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HomeMy WebLinkAbout008-1028-70-200 ~ I a a° I N y l~ Oq C a 0 C ZV O X O N M ° Y ~ I CL I o.. I ri ~ € 0 3 I N ~w CD CD cc C Z N LL C O o y c 3 " ~C Q ~a I ! I I Z y - O Z •d d I O04 Z d m I O O Z C I m r 7 (D Z a c O I w H ( z I a~i ` M I ~I ` N N 7 p~/J1 N a h • _ ICI a O (p I O O N Q w N zco z z I N d C I N {0 C N V! ~ L O1 a C ~l w O N W b O c - O rC Q ra N Z N> ` 3 3 a a CL CL CL A CL 'S I o N o } U) J U rn rn m m ° - v ° :3 ml ~ a cn cc o w w 30 j LA f- O N in -06 l ~ L N C C C? a p @ -0 :z C co O U N y C R d 0 Cpy N f0 N N d C C ° Ern w Z ° I ~.y OD N a0+ E C L ~y O (n cc u 04 0 Z N H 2 2 U) W co N 0 Cl `m dt _M a ` C ~ I 7 O 3 .O R v~ A U a o U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 C. C``". t._✓ ryr. ADDRESS T- SUBDIVISION / CSM# LOT` SECTION _T VT N-R W, Town of ~„u~.`„ ~►c~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -A PUCam- ~~~w~ &00 -N> rots*, p nr -L3Lo INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. PUMP CHAMBER Manufacturer: 0-4>k5Pv- Liquid Capacity: Lr?S0 Pump Model: ~t•v Pump/Siphon Manufact. * .o v Pump size d V► Elevation of inlet-: 6,Y Bottom of tank elevation Pump on elev. ia3,3(Pump off elev.: g 91 ra 6Gallons/cycle : Alarm: Man.: Switch Type: LocationiLe Distance from nearest prop. line: Frontt~A SideL001 Realq(OFt. Distance from: Well ~00 Building Ap SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Gq Length n Number of Lines: Area Built,L x/9 Exist. Grade Elev. q G►Q Proposed Final Grade Elev. Fill depth to top of pipe: (0` No. feet from nearest prop. line:Front6!?~, SidA W 01 qoo Rear Ft. No. feet from well: 00 No. feet from building- HOLDING TANK Manufacturer: Lk),QISe Capacity: I o25(~ 7 ~ r No. of rings used: Elevation of bottom tank: ~~,►c( T Elevation of No. feet from' nearest prop. line:FrontbOC), SideLOO, ReaR00 Ft. No. feet from: Well, building .29L_, nearest road Alarm Manufacturer:- Le CJ- r+ C^) ' I INSPECTOR:- -Ar DATE : PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj f Wisconsin Departinentofindustry, PRIVATE SEWAGE SYSTEM County: Labora`nd 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 PI BOURN, RICHARD X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / ) I Benchmark SDI, /66 Dosing Aeration Bldg. Sewer H F olding St/Ht Inlet 105 ~q,13 TANK SETBACK INFORMATION St/ Ht Outlet $q 67 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ~o p' ~0 1 -)00 NA Dt Bottom Dosing d b l ZqL gob, y 2 dui NA Header/ Man. ~q, Aeration NA Dist. Pipe ,q5 q~ Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand /Soy f Model Number I GPM TDH Lift $io~ Friction System TDHI,!~l Ft Lc ss Forcemain Length p Dia. HH Dist. To Well U,1W SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of T nches PIT No. Of Pits Inside Dia. Liquid Depth S I DIMEN I N DIMENSION rr SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacture SETBACK INFORMATION Type O CHAMBER Model Number: System: b661 -5 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 I Depth Over ,J I'' xx Depth Of xx Seeded/ Sodded xx Mulched ~n JJ i Bed/Tr nchCenter Bed /Trench Edges 3) Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.10.28.16W,SW,SW,LOT 2, CTY. RD. "BB" g ; c`1~ -7-1 1 }j.,C1 u1Si ~E Plan revision required? ❑ Yes ❑ Noq << Use other side for additional information. 