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HomeMy WebLinkAbout032-1064-40-100 0 N O 3-V 0 o d m 3 3 n 3 m m 0 m a h' (D o T m tD 3 lot Z U) N) 0 0 m O ° CD III O N O• [D 3' m o m R to A n- S S. 0w 7 O r.f A ro O O 5 . CA O A O N C1 Cl 0 (n O° -U 0 0 0 M N --1 O p rr'-iiO p O 3 -4 m (D a o m co 3 ° --Et < v m "ftm L A A (D Z o o tO I ~ A m tOn o r, CA c CD 3 6 r • z O O O (~lcv1 o C * * < N Z 5:: E3U fA fA fA o D Ci o, N 0 O cjl Zo i T N V t.0 d' N N P- 0011 N 0) N Z Z -,Z o -a D m o w 0 =3 o n p CD ? lr • 7 N N ;u C/) CD CD CD c v m w m m o. CD z CD Z 0 CD 0 a C) 7 O j A ca T G Z C ' z co N m z m P U) I o_ a n~i c Z a o CD I ~ I h A 4 fi I A I p V N O O V A 0 oe b ac Q N tsa O ° a ° Parcel 032-1064-40-100 06/06/2007 05:25 PM PAGE 1 OF 1 Alt. Parcel 24.31.19.320D 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BRUBER, DANIEL T & LAURIE A DANIEL T & LAURIE A BRUBER 763 210TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 210TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 5.500 Plat: N/A-NOT AVAILABLE SEC 24 T31N R1 9W PT NW NE BEING LOT 2 OF Block/Condo Bldg: CSM 9/2656 5.5 ACRES EZU-1164/616 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-31N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11/01/2000 632842 1555/463 WD 07/23/1997 1084/113 WD 07/23/1997 1070/61 WD 07/23/1997 1041/473 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.500 60,500 100,600 161,100 NO Totals for 2007: General Property 5.500 60,500 100,600 161,100 Woodland 0.000 0 0 Totals for 2006: General Property 5.500 60,500 100,600 161,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 10-19 / ~~~~Ld U /U(s y yU ~n~Li A /O~ ~~d 3~L ~i~d~'~ /OD' ~ ~D/CAD . ,~zo~ 0~ J 503014 CERTIFIED SURVEY MAP V Located in the Northwest one-quarter of the Northeast one-quarter of Section 24, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin OWNER LEGEND Wayne Breault 0Set 1" x 24" Iron pipe weighing 1.68 pounds 765 210th Ave. per linear foot. Somerset, WI 54025 A~ o Fence NI/4 CORNER NE CORNER SECTION 24 SECTION 24 T31N, R19W 210TH AVE, T31N, R19W 2" IRON PIPE_ TCO,_MONUMENT - - - - 2684.87 - NORTH LINE - NE 1/4 8 8*14'02 335. 6' SSS'14'02"E 671,22' 6, 269.61 1678.04 0.8' WEST 66. 0 269.57' i / N OF FENCE w $88°14'02"E 335. 7' `J W t 100' 114- REFERENCED TO THE BEARINGS ARE w SETBACK 1 This Certified Survey Map NORTH LINE OF THE $ WELLO represents that parcel described NE 1/4 ASSUMED TO BEAR S88°14'02"E. z SEPTIC HOUSE in Volume 512, page 614; West one-half of East one-half 0 W of Northwest Quarter of Northeast Quarter (NW4 NEI) of section 24, m Township 31 North, Range 19 West. SCALE 1 200 LOT I I m v V J V D 100' 0 200 m a - cn (D m -1 Ad ww ` ip l0 2 m N 0 m o Q F W/8 I ,r,~C► CO m OCI, 1,696 SO, FT DO LAS J. /N IC: o Z 4.63 AC. cn F jZ EXC. R/W ro IC y 8-2145 ~r- -I o 192,801 SO. FT. o IZ y I D m w 4.43 AC, La 'n r- r HUDSOti JC --i rn I> Wis. m yi m N CD rn fm Im b ° w C Io D ro w 268.72' ro ro Ir A IZ o N88' 14'02"W w ° jz 0 -n Z' lY' I cn 3E A = IN £ m z a p f o A~ C APRMVED 11 Z LOT 2 M m z A N m 1~ arm m VfV ~ a PE~RC g AREA ii . O Ap COMTY INC, R/W ,rnpr&"5Ws.Pjwr4n9 239,799 SO. FT. ZOwqiSand 5.50 AC. NOTE; AREA SOUTH 6 WEST OF f'Q01~ FENCES MAY BE SUBJECT EXC. R/W 1 SO. FT. TO RIGHTS OF ADJOINING 237,6221 OWNERS. 