HomeMy WebLinkAbout032-2061-80-110
Y
7
4► 9 y0
S TC - 10 4 i~
AS BUILT SANITARY SYSTEM REPORT MAyr i3
OWNER en /rs Lf
ADDRESS / £ L
SUBDIVISION / CSM#LOT #
SECTION_,4,~_T, sly N-R,Zg W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Z/
CA
X
To
9
s
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer. ~Liquid Capacity:
Setback from: Well( House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: -Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Sam/ 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: -
PLUMBER ON JOB:
J
LICENSE NUMBER:
INSPECTOR:-
3 / 9 3 j t
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
LaboranclHuman Relations INSPECTION REPORT ST. CROIX
- Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
WOLFF, ROD
CST Elev.: Insp. BM Elev.: BM Description: Somerset
Parcel Tax No.: 10, 1 .99394
TANK INFORMATION ELEVATION DATA Dy
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer S~ 9 02
ding St/ Inlet 7, 331 9,1-31-7,
TANK SETBACK INFORMATION St/ Outlet 7 (id d
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > 56 NA Dt Bottom
Dosing - NA Header. ,J S~2
Aeration A Dist. Pipe aS'
i
Holdin Bot. System
PUMP / SIPHON INFORMATION Final Grade
91-7
Ma
Model Number PM
TDH Lift Lriction System TDH Ft
oss Force ain Length Dia. If Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION ~`(D DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
* Model Number:
INFORMATION Type 0 7e, ~v CHAMBER
System: ,-r S(O 7f OR UNIT
DISTRIBUTION SYSTEM _
Header / Manifold Distribution Pipe(s) x Hole Size x Hole S Vent To AiM-Rtake
Length Di Length Dia. 7 Spacing }
SOIL COVER x Pressure Systems Only xx Mound Or 7At-a Systems On y
Depth Over „ ee Depth Over ~i xx Dep. xx Seeded /Sodded xx Mulched
Trench Center 30 Bsd7Trench Edges 3d - 3` Topsoil El Yes No ❑ Yes [I No
COMMENTS: (Include code discrepancies, persons present, etc.) -,~/4 45
LOCATION: Somerset.18 30.19W, NW, NW, Lot 2, HighwayS 35 & 64
< q C r - ,
~o.
Plan revision required? ❑ Yes No
Use other side for additional information. s Q~ aQ
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
1
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
i
I
i
SANITARY PERMIT APPLICATION
~,~L=7R
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANIT R ER IT ~
-Attach complete plans (to the county copy only) for the system, on paper not less than 005
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. -
PROPE OWNER PROPERTY LOCATION
(or)o
Z~Z
% ! '/a, S T , N, R
PROP TY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, TAITE ZIP CODE PHONE NUMBER SUBDIVISI N NAME OR CSM NUMBER
II. TYPE OF BUILDING: Check one CITY NEARE ROAD
( ) State Owned ❑ VILLAGE rFer
Z Public ❑ 1 or 2 Fam. Dwelling of bedrooms - PARCEL TAX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 (9 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Faftory 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. ❑ Reconnection of 5.E] Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding.Tank
12 Z 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
S Feet Feet
Vll. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank AIgo
Ej F1 , F1 [j I L-1
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installs on of the onsite sewage system shown on the attached plans.
=Nam Plu er' i ~t. St ps) MP/MPRSW No.: Business Phone Number:
- ~
I ber s Ad ss Street, Ci late, Zip Code •
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssing Agt Si re N to
Approved ❑ Owner Given InitialSurcharge Fee)
Adverse Determination o (,j
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
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.