4", SBD-6710(R 05/91) Date Inspe or' i mature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , i I ST. CROIX COUNTY WISCONSIN ZONING OFFICE moil" I N N „~■,6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 18, 1994 Richard Bourn 477 C. T. H "BB" Woodville, WI 54028 Dear Mr. Bourn: On November 07, 1994, a sanitary septic system was installed on your property located at the SW 1/4 of the SW 1/4, Section 10, T28N-R16W, Town of Eau Galle. Please be aware that prior to occupancy of the mobile home on the property, a temporary occupancy permit must be obtained, as well as a major home occupation permit for the intended use on the property. You may apply to the Board of Adjustment for both permits on the same application. I am enclosing an application. Please complete and return to the Zoning Office along with the appropriate fee. Should you have any questions, please contact me. Sincerely, Mary Jenkins Assistant Zoning Administrator cc: Clerk, Town of Eau Galle File SANITARY PERMIT APPLICATION v'a~r!R In accord with ILHR 83.05, Wis. Adm. Code CT btzi~ ' STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than P O` 48% x 11 inches in size. - 1:1 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 R-,'c_A 1Rd OURS Y, SiJ%,S /d T N,R '06 E(oral PROPERTY OWNER'S AMAILING -ADDRESS LOT # © T BLOCK # CITY, STATE I , ZIP CODE PHONE NUMBER SUBDIVISION NAME/OR CSM NUMBER wOa~v4) <S .S o;;k 7/s be9-37/ L Z/ 1:1 CITY p NEA~ OAD~~ 11. TYPE OF BUILDING: (Check one) State Owned V ILLAGE : C~,4.4,4 G LL C 1=14 OF: ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 72, 10 Apt/Condo CJ 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 4-0 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 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 g 8 $1 7 q3 r 4 Feet 7 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank W e 11),"o - Lift Pump Tank/Si hon Chamber 1 49 07 6 o 7AA k El L1 I F1 1 11 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PlumbLer's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 7 17 r Z-2 LEa);n 42 IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanita Permit Fee (include geroun water Date s74~ I uing Agent Signature (N ee) pproved ❑ Owner Given Initial ~f Adverse Determination ] vlJ• X. CONDITIONS OF APPROVAL/REASONS FOR SAPPROVAL: r' .,l ~l a ~1 h O me 0 C,e e Y1 0'►,/~.c Cam"` e C.c1'►^1 S SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' . , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Saniitary Permit Transfer/Renewal Form (SBU 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 a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. 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) 0 d A Q S K~ I I I O J ~ ~f k Y IoM ~ y cl a 3 PACE ~ OF 4f 1 C, Froth Alr Inlets And Obesrvallon Pip* ( Approved Veni Cop MIAIrn.. 12" Above Final Grods 20- 42" Above Pipe _ Cost Iron To Final Grade Veal Pipe Marsh Hay Or Synlhelld Covering Min 2' Aggregate Over Plpe OleHlbullon - Teo Pipe 0 0 0 0 0 6" Aggrogals o Perforalod Pipe Below fteneoth Pipe o -'Coupling Terminating AI Saloom Of Syelem 1 SOIL FILL DISTRIBUT10f.I PIPE SyPjTM APPROVED ETIG COVER o 'MATERIAL ot7, 9" OF STRAW 2"OFAGGREGOE j OR MARS" HAy ELF V. OF___LEE ~k ~3 '5" p1S~ R!,a!;T1 71J f If P To, PC AT LEkS7 4AJC1.IEE S PI,E,L.Orn/ O,RIGIKA,, ,L• C0,1ELA,O,E A.j L ,C A S T Z O I AJ,C ,F. F .S 43.07 UP PIAR 1E T, H A 1J `12 1;N C ~4E 5 Iq E,L O W F,I fullDyl C►t~'r DyOrE MAX)p,uM ©,€Qrli of F-)(tAVA-ricp r-go''t ORibwu 6AAK- WILL BE IIJCM.E•$ M!,N;I)M,UIM ®IEpTk1 OF (WA ATIOO feOfAt 0~16kOAd- GgillgE WILL BE 3 6 