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HomeMy WebLinkAbout038-1171-00-000 1 1 STC - 104 AS BUILT SANITARY SYSTEM R OWNER Al Lunde (Valley Custom Homes) t ed, ADDRESS Box 686 St. Croix Falls, Wi A`SUBDIVISION CSMCountrY Meadows LOT 13 / # # SECTION 13 T31 N-R 18 W, Town of Star Prairie ST. CROIX COUNTY, WISCONSIN pG k". t ~ F PLAN VIEW /OfJ~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM $ys fr rrr r~,~ t/ ~ a6~ L-T 'y7 ~o ~d INDICA E NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: lyti) Goe Ne-2 Ll'p J ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Weeks Concrete Product!Liquid Capacity: 1000 Setback from: Well House Other Pump: Manufacturer NSA Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 18 Length 40 Number of trenches 1 .0 Distance & Direction to nearest prop. line: ~O Wes 7- Setback from: well: House Other //off GTE S.r~ SaLGG%dl 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: a a7'c7c PLUMBER ON JOB: Rodney Hendrickson LICENSE NUMBER: MPRS03470_ INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andHumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.: LUNDE, ALLEN 1i CST BM Elev.: Insp. BM Elev.: / BM Description: Parcel Tax o. 1 li . Gt? ate-, c~~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic 6C)"~-C Benchmark Dosing Aeration Bldg. Sewer Holdin St/ Inlet 7 W fs-/ TANK SETBACK INFORMATION St/ If Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic _(00 U NA Dt Bottom Dosing Heade Aeration N Dist. Pipe Holdi - Bot. System PUMP / SIPHON INFORMATION Final Grade Manu ac emand Model Number M TDH Lift L Iction SYs TDH t Fo main Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/ Width Length i No. renches PIT Of Pits Inside Dia. th DIMENSIONS Of DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING INFORMATION Type Of e-> i C Mode Num er. System: loe-c OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes / /i / x Hole Size X Hole acing Vent To Air ~al:e] Length ~I Dia. Length 1 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade s Only Depth Over i -3? Depth Over ti xx Depth Of xx Seeded / Sodded Mulched Bed/denter Bed/T ges Topsoil ❑ Yes No Yes ❑ No ,V~icl 1-1 COMMENTS: (Include code discrepancies, persons present, etc.) 9 67 LOCATION STAR PRAIRIE.13.3 18W,LOT 13, STAR.DUSK RD & CTY. RD. C Plan revision required? ❑ Yes 0'N-0_ Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e~o ' rr I, i SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SAN IT RY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El n 3 8% x 11 inches in size. C eck i r v ion to revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWN79' PROPERTY LOCATION L L V A-L e CA r Y45(<) ST 3N, R r~ E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # j~ BLOCK # bo)c (0,0(0 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAVE OR CSM NUMBE f. /Lu < Ls i SYa1 ~3 g~ 3- C G tc A-1 -F& &;4 U w S II. TYPE OF BUILDING: (Check one CITY NEAREST ~ OAD I / ❑ State Owned TILLAGE 5f.* ~RM l2, $'f-4.2 d 445 Qd d ❑ Public X1 or 2 Fam. Dwelling- # of bedrooms Z_ PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) ? /7 r O0 1 ❑ ApUCondo 7 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 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 XNew 2. ❑ Replacement 3. ❑ Replacement of 41:1 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 X Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 (s q. ft.) (G s/day/sq. ft.) (Min./inch) oEQLEVAT'10- ION ` '7,. o -7oZO ' YZ -5- S", Feet ` 7 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App ITanksRaInks structed _F] F-1 I F-1 El Septic Tank or Holding Tank 000 Pie/I; C6 VC, IZJ Lift Pump Tank/Siphon Chamber F] F-1 El 1:1 1 Ej Ej VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name ;L4A_1_C lumber gnatur : (No mps) MP/MPRSW No.: Business Phone Number: a jA1 am` 40/?,~~ so 3476 Plumb is A ress (Street, City, State, Zip Code): a? 6 l "SS 2 / S_ oq IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sarillgary Permit F Includes Groundwater Date sue Xssumg Age t Signature MPS) Approved ❑ Owner Given Initial yS~q/~~ Surcharge Fee)/~ Adverse Determination / /t' t rah 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. 