11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
Ill. 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)
eG
• cr~~ I SAFETY & BUILDINGS DIVISION
l r
State of Wisconsin
Department of Industry, Labor and Human Relations
October 18, 1995 5 2226 Rose Street
1 La Crosse WI 5460,3
4
I O CONSTRUCTION
KIM 0 CONNELl,
308 MIDPINE CT
STAR PRAIRIE WI 5402'6
RE: PLAN S94-11321 IEEE fE(.EIVED: 110.00
WOLFF, ROD
NW, NW, 18, 30, 1.9%'
TOWN OF SOMERSET COUN IFY OF ST CROIX
NON-PRESSURIZED IN-GROf'Nl:) SYSTEM
The Department has ended the review on the above-referenced submittal. The
review has been ended be=cause the requested information was never received.
If you decide to resubmit this plan, it will be trt?ated as a new submission.
This will include new plan fees and t1he assignment of a new plan
identification number.
Inquiries should be directed to me. at, the number l.i-,ted below. Please refer
to the r,lan number shown above.
ncerely,
Dennis Sorenson
Wastewater Specialist
Section of Private Sewage
(608) 785-19,336
CLC'. 4,T. C. to kll
i
SUDA-7887(8. 10/84)
soft
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
October 111. 199A 222C Hope Arkek
La QnAov
p , d5~°vTl
j, ` ( YON
KIM 0 1_} ft } t1t.'}~t S(~[~L{.1'7~ .I. " ` c "mss
STAN PRAIRIK NJ 5402C,
RE: It AN S94-41121 FEE RECEIVED: 110.00
WOLF F. 100I)
Nk Q. 18, 30.191,
WN OF SOMERSET COUNTY OF ST CROIN
T ho Department has reviewed the above-referenced E"hivittal. However. it
cannot; be processed until the Allowing additional information is provided:
l,e:::i.t ifient ion for the :•:1. ."i.1'g of the proposed sy0cm. Thu 1988 *oil report
t-to+-':_° Tiot. tt.ntaiit percolation test. 7".'3t v. i-able 0 i a :t possible toad rates
,lt^V:Sa`ialing on the soil condition whiv n in not a Qportoj in oz=.rT,'I3Iat;T1o.`_3'ical detail
a i ' 'ire iit:)f^: doing. 'Ihv range in Table 0 I. from Not Permitted to 0.8. I
t _1ti to thin you are cot"roct with the 0.6 j}tCr{)"ved, but (flu;Ft }l€ve a Near
upon which to approve the request. You might want to discus tt,e
itun hail with Tom Na-Won .ad7tt/or Jim TI'iolI1Ltnon in the St. Croix Co. Zonjw''
O f)f:'`"`•. 'Ihmr~ may be 3t way to C'I.tI0r; witPaow dCrLIIg a pit °,tount; on.
llhmittaln to thin office that i'equirp Wrlit.aonni information will he held for
months. If flit;} reo"Med information is not I`e't'•'kedf fitli`ing tl}& time,
a determination will he f3lrtde on the information tore i` eq.
!!inched you will Find a seconS copy of thig intlar. Pipabe retain one copy
of the _[et"tur and return the .'eI:`ond to, with the mnt.i'rialR we have requested.
noted, inf"rmation that has boon requested.
Unius; otherwise Inquiries should ho tiliirect.ed to me at t'..ho numb or j ist& t,±`tow. Please int-for
to W- - pi nit nuiiil' or show" abov-.
Sincerely,
r;iti it'hon
Plan Revipyer
't io" o Pri i'te `'at -"at,:-
KOE) 785-9336
r';r;'; is 7
ST t-,htll N
SBD,6423 (R. 01191)
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of
Labor,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 J
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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP OWNER:1 PROPERTY LOCATION
GOVT. LOT h(j ! 114 J 1/4,S T N,R '140
row
PRO RTY OWNER':S MAILING ADDRESS LOT # OF # UBiD. NAME 0 CSM #
/ a'
CITY T TE ZIP CODE PHONE NUMBER C [-]VILLAGE OWN NEAR T ROAD
< - - psi
New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building
j J Replacement pq Public or commercial describe
Code derived daily flow gpd Recommended design loading rate ~S=bed, gpd/ft2_4,:~ trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 'bed, gpd/ft2 fy trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft 'dL S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN
FILL HOLDING TANK
U=Unsuitable fors stem ❑S ❑U ❑S ❑U, ❑S ❑U ❑S ❑U ❑S ❑U ❑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 Trench
3
Ground -
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print" Phone:
Address:
Signature: C Date: CST Number:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bouxiary Roots Bed Trench
' •ti
M..