INCHES LICLUSE k.IUMBER: , DA-r r- 11~ PAGE PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP PIPE APPROVED LOCKING 4' C.I. VENT P WEATHER PROOF JUNCTION BOX MANHOLE COVER ~ 2-5' FROM DOOR, WINDOW OR FRESH 12"MILI. AIR INTAKE I GRADE I yu MIN. I ~ IWAIN. CONDUIT-- - 18"MIN. INLET PROVIDE I - AIRTIGHT SEAL I I i I R I I ~ v APPROVED JOINT A I I I APPROVED JOINTS I I I W/C.I. PIPE W/C.I. PIPE I I ~ I EXTENDING 3' EXTENDING 3' ALARM ONTO SOLID SOIL ONTO SOLID SOIL B I ON C ~ / ® I ELEV. 474 s FT. PUMPS OFF 0 CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC a SPECIFICATIONS DOSE ' TANKS MANUFACTURER: _0I5/..<-ec_"~ iJUMBER OF DOSES: .-T~--- -PER DAJ TANK SIZE: TA GALLONS DOSE VOLUME INCLUDING BACKFI.OW: GALLONS ALARM MANUFACTURER: $ e4, O MODEL NUMBER: CAPACITIES: A= 3 INCHES OR 14-16~SRLLONS SWITCH TYPE' R6- Ir g = 2 INCHES OR ap-AALLONS PUMP MANUFACTURER: O LL -eye c = INCHES OR /(OZp_PALLOIJ5 • ~j ~G7~LLONS MODEL IJUMBER: 4 D = INCHES OR 113 SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE GPM VERTICAL DIFFERENCE BETWEEM PUMP OFF AND DISTRIBUTION PIPE.. a FEET +,MINIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET + -.50 FEET OF FORCE MAIN X - ~F loo FZFRICTIOM FAC70R..__2_ik FEET f. l ~s 1 0 TOTAL DYNAMIC HEAD = FEET INTERNAL. DIMEWSIONS OF TANK: LENGTH ! I ;WIDTH b iLIQUID DEPTH s-J SIG NE D: LICENSE HUMBER: `~~°6 y/Y DATE: ~~O 5741 to CC W w w HEAD CAPACITY CURVE aura 61/4 4 ~ "53-55" SERIES 4% _ • 125-1 TOTAL DYNAMIC HEAD/ 476 FLOW PER MINUTE EFFLUENT AND DEWATERING o - Q 6 HEAD CAPACITY 20 UNIT /MIN -11/2 - Lll FEET METERS GAL LTRS 43/16 111/2 NPT = 5 1.52 43 163 m V 10 3.05 34 129 15 4.57 19 72 } 5 19.25 5.87 0 0 Q 1 4 D 10 O ~ 2 5 915/16 0 US 10 20 30 40 50 3 /32 GALLONS LITERS 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Piggyback Mercury Float Switches • Available with special cord lengths of 15', available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non-automatic 15 ft. SELECTION GUIDE M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts-Ph Mode Amps Simplex Duplex 2. Single piggyback wide angle mercury float switch or double piggyback mercury float M53/55 115 1 Auto 8.0 1 -or 1 & 7 - switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 10-0075. D53/55 230 1 Auto 4.0 1 Or 1 & 7 - 4. See FM-712 for correct model of Electrical Alternator, "E-Pak". E53/55 230 1 Non 4.0 2 Or 2 & 6 3 or 4 &5 5. Sensor mercury float switch 10-0225 used as a control activator, with E-Pak (3) or (4) float system. 53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 IbS. -.3 H.P. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in simplex or duplex operation. P/N 10-0002. 7. Two (2) hole "J-Pak", junction box, for watertight connection orsplice, P/N 10-0003. For information on additional Zoeller products refertocatalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alterna- All installation of controls, protection devices and wiring should be done by a qualified nator, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control licensed electrician. All electrical and safety codes snows be followed in addition to the Box, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Z)F ZZIL TZ7. 3280 Old Millers Lane Manufacturers of . ° O P.O. Box 16347 • Louisville, Kentucky 40216 O (502) 778-2731 • FAX (502) 774-3624 Q~4ZITY PUMPS S,vcE ff 3~ r- 'n D In _ 0 N0 rN M ro NG N Q o r N o. -n d -~JC A 3 ;7 (7 I m ll! 