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, and holding tanks for this system. Check experimental approval only if tank pump/siphon 9 s 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) r cn-i. Wro - oo Co LO Lr)Lo rC9 ■ • r- 3C O M CTS= to CO CO Cc torn ~rN+• ~o cco° to ED ° LfJ~- C~ O N ❑ S c -3 o ❑D Q3 LO LO OD LJ1 CD n -0 n -3 n m 3 ~ < : ~ A C OJ i.n IL G_l Ql fTl ❑ O S - LO " m 0- CD b CD - co Ch Ln co m = vF C~ " C7 c CD 7 < 7 3 O W to O- i--i C7 S -1 O rf CD -3 0 CD 3 ❑ r, O 7 C ❑ CSp CD ❑ r`` O N = ~7 7 C7 ❑ O (n ❑ 3 O CD CD 0.0. 0 0 0 77 O TCD0 N co 77 f] 7 -1 `O 31-- rL Co -0 r co 77 O 0 O > ❑ ❑ 0- C O ' + CD 7 LO --~.~.r►~ l 0. CD ❑ C. O r~ O C3 CL CD CT A CD M -t. North Ln CD r+ 0 I CL C S d lTl CD C)7 015 9 SW-UT 07 O CD CD a 0.O ro [D O Q tz 3 Ul c ❑ cn F. CD Lo 7 r o CD r* ~ Ir r o CD W co Ln W A C? rn CD -0 = CD r+ 1 ❑ co CS p O A * r- m x" cr y m o M 0 U3 Lin x w CD m - CD rU o n ~ u1 ~z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS Z&j % _ S~ y (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: ITOWNSHIP/WNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: S6 1/ 54o 1/ 3 /T31 N/R/8 E (or) W C UNTY: y, MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: X New DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace q RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(opti nal) QS ❑U ®S ❑U ©S ❑U ❑S ZU ❑S ZU s, Z)) I If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate:,pp Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- > eD lam'- /3// 8 - Z -7 ~ 2 .6.1 3 z 7 - B- 8g Q/4 88 o yv ` 8 /z . /s~s z 8 - 3 7.4-. ✓Y'-~n~ 7 Cv 6wJ / - j-8 d B_ 3 9-7 9(~ T, B- g~ 91 8i O_9 9-1 _ LYn J.', z8 38"•8,?J B- S d'S 3?5P. 8S -1g? e// 8- 2 6 ` 2 5~► J"/ z~ - 6.17.s 8.S b'- ' Brl S S i9 J' • C.r. i B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- /O /_3 / i% P- 3 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 9s o d ZLQ f I All, Q ~7 L b~ 17 r U~ s a i a I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ` o s l:9 ifi dpi 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: E ~Q w rt-s z3 / /9 5,_? ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): /S D fh uF. C Svdj-j 3 d 5Z 7/s 9'7z -oF CST SIQ,. JATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - ,M 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 soction 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 mods - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - 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. i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,' DIVISION 7969 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N, WI 5370 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: , sw 1/a j3 /T31 N/R/8 E (or) W 4 't 1/3 C LINTY: y G ADD 5o,2_ (1-r USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: r~ PROFI PERCOLATION LE DESCRIPTIONS: TESTS: Residence a Xvew ❑Replace z ~ i99 z z /9yj RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(opti nal) QS Du ®S ou ©S ❑U ❑s Zu Os WU B~ If Percolation Tests are NOT required DESIGN RATE: ~ If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C_12_e~ Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 67-0 B- I L~O 98 > 8° -1 a 17 s z 8g Q/ 3 ) 8l~ O /D /d ^.Z 1O 2 2- B 3 7 `%E?. drr~ 2-G64J .3 ,7 9F 8 0 -9 • B//, 9 - Z 9" ~e. e-1 Y,* z. 9- 38 `'2. d~ s B- o - 6F'/ ' ?I-e7 B- Sl 91 'r 36> S 9~ ~s 8s - 8'~i3/~ z 6 ' 2 ~•I S,'/ z - 3B ass B--5- - 6r 617.s ~J 9 r' Cs. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-IN HES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 I D PERIOD PER INCH P /4 P_ 2., /4 P- 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. Q- v SYSTEM ELEVATION 9S y 3- 0•d TAI 1 2a a• T nT ~P_ - - Z - ,o I l I 1 Q / I ! > -.I : T TN d mew. ioo. Q f I _i 335" 3 r . i ! i I I 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: c /awJ ' s z_3, /99u ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 3 ? D 54 2 /s u2z -~Y CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. Dtl_HR-590.6?95 (R. 10/83) 0\117.11 f Lo Lo r LO lw < ~ c+=o ~o q O X ~j7 4W4D~. 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ZIP- '7/ PROPERTY LOCATION: -SW 114'sW 1/4, SECTION- !3 . T LN-R _W TOWN OF S'7~A12 2Ai i` St. Croix County, i SUBDIVISION b RX ~w do -5 , LOT NUMBER__Z3_ 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 maybe 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/Ile, 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 fficer within 30 days of the three year expiration d SIGNED: DATE: t7- / d? St. Croix co. Zoning Office 911 4th St. Hudson, 111 54016 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 ,n delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenta 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 J. 1, AI C/4-- Location of property-SW 1/4 :2: ✓1/4 ~ Section J-2-3, 'T &A N-R_8 W Township 2 PRA R_ i Mailing address _ 7-3 ~.