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
FT ---F -T-7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
FT
Remarks:
SBD-8330(8.05/92)
AIIJ
S;z
CJ) A,~ Sol , ~cr
J
s ~
7 0' _ za3- -
a r
b
i
,o
. Wiscomin Department of Industry, PRIVATE SEWAGE SYSTEM 1 Safety and Buildings Division
'Labor and Human Relations REVIEW APPLICATION Bureau of Bslilding Water Systerrif
-
Hayward Office La Crosse Office Madison Office Shawano Office Wa kesha Office
209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 4011 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 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 • f'+
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 plansfinformation. 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 forfn or have uestions on what information to
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your r4iferer 4 alQ
R.
1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time
A ointment Da a Revi er Name Plan Identifi tion Number .
2. PROJECT INFORMATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Project me [:]City Village Town Of: County
Project ocation
GOVT. LOT j/jj 1/4 1/4,S T N ,R E or
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type (include new and existing tanks)
Up To 1,500 gallon septic tank S110.00
A n At-Grade 1,501 - 2,500 gallon septic tank $120.00
H C] Holding Tank 2,501 - 5,000 gallon septic tank $160-00
M El Mound 5,001 - 9,000 gallon septic tank $200.00
N 19 Non-Pressurized In-Ground (Conventional) 9.001 -15,000 gallon septic tank $300.00
Over 15,000 gallon septic tank 1500.00
P El Pressurized In-Ground
O Other: Up To 1,000 gallon dose chamber $ 70.00
1,001 - 2,000gallon dose chamber $ 80.00
Building Type (check one): 2,001- 4,000 gallon dose chamber $100-00
4,001- 8,000 gallon dose chamber 1120.00
D Dwelling, l or 2 Family 8,001 -12,000 gallon dose chamber $140-00
P Public Building Over 12,000 gallon dose chamber S 160.00
S State-Owned Building
• Up To 5,000 gallon holding tank 160.00
5,001 -10,000 gallon holding tank $100.00
Code Derived Daily Flow gpd Over 10,000galion holding tank $150-00 , 43:1Z 0 Check If Replacing Existing System Experimental System (additional one time fee)
$300-00
Revisions To Approved Plan 2 S 60.00 .
e i io r Variance: Setback $ 100.00
1994 Site Evaluation . $ 225.00 . • • .
Petition For Variance O C 4 Plumbing $225.00 .
Revision $ 75.00
Groundwater Monitoring rounwa a 1Ulonitoring - 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: Zia -
Priority Review: Enter same amount as iSubtotal• I ja
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Toial Fee: ~Qr
,
5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) Co a y Nam Conta Pers
) - n f r a2w (n f r - Z29/ !L220.wx P
No. & Street Address Or P.O. Box City, Town or Vill e, State, ip Code
t
I 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. 1
NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually.
SBD-6748 (R. 07/93) OVER
r .
