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HomeMy WebLinkAbout030-1057-70-200 LQQ&`'s Pertrr$tAtof4TgAqH 23.30. 716- 7 1`?~ iXJ, SEWAGE SYSTEM County: 1,al5or and Human Relations INSPECTION REPORT Safety and Buildings Division ST- CROTX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 199919 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: X W ST. JOSEPH ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1190, 1 1 Az_ 030-1057-70-200 TANK INFORMATION ELEVATION DATA A9300323 12j& jq3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark ~ /00 0 iuoa Dosing 106,0 14)0, Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic Q5-1 q0 NA Dt Bottom Dosing NA Header/Man. ~3-"Y6 9 Aeration NA Dist. Pipe Holding Bot. System S9 3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Forcemai n Length Dia. HH Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ! Length 7 5, No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J1' DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: "r), >/,9011 o?g/ 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 X 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: ST. JOSEPH 23 80.19 201H AM 1-15 q pl l (~tyJ G s } Plan revision required? ❑ Yes ~j No Use other side for additional information. a C SBD-6710 (R 05/91) Date Inspector's Signature Cert No. f 4 Qy ciy r STC - 104 AS BUILT SANITARY SYSTEM REPORT O P v SUBDIVISION / CSM#,O:,g /Ln ,e- LOT SECTION T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s. '~-e- 4 AA'' \ Q B 2^ S'~ 7S' xtv -3 IND C TE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r . BENCHMARK: k.. C Q S' / / S ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /0,* e Setback from: Well ya ' House Z- I-' Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length 7 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Z , 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: zzz</ 93 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt SANITARY PERMIT APPLICATION T®ILHDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY S T S~~ANI R PERM =Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ chec"k If refisIon to pr sous 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 T-c UC- ,uW %a,vw %a, S T,3 , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Sup 40-e-gli6y CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER aft.-e r, e A C 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE ❑ Public1 or 2 Fam. Dwelling-# of bedroom PARCEL TAX NUM ) 111. BUILDING USE: (If building type is public, check all that apply) ~J~B ~l0 S -7 - 70 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 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. ® New 2.E] Replacement 3. ❑ Replacement of 4.0 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 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~Qf, 6 ELE ATION v/~L 96 e WV Feet A04" Feet Vill. 