5.46 AC. (fm}oewa*d wrthw80° 2.3', N88°1930"W 334,04' 8.5' Qdy~ of SOUTH LINE - NW 1/4 OF NE 1/4 10.6' J UNPLATTED LANDS x,c1R;~ ~.1 L ti This instrument was drafted by Douglas J. Zahler FILED 0 JUL2 819931- 4 JAMES O'CONNELL Register of Deeds S 6 SL Croix Co., WI Vol. 9 Page 2656 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION --"k- I LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHIP MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: tj ul1/ IU,61/4 2ol /TY N/R/9Z(or W ,c 7- AJ A AJ AM COUNTY: MAILING ADDRESS: ST. C o/ 5T.~I/E JR !~f t30~c /~/8 /VEw /?icMMoND WE S% USE DATES OBSERVATIONS MADE n~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: l~lResidence 3 AVi? P<New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system 7 C~~TI~~ . MDs . IN-GROUND--P URE: SYSTEM-IILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) IfC~ S U S U EIS n GO,cJVEAJT i oNAL J3 ~D 2 x 5~;~ If Percolation Tests are NOT requ DESIGN RATE: ired , / I If any portion of the tested area is in the ti~ under s. ILHR 83.09(5) (b), indicate: AM Floodplain, indicate Floodplain elevation: /V o PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O 0-5, Dk GYj3rl l5 ; d-S'- /_O an 51; AJ0/VE 7 (o_s tJK G'n SC1 /~y'--~_,~' 6r+ /S~ ?~-6.S~yBnS a S O t /fS' AK a-y-Bn S yj6p, S ,w /'.?r1a B_2 7_D /po.9 NOA)E 7. 0 lk;l ADkBn dlrfyS -/S bar s~ 6-s -7ob*2r,s/ O - 0.7' j>/< a,, S 0.7 - _S DlC Y 3r' Co S AV, B- j ?f- 3 10.7-/ /U04/6 $.3 sOrr, 0 ~r J-5- S.~ Y. *A 5 w arla6Je Dk Bn wjrf S- , 'I p i d /3r ls~,/-0 ~~,o'GY H ►e /1/~N~ S-f ~3►i 51✓/!%?r Pin 14 t. t.. - .rj B- / O-CLS' DK !3n.5 -j? y h Go 5~ /_3 AJ 6 3 .0-S' Y'8." f DKY n Sfra#r"f,;.q' W ll7 K /3n ►r y - s a•,, Sj6. s~-~3 yl3r, S 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INe+H-E& AFTER SWELLING INTERVAL-MIN. PERIOD 1 PE D2 PERIOD 3 PER INCH 3 ~ P- 3, NoA a M/6 1/91 J P- Al A)gr t M/ A P- 3 FW Ajolue < j M'6 4 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 all borings and the direction and percent of land slope. SYSTEM ELEVATION !F8 . y ~/G A✓ _Tj3/~✓J A/a,'~ 117 5. s'IDe o A r'vvr 'lh t (SGtJ Cort er o , OLG4 k_ l 7 tie e a r le -e 3,!0.P p a ~/,In7 f z +t^nTe r~ ; o i Jaj _1~1 - S 25 SdrnPO~ Pif'spv~' ir%vi W v A 0?ar ~l 5p,i t f IQa F G o~Gf f Yl /~2'c ul cl7~rr 7~~57~r o 3 ! act, V A 132rbed wriZ? G~ O I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce nd mye17}t~ods siQd in th onsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge a lief. J L NAME (print► TESTS WERE C ~bE~ ImN n ADDRESS: CERTIFICATI N R: NE NUM ( tional): S /3a sa < h1 - , 3 3 6 CST SIG TUBE J_JZj , Cam. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - L INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand - Greater Than 'sl - Loamy Sand < - Less Than 'I - Loam Bn - Brown 'sit - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. .Z STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /t I/,41E',V ADDRESS -76,3 Z f U1 1A UR SC~~c-t EfQ 601" S. 5 LI d 2 5 SUBDIVISION / CSM# 5 0 36l q uaj. 5'12-- Pa 6/y LOT SECTION 2, ~ T 3 ( N-R I ~ W, Town of u~- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORIGINAL > y 111 ytl,.. 1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. . IN it Tr) ? of S Tf 4L T ~~.vcE- ~1b Sr BENCHMARK: EIE/F'T!ON - X00. O ALTERNATE BM: B bT1~µ OG-~ O ✓`/7~/.v 0' /f / N-~DU•S E 4!