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY BUiLviNCi5
INDUSTRY; DIVISION
LABOR AND PERCOLATION TESTS (11 P.O. BOX 7969
HUMAN RELATIONS ~ A19 A2Sf WI 53707
IIIJJJ a! `f •j
3.0911) & Chapter 145) 9 4
(IL 8
iSE ATION: ' SEON:N /MUNICIPALITY: ` LOT N .:BLK. 0.: SUBDIVISION NAME
/f / co vac r d? v~ou~i w
COUNT /MAILING ADDRESS:
DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL D S RIPTION: A E S:
'I L
Residence - y Vew ❑Replace 1 2-11 __Zrd
RATING: S= Site suitable for system U- Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSUR S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
COS ❑U ®S OU [gS ❑U ❑S U ❑S U
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: LFloodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO Q R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B
y~~ O !o r S z /o ' oZ rs Sr ,3 0~ /Q a
B- /Op /~o'LG 7 O
B-
-aef PERCOLATION TESTS
TEST DEPTH . WATER IN HOLE TEST TIME DR I WATER L V -IN HES RATE MINUTES
NUMBER ll$ai6 AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P R PER INCH
P. 3 0 h _20
P- O
P- a CL
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori•
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at ail borings and the direction and percent
of land slope.
SYS EM ELEVATION /el SySfe~t ~l
i
~z _ T N
W _N1
1.
~l
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in'~ cord wftfi the procedures and methods specified in the Wiscons r
'4:
Administrative Code, and that the data recorded and the location of the tests are correct tbtthe of my kflowledge and belief
NAME print : N.. TESTS WERE COMPLETED ON
t I ,
19
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
2 r 7 /x.,26 7ElL
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR•SBD-6395 (R, 10/83) - OVER -
Cf)
o I' O
ti o
1
w
LA
1'l
1-41
G~
Y 0- PAGE OF
Cf ti S S Z.c l U l-% p Y r'1 c lJ S. S trr
d!W
®p IT
r
Fi,6A Ali Inlali, And Ob►oirallon Pip,
5ApproYad Y6n1 Cop 94-41321_
►Ilnltnunr 12' Above
final W ode t
20. 42' Above Plpp _ 4* Cast loan
10 final Gr,da Vent Plpo
Warn Ilot Or SyL2' Co.etlny
ruyyteyale Oe
OI Ut10~llon •
Pipe o ° to Too {
t
Ayytayo18
Beneath Pipe ° Pot totaled Pip" betev
o ~:.gllny To~nlnalln0 AI
Bolloor 01 Sirloer
e. l
SOIL FI►,L
OISTKIOUTIOt.I PIPE
APPROVED SwTAcTIC COVCI
OR 9"
2"~116GREGAIE r /1A7EFZ11~1 Of STRAW
OF, t~ARSW NAJ
AGGREGATE
ELEV. 0F~ FEET
o S
DIS'rRIryrJTIOIJ PIPE Tp BC AT LEAST IUCH£S BCLOW ORIGIIJAL GRADE
AI,JU AT LLXST LO IIJCHCS BUT 1.10 MORC THAI) tit IAIC►IES OELOW FINAL GRADE
I
MMUM Mr►1 OF FXCAV`Afloij rKom OR16V AL 6~AK WILL BE _ IIJCHES
L# I
MHIIIVM CKFT-i OF EXCAVATIOW rAOM CV?16 JAL GRApf- W11,1- 5C 1NCNCs
t
I
SIG►JCO: ~ ~
r
1
LIC C 1J SC IJUMBC IZ:~
i
DAT E : - 9-
i
RE
PR 3 iga9
~ r CY
4483.4 s
CERTIFIED SURVEY MAP MAYaI y989,~
JAMES O'CONNELL O
LOCATED IN PART OF THE NW} OF THE NW} OF SECTION 18, T30N, R19W, Regift of Deft
JJ
TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. SL R Co., W1
small tracts ti
SCALE IN FEET
N00°07'07"W
100 50 0 100 WEST 8.70'
N 0- CM 1 WEST 294, 9 '
E 155.00 212.81' 82.18'
m u (v Kr .
d N d /
rt ~ y0J
O (D N •tiy / ~S /
o -3 e
V O M c
S
co --h
m /
m
z ~
s m ~ /
a o LOT 1
M
0 162,707 sq. ft.) z /
)INCLUDING R/W /
3.74 acres
cb o /
NW CORNER 131,281 sq. ft•)EXCLUDING R/W o° / ,/•o
SECTION 18 3.01 acres
COUNTY MONUMENT/,-,3
r o 01~ o° small tract
EAST 391.38'
309.20' 82.18',
/ C.
