )~Approved ❑ Owner Given Initial 7 /A A Adverse Determination X. ONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: _1 -.0mummMOMML. A Ile 4 SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ~ y 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 (,SBI? 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) mast 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 adn,inistrator 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. FiII in the capacity of every new and/or existing tank, list this total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if Wanks 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 mainsAvater 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.11188) L v4 n S ~a 4W ~ F cl, o -d n IC , F ,sr ~ ~y F 1 r v , 4 ro c Itr- 11 ' -G r o Fresh Air Iniels And Observation Pipe Approved Vent Cop Minimum i2" Above Final Grade S~~ y0 20 - 42" Above Pipe 4" Cast Iron or A- Vent Pipe To Final Grade Marsh Nay Or Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe o 0000 B= Min 6" Aggregate Beneath Pipe 0 Perforated Pipe Below o Coupling Terminating At Bottom Of System C= A= 7ST 3 j B= dL► ~-t C= i a r ~ O - - - co Fn C)o c, 7 C` SY }P ~ r ~ co n ~ = N ' Ln- T~ 1 m :c O tl o Z : Fri ~ Z ~ sy N 0 o T r- r--- w C) 57 UT Wiscop!!in Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of Labor Human Relations 4)i vision 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 si but ~f0 I' not limited to vertical and horizontal reference point (BM), direction e PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro REVIEWED BY DATE 14 APPLICANT INFORMATION-PLEASE PRINT ALL INFO ION 'FI~Eat PROPERTY OWNER: , r jr, EFRCIP ATI '00M~ S 3aT N,R E (o W PROPERTY OWNER':S MAIL! G ADDRESS BLOCK # D. NAME OR CSM # ry CITY, STA E ZIP CODE PHONE NUMBER ❑CI OWN NEAREST ROAD l ) ift 'rlel 7 New Construction Use [,)f- Residential ! Number of bedrooms [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 440~,V gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required 4 i6Q bed, ft2 trench, ft2 Maximum design loading rate ed, gpd/ft2 , Zr trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 10 - 7 Parent material /%4,fcy e1 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem AS El U AS ❑ LI XS ❑ U S❑ U ❑ S f&U ❑ S Rfl SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence BoL~ Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmn h ,,e e Ground -9 Q~ ,3►--~ 7 elev. t. Depth to limiting factor .Z"_ 3- ~ Remarks: Boring # Z!~ 37 Ale Ground elev. i5ft. Depth to limiting factor 3- Remarks: CST Name:-Please Print C Phon Address: Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page ml,, of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench R -M, Ground elev. Depth to limiting actor GJ ' f Remarks: Boring # .01 Ground elev. , Depth to limiting factor Remarks: Boring # 5:.~::.:.;:• i/+'f~~ ~ war 4111/ Iwo OF 40. Ground elev. q3. ft. Depth to limiting factor Remarks: Baring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) M Soil Test Plot Plan Byron Bird Jr. Property Owner 896 68th Ave. Address Amery Wi 54001 -1/4 1/4/S /T N/R_W CST #3479 Township Ufa dr~,~, c Date County 0 Boreing L Benchmark * H.R.P. System Elevation 90?- 12-14 47, 7-17 0 -HOMINGTAN"ERVICING CONTRACT Contract Date FEB-16-1995 This contract is made between the Holding Tank Owner(s) Name(s) and I PumgONwa UWD WASTE MGMT.. INC. - I! I 550 RILEY AVE. Herbert & Sharon Fouks I NEW RICHMOND. WI 54017 (715) 246-5738 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) Part of NA OF SW4 AND IN PART OF THE SW-14 OF NW--4 ALL IN Section 32, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin Described as follows: Lot 5 of Certified Survey Map recorded in Volume 10 of Certified Survey Maps at page 2.8_59 - - - - - - - - 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which ha: signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of ST. Croix County, 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and tc enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pad the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3 The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; 9 The disposal sites to which the contents from the holding tank were delivered. t. