HomeMy WebLinkAbout038-1132-10-300
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION_✓;TN-RJe!l Wi Town of l~
~i Y /~7 rig! C-
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,,I i(/ iii
Iltlf
r
v
II
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
w
BENCHMARK: r ~ - r~css~~~-
ALTERNATE BM:
SEPTIC TANK PUMP CHAMBER HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: ljoec%
Setback from: Well CLL'R' ouse ~S- / Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width:
/,Z Length Number of trenches
Distance & Direction to nearest prop. line: ~ 2,
Setback from: well: Z1-1C L;1//House 5 Other
ELEVATIONS
Building Sewer ST Inlet. % ST outlet
PC inlet PC bottom Pump Off
Header/Manifold ~Z Bottom of system
Existing Grade Final grade G
DATE OF INSTALLATION: j
PLUMBER ON JOB: 7
LICENSE NUMBER:
INSPECTOR:
3/93: jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and flt4man 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 Plan a:
BRINKMAN, PATRICK 1i
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
lOf~, l d U . ~.i
A94 DO 2 07
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /09,75 /DO,
Dosing
Aeration Bldg. Sewer 75 9 y, 5
Holding St/ Ht Inlet 93,7S
TANK SETBACK INFORMATION St/ Ht Outlet 8, g 93, ~vr'
Vent
TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet
Septic .Q a S r > a S ► NA Dt Bottom
Dosing NA Header/ Man. Aeration NA Dist. Pipe J 3 , ~S
Holding Bot. System ,4.v S~, q ,
7
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 5-r 6,3
,yW
Model Number GPM
TDH Lift Friction System TDH Ft
Loss mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
DIMENSION Width Length No.Of7dches PIT No. Of Pits Inside Dia. Liquid Depth
/ DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER ~ ~ ~ v& Model Number:
System: .3 S OR UNIT
. 2 00
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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
No
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No ❑ Yes E]
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATJON: Star Prairie.32.31,.18W, Lot 3, Winding Trail Road
DOD r-4,11,
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. ;SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
i
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: T
I
I
' i
I
SANITARY PERMIT APPLICATION
^.~i ■
r~
r~~l~n■i In accord with ILHR 83.05, Wis. Adm. Code COUNTY
#
STATE SA T; 4111 ERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than oo~'/
8% x 11 inches in size. ❑ Check if revision to prhous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PPJBMTY OWNER PROPERTY LOCATION
r7/~ '/a S&Z, T /,N,RZ E( )W
PROPER ~ O NNER'S M~ING ADDRESS ~ LOT # ~ BLOCK #
09 11 Z
CITY, STATE I ZIP CODE PHONE NUMBER SUBDIVISION NAME OR~SM NUMBER
CJ n v4~
II. TYPE OF BUILDING: (Check one) CITY Vj NEAA`REV~'ST OAD
State Owned O VILLAGE ' ~
❑ Public M[1 or 2 Fam. Dwelling-#of bedroom-) PARCEL TAX NUMBE (S)
III. BUILDING USE: (If building type is public, check all that apply)'
10 Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
50 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. ❑ 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 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 220 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.) PROPOED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION *5q L
`7 , eet Feet
VII. TANK CAPACITY Site
in allons Total of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tans Tanks structed
Septic Tank or Holding Tank GL~ L+ F1 _Q
Lift Pump Tank/Si hon Chamber
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' i ature: (No Sta s) MP/MPRSW No.: Bus- ess one Number:
S g 641L 6101
PI ber's Address (Street, City, State, Zip Code):
IX. C NTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued IssuIng Age big o St s
-*lee irc App roved El Owner Given Initial J'75~ harge Fee)
Adverse Determination
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 parceltax 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.