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Z-)7 4A V N C G C x (D J; K r c ~ A L ° ro eN O ,p 0 0 -f- CA LA c ~Fs `D ~v CA ( . + 0 up LP v x~ Oo JA M O (D N O 01 N z J' o. t° 'I n m c to O N CL > W A B A 0 10 c N J O 7 CL #n 0i V) 9D c I_ ~ A 0 D 1/~ O/ W M ca m ,1 A l ~ m In p G$ o 9D o (D A z 4n m or v " (3 v = H N m D Ti b ~l z C ° ti v J~ o N = N A cn n A V a n ^ ` r v v+ T a CL< 0,- a- ~A mN o jx III C7 N V W %.0 C7 un rn Q I V 1 O to V, O O d y V v to ON 0 1~, I 3 1 0 c rlu c ~ -I J v Ilk pN_ ~L 1C- I v x O y a UPI 0 In -D I ~D L 6 t^ =r U) ~ v 3'Tay'tt16N 12.1AGN ~ ~ P N C U) Q C4 C Lf) o ~ : Ir LA V) r _ (A J\J 0 0 w I Oo 11 A o / I~ 4'764 98 CEM'XrXEO SURV" TRAP MOLLY OLSON" Part of the Northwest 1/4 of the Southwest 1/4 and the Southwest 1/4 of the Southwest 1/4 of Section 10, Township ?8 North, Range 16 West, Town of Eau Galle, St. Croix. County, Wisconsin. C 'Indicates 1" x ?4" iron pipe weighing 1.13 lbs./lin. ft. set. "'Indicates fence. UN P L A T TED L 'A N D S Owner 1 s Address : 474 C.T.M. 11BB11 -,.~odville, WI 540?8 k S 00. 04' 0J., W 636.33 ' E L I N E W 1/8 Sw 1i4 Phone- 1-715-684- 3714 O ~ INS Q Q~ i LED 9 Dtc O 61991,. 10 JA1AE,4M c &CONNELL Sc Rook* of Deed, N ~I W a y ` f St Crab: Ca, WI p~ t N p ~ N O ~ • VI ,t • O r V~otb hC ` h , M • 4m JI s y a JI ~ 96 ,J b N 000 34 ' Of "E 64 9.99 UN PLATTED LANDS a b- _ b ow ~ v t w 8 N Z 2 ALL 9EAR/NO$ REF. TO THE WEST LINE Of THE iu r►d 1 O = y SOUTHWEST 114 OF Sec. I0, r26N, R 16 W, : r b 8 y ASSUMED N00'00'00"E 3 ~I + 1. O N> ~ O ~ O t t O ~ b r QI t 4 Q b b O j V O b 0 y j it • ~I W at Z ~7I a s 1818.311 - 96/. 66' I Ll\th slI W LINE SW 114 NOD* 00'00"t 2646.10' ,`,,~~~NU~u~rrh 6 ' C.T.H. BB" ~gCONS ' Dated: July ?9, 1991 Revised: September 12, 1991 ? r~LAU CE• ~ This instrument drafted =.M PHY : #C Z by Laurence W. Murphy ~o 13 a ? APPMAl k4 ) As A •'%RIVER FALLS,, •,44 i • Wisc. Vol 9 Paste 2426 LAND ~ll I Certified Survey Maps ~r~~~~~~~~~,~ 'X?~sr~►'~:~iF~ vx ~,n,:SP(,~1i1~?t; .4N!) .'_'J~11N6~ :'Ufvlhru'Ttl~= St. Croix County, Wisconsin Laurence W. Murphy Registered Land S veyor $ H EE T / OF 2 I CERT^I MEO SUR!1 I MAP MOLLY OLSON- part of the Northwest 1/4 of the Southwest 1/4 and the Southwest 114 of the southwest 1/4 of Section 10, Township ?8 North, Ranee 16 West,Town of Eau Belle, St. Croix County, Wisconsin. bescription: That certain parcel of land located in the Northwest 1/4 of t-he Southwest 114 and the Southwest 1/4 of the Southwest 1/4 of Section 10, Township ?8 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southwest corner of said Section 10, thence N 00 00'00"E (assumed bearing on the West line of the Southwest 1/4 of said Section 10) a distance of 1027.791; thence S 86038'44"E 603.09' to the POINT OF BEGINNING, of the parcel to be herein described; thence N 00034'05"E 649.991; thence S 85023'48"E 639.59'; thence S 00004'03"W 636.331; thence N 86038'44"W 644.53' to the POINT OF BEGINNING, containing 9.459 acres, being subject to and including easements of record. Oated;.,July 29, 1991 Revided: September 12, 1991 4 tfSS i State of Wisconsin) - County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direrltion of the Owner, Molly Olson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that this map and description shown hereon are a true and correct representation thereof. N~~1111~IIII~ 1 ~K..axJ1, ;0k fig,/ .e , • 1 LAUR6 n// S This instrument drafted by Laurence W. Murphy ` rr W M P _ 20 ~~,;...5... 