HomeMy WebLinkAbout042-1004-50-110
o0
0
M 0 6'
c:, ~ v I
d 4 0
Q)
a~
N ~ I
N O
~ O)
p x
Z
_O
~ Y
C
y 'a
W N
m o
10
. Ol N
0
Z o0 m I
~ m ° m I
C
LL
_ p N Ch
N O
Q ~ o I
~ ~ M I
Z z o
~ a
Z
04 a m
Z
o
o z v
o z
z
o N
16
o z
F r C
c
' v m
'D 0 3
y _ N_
co a)
n
N O C
V
O N Q U
O Z CO Z p
N .1 z
co ~ d 'C I
O O £ N
CL a m b 0 oco
ao o- °o I
O p a o a M O
0* E -E- u h /1 Z > W E- I- F- _ cal
L1 Cn o v
0 0 0 0 Z O
►~,i m a a a
z o cn ~ 0' (O
to J U o rn rn o
o (o } ~O
i o m ? o
N X73 _O
Ali O a O
}lam I ~ N N
~ O w- N C
i O o! T - O C: E O N
L p
a O i O O ch C 4 N
V 4 M E N a 0- -0
E C N (o N
p o CO f C L ) _
L: O- N O N H N M
i..~ ! N> O O m E N U
O O > C[.1 N O
r
V d £ a
L a
`irri E 'c 3
rw m
A c°)a~I'O~v
S T C - 10 4
t Q/ /ate
AS BUILT SANITARY SYSTEM REPORT
.~j. `
Cb
RECEIVE"'
OWNER Timothy& Deb= h Briggs
A' R 0 4 1„916
ADDRESS W6955 County road N
57 CROIk.
C9 COUNTY
_P-1 denvi l l e., WI 54003 ZONINGOFRGE
SUBDIVISION / CSM# Volume 8 Page 2208 LOT # 1
SECTIONNENW4 T 29 N-R 18 W, Town of Warren
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEE OF SYSTEM
i NdeIA
~1 loo, o' 6n
APA
v~` S'caie / X. CoO
~ . Bg
Z<
Batt \ ,
N
)00(5r( Welter 5q t,C, ink
71, Gaa84 U
7
NURTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r k
BENCHMARK: T6 /A O 'J ~ 1 /^Oh ie,, 2
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: WeiS,-r Liquid Capacity: /Ow
v i
Setback from: Well House 15 Other
Pump: Manufacturer NI Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
r
Width: 1oZ Length o
7 Q Number of trenches
Distance & Direction to nearest prop. line: South
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: l //&&(o
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsrn;DepartmentofIndustry,
PRIVATE SEWAGE SYSTEM County:
Laboltnd Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village a Town of: State PI
BRIGGS, TIMOTHY & DEBORAH X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
ll.0f ~W rJ.& J 0384
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic J Benchmark 3 ' /po, !
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet S,i y gg_~~
TANK SETBACK INFORMATION St/Ht Outlet /4' 9g,14
Vent
irito ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Ar
Septic NA Dt Bottom
Dosing NA Header / Man. 7.3
Aeration NA Dist. Pipe
Holding Bot. System g- a ° 96 ,
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Lrictio System TDH Ft
Head
Forcemain Len Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Id, Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 90, / DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / TREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of CHAMBER Mode Number:
System: 0 'U 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 n Depth Over p xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil C] Yes E] No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Warren.3.29.18W, NE,NW, Lot 1, 120th Street
y
Plan revision required? ❑ Yes (D"No d
Use other side for additional information.
SBD-6710 (R 05/91) Date I sliettor's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
_ I
I
SANITARY PERMIT APPLICATION
COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
St Croix
STATE~~T~RY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than --~~flJJ O
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.