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)
PLOT PLAN
PROJECT Patrick Brinkman ADDRESS 109 Sunrise Dr. Somerset Wi 54025
NW'1/4 SW 1/4S 32 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
DATE 8/26/94 BEDROOM 3
0:~~/
MPRS BYRON BIRD 7R. 3318
CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X54'
BENCHMARK V.R.P. Base of Steel Stake Red Ribbon ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark
VENT SYSTEM ELEVATION 95.6
12" GRADE
TYPAR COVERING
1"3' 6'®3'
i SEWER ROCK
12'
650' Property Line
56'
Vent
B-5 120' B-2
B-
15' Rep A 13% - - - 59
' Slope
250 g, - M. 230'
B-4 60' 60' B_1 10'
S
5'
Pro 3 Bedroom
House Area
650' Property
Wit D. sin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa e of
l..abo~d Human Relations g
IJivision 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
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 ~ct778-Z RirVIEWEDBY DATE
PROPERTY 0 E PROPERTY LOCATION. '
GOVT. LOT 1/4! t/4,S T N,R E (o o
PROPERTY OWNER':S MAIL NG ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
CI STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN, NEAREST ROAD
~/J'~ dip s-~•/ !iC/~ r O S Gcr ®/'Gt ~i.•. c/i s~ ~~'cc
New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
j j Replacement G [ ] Public or commercial describe ~i
Code derived daily flow 5j gpd Recommended design loading rate 7 bed, gpd/ft2 O trench, gpd/ft2
Absorption area required al bed, ft2 i57e!~? trench, ft2 Maximum design loading rate bed, gpd/ft2~trench, gpd/ft2
Recommended infiltration surface elevation(s) 6 ft (as.referred to site plan benchmark)
Additional design / site considerations A%,!) A7 Parent material Flood plain elevation, if applicable /L/1,;9 It
S = Suitable for system CO VENTIONAL I~QLIND IL-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem MS ❑ U t!9 S❑ U fS❑ U WS ❑ U ❑ S J$(U ❑ S Nil
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 Tmnch
0-10 IO r 31-2 . 6
ld IO 5 S 2m cv ,5 .
Ground 3 .S QS f/
elev.
12
Depth to I
limiting
fact
5,l
Remarks:
Boring #
F t L+~, nzr r✓~
I r 3A e-2.4n /n
Ground
rvx
t.
&A
Depth to
limiting
factor 79
a.s
Remarks:
CST Name:-Please Print c Phone:
5' - ld
0'f CJ,-
Address:
Signature: Date: CST Number:
Z 9
PROPERTYOWNER DESCRIPTION REPORT Page _403f
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
5 -6
0-9' D 3 2
77
-5A IY2
Ground .3 .3 - /4 S • 0
elev.
Depth to
limiting
facto, ,r
y/
3.9 Remarks:
Boring #
10 r z
IOU,
WA
3 s o ,
Ground
elev.
Depth to
limiting
ctor
Remarks:
Boring #
I-w 16.,- 3 Sl r . 6
Id-A
vln T-
-3 IVY 1(1'r5li~
Ground
I v.
ft.
Depth to
limiting
factor
7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
T
Soil Test Plot Plan
Project Name Patrick Brinkman Byron Bird Jr.
Address 109 Sunrise Dr.
Somerset Wi 54025 3479
Lot Subdivision Date 7/26/94
NW 1/4 SW 1/4S32 T 31 N/1318 W Township Star Prairie
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of Steel Stake Red Ribbon
System Elevation 95.6 * H 13 p Same as Benchmark
650' Property
56'
B-5 120' B-2
15' Rep A 13% B-3 Pri A :16%
5
'
250' lope gope * M. 230'
13-4 60' 60' B-1
Pro 3 Bedroom
House Area
150'
650' Property Line
FILED
g p1u 2nt X994 ® 2
JAMES O'CONNELL 3
Register 01 Deeds
520599 - L S~.Gd► Co.,0
CERTIFIED-SURVEY MAP
Located in p.ar_t of,the NW4 of the SA of Section 32,. T31N, R18W, Town
of Star Prairie, St. Croix'County, Wisconsin.
;.'ROVES N
L •i-1 M
11UG 2- 4. Wil
0 of ~
O
-0 4- O
w O O
UfX COUNTY
d = c
OWNER :.:r. -irv4iensive9taadve in Feet d v
Russell Flandrick Zoning a s
R.R. 4 Box 192 F .-xs Committee 100 200 400 d 4:
New Richmond., Wi. 54017 a
` )Ot recorded
i C y
N
ve :Oin 30 days of: A
L
ipooval'daba v C
:~c P7
:&roval:shall be co
.a.rS; void VOLUME 1092 , PAGE 1408
W Corner of TEMPORARY ROADWAY EASEMENT
Section 32 CUL-DE-SAC TO BE REMOVED UPON
M ROADWAY EXTENSION`
s
G k N 7 '
N I /
N89°29'03"W 756.23'
~ 690.22'
66.01._/ m2n LOT 4 o C~ N00°10'26"W
C> 0 o202.11'
3:80 Acres
rG'Oij M 1650,372 ' Sq. Ft. Oe a (,~1
LEI'
ZI a ( S89 2,910311E 684.381 9 c I
Y I► , x N12o37!58"E3./33• N12°37'58"E JI
57.151 I' 57.15'
4- 40
LOT 3 I I 1 n
n , I
-FJ_j I d T 6.92 Acres 6I6 r IU
I- r s o o
= I-~ o 301,288 Sq: Ft. ~I
'g;
a u Co
1 ° o Ln
Oa
11m
n W
d +
-4
u L( i N V N
.