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. )wner(s) Name(s) (Print) i Owner's Sig lure(s) Herbert H Fouks Subscribed and sworn to before me on this date: Sharon C, Fouks, I 1 umper's Name (Print) I Pumper's Signature Notary Public ?Lre.rs /_~Zu~d (,Jane ftl~ I My commission expires: umper s Registration Number 31) s 74 (R 09/88) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations _ i T= ar8AW GIUOU 2R3iVOy .3 `.,A Y3JIA 08a V o4a NV 'CHOMMOIA W3M r,rr~_;apS ~ I I i I Docurni.trt No. This space reserved for recording data 5.24905 HOLDING TANK AGREEMENT Agreement Date This agreement is made between the FEB-16-1995 County or Local Governmental Unit Holding Tank(s) Owner(s) ST.Croix County, Herbrt H, OR Sharon Fouks (Called Municipality below) We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) Part of NA of SW% and in art of the SW% of NW% 4 4 p 4 4 all in Section 32, Township 31 North, Range 18 Weat, Town of star Prairie, St. Croix County, Wisconsin Described as follows: lot 5 of certified survey map recorded in volume 10 of certified survey maps at Return To page 2859 )r that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of >ewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under :h. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. 4s an inducement to the County of St. Co i x, to issue a sanitary permit for the above described property, .ve agree to the following: I Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Stats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s 66.60, Slats. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. f The owner, except as provided by s. 146.20 (3) (d), Slats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s 146.20 (3) (d), Stats., the owner shall submit the report to the municipality and the county. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this ,ryreement rnay be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. lwner(s) Name(s) (Print) Owner(s) Signature(s) Herbert H, Fouks Subscribed and sworn to before me on this date: Sharon. C, Fouks,Q lunicipal Official Name (Print) Municipal Official Signature a Notary Public / My commissl expires: r--'yam s.k 1,,nicipalOfficialTitle(Print) W 1 r;1?3 (H 10'88) This instrument was drafted by the State of Wisconsin Department of Industry. Labor and Human Relations. 524556 CERTIFIED SURVEY MAP Located in part of the NWk of the SA and in part of the SA of the NW a, all in Section 32, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. N ~ m .,%,%w Lt^ 1r hl L C , o • \ 7 zm S.. D a 0Om w 6 ` , ~t ~ ~t Z ~~JL1~;+Ji 1~ rt 0: :0 m m -n Z as' . $ a O Av v'Ffv'ert cJ'; :;rep oN -kn W -n mzm UNP ATT~D LANDS a c N89°29'03"W 350.00' WI/4 CORNER 00 SECTION 32 O z m 1` Oo Co _ co '-o LOT 5 ~.1 N w r N °o ly Ir N Z Cc I I> 2.01 ACRES r^ 0 4 IU I-~ m 87,494 SO. FT. a w 10) I N I('1 m ni N) IC7 Ln cn O N S m 91, + eO' ,r , V, S89°29'03"E , 0 G N 340.22' S89°29'03"E 350.00' /C1) OT 4 Icy / C fY N - - IML / = -00 CD 0 W „IcTI~c _ W 80 rL'' IEn SURVE-Y NIAP i~- ID N w m VOL. 10, PG. 9$15 33' I33' a d 1,70 C 3C 10 0) ID I J o ~c LEGEND Iv m " ICJ I d 0 ALUMINUM COUNTY SECTION MONUMENT FOUND a B DD z m 1 1' 1 1/4" REBAR FOUND 6 6 SW CORNER m c") SECTION 32 • 1" IRON PIPE FOUND x c `T ► O I"X 24" IRON PIPE SET, WEIGHING 1.68 LBS. y PER LINEAR FOOT. F O N 7 d 100' ROADWAY SETBACK LINE N e~ 'h FILED n F r. 2 2 1994 ► Q JAMES O'CONNELL Jr OWNER Register of Deeds RUSSELL FLANDRICK SCALE IN FEET SL Croix Co.,WI RR 4 BOX 192 NEW RICHMOND, W1. 100 50 O 100 200 co J 54017 VOLUME 10 PAGE 2859 CD AMON& C 6992 a9va oI mm'I0A •aoTnpP ao3 paPog uMoy alpTadoaddv pup aoTjjp butuoZ AlunooxaoaD 'ISSdaOq -40VIuoo Taoapd Aup buTdoTanap ,ao buTSPgoand aao;ag •('o T ssaoop 'azis qoT wnwTUTw 'spupliom ''a•T) suoTjvTn69a pup saTna 'sMPT dTgsuMoy put? Alunoo 191viS oq ioaCgns sT dpw stgj uo uMogs Taoa2d gopa _ _ • awes aqq buTddpw pup buTA9Aans ui xToaD 'IS go Alunoo aql go aouvuxpap uoTsTntpgnS puvq aqq PUP sagnggqS uTsuoosTM aqq 30 fi,E'9EZ aajdPgO _go suoTsTnoad juaaano aqq ggTM paTTdwoo ATTn; anPq I jvgq .paq?aosap PUP paAanans AjPpunoq aoTaagxa aql go aTPos of uoilpquasaadaa joaaaoo P sT dPW Aanang paT;TjaaD sTgI lvgl AJTIaao osTP 'I •paooaa ;o sIu9w9sP9 TTv 01 joaCgns ST pup ('~3 'bS tW L8) saaov TO'Z suTvquoo Taoavd pagtaosap anogv 9g-4 buTaq pu-e -v -4o'I pips go auTT ggaou aqq uo qutod v oq lea; 00'OSZ 'H119Z1OTOOOS aauagq :qaa; 00'0SE 'MnE016Zo68N aouag1 !lea; 00'0SZ 190T3go pTVs IL 80v 95vd 'Z60T awnTon uT pagTaosap PUP papaooaa quawaspa ovS-as-Tno v 3o auTT IsaM aqj buo1v 'Mn9ZiOTOOON aouagq !t qo'I pTVs 30 aauaoo SN aq~ o~ ~aa~ 00'OSE 'auTT glaou pTVs buOTV 'a,,E0,6ZO68S buTnuTIuoo aouagq ,:5uTutrTbaq go . 