PROPERTY OWNER PROPERTY LOCATION
Timothy & Deborah Briggs NE t/4 NW '/4, S 3 T 29 , N, R 18 )ERWW
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
County Road N 1
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
TATT 154003 1015 273-3169 volume 8 Page 2208
II. TYPE OF BUILDING: (Check one) NEAREST ROAD
nn ❑ State Owned
120th Street
Wagr
❑ Public L,X.~ 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMBER( S)
III. BUILDING USE: (If building type is public, check all that apply) 042-100(-5&4+& -s0-110
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 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. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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-Press rized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 *seepage Trench 22 ❑ In-Ground 42 El 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
450 /a ,S to Y J15- Feet bl - 8;k Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
App.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic
Tanks Tanks strutted
Septic. Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PSi atture• S mps) MP I No.: Business Phone Number:
Paul C.J. Steiner t 6780 715 425-5544
Plumber's Address (Street, City, State, Zip Code):
N8230 945th Street; River Falls, W_Y54022
IX. C NTY/DEPARTMENT USE ONLY
)
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing g77n;
C. Surcharge Fee) /
/
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 a 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, 6013-266-3815.
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 tie 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.
Vill. 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)
Owner's name San. Permit No.
H63.05 PLOT PLAN
Show:
l 4 Location of building served Dosing chamber
(D Septic tank Er Vertical/horizontal reference point
Building sewer CHI System elevation is Iq 6.S O
v~ Effluent system Q Well C See 13a-TIIE~' Stx-nw)
El Replacement system area Q Property lines Win 50' of system
N•q. Distribution boxes R Scale = 1 ki = b O i or dimensioned
►J.q Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
-7'7
o
0
(P
~ tzCssT Lwr 31 I - ~1.. loo , o o~V
Lew E A!r l R.LII~) P! a~
24S-So'
prT LkMST So t-lzt" ~ - s3
~T p\zo~tcv~~p r1M) kT LWrsT sA -
Z S' F-cZUw1 S~~11C l"h~v)t . ! - - - - -1
w~
~ ~p o 0 G~ W ~'cTS F~2 Cl1K+ e'12.t+~'~ - - - - - 4
UL es,
W
mz
41963 S
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St. CroixCounty and theSt.CroixCounty Zoning Administrator, does
not assume or hold itself liable for any,.defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
7~a
ze i o' 47t~-"~
P iun r n ure Licenseo. Date
T~rh ~ ~e~oZl~ E3 Z.l G~ s
88~
- ~j__r
- - 3~
v Pius
t~ER>:oR NMEL~ Pv Q-
r o~s~BvTU>u PI pe O
SoL~ 1~~naR LL 3'
C,2.0SS T-) ON
y"~1EU? pipe W/
NI.PRuveU CRP _
-AT L~"RST 17."A$o-1E
Fr~Tls!}~ GRADE --I. 6 ~
f G2/!D~
N;'ARUVSO S` X)T)4E7C
00
_
`r"~~} C lc ' 1 ~ 1 `~1 ~ L OR '7 y , ~ , J `J ~ ,J ~ ,j ~ ✓ :J J i:. G
OF v13 t(Nm ipr) CTID SMNW C-LC`V.
v"Pv c II I S-Maunou Q1 pe
I/y, y To Z i~Z y ~G G R E 5 r~ TE i~72l=01~A`T~ P I S l~ .