~~N26qe 112.0 SEPTIC TANK / N Manufacturer: 42'E/f s 4!!W4 TG 40- Liquid Capacity: Setback from: Well House 13 ' Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM 2 Width: Length 09>5- Number of trenches Distance & Direction to nearest prop. line: / F' 'V0 ' LO L Setback from: well: 170 House 10 Other 5QPT C T. , 4v q1 o/F ~o v ELEVATIONS C /of. / O ST Inlet /67.32- ST outlet /6 7 /p Build i ng Sewer p PC inlet .P tbbttgmn Pump Off See- Header/Manifold ~ Bottom of system /O/* /0, 9. 01 /6 S Existing Grade Final grade c 6 - _ DATE OF INSTALLATION: ~UN E PLUMBER ON JOB: 1-0&Er-T- uL~ P I'Cj. T- LICENSE NUMBER: M PR S33 07 INSPECTOR: y J ~tii~~~vS 3/93:jt 2.1 o Avg . aiLr ► PIDT GG SCALE: 30 ► asT- TAP of s~ hod. b uo. T. L 2p 3•D =P 0 /9' w i `X OJ r TRENCC'A t~ _ 5'x g0 g, A ^ TOEtd, g t 10Ler TO oQop Qox roy.~d 3 ro 70 O t M Se4. 40 (-v c ~ bb D U ttp w tE~S Car- . p S Ep p re 7 . 13 6. t3,1 z - t3 o t~o~ 3 (3E~QK s F-06-E- E f s P ply G-- tau. ° 1r2.0 i, T'Rok SPECS - 3a reU rop of PrpF TOP/ E @U• HCAM UETk 0 kutll 10L 1021. 75 /02 . &V Q /02-9 loq-0 /03119• ►'h or (3 o k • TkEu cG~. "C3 ►t FLEDS I sr ru - 3~t~ If ,-y' e-pr ZfvD~e 271-y D/'ST ~i~1i:vG, I+isE$''part`~'1t`~'y~ 24.31.19-WATE SEVITAGF STEM-VE • County: Labor and HumarT Relations INSPECTION REPORT Safety and Buildings Division oil, GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.: Permit Holder's Name: ❑ City El Village IR Town of: State Plan D No.: ~p v.: Insp. BM Elev.: BM Description: / Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400062 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 / -?1011 Benchmark Dosi ng Aeration Bldg. Sewer 2-- Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet W3 16 F Vent TANK TO P/ L WELL BLDG. Air Intato ke ROAD Dt Inlet Septic g- -5- `3 NA Dt Bottom Dosing NA Header/Man. 7`666 taa.SB 03. ~ Aeration NA Dist. Pipe 7 5- Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade X. 7 . lor,Y, Manufacturer Demand 1 ( OI7 /J q,9c/ Model Number GPM_ 7b TDH Lift F Iction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1~_ DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O / CHAMBER Model Number: System: (%jj-r) /9 /OS 1-70 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia I Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.24.31.19W,NW,NE,LOT 2,210TH AVE. 7?,L42, b ai C Jr ~ ~ .mow rd• n's S4 Plan revision required? ❑ Yes ❑ No ~f Use other side for additional information. ~TLAt ~O IL SBD-6710 (R 05/91) Date Inspector's Signature Cert No. i SANITARY PERMIT APPLICATION E DILL-IR In accord with ILHR 83.05, Wis. Adm. Code co 4 c w STATE SANJTAR~RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than QQ!//~~!!//JJ~~ 33 8% x 11 inches in size. ❑ Check if revision to pr vious 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 6 $ G£'/44W 10(1E150.t.1 NU) y4 PLe Y., S Z T3/ , N, R IT E (or PRE/OPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # L /3oX Lz.1 CITY, STATE ZIP CODE . PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5YoZs sc, ~s Rm 50300Y vor.sfZ p~•Y CITY NEAREST ROAD II. TYPE OF BUILDIINNG:: (Check one) ❑ State Owned ❑ VILLAGE : sdw Qj ~e ❑ Public 6?1 or 2 Fam. Dwelling-# of bedrooms - R u ) 111. BUILDING USE: (If building type is public, check all that apply) 3 `UC.C 7 C Q ` ~p 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 120 Service Station/Car Wash 50 Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2.0 Replacement 3.E] Replacement of 4. ❑ Reconnection of 5. ❑ 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 WSeepage eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure - f 43 ❑ Vauit Privy 14 ❑ System-In-Fill 1-- 5 e4e.