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 strutted Septic Tank or Holding Tank 040 ' C 7` Lift Pump TanWSi hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/ RSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): I S G r v r G~ IX. CO NTY/DEPARTMENT E ONLY ❑ Disapproved Sry Permit Fee (Includes Groundwater Date Issue Issuing A 7aure ( tam 'm urcharge Fee) Approved ❑ Owner Given initial !Ri Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS J 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, 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 131/2 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; close 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. I SBD-6398 (R.11/88) c e ~ .f~G~ Tae Q 7` ~4d se _57 4) ~~°T~ G d- l~a•r.s~ Scatier:Q Fxer~ Wes~~6~'~%.L-e Al 1l vrt F , 8Y Xcy arcs/ ~/ee.gt sejo7~ ASP 45r d A t ~ ~m Ga der ' 000, abor and d Human ment Relations Industry, Labor L SOIL AND SITE EVALUATION REPORT Page ~ of .3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 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 PROPE WNER: PROPERTY LOCATION 4)1) t C I- GOVT. LOT u/ 1/4 1/4,SZ3 T je N,R /9 f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # ) 3 5 ~Q 3 Al/4- N14 CITY] ATE ZIP CODE PHONE NUMBER ❑CITY c c~ . 5 4-o r C~ (his) sg-q _5G 93 C ILLAG JUOWN NEAREST ROAD vs~` h New Construction Use ~q Residential / Number of bedrooms 3 ( 1 Addition to existing building j ) Replacement ( ) Public or commercial describe Code derived daily flow ~O gpd Recommended design loading rate __!~o bed, gpd/ft21Ltrench, gpd/ft2 Absorption area required 75'0 bed, ft2 G 3 trench, ft2 Maximum design loading rate r 7 bed, gpd/ft2 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/ site considerati,~ Parent material ` -0 a'4-1W4" Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM N FILL HOLDING TANK U=Unsuitable for system s❑ U ❑ S U 0-S ❑ U 0 U ❑ S ❑ S 15U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft 13 in. Munsell Qu. Sz. Cont. Color far. Sz. Sh. Bed *6 L9 a rk7 -j S- f~ ~ -~e 7 8 Gr Ground B~pL N /-S O S /YIv J'7 .119 Depth to limiting factor Remarks: Boring # El -S / dry! 9r ~ cJ ~ Ground " 8Z_ 7, S .2 `'f/ P S v 4- V N- • 71'6 elev. 7-o Depth to limiting factor f`^ F,: n y / a Remarks: CST Name:-Please Print / n Phone N o~ _ st.yi ri.,~ Address: JAS, Signature: Date: N 6v ~ /Dr !8-y3 G°S 0'r_ !?.Q PARCELI.D.# ~C-~ 049 4(~SS~ Page of 3 Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont Color Texture Consistence Bo~ncJary Roots G P D/ft W~ Gr. Sz. Sh. Bed Trench 4•:. elev. G~ ~a v AV 7 Depth to limiting factor coo" Remarks: Boring # • A.,w~ D -z~- Al J&Ln I-- S/ am V Me ct) v 7ln,, :i s Ground 3 8 2 22 0 IV elev.W 7 c9 /p0 ft. Depth to limiting Wtor Remarks: Boring # 7 /ors t~ si ,rr e!; 7 t-1 /Ot- si Ground --7~ 7, S 2 YIO->'t E - S •vA , elev.A Depth to limiting factor } z4ELL Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: 381) -8330(R.05/92) STEEL'S SOIL SERVICE /,,s--f- Z'0?' Gary L. Steel C.S.T. 2298 V4SS [s New Richmond, WI 54017 MPRSW-3254 246-6200 NW V* N uJ X~ S 3 - ~3pw -!Z Fj cb (715) ;k ao.S G'Ph 2° h,,q,~smkdl. Z5 3 I ~ II X95 ~ 'I ~ II 1gm r 441' ,s 4-11M ery b i9-S E .4.4- fv. W .LB-rn& rc- = kd,4 -y o iB 3 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of " .3 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 81/2 x 11 inches in size. Plan must include, but ~rp not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE WNER: 'YY1 AN-C O PROPERTY LOCATION GOVT. LOT I?la) 1/4 j0 d 1/4,SZ3 T Jd N.R f(or) W PROPERTY OWNER':S MAILING ADDRESS 3 in Y' S L0 BLOCK # SUBD. NAME OR CSM # 