O
O /
O /
do/
K, w O /
C
k~c LOT 2
97.801 CURVE DATA R/W
N76o3p,oo1~ 146,328 sq. ft. )INCLUDING R/W R = 5654.58'
' ~ ,V 3.36 acres ) p = 1°55'27"
W o C = 189.89'
C) 113,414 sq, ft.)
n C, EXCLUDING R/W / L = 189.90
.r 5 2.60 acres ) CB = N25005'43.511E
i a w r ,pQ' /
a m TB = N2600312711E
TB = N24°08'00"E
kec %
shed _ C.S.M._ CURVE DATA CENTERLINE
f /Vol.-5- R = 5729.58'
N S)6 301op8 Opr % Page 1292 6 = 1°45'26"
/ C = 175.72'
Certl f1 ed Sur 363.831 76.81, L - 175.72 ~_eY CB-N2500143nE
o Volume 5 Man
- N25°53' 26"E
TB -
TB = N24°08' 00"E
44-
APPROVED
OWNER
3..1
Donald Michaelson
W{ CORNER LEGEND MAY 3 / 1989 Box 365
SECTION 18 Ez ST.G?OIXCOUNW Somerset, Wi. 54025
l~
tT' n 1~7Fi': h'•-J
COUNTY MONUMENT' E's~~-•~.•=`'-, ~ 1 IRON PIPE FOUNQ:~;,.•, _ VEPARICSPLAWIfVA
AIMEE
`c"•~,4O SET 3/41' x 24" IRON REINFORCING BAR WEIGHING 1.50 LBS/LINEAR FOOT.
This instrument was drafte~eb$y`',D'od§las Zahler job no. 83-53-189
VOLUME 8 PAGE 2108
J
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS f'~~_l / ~r
PROPERTY ADDRESS S^~~
(location of septi system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION ----1/4, 1/4, Section_ T-,.~N-R W
'OWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME S, PAGK214/ g , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic
tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and retu ed to the St. Croix
County Zoning Officer within 30 days of the three year ex iration date.
SIGNED: C~
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, 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 ~)eg
Location of property & 1/4 UJI) _1/4 , Section, TAN-R Zg _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 5~17 and Page Number 0:~__ as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 5G010 , 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.
671 4v
Signature of Ap cant Co-Applicant
- I
Date of Signature Plata nf Sinnat-iirP
~ 4
DOGU1NtNT NO. ti'1'ATE BAIL OF WISCONSIy TOSY 11-1M~ ^'n ~"'as "a""'w~° ~°a "~°°oaaMe o~*s
t.r.s+..s .n. c«,...a
uNO co+~MCT ,REGISTER'S OFFICE
j~50Q'l~y ~ ns vs~ row ar.L ~ra,►xsacnoxs wssRS avn:
sss ~ erressn As+n ist o'rsRR LION-CONaVISiR CROIX CO., Wi
AC2 '*s~~~~nnnuw~ _
+~'~~a Reed for Record
i ~!!i Co~n~k ~ a~ _Donal_d.A._Michaelson_-and ,fU~ 2 51989
f ,~a11ZA~Kicha~lson~ husband and wife _ ._w-•- at 1:30 P. M
~ 1' w1e1Me was as mace) -wad.... a4d..~:.. W4 ~.f ~a.. 4 i ngl e..pR.r, g qt}.
».M t••whelMr oaa ar mare).
Vasdor eslY and sirens a eonv~q a parehaaaq upon tae prompt and faII psr-
floemsnee as this contract b! Pnrchasar, tae following property, toietasr ith tM . .
prodte, Bssasns and class apparanant interests tall called tae "Property"),
1.....~.G...Sacai~ $aa et wl.~ontz~:
~ Ta: Parcel Na 032-2061-80
~ Part of the NW-1/4 of NW-1/4 of Section 18, Township 30 North, Range 19 West, Tows
of Somerset described as follows:. Lot 2'of Certified Survey Map filed May 13, 1989
i in Vol."8", page 2108.