Nfl C30T`Sb1F'1 Q1= BED
a~L~w t~-IpES ~
DISTRIBUTIOIJ PIPE TO HE AT LEAST AUCHES BELO\,✓ ORIGIMAL GRADE
AQD AT LEASTZO 03CHES BUT WO MORE THAVJ 4Z IUCHES BELOW FIMAL GRADE
MAXIMUM DEPTH C)F EXCAVATIOU FROM ORIGIUAL GRAD- WILL BE -I~~ tIJCHES
MI I UM DEPTH OF EXCAVATIOW FROM ORIGIUAL GRADE WILL BE 3'Ll INCHES
7 klo
P um r s signature icense No. Date
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
"'D"_'Y, DIVISION
LABOR A'ND PERCOLATION TESTS (115) 5`/t # 4 2Z P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 5 7
(ILHR 83.090) & Chapter 145) ,g
LOCATION: SECTION: TOWNSHIP/ UP +G+POkt: : LOT NO.:BLK. NO.: BDIVISION NAME:
Nc 1/ Nw V4 /T7-9 N/1118 E (o qQ I aAos~o Cs►~
COUNTY: OWNER'S MAILING ADDRESS: n
SzCko tx etc AQ4 0v,, 4 IJ1sv K1C1rnoAVf~ S4o/ 7
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: FI S: PERC A /j TESTS:
,NK CNtw ❑Replace I S~`f L~d 5 ~p / 90
Residence
v~ Swcs v SZ 51 ~ - S laT'r,~l~ /
RATING: S= Site suitable for system U- Site unsuitable for system
OI~V,ENTI~NAL: MOUND: []U IN-GRQUND•P URE: S JT,EM-IN~-FILLHO~LDING A K: RECOMMD~ED SANE (optional)
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the -fA
under s. ILHR 83.09(5)(b), indicate: 01_1oSS 3 Floodplain, indicate Floodplain elevation: IV K
t PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH MI. ELEVATION OBSERVED EST. IGHE T TO BED OCK IF OBSERVED (SEE ABBRRV. ON BACK.) C
4 /C 1 SL(.-~ 18`19evL Z0*1&Z J N5 QZ'1r;9R,,~V
B p$ ~,SbZ
&fnar ~ r.oa 1O''h&AQ Ms u.siC47 CoI r
B- 16.'52 1.7% > g ~O 19"&LLTS l&"9QNS,L 67'R&81I?nI MS
B- 3 T-T ~ 97% 0 Lr > 7.75 -1s"tkLIS Z4' BaN L 18" R&IRPN A1S &e st 36`8RN MS I cwk
19 BL1LTS /9 anNL 17"eR.vSL 20 L +e~, S G~
B-. T4Z o0.04 t4oN r: > S.4Z 11"Rix.rC146,e /S~R4eeN►~Is~'~„?
B- S x.67 9 9. Ts7 Norv 7 11 '"ALL-rS 27" eQU L 19' R& kkn FS he,.Isc 4c' 8 RN AIS
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER LNO"n AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PERINCH
P_ 1 5.30 gou>E /o/ ,g0 O ? 3 > 3 <
P- 2 3A o 1Jot4f. 99.90 3o -Z'/-Z Z%4 2 /3
P- 3 3-So oNd o .o0 0 Z Z Z / S
P-
P_ ELOAT ON AT 8RL
P-
PLOT PLAN: how locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vert cal elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION Ci I{j.So
i I
41 Cc12N@ - F~X► G 1 T...C M Off l~ 1Z 1~, t_
l t ,
r
If G
8~~a~ ~
►
v' _
E z
l ~
i_. . ..e.
i
J
n
r L
4 l~ I ~
r _
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NA004v (print): A0 TESTS WERE COMPLETED ON:
14gs'ON J014t4.50N Svc fcs~1NG, S 40
ADDRESS: CERTIFICATION NUMBER: PHONE N MBER(optional):
407 SEcQN4, I v &&d Ai I SA014 3~~4 3~6- oXv rN,
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
AB AN RELATIONS PERCOLATION TESTS (115) GSM c~MADISON W DIVISION
X 3907
HUMAN RE
(ILHR 83.090) & Chapter 145)
N~CA,/ N~,/ E~10~T~9 N/1118 E (o TOWNSHIP/ QidttF~ ~h~i': LOiNO.:6LK.NO.: VISION NAME:
n ,~U~,Of•"6S
cSM
COUNTY: OWNER'S MAILING ADDRESS:
S~C*0Ix EPIC-
14 a2k o~xlMS -Pr 4 nl~v AcHnalvA 54017
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: I PROFIDE NS: A )O TESTS:
Residence UNV, MN@w ❑Replace IL S~1 G~1D S ~OJ~O
UN
S0)cz VAM* !a SZ < I1