o J
d
s in _ o
m z ~ o
I', i I x
649.801
66'.00'
S89°29'03"E 715,80'
c
LOT
C DC 661
o r,.
j.. Q Cn ty. , r J •
M SH `rr•yy'l'l ~~k' y„j~
LEGEND
SW Corner of--4
Section 32. Aluminum County Section Monument Found"."
♦ 1i Rebar Found sy,~ ~fUt:u:,;•;:';%.`.
• 1" Iron Pipe Found
0 111 x'24" Iron Pipe Set, weighing 1.68
lbs, per linear foot
x Existing Fenceline
100' faadway Setback line
SHEET 1 of.2 SHEETS
VOLUME' * 16 PAGE 2805
LOT RADIUS CENTRAL; CHORD CHORD ARC TANGENT TANGENT
NO, LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING
334.001 11013132° N07601112'tE 65.33' 65.44' N0102412611E N12°37'58°E
+4. 233.001, 1204812411 N06°13'46"E 51.97' 52.081 N12°37'58"E NO0°101264
5-6 80.001 6503811611 N32038142'tE 86.721, 91.651 N00°10126"W N65°27'50"E
6-7 80.001_ 24503811611 N5702111811W 134.461 342.981 N6502715011E, SOOO W 26"E,'
8-9 167.001 12°4812411 S06013146°W 37.25' 37.33' S0001012611E S12037158"W
10-11 400.00' 11013132° S0700111211W 78.241 78.371 S12°37'58"W S01624-264
SURVEYOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby
certify that by the direction of Russell- Flandrick; I have surveyed,
described and mapped the land parcels which are represented--by this
Certified Survey 'Map; that the exterior boundary of th'e land parcels
surveyed and mapped are described as fol'.lo.ws':
A parcel of land located in part of the NW1/4 of the SW1/4 of Section
32, T31N, R18W,'Town of Star Prairie, St. Croix County, Wisconsin;
further described as follows:
Commencing at the ,W1/4 corner of said Section 32; thence S00034'33"E,
a'long'the west line of the SW1/4 of said section, 209.42 feet to the
point of beginning, thence continuing S00.1)34'33"E, along paid west
line, 696.74 feet; thence S89029'03"E; along the north line of Lot 2
of Certified Survey Map recorded in Volume 9, Page 2661 at'the St.
Croix County Register of Deeds office, 715.80 feet; thence
NO1024'26"E, 322.06 feet to the point of curvature of a 334.00 foot
radius curve, concave easterly, whose central angle measures
11°13'32", whose chord bears N07601'12"E and measures 65.33 feet;
thence northerly along the arc of said curve 65.44-feet; thenc.e
N12037'58"E, 57.15 feet to the point of curvature of a 233.00 foot
radiu3 curve, concave westerly,.whose central angle measures
12048'24", whose 'chord bears N06013'46"E and measures 51.97 feet;
thence northerly along the arc of said curve, 52.08 feet; thence
N00010'26"W, 202.11 feet;'thence_N69o29'03"W,°756.23 feet to the point
of beginning.
Above described parcel contains 11.77 Acres.(512,77.4 Sq. Ft.)"and is
subject to all easements of record.
I, also. certify that this Certified Survey Map is a correct
representation to scale of the exterior boundary-surveyed and
described; that I have fully 'complied with t-he current provisions of
Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision
Ordinance of the County of St. Croix in surveying and mapping the
same.
i
VOLUME 10; PAGE 2805
1
r
CERTIFIED 'SURVEY MAP
Located in part of the NA of the SWa of, Sec.tign, 32, T31N, R18W, Town
of Star Prairie, St. Croix-County, Wisconsin.
OWNER'S CERTIFICATE OF DEDICATION _
•
As owner, I hereby certify that I caused the land described on this
plat•.to be surveyed, divided, mapped and dedicated as represented on
the plat. I also certify that this plat is required by 5236.10 or
5236,12 to be submitted to the following for approval or objection:
St. Croix County,Planning and Development Committee and the Town of
Star Prairie.
WITNESS the hand and-seal of said owner this, oZ d.ay of 19l
In the presence of:
Witness sell Flandrick.