~~7"~ St S?` 6L,y ~s 1A It'- !Z2/4QA!/ Address of site At-19'e vsK DQive Jeu1 1Jsubdivision name__ e0uPj±j y AeAdn j Lot no. 13 _ Other homes on property? yes____K_No Previous owner of property ! Total size of parcel J..~ Date parcel -was created 9 i'Are all corners and lot lines identifiable? Yes Is this property ' being developed for (spec house)?_X Yes No Volume and, Page Number 311 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 OIL 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 thi^ 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. i'7 , and that I (we) own the proposed site for the sewage disposal system orreI entry obtained an easement, to run the above described property, (fwe) the construction of said system, and the same has been duly or recorded in tie office of County Register of deeds as Document 5'i5~/p 7 No. S gnature of appii cant • Co-applicant 7'7' Date of Signature Date of Signature. Y- DOCUMENT NO. . STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED VOL Ins, ~ Gar Brunclik and Allen L. Lunde d Y____ /b/a Homestead RWdd r ftwowil Development - JUL' 5-199694 quit-claims to Allen L. Lunde i 10:00 A. ~ •-•-•----------•51rui~Dod~a the following described real estate in St. Croix x County, State of Wisconsin: RETURN To Allen Lunde P 0 Box 686 St. Croix Falls WI Tax Parcel No: Lots 4, 81 61 132 15 and 18, Country Meadows First Addition in the Town of Star Prairie, St. Croix County, Wisconsin. i t Y .Y ` t+ This _..._-is-not homestead property. (is-not) V1 Dated this June day of 19_.-_94. ---(SEAL) - (SEAL) * r nc ik (SEAL) (SEAL) * * 3c----U44-X".. Ze Allen L. L AUTHENTICATION ACKNOWLEDGMENT Signature (s) .-.-...Gary Brunclik, Allen L. STATE OF WISCONSIN Lunde as. County. authenticated this20 of_.-...-June 19 94 personally came before me this _ --------------day of a - , 19 the above named Kristina land TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized b ` ` - - Y § 706.06, Wis. Stats.) - - to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina 0 land AttorneY at Law - Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19--------•) QUIT CLAIM DEED STATE. BAR OF WISCONSIN Winconnin Legal Blank Co. Inc. FORM No. :1 - 1982 Milwaukee. Win. aT°-' D LANDS BY OTHERS NORTH LINE SW-SW 6 11"E 2227.26' - --230.00' - -------200.00'- - - - 200.74' - - 5.88051'11 "E. 1524.04' W w , cu W) N f co3 12 (0 . w • \ 4 so. Fr. 14 AFT-' o .•+1<~. - v S5. 8 , AC, Z 1. 26 AC. o BLOB sF1. 45 AC. N 63. 196 SO. Fr. Z rB4 ; ~i 1. 45 AC. A.P. C) m A.P 92.22'- yo '-174.78':- - ~ / - N88-51'110W 267.00' 20' ao ` ~7T~ "a?TTk26) X25, A.P / ~22~. T / Ry ~7) S88.51 ' 11 &E 267.00' (el (91 2 ~y) e6 0 1 6° ~°t~~ 109.00-- - - 158.0 50 WIDE 2 !NT DRIVEWAY _ ASEMENT TIC 9~ O~ 99, t~ O 7S 6 9 7 _ 0, BLDG SETBACK 41NE A p a o \~~Z \ %00 57 L O i►) \ 5 ° 90,393 SQ. FT . 2~ 90. 726 SQ . T . . r 2.08 AC. 2.08 Sg14 121 t13, SQ.FT. cv n j A. C. s. / F ~ I DRAINAGE AC' 2 1~1NG ` EASEMENTN I -REA 1o AN 9 `06 )~I 130' WIDE) 6 6' 7hfll9 A tEp o 0 Ate m MS.* 110N tR, ELI r' s. D the VW RE EN t~of ow U.S. - % - AM ~VA1E-6. N88 X34 ' 10 "W 336.01' Certl 510 I 3 I B£NCH MARK L N m TOP OF /"IRON PIPE EL£V. r 994.73 O L .,y Q U. S. G. S. DA TUM _ _ 2.30-- 152.30 _ o ti 1 "W 45 so' •o LOT 5 v - (A rq fit) _C S.M. v - - o t~ V. 2, P. 2467 0 _ CO ' N o N ST. CROIX COUNTY WISCONSIN ZONING OFFICE N r x n a n o i l ■ ■~..d ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 January 6, 1995 Mr. Al Lunde P.O. Box 686 St. Croix Falls, Wisconsin 54024 RE: Septic Inspection for Lot 13, Country Meadows Address: 1326 Stardusk Drive, New Richmond, Wisconsin Dear Mr. Lunde: An inspection of the septic system for the above lot was conducted on August 29, 1994. This property is located in the SW, of the SW; of Section 13, T31N-R18W, Lot 13, Country Meadows, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please feel free to contact this office. ~ncerely, mes K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin mz