6CrV"Wrs7CT AL i A) CITY ATE -SVW 4w- S'c. ZPHONE NUMBER []CITY pyILLAG MOWN NEAREST ROAD i S►`k9ffp (74) 5 -56a 93 S y~ v.SC h H-New Construction Use ~j Residential/ Number of bedrooms 3 [ j motion to existing buckling' ' (j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate _bed, gpolR2 .7 bench, gpd4t2 Absorption area required 7-to bed, 112 G t~ 3 trench, ft2 Maximum design loading rate l 7 bed, gpd/tt2 _-4 trench, gib Recommended infiltration surface elevation(s) I s0 - It (as referred to site plan bertchmark) Additional design / site considerate ~s4_ Parent material 60 _ { rJ Flood plain elevation, it applicable ft S • Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM FILL HOLDING ~Tu~t U - Unsuitable fors stem 19S ❑ U ❑ S O U 13S ❑ U ~ (a U ❑ S ❑ S 151) SOIL DESCRIPTION REPORT a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundsty Roots GPD/ft In. Munsell Qu. S% Cont Color Gr. Sz. Sh. Bed rench 1 3~ Ground elev. o Depth to t't'. limiting factor Remarks: Boring # -5 51 14 -1 j- e,4 5 El /l/ _5'/ d nY7 r Ground elev. zp I ~Q Depth to limiting yfactor / ~r Remarks: CST Name: Please Print P ne: Address: Signature: Date: CST Number: CAU PAHGELI.D.l1 J q 0..5~ Vage -of / Pa ' Boring Horizon Depth Dominant Color Mottles in• Munsell Qu. Sz. Cont Color Texture Structure Consistence GPD/ft Gr. Sz. Sh. Roots Bed ; 3 rertdt 2-, rt Ground Y y. m YY1 L , $ , !o elev. O U S Depth to limiting : factor (90 ! Remarks: Boring # t° s/ a m v YYL ~o c4.) d 7 a-~ S /f C d Ground 7-8 elev.v s D S lYl 9 ,~s9 !8 ~oO ~t II Depth to € limiting If, for9U' ~ Y~ Remarks: _ Boring # • 7 /U r~ ~ S/ :r S a 'n d cr~ a,~ , 5 AI S/ ate,, C) Ground -7 7, 2 !►2 , , i nan S o s r~v~ ,tip Depth to limiting factor = ~ v i Remarks: Boring # t i Ground elev. ft. 9 Depth to limiting factor Remarks: ;BD-8330(8.05/92) STEEL'S SOIL SERVICE Gar'v L. Steel %J 91 C.S.T. 2298 c- H{ e~ti W SS e= New Richmond, WI 54017 MPRSW-3254 Nw Y~ N uJxf 4 - -/-.30n.~ ^0~ Ftb (716) 246-6200 .s'- aUs e--ci) ea A . , PIP IF- - I ~u s \ / 26 Q~5 ~3HX95 444- 0 W .~csrn~ i2 = /00 104. /V Q, y rte. /o~,~-~3 nLE 419094 'X N ~J O :u u I- o -1 a crou eft" ' ~ Fy Wbo oo& w 1~ 'I UJ 1,7 7 - aa u, i=i owned I : sL c M C'. N C C+7 M, /O 33.06 Nl10 7,36 E~ -~J' Ala;te~ I 1 Gy N 65 690.26' a i N P, I l~ / 7.20' 2 n i J i 0 i) A 0y 1-1 3 -60 u L" DN ] N °n C=J Cl' \ C.) N M o (n N CA ' X -j 0 - W I / I y ~ N T O O W N i I / -n n 1-3 s i I 1 VVV 9Go~ „ 4~t1=•° to -y N, oca=? v-~ 1 I : T ...I'ut - =r TI:1'` 27 0 C►~] 0 I g p ra --I -'~--{--1-i-1--1 a+. N00° 32' 43" W 811.18' 0 t- \ 776.85' eI' :J 34.33' ~ -i . I APPROVED -4 W t 1\I r _It- 1\I1~i~'IF'} p0 N i ,t l,'I W O.. W 1,1 O}1 C W O j U bnj 0n C u. C'' \ 4 \ a tO a t i.a *i lF~l( 1IL:`R (a i 2 31984 00 A n ii i i C", 1) N N is W T I \ M I L41 C-) s tT N o y ST. CROIX COUNTY (.3 ~ j PREHENSIVE PARKS PUNNING I v r! \ CUI (,~I CJ W W l m z v OD A c I .t I 'o „)1 r I-' i \ AND IONINO COMMMI x o ;L t ~j.^I, :lt.)1 ` l7 ICI' ]I I a, Ia, ql z O pC, h ~3 C> j ;;IH N/gos Te P i O ; F1 M i rS') . Cj] .3 f Cs)I ~~i,l !N~tO C" C]!, r(' p gg9 m i I n j I C \ 1 S4 'NJ , C lt) O 0 39, ;'Z9-36, 770 Ol `J UI I 0) iV I N I N r-: iA Ol ' l0 )l\ _ •r• N \ i'' r, I O) i ~ N 230 m 1• 1 r 0) N I Olt), ) ~ F i c; I C.