State of Wisconsin ),SS
County of St. Croix) Georgeie.M. landrick
Personally came before me' this Lq. day of __.19the above
na ~d,Russell Flandrick to me kno n to be the persons who executed the
F-16 It4g~ instrumen and ack owledged the same.
c r`
OU)
v
-NI lic,: Y/- C-,fo/,< Wisconsin
saon :exp,ires a
EAc•h.,~
4xai~f•'shown on this map i.s subject to State, County and Township
laws, rules and regulations (i.•e., wetlands, minimum lot size, access
to parcel, etc.). Before purc•has:incq or developing any parcel contact
the St. Croix County Zoning Office and appropriate Town Board for
advice.
APPROVED
AUG 2 4 '94
N
Y
U ~
ST , C`01X COUNTY
b co!nprvhanslve Plannir
Zoning and
E=•~..'ks Committee
T
A
-d if not rocorded
w y.jitliin 30 days of
approval date
approval shagbo
`v nid! & voir~
e
L
.4+
N
C
• ri
H VOLUME 10 PAGE 2805
L
SHEET 2 of,2 SHEETS
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADPRESS : /_T_ e -FIRE NO:
~LOCATIfONs~l/4 x_1/4, SEC. T.2J N-R W
TOWN OF:
--f
ST. CROIX COUNTY
SUBDIVISION: -~~rn LOT NO.
s
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 to
help with the cost of the 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 the St. Croix County
Zoning a certification form, signed by the owner and by a master
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. Certification from will be sent approximately
30 days prior to three year expiration.
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 form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
expiration date.
SIGNED: O~
DATE:
St. Croix County Zoning office
911 4th St.
Hudson, WI 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 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.
r `
Owner of property
t
Location of prooperty_,~~kZ 1/4 1/4, Section D ~ , T__F
Township / Mailingaddress ct
Address of site
Subdivision C
name 5 Lot no.
Other homes on property? Yes No
Previous owner of property e\-
Total size of property ~2 y
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? XYes No
Is this property being developed for (spec house) ? Yes No
Volume
~p21/ and Page Number !yo 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 of ice of the County Register of
Deeds as Document No. ' and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office the County Register of Deeds as Document No.
r' -
Signature of Applicant Co-Applicant
Date of Signature Date of Signature
I
.
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-19821
5209'8 . rN
Vol ; C-R'S- OFFICE
l~us-sell__L,.•_-Flandrick_-and Georgene M. ST. Psc~dfar CROIX ~ CO. M
ord
Flandrick,, _-husband and wife
. SEP 2 1994
- 9.45
conveys and warrants to ...Patrick.- D_.___ Brinkman, ty /A. I? A. M
---a_..sing-le---Person__-- l%
of feeds
RETURN TO
the following described real estate in St_.__CrO1X County,
State of Wisconsin:
Tax Parcel No
A parcel of land located in part in the Northwest Quarter of
the Southwest Quarter of Section 32, Township 31 North,
Range 18 West, Town of Star Prairie, St. Croix County,
Wisconsin, more particularly described as:
Lot 3 of Certified Survey Map dated August 24, 1994 and
recorded in Volume 10 of Certified Survey Maps at 2805 as
Document No. 520599.
Together with a non-exclusive easement for Ingress and Egress over
the Public road shown in volume 10 OF Certified Survey Maps,Page
2805 and also Over Outlot 1 of the Certified Survey Map filed as
Document No. 503275 in Volume 9 of Certified Survey Maps, Page 2661.
This is_______________ homestead property.
(is) (is not)
Exception to warranties: municipal and zoning ordinances, easements
and restrictions of record.
31st 19.. 9-4..
Dated this - day of August.----- -
--(SEAL) GL= t`~ (SEAL)
* Russell L. Flandrick
(SEAL) 9t > - oC'Lc ~t(SEAL)
* Geor ene'F~Flandrick
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
ST. CROIX SS.
- -----County.
authenticated this day of__... 19 Personally came before me this __31st day of
August 19.94_,_ the abov named
Russell f- Flandrick anc~
- - -
* Georgene M. Flandric
TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife
(If not-
authorized by § 706.06, Wis. Stats.) S
to me known to be the person who executed the
for oing instrument acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
- -
=
REMINGTON LAW OFFICES
Judit$ AA. R min ton *---Lxr~----- - iLe
New_ Richmond, Wlg ___54017 St. roix
Notary Public - - - - - County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
Linda K. Rice date: 19..>
Notary Public
*Names of persons signing in any capacity s ty o 1an8 their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.