. 'I
i'
i.
. ' Tai. -°-1s , nosi homestead property.
I t~) t~ A PLACE DESIGNATED I~ WRITING BY
' . a parches tae Property and a pay a Vender at ...---...-~..----.-••-•-•~y SELL
Z 5AC.110
tisa sam ed 5,,,14a 0 04 . is tae foUowini manners (s) 1--- •
' b the balance of 11.x300..00...---.- . topther with interest from dsa
i a1 tbs emacntbn of tais Contrsat~ and i.
. hereof as tae balance oatutandini from time a time at the ran of..,.........~.i) pee cent pea annum
Dais peM ~ is lull, v follows :
Balance payable in installments of $155.00 per month or more at the option of the
Suyar, including interest at the rata of lOX per annum, computed on unpaid bala:lr:ES.
~I lirst payment shall ba due and payable on August 20, 1989 and subsequent payments shall
ba due and payable on the 20th day of each succeeding month. Interest shall begin on
July 20, 1989. Payments shall be credited first to interest and the remainder to princip
The Entire balance of this Land Contract shall be due and payable in full no later
than July 20, 1993. SEH ADDENDUM ATTACHED HERETO. 20th
sorwerer tae an~ onbtsading balance ehsU be paid in fall on oz befog tbe dq of
Ju g~~..._~....., 19 (tom maturity dace).
laUowini a>iy detanlt b payment, interest wall aaerne at the ran of .i~._--•. % per annum on tae emirs amount
b ddanlt (which wall include, witaoat limitation, delingnant interest and, apon accelarstion or mabority, the eontirs
pe3aeipel balaLOS)
I Parcasase, aaless esxnaed bP Vendor, airees a pay monthly 5o Vendor amounts safflcient a pay rrasosably aatki-
I . Zed annual trine. special assea~ssent+. Hre and required insurance premiums when due. To ibe aitaat recei~edby Vendor.
I' Veabr mess a apply payments a these obliptioos when due. Such amoante reosi~ed by tae Vendor far payment of
farm, ssseesnseats and '.aasranae will be deposited inn as escrow Sand or trustee aooomd„ but shall not bear interest
~ oaMss atatewise required b! law.
Psymaab shall be sppNed Brat a interest oa the on paid balance at tae rate speeiiled and teen a An7
` withant reminm or tee u a rineipal at any time atter.._......_ July__20 _-•N ~-8 (OZ,)
f ma be ~ '
Is the event of nay prepayment, tail contract shall not be treated as is default wits respect a payment err lossg
r tae anpsid balance of principal, sad interest (and in anch case aeecaini inures( from m"nth a month wall be treated
r unpaid principal) is lw than the amount Shs! said indebtedness would hags been had the monthly payments bees
made a. Brat speeiBed above; prorided that monthly psymenb shall M continued In the Brent of credit o! any pr~eeesda
~ ~sassnee oe eoadmnatioe, the condemned premises sins thrreatter eulnded ba~afram.
Parchsset slates fast Parehaser ti satisfied with tea title v shown by the title erldena anbmitad a Pnteassee
fee esamiaatlea esespt:
r
:I
I '
parehaaer sires to pal the cost of fntare title eridenee. I! title eviJenoe b in tae form of an abstract, it shall '
- bs relsined bl Vendor. nznil the fall parehaw price b paid. July 20
1Y89..... ~
Pnrebassr shall b~entttled to take posseuion of tM Property oa...--
Vie. o.t D•~•
LAUD e011?=AOr-~2felNl~e1 aM n'AnnwaitAR 01.1►ieCOA11i1N Wbeon.~a Iced aleck ~ !M-
vn.~.... pig-
- -