713 ~AJ~ Each parcel shown on this map (plat) is eve Au~`'~, subject to State and County laws, rules 9F•'''•~•••"~gJ and regulations (i.e., wetlands, minimum LAND lot size, access to parcel, etc.). Be < 11111 fore purchasing or developing any parcel \ %Laurence W. Murphy ~r contact the St. Croix Co. Zoning Office Re istared Land Surveyoi^ for advice. Vol. 9 •Page_2~426 Certified Survey Maps St. Croix County, Wisconsin SHEET 2 OF2 K , STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER %C /4'~ 'D V i o fI MAILING ADDRESS ~J - e'Ty 0',l PROPERTY ADDRESS 19 ka6 (location of septic sys em) Please obtain from the Planning Dept. CTTY/STATE c~ o~U C-L /S 'S-21 a PROPERTY LOCATION - 5~ 1/4, -54) 1/4, Section 16 , T_ 22 N-R_Z4 W TOWN OF~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTHUDSURVEY MAP y7G y' VOLUME f , PAGE 2y LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating conditioq 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 a ion date. SIGNED: DATE: z y St. Croix County Zoning Office Government Center 1101 Carmichael Road [Judson, WI 54016 11/93 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 /F Z4 16 © 0 A /1 Location ofpropert Stc) 1/4 S41/4, Section 0 ,T ?N-R_LW Township Mailing address - Address of site subdivision name Lot no. Q, Q other homes on property? Yes No Previous owner of property ';wo Ll:~ © Ls0 n Total size of property i , A Total size of parcel 4/ .3 Date parcel was created l Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number 'O as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINGS - A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site or 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 t t of 3 of the County Register of Deeds as Document No. ignature of Applicant Co-Applicant q ///,g 14!~w ~Z - Date Sig atur Date of Signature l_y*~,,, 'i• •15.:x f4 11 ..iyuTr]:'Y1di S. r. • TH1'i RL,r_R'-: FOR RE;;ORCIN~ O4'A DOC LJt,L..,%r IN J.'o l -IM2 QUIT CLAi DEED 47E931 _ VOL 927 PACt 1.10 REGISTER'S OFFICE ST. CROIX CO., WI Molly Olson, f/k/a Molly Bourn _ Recd for Record - - DE01a1991 _ - -..Richard Wayne Bourn, a sing a person 11roro:00 A. M iit,~ to gnlt-cl.t V Reg:ew of Deeds St• Croix _ CO:Int)', the (ollnaing described real estate in - R`r TO state of Wisconsin: Tax Parcel NO- Part of the Northwest Quarter of the Southwest Quarter and of S4 the Southwest Quarter of the Southwest Quartt(Ni ht (28)and SW4 of SW4) of Section Ten (10), Township eny-eg North, Range Sixteen (16) West, Town of Eau Galle, St. Croix County, Wisconsin, more particularly described as Lot Two (2) of Certified Survey Maps filed the jjh day of December 1991, in Volume 9 of Certified Survey Maps, at Page 24266_, office of the Register of Deeds, St. Croix County, Wisconsin. This _ is not homestead property. (X;r tis not) / 91 day of It Or'/n 19 hated th-: y~~L~G~•~ (SEAL) (SEAL, Molly 'Olson (SEAL) (SFAL) AUTHENTICATION ACKNOWLEDGMENT si~r.ature(s) - STATE OF WISCONSIN ' _ St. Croix t'rnlnt, t"tl.,,r,t:cated this day- of 19 I'cr r \il:. came before me th`:s day of C1ca-..t\ _r 1'9_91. the above :an;td Molly Olson, f/k/a Molly_Bgdr-n TI"C .E: m1 :%titF;R T.\TE 1;AlZ ttF CiIi-tO\SIN ;utt „ rc<ed b; ;n';-rn;, Wt,. St.ttsJ to , „ tFe h. r=nn wh~ ese4ted tF.N ore. nc ins r _ .u,1 rul nrlc i tt,e SFr. f .y Thomas A. McCormack Baldwin, WI 54002 t I, r S_I T e 19~ car n ~I , r•, rt it not, t,ito e-,;vr tiw1 ••r :okl:. .,1. 1 11 .1^-~ C1.:1!~f LE: fSD 'f \IS ra\1 nI \\I.. n~-i\ r _ 1'nK 1 ♦ I "F rv v Ilk 0 Q. ~2