RATING: S= Site suitable for system U= Site unsuitable for system ROVND-PRESS OI~,STI❑U ONAL: MZS. ❑U IN G_ S DU RE: S ffiUj-INQ-FILLHO[LDING A K: RECOMM DEED SYSTEM: (optional)
Fu'f Percolation Tests are NOT re uired DESIGN RATE: I If an -f
q y portion of the tested area is in the
nder s. ILHR 83.09(5)(b), indicate: CLdSS Floodplain, indicate Floodplain elevation: IV A
ths at PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH 00. ELEVATION OBSERVED EsT-RTffH_EST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
19 6Li_-rs 1119 $2wL 20"gRuBLS4z'LT$Qtir+IS
B- .62 1,46 1 >4,oa ro"RneAN AS 6 Nst-'cob
B- "4 "1 <,0 9.7% > $ •S'O 19' &L4_T'S ICERAI S, L 67" Qo82N MS ~P<A
B- 3 T-7< 97.94 0 E > 7.-7 1S"k'XrS Z4''8a,.,L Ift"I?L&vMS 4ENu 36"BRN~S~ar2
19 9LC.rS 19 aamL 17"ePASL ZO
13-, 4 4.4Z 00.04 E > g.4Z rl''BaNCS1FG~ IS"R48eN~s~F'G~t
B- S g.67 11167 NbNj, Ys.~ 7 it".91.L-rS Z7"9QUL 19'R&kkn FS pff,,,u 4t' BRN ►'►'IS
B-
hwc- FT PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP I WATER LEVEL-INCHES RATE MINUTES
NUMBER ID16MfS AFTER SWELLING INTERVAL-MIN. -PERIOD 1 RI D P PER INCH
P_ l 5.30 40K)IIIE /U/ ,g0 O ? 3 > 3 t 0
P- 2 380 QoMA 49.90 ?0 Z' z Z%4 2
P- 3 3 -SO owe. 100-60 0 Z Z Z /
P-
P- ELIEVAT ON A_r I<RC.
P-
PLOT PLAN: how locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vert cal elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTE ELEVATION 46.So
I 7
k s E
~c,~ CcQr.11E~' ~15!Ir G TCM vO~ I jIZ1
Ig~~~~gRK- / I ~ P►~
-5 AlE3
E
E
r _Tp. _ .j _
f
I
4 I ~ p
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
1404Y 30Ngso'j JOK.4sON S~,+~ crY►NC~ S g Z9
ADgRESS: CERTIFICATION NUMBER: PHONE N MBER(optional):
407 SCC.a~,~ S~ 4or 34-tu- o 0
lc,sd~ I ~ ~4 ~k
CST SI CINAT
W44
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
i
4586.42
C ER T I F-I ED SURVEY 14A P
Located in the NE 1 /4 of the NW 1/4 of Section 3, T29N, R 18W, Town of Warren,
St. Croix County, Wisconsin.
Owned by: Richard Hopkins
Rt. 4
New Richmond, Wi.
54017
N I/4 CORNER NORTH -SOUTH 1 /4 SECTION LINE
SECTION 3
T29N,R18W UNPLATTED- LANDS
S 00'05'32"W 290.50' ( SOUTH) S 00 05' 32"W II
-j :7 LU 238.02' 4560
w I. I 00 - S 1 /4 COR.
0 p I CERTIFIED -SURVEY_ O SEC. 3
010 1 MA P M O
C\j I VOL. 11 PAGE 121 _ N O O
0 10
CY)
z1 ( NORTH) V ~it~D
S 00'05'32"W 290.50' Z
45.00' 1 248. 50' ao 8 MMES o 61990sh, 2
R a~ONNELL
I y Z.,/ m L S~ Croix speeds
i LOT 1 00
w1 0 10 140,438 Square feet (3.224 Ac.) pj
o lei I Including Right -of -way
0 M
61a) N 131 , 440 Square feet (3.017 Ac.) 3 I
1. I Excluding Right-of-way (n1
u-1LID a
°I'a' 30' LO zi
al
w1'q I _jI
45.00' S 00'01'57"E 524.75' Lr)
zi
:1 LU 1 479.75' 1
I
w10 I I m WI
zl0 I < 30' UTILITY EASEMENT ~I
Z 1- I
a
0j I
F LOT 2 a 1
I 129,277 Square feet (2.968 Ac.) zl
m M Irn Including Right -of -way rn 1
rn rn
rn i•
z z v 1 18, 163 Square feet (2 . 713 Ac..) v
i 50' a IN Excluding Right -of -way a
0 45' 1
w 1
z
i ..I 1
= 45.00' 477.09'
o w N 0 0' 01 ' 5 4" W 522.09'
- APPROVED
z -O
I i -UN-P-L-AT-T-E-D -LANDS
0) - MAY 16 199
C\j 0
o 5T. CDOIX COUNTY
co 0) 0 ° COMP12EHf3VS W PARKS PLANNING
z AND ZON o,- COMMITTEE
Bearings referenced to the North line of the
NW COR. NW 1 /4 of Section 3, T29N,R 18W, recorded
SEC. 3 as N89°29'00"E.