-e. 7 X ~G7 VI. ABSORPTION SYSTEM INFORMATION: /O~•~~ ~~-S' 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE y REOUI ED (sq. ft.) PROPOSED (sq. ft.) (Ga /day/sq. ft.) (Min./inch) ELEVATION < ~O 7~V l~p O •9 N /00. !7 1041,0 Feet ,4 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 600 Septic Tank or Holdin Tank (.0001 1 Lift Pump Tank/Si hon Chamber 'vC4 714 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) WP/MPRSW No.: Business Phone Number: ~'O i T ~GgRICGcT 3307 J1 9403'0' Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing AgelntSI0dture 8 ps) _ Approved ❑ Owner Given Initial O $)u, Surcharge FeC) Advers Determin tin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A paflitary permit is valid for two (2) years. ` 2. 4'~'Your san-itary permit may be renewed before the expiration date, and at the time of renevral 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 T! ansfer/Renewal Form (S,'&;.,, 6399) to be submitted to the county prior.to installation. 5. Onsite sewage systems must be properly maintained. The _~,pt+ tank(s) must be pu 7^pe,j Yy a licensed` pumper whenever necessary, usually every 2 to 2, years. 6. If you have questions concerning your onsite sewage system, contact your local code adn{inistrator or the State of Wisconsin, Safety & Bpi.ldings .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 member(s)-of where the system into be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Owelling. 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. Abs^rotion system information. Provide all information requested in ##1-7. VII. Tangy Fill in the capacity of every new and/or lank. Eist the total g=illw,s ~Eurnber of tanks and manufacturer's name. Indicate prefab or site constructed and iank matey i.ii. d rnrl>rte ror all sept c, pump/siphon and holding tank; .,or this system. Check r Y,,r rn~ ;t=,l ,pprova c / if ranks received experirr::.~;? product approval from DILHR Vlli Respons+bikty statement. Installing plumber is to fill in name, license ni.rrnbe, with a,!)KiropOkkk fe prefix (e.g. MP, etc.;, address and phone number. Plumber must sign appl:c=ati.^n form. IX. County/Department Use Only. X. County/Del-.,artment Use Only. Ccrnp etc: plans and specifications not smaller than 8'/s X 11 inches must be submitted to tn.- county. The cleans rr^ca3 i tic,'!ude'he`following: A) plot plan, drawn to scaie -r with complete dime I Jo ,cation of hol l+ng :~trrK;s); sent+c tank,"sl car tithertreatmeiittanks; bu,kir.`-1M1yPjeils;,water' ariferservice.; streams and i al es- pump or siphon tanks; distribution boxes, cofl .