^-: C) O I 1 x .C," °o • 00' 1 W ' I"'Irn r.•. n ~l~'^ Jjf! rJ L) ::J I mDpl 00 Ci 'j 1 ;i J 0 00 L j 1 't) \ CD :-J o i `(J CA C 40 rn (1) -A U k Z O top tp W - W - - 1.7 i In co ~i,i: M C) iJ < I m to w-n -n v 0)CD .Iw _w IOr• •j rill u) C7 (fl 1 1~ y IJ (11'~ CA J rT 1ir Cn i i r I I,,) iv (A r y V S: -3 N W ID H 1 3 O C D v (a C~ i tl' OI 0 0 O 0 L, I- N 0 Z D Ol 0 O1 Lri W WIAIW 'rI d C) r0I0 (a AN 0y J'+ 1'S ( j '1.1! 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T,1t?rl C. yaac- a .:e, ' have spa:-vet, e~ le r .:c :ec~-oin v ;ich;)-ou- owner: sa - lan( -he land.. na::cel is re,) P.:3 -In.^-Ci =i1 _S Ce?. i:...xa°C.. ve c'?, ?cZ`: '1F~' eX':r?i:..0)' ?-)o e.).,-., o i :Cl? st u .r ve y e c anc: ' r :a e 1-,e SCi:i_?)E's. c.,S .°_OllOWS ir;.) c: parcel of lane: loca'te(: rl n art of -he 1/4 ox ;:ze o ^e _ion 27. i_r1C( art. Of GOverririen't Lo:: 5 O:c Section 237 all ?_i n 30 19 Town of `''t ~ osep h - c,7:oi c County. 'risconsin; -~-rr`-ae?- C eSC3.-4 b'.C'. as :`Ol lows : . cinc. air 'i-.he 'N" corner of sa4_c, :3eco:z 23. sa:.r oini: also ;~2:LnC; Co.•r.lr^~e~l ' the ~-)oi_n'': -c beginning of this ciesc.rioi: i_on ..:.fence 17 290--41'-4V along 'c;:le i~O -h line o 'Che id'? l/4 of saic, Sec :ion 23 ; 1317 - 37 :see -i:0 the N-i corner o :,o't: 1 of Ce is i_i:1P_Ci Survey ;:':a?:),- VOlu)-,:.e 3. ?aga aS reco.rC',.e(-7 _n -':hA ncf-k" ice of : ie -.S t . C oix Colin`C j ,.ZeCf 3_ S i:" of :DeeCa :h.~nce S 510-55' -24" along :ale no..r-hwes-terly lin~:- ~-)z Lo` 1 of sa:_c. Ce,:`ifieel Sus:ve"11 I a~, 402.50• feet i:o '..Ae co ne.-: 0:. Of Ce):'`.ifieCk S1z~:v°`i~ -.il'•7" hence 390•-4l'-,10:' -oi alone he sol:file -l;' lade of ?,or- 1 of sai_c,,. Ce:_ :-i f j.eC. :iu::Vey 53.15 .'_P_et- :O cen,_e :-l..ne Of a. 66 foo:: ?:-i_va`:^ 7,oaC,. easc~,:ient as reco-C.ec_ on scii_C Ce_r :.e..C v. -ve',~ an ; ::fence S 510_55''-24:' 7: long said, cC\ n`e.'.•:-lJ_ne 3.3.62 :hence 2n0_-32' 11:' along sa;i,_ 242.3 .`.eeL--. ;.leriC:' 030 59-07' a:lonC , s c er,.l 1 0c ari d cent ]_I..e. 172.12 fe c. a].ong £;c.:'. C :?n'':erline j 229 . 92 fee'i: 't0 -:.1C? poin'c of Cili-Vc.::u - 674 .3.7 2oo':: .-a cJ.Us cu=Vc4 concave sout7.e"-._s-_'-erly. having cl. cent-rzl ~:r1C~'-c of 160--521-2,,'.'-- unC. 47h0se Cho -C. bears '10--52' -37" l97.~M ee'. :,hence southwe;-' e::1.7 along said c-,?::ve a:zd cence.--1 _Ile ll " . `;5 ree`: ',.O 1e= point Of tan =''CJ''), 1 e1.Ce 730--.261-2311 alone; si:, iC: Cen :e "1~.i1C 455.45 few- ";::,a o.- c o:. a 225.21 Loo*.-. CL?:"V'=' " ii]C:o'✓e .;%:i'V'_11~f ::t C,:2i7a1 angle o 47 53' _ 1.0: aI1C'. W!,c,sa Cho'.'C. i'.)ec:)-s :.1 '120---37 .02 l r!2.79 fe_e'C. 'i-her1CC. no:. *,-I-i 'es _.--l.' along s:-.,.C. cu.--:ve an(_. 1',.? .22 `ee'c --O tho -)o -_n of GangeilC.J . chenco _5Z]` 2" 0' --27': along saie. cent-e::l i_ne 156.10 fee-:.-. to 'Che poin' O' C..i ?-v a. I:u:CF. O _ F 357 .21 f0o-'-- raC.S r;urvC? concaves. sou::1 ilaV.'.i~.g a cell :ral angle of 150-531-00" a,nd Whose cho_'C. A,ears : 5 SC.-36' -57" T'• 9.71 feet- ~:i1_-nC~ w._sr-._rly along sa-_c: curve and c..nte_-l:_ne,- 99.02 =fence 1:1 110--4_7' • 36' E, 690.26 fee'` :o the 1:o-Ch line o%. : ai_d 1/4 Of Sec'cic.n 22 ' t?_.ence 890'..55' -'_l3" along sa.e: line w' :he N~~._, of - of 114. o)_ ':ee2?.: 220.00 feet to cn=_ noin': O1 !)eci?.1:...zing. OCr~'':;1N3:: wi_':'1 anC. su;_,jec `C_ i:0 a Ca :,=00': .