9111 oq qaa; ZZ'OVE 't IOU PTvs Jo auTT ggaou aq1 buOTv 'S„EO,6Zo68S aouagq !aoT;;O spaaa ;o aagsTbaU Alunoo xTOaD 'IS aqj IV S08Z abed 'OT awr'Ton UT papaooaa dpW AananS paTgTgaaD go t loq go aauaoo MN aqj oq 1aa; Zv'60Z 'uOTIoas pits go v/ZMS agq go auzT IsaM agq buoTv 'Su£EIVEOOOS aouagq !ZE uoTgoaS PT2s ;o aauaoo t/TM aqq IV buTouawwoo :sMOTTO; sv pagTaosap aagjan; !ulsuoosTM 'AlunOD xToaD 'IS 'aTaTvad JPgS go uM01 'M8T-d 'NTEL 'ZE uoTgoaS UT TTV 'V/TMN aqq 3o t/ZMS aqi go gapd uT pup t/TMS aql aO t/TMN 9141 ;o laud uT paIVOOT puPT ;o Taoaed V :sMOTTo3 sv pagTaosap aae paddvw pup paAanans Taoapd puPT aql ;o Aavpunoq aoTaagxa aqq gvgq !dsW AananS p91;Tga90 sTgq Aq paquasaadaa ST goTgM Taoapd puPT aqq paddvw pup pagTaosap 'paAanans anPq I 'xOTapuPTa TTassnU ;o uoT1oaatp age Aq qvgq AjTqaao Agaaaq 'aoAananS puVq uTsuoosTM paaaisTbaa 'uabPgAN '0 uaTTV 'I Ii.IdE t76Fq i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER HerhPrt & Sharon Fouks MAIMING ADDRESS 876 LincolnAv. Amery Wi 54001 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION NW 1/4, qW 1/4, Section 3- T 21 N-R-1-8-W TOWN OF Star Prairie ST. CROIX COUNTY, WI SUBDIVISION LOT NLMMER 5 CERTIFIED SURVEY MAP VOLU , PAGE_~ ; LOT NUMBER 6 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. Tile 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. 11We, 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: DATE: St. Croix County Zoning Office Government Center 1101 Camiichael Road Hudson, \VI 54016 11/93 ~6.0 b 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 Herbert & Sharon Fouks Location of property NW 1/4 SW 1/4, Section 32 IT 31 N-R 18 W Township star prairie Mailing address 876 Lincoln Av. Address of site Subdivision name Lot no. 5 other homes on property? Yes X No Previous owner of property Total size of property 2.01 Acres Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ X Yes No Is this property being developed ,,for (spec house) ? Yes X No Volume 1 i and Page Numbe CK9 as recorded with the Register pi 0-, of Deeds.1d 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 alpo 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 in the office of the County Register of Deeds as Document No. 524905 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. 524905 Sigpture of App 'cant Co-Applicant Paf-o of Cinnatiiro Tla ~-o of Ci.-rn ~i-iiro FED-14-95 TUE 13:19 H06LLE BUILDERS 2467227 P.03 ' FAX: PAGE 2 ' UE~ib f] :nR Ifl~LAR1IFJ>~'A)138~ ~G~ NO. REED Y-011 W"K REat"90 r6R per-.. WA*. i?OCUMfN7 WAiiRAN" IIITAT't DAY OY Vg19CON$IN roku 4-. tf6 f _.-Russell L. FI&ndrick and GgDX949e M Cd~ jgcz r:l dr e;cJr . .us 1' aria tin . a.. ux v.... file .l mer tial R~p~erty _ rand watrlultx to r ,6li+Gq A.. . esrT.~a . Sti,'Lrp i C_w..p Q. 1GA.o...L~4i[txtAAL:..10.RL1..1xa, %._AA Aux v.ivd><ehi,p.. mAx.l.tal ..tape}CkY......._ - n~ ht.JnN Te Uw Ieltxwir4 Ionainei ro*i eri+b in a.tirey, .rw•~=-: ,~...,.a.-. lttnw of w11ay„3n: 702 Pired NtH PYoyerty i.ucated in part of the Northwest Qumr.ter of the Southwest Quarter and in part of the Southwest Quarter of the torthwest Quartelrl all in Section 32, Township 31 North, Wisconsin Went, a TcAm of 11a++s 1 Star Prairie, St. Croix County, n Lot 5 of Certified Survey flap recorded in Volume 14 of Certified Survey Maps at page 2854. Thin ......--i a hwo toad prefrertr. (tat (le not) Racepiiua to waste ks: municipal and zoning prAtnanoes, easements and rostrartions of record. 1t1.~5,.. Vaud tUlx ~JF day of j.anuar.y........... lFfiAl.j 4~ae:1 andrick R ........1. 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