{btic -ttron sysieln•: Yet +H '-one~lt system ar(?a§ and he location of °1t `Y l1l;c`:ng served, ~R) h00:7Cntal celevatiron i 0;, i- -pints; C) complete specifications for pumps and controls; close volume:; elevation differences, ' k,!i,.:n loss; pump . performance curve; pump model and pump manufacturer; D) cross section of the soil absorprion 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 surcharces (fees) for a number of regulated practices which can effect groundwater. The monies collected through these si ,charges are used for ;norutorin~ orcq.indWater, grc:uno- water contamination ;nvestigations and establishment of standards. SBD-6398 (R.11/88) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 10 OWNER/BUYER Ale ADDRESS ~o Z 2 FIRE NUMBER 3 f s c7"_ 4,, _77 ZIP S`~O2 S CITY/STATE .Sow e._5,-,7"_ PROPERTY LOCATION: Al 44--1114, AIX 1/4, SECTION '?q , T 3 / N-R / 9 W TOWN OF ,SS c sc?~ , St. Croix County, ' SUBDIVISION S_e) 301 LOT NUMBER 2". 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 a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing. system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, , journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary) ' the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: _ F X St. Croix co. Zoning office 911 4th St. ' . Hudson, WI 54016 STC-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), thenia 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 10/ ~ le - ?-4 <c 4,, N t /So .J Location of, property ti(/J 1/4 Alk 1/4,, Section T_1_1 N-R j 9 W Township Mailing address Address of site I (0-3 -a /a 4 so:Y,~rf{rc,r subdivision name _ e`SA 5 d U'` blb/ ~~/Iot no. Other homes on property? yes No Previous owner of property Total size of parcel S CIS Date parcel -was created Are all corners and lot lines ientifiable? =Yes _No Is this property losing developed for (spec house)? Yes _,~_No Volume l~ and Page Number `f= 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 & 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 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. County Register of deeds as Document No. --C~~2~.~+~ /lam Signature of applicant. Co-applicant 3 Date of, Signature Date of Signature 02.,16/94 17:30 S 715 294 2188 UIEBROCK CONST. P.03 503014 CERTIFIED SURVEY MAP Located in thw Northwest one-quarter of the Northeast one-quarter of Section 24, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin OWNER LEGEND Wayne Breault o Set 1 " x 24" Iron pipe weighing 1.68 pounds 765 210th Ave. per,linear foot. Somerset, WI 54025 Ad FiYnce NI/A CORNER NE CORNER SECTION 24 SCCTION 24 TSIM.RIeW ,BOTH AV~_ T31N,919 2604.01' ENT 2"IRON P1P~f _ _ ,-•-,/~.~Q RT+ LINE - HE 1/4 •14' " 335.0' 388.14 02'E 671.22 i.00' 260.161 147SOA l O.8' WEST 66.00 289.57' , t_/ N OF FENCE $00'14'01"1 335.57' w fi Q 1 100 i4W BCARINGS ARE $ m . TACK , g `1'his Certified survey Map F9 T T9 RNORTHNLINF Os TIIE g wE«o r represents that parcel described NE I/4 ASSUMED To tla,se in Volume 512, page 614; GEAR 600014*02"9.% so O PEPTIC Vr_ Wcst one-half of East one-half 8 i of Northwest Quarter-of Northeast Y I Quarter (NW} NE;) of Section 24, SCALE I.200' LOT 1 Township 31 North, Range 19 West. M V _V V V 100' 0 100 •4 0 Q u~ ~ m N of W~9 INC. R/W ,c "4..63 AC. 30. FT N % DQUOLA ERJ. 1Z G EXC. A/W H Ic S•2145 C 181,001 90. FT. G iy HUDSON IP u 4.43 AC. W Ir • E WtS. m M 1p m I rn Ifn p t, iD N W I 268.72' o N Ix n ° '1 N849 14'02•'W N o I N e (/f to a f~ti 1YI V r >E APRWED sp '6- P EjR C 8 AREA .31 , OftayCOUMTY INC. R/W +dnpr61k4vW6+.P~r" xav,rvv ss:.f r. ZOi►~Dha+ NOTCH ARIA SOUTH 0 Wti.T Of S. 60 AC, rpolk-0501WRI116 - f6NCLU MA'r r1E su11dECT EXC, R/W TO RIOr1TP OF AOd01NIN0 23%+621 yU.ft'. OWNERS. 