LEGEND
- =
SECTION CORNER MONUMENT SCALE IN FEET 1" 100'
o I" IRON PIPE FOUND 0' 25' 50' 100' 200' 300'
p I"X 24 "IRON PIPE WEIGHING
1.68 LBS. /LIN. FT. SET.
FENCE
(SOUTH) PREVIOUSLY RECORDED INFORMATION 490-1720
DRAFTED BY JWG
STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Timothy & Deborah Briggs
MAILING ADDRESS W6955 County Road N; Beldenville, WI 54003
PROPERTY ADDRESS /o?y~ ea/~'lyy E
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION NE 1/4, NW 1/4, Section 3 T 29 N-R 18 W
TOWN OF Warren ST. CRODC COUNTY, WI
SUBDIVISION LOT NUMBER 1
CERTIFIED SURVEY MAP , VOLUME 8 'PAGE 2208, LOT NUMBER 1
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 I, 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. 24i~zl
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 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.
Owner of property Timothy & Deborah Briggs
Location of property NE 1/4 NW 1/4, Section 3 ,T 29 N-R 18 W
Township Warm-n Mailing address N6955 County Road N;
Beld nville, WI 54003
Address of site h2i/3
Subdivision name Lot no. 1
Other homes on property? Yes x No
Previous owner of property ga2m
Total size of property
Total size of parcel
Date parcel was created May 16. 1990
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house)? Yes X No
Volume 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.
I
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. , 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.
Signature of Applicant Co-Applicant
2- fi
Date of Signature Date of Signature
State gar of Ti :onsin Form 2 1982
534921 WARRANTY DEED
" REGISTER'S OFFICE
i!
DOCUMENT NO. rC
^ ---li - V0---- A ',-1(;1._ ST. CROa co.,wI
I -
Fta%;'d for Record
Harv! yy Johnson - - OCT 1 3 1995
_ - - ~t 9: 30 A. M
ReglstarnTDeeds
7onveys and warrant to - Timo th S. Br 1~gS and
and Deora lH Eu Brigs, husband and wife,
THIS SPACE RESERVED FOR RECORD-NG DATA
-.--v.vE A RETURN DRESS
~I~•Lrwe~l/ ~ / /
`_7 eL /
the following described real estate in St. Croix to ~(S s-
County, State of Wisconsin: eL~ u S v00.3 1
j
I Parcel Identification Number)
Part of NEI/4 of NW1/4 of Section 3-29-18 described as follows:
Lot 1 of Certified Survey Map filed May 16, 1990, in Vol. "8",
page 2208.
I
PEE ~i
it
~I
This 1S not
homestead property.
Y AX (is not)
Exception to warranties: Easements, restrictions and rights-of-way of record, ~I Fr
if any.
Dated this day of _ October 19 95
X - - (SEAL)
(SEA 1.)
. Harvey ohnson
(SEAL) (SEAL)
I
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Harvey G. Johnson STATE GF 7►ZSCONSIN
County.
authenticated t is day of _October 19_9 S Persoaaagv came before me this day of
- 19-- the above named
Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN -
I ~'r
(if not.
authorized by §706.06, Wis. Stats.) to me Itn"a o be the person who executed the ya,
foregoing iawrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0 lg and
Attorne_~at Law Notary Pia- County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My comramse, na is permanent. (If not, state expiration date: t;
necessary.) 19-- )
'Names of perwns %ignmg in any cspacov hnuld he Ivped ix printed Wow thar ignalurm it
WARRANTY DEED STATE. BAR OF WISCONSIN Wisconsin Lc%al 81ank CO.. Inc.
FORM No. L - 1982 - Milwaukee. Wis. ,I
1
I
I
I
i