5.46 AC. 1f t+p~KOfd~ witMrQBCdgs of ;.31.4 ' 0400.19' 30" W 334.04' 0.5' ODieo '~i~1' SOUTH LINE - NW 1/4 OF NE 1/4 0>f~l1i=+b~ UNPLATTED LANDS This instrument was drafted by Douglas J. Zahler FILED ~ 1 p JUL2 8 IMA- JAMES O'CONNELL Aglster 61 Dood+ S CO SL C(OIX Co., WI • TNIS 5►ACE RESERVED ►on RECORDING DATA it oocUMENT NO.. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-1982 II 51.43717 MA 61 R.GISTER'S OFFICE it ST. CROIX CO., W Robert L. And Isla I Lennartson PaedtrrP--=.,d t MAR 21 1994 4:25 - nA M Mixlen (~T. and.I,eAnn_ M,-..No].sQn-----' conveys and warrants to I Rr~ateral)ee 3 - - i ,I County, _ - .01X• ._.....S- the following described real estate in Tax Parcel No: State of Wisconsin: l; ow: Part o[ the NWk of NE k of section 24-31-19 described as fe12656 Lot 2 of certified map filed July 28, 1993 in vol. 1199' page 2656 Ij It I i. i i , i. This 1S._riQt-------------- homestead property. (is) (is not) Exception to warranties: 19. ..day of Dated this - (SEAL) - (SEAL) f - - ,i tson (SEAL) - > :..Kober-t-.L, Lenny - - II (SEAL) - - - - f - 'I I~.__.Lennztson. - ACKNOWLEDGMENT II AUTHENTICATION I STATE OF WISCONSIN Signature(s) ss. ! County. 1 ..day of this ,19 Personally came before me 6., 19_qq. the above named ~i authenticated this --------day of_.--- n------ T C~04X ~-e n!'?44!^T.` 1 ~t I TITLE: MEMBER STATE BAR OF WISCONSIN ;I i authorized by § 706.06, Wis. Stats.) to eg known to bg-the person wledge"the who same.executed the (If not foregoing inst[u • nt) and n9, THIS INSTRUMENT WAS DRAFTED BY t(' yam G r.3c--S ~ r ~.J ~i ------Count}, Wis ~k : Y IF, utt.. If; not, state expiration iI Notary Pull My Commiss,r~It I r^ :9...~-• ) d 1 (Signatures may be authenticated or acknowledged. Both `r- -r . date: - are not necessary.) II in any capacity should be typed or Printed below their signatures Wisconsin Legal Blank CO.. inc. i; *Names of persons signing uu..-.,4eo •nr.~---: - STATE FORM NoF 2 WISCONSIN I wAnaANTY DEED SEII- WAYk)E- ISkeAUrr 7CP5 2-to t>~ AAA. S6k0-1eSA-f -7feba.5 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P of 3 age Labor and Human Relations - 6rvision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY s r. G/PO/'JC Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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 PROPERTY OWNER: t3 0 yEQ : PROPERTY LOCATION L-C ~ N E Soa GOVT. LOT N W 1/4 !J E 1/4,S 2( T 31 N,R I E (or) W PRQPERTY WNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # t'- e) • 90K 2.21 Z GSM Se> o/f/ (JG/. .912- CITY, STATE ZIP CODE PHONE. NUMBER ❑CITY ❑VILLAGE iikWZN NEAREST ROAD 50Mr=RS&-F cats . 5yo>-5 (?1 ) Zy~ -S~f~ Soy-f~r12s~ -2-10 tom. ,~-VA_ [New Construction Use ( Residential / Number of bedrooms -3 [ J Addition to existing building j ] Replacement ( ] Public or commercial describe Code derived daily flow YJ`~ gpd Recommended design loading rate ' s bed, gpd/ft2 ' G trench, gpd/ft2 Absr•ption r. ea required bed, ft2 15 o trench, ft2 Maximum design loading rate 5 bed, gpd/ft2 trench, gpd/112 Recommended infiltration surface elevation(s) Ste- • 3 It (as referred to site plan benchmark) Additional design/ site considerations ?.t S~ T!2 ES O.Po/~ ISO X J7,' S 7-R 18 V 'T'f oa Paren material 5C5 10 " 5 flaw S AS L3 f= kkh RDT" Flood pplain elevattion, if applicable eV- r~• . ft P 1`T Lg-o n... v& /0) . S = Suitable for system CONVWIO U L MOUND❑U IN-GROUND U ESSURE _GW& SLYSTE" FILL HOLDING TANK U =Unsuitable for system 0405 ❑ [9'$ 2 8'S U C•~T ❑ U ❑ S 'Ttf , H-AP tODOO 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 0-1( 1.5 he 31z. s i~9,4N , 94 44~ ~ s r7~ .-2 . 8 42- Y-24 ?syp- Y/Z fs o. R *%z `F c 00 Ground C 2,6-37 7.S y9 'f S]' 2,.,549 M4 fR CS 4-f • •G elev. S'r~PATr F~ e D /0,..58ft. C z., f • /n 7 5YA .5 S o2:2 C 5 . S . Depth to " S 0 f Ip G~ .Q C S / li miting factor y~ Remarks: Boring # { ns P 9 Y,O 312.. 1.s C. f , Je Mf of e s . '1 40 4 2- 7-1? /o Y/e 3/3 3 l~ . 7 kA P YG ~.s ye S ,mi,s aeX Cs 7 .d' Ground . elev. G2 G'G syR S sd,~ A `ee, CS .5; /oS• ~ 0 la) /0 Y4 Depth to limiting factor a > OD Remarks: CST Name _Please Print Po (3iL= p-7- 2xL-8 R C «T-- Phone: 715-_ 39 _94.5 Address: (ASS o' per P , t~vDSo,~ cv~s . S~ar~ 3- Z - y/' CsT.4, Signature: Date: CST Number: Cv~;c>T~-~ 7">E`sT' co.~0~•Tio,~,> S T'a ~ os q00 eel ~ T ORIGINAL PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z of .3 PARCELI.D.# L-07' 1+ Z can 5030t/ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mrxh ~k ~tLJ20.~4 v j: 3 Q d-p io ye 3/Z - 51 2.,-F, s6k /►ti► f R C s lv~ S 1 f::::hh.,. / 2, f s,&& nM-F,e e s 2 ana~ , A, 9- /o y~P 3/3 S -F . s . Ground 3 7 SO y~ lS D,,►+, ~ ye .7 oc> v /OS elev. ft. C 2 ?-I-" /Oyie Y y S ©a+~ S Gl w i .7 Depth to C 3 5-//o 5 yR / s/ /.-F, sdi~ N►~'F.2 y , s limiting factor „ Remarks: Boring # ALP d'/D /O /Q 312- S~ 2L. f, 5,AM vf/Z S 3U7~ S • :tata...Y~• C~ O yZ ~s ye y/L s sde nM VPR C5 . S Ground elev., iir Yy ft. Depth to limiting factor „ A2 Remarks: Boring. # 0-16 /D yjP 312- s~ 2. f , 54 nN.fi2 CS, l u . S • C ~v}nv}~4ti 60 •3 R f o ► Am, S iNn ,e C s 1- • ~ ~•:.S Ground elev 7 'l4 -s YA 1, f ,,5,6& Mn'F k i y ~p7.7 d~ ft. Depth to limiting factor G „ . 7 Remarks: Boring # Ground elev. 1 ft. Depth to limiting factor Remarks: OWN ooon,o ncmn~ 00, J l 6 T Z oSM S 0301 q 5CALt yo' • s 13,+( '160 E ~O/ 7-5 o= R F4 S t T-- - ro p c~- ST£ L f 00 I/fo-P i x7p 6 GS M 410('p i .a I aq 2CJ kl /00, g rA E. l~ I i /00, - . - l 30 j 3 ~oQr~ . t-I-0 ht i r - ~~EUhr•o~ s - ~ o to p, ioZ.sg , / svc,~~sT~~ TREu~.G~ ~t~uhT~'oaS ~3 1oS. ~z 13, Ill. qq ?o P) 107.7 low TR~~c~ )00.00 8 Fresh Air Inlets And Observation Pipe I-Ae/0c Q..- Approved Vznt Cap Minimum 12".Above Fi i of Grade W MW 4" Cast iron 2 $ " Above Pipe Vent 'Pipe 'to Final Grade Synthetic Covering r tin. 2" Aggregate Over Pipe Distribution - Tee pips [70 0 0 0 (e w Aggregate 0 Pertbroled Pipe Below peneoth Pipe 0 Coupling Tarminoting At Bottom Of System 5ys TCAf a o i 6 w # "Fresh Air Inlets And Observation Pipe Aoproved Vent Cap "Minimum 12" Above Final Grade ,viS'f{f~ /0 y o , C AP Above Pipe -Vent F;aa 'to Final Grade Synthetic Covering =Mina 2" Aggregate Over Pipe Distribution - Tee V-0 0 0 0 0 Perforated Pipe Below Aggregate sysrFM Beneath Pipe o Coupling Terminating At Bottom Of System P5. 3 °t 3 74 4VC. L e T t c.SM S 0301 q b l~al . SI ~ . Co l (e (P ' wig h `f l Qy u ~ F s ~ t l'~= yo v = (3 Nl Sa-7- - Top o~ ST£~L ~ N { /00.0 ~ i o ~ svpvt-yorP 's ~p 6 LS M , (5 coo /00 0 0' To pp~~4-4T SFf~Tic /00 ~5 O , ~UNCiPfTf 1 30 ELEUhTvok) S - wEll BI /02-.S? I (3z rds (1y, ~ suv~o~sTtD T Reu~.l~. ~I~u~T~'oaS C33 ios. Wz Ill. qq ~S ►07. 7B low TR~~c~, ~oo•oo 3311 y