-,:lva.::e. ZOa•.C. ea.sc;lenu cS .:eCUi- .~Ic.. 1. on Cep:i_f i_(9C. 1".".a.p VUlU;iie 3. ?£.C? ~.r7 has :hi.s Ce- ^}.c c.. Su;.vey i;ap is a co...rest: ?;-eserlia'ci.o;l o` ~h ~ ex :e i.o): ;-)oun(fa:- y surveyeC and 3escr ibe ' - ..:.c ,-34 T, 'have .Ve laull y cornplieC, With `L i7E:'. cur:.-ant- a:)::OV ~.5:_Uns OL 23 ^i_sconsi_n ?evisec:; S"i-atues in surveying and rkiE.;-) )i ng same: :C) lAY S T ATr .'.:_N'.i' ( The roadway shown on this map is a -,private roaaway ALLEN C. any maintenance costs of the ,:oa6way, afi:er_ ' WHAGEN ~ i.'ts approval by -the Zoning as z: 9 S-1401 s ~andr.. rd road( shall be sha,rec pro•-ra- :a by _ae HUDSQN, aejoi.ning p-.-onR:ty owners. Shoulc '.:he ,?rivare \ttr13 t~ roadway be ta'cen over by a r11un:_Ci;? ali_'t! aS 7U>>1i.C W ~ "y )road,- riaini:enance costs there ac-.er woulc: he a `~'~s '~N '-)u blic expense. ~ I o Volume 6 Page 1738 C~ Ul ua Q S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ I -P-(' e LZz!7 ADDRESS FIRE NUMBER- _.7 / O CITY/STATE ZIP Pr f 60 1/ - -S--PROPERTY LOCATION:./F--1/4,1/4, SECTION-Old , T 30 N-R c W TOWN OF S3+ St. Croix 'County, 0_5t4 v . G /7 SUBDIVISION_ Yh , ,n ,,,fl d,, , S i , 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 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/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 Y DNR. Certification stating that our septic Y 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: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 5TC-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), 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 G Location of * property /=1/4 MI/4, Section cW_S_'7_, T2,L_N-R__(_,W Township V 1v Mailing address .,o j0 v-- ss Address of site _706 U:w cs rn 176 Subdivision name t- u -43 n L 12, 1) of no. Other homes on property? yes - ^ No Previous owner of property Total size of parcel Date parcel -was created - A160. 7 'Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? Yes 1-40 to/~ QX3 Volume___'(~E~and.Page Number 4 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 No. 5'009 p'3 , 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. y i nature of applicant g Co-applicant /O - Date of Signature Date of Signature i THIS SPACE RESERVED FOR RECOROIN6 DATA r 1. DOGUFtENT NO. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-ise2 RcGlSTER'S OFFICE 500903 VOL 1O~fjnwE 2gJ ST. CROIX CO., WI ' Re-'d fof Record ......1tQR~~iT..W.zL.IJAM..sYtANS9N JUN IT 1993 conveys and warrants to .....S.TE.VEIL.P....-MARCELL.6_-PND_•-LORI...... Register .,I_.. MARCELLO,-..husband..and..-wife.....••-•_.._- .uzvivAZabip-.maitai_.Property-------------------------------- - , - - . . _ Y.;. r SC fie}; Q ~--------°--C°nntY. t the following described real estate in Tax parcel No: State of Wisconsin: llZ Part of Government Lot 5 of Sect3-n 2 all in Township 30 North, Range 19 West, St. Croix C©~nty, Wisconsin described Map filed November 7, 1986 as follows: Lot 3 of Certified Su-iwey': in. Vol. 6, Page 1738, Doc'. No. 4109 Wit- with a private road easement for ingress and egress as 3, Page 861. Together recorded in Certified Survey Map in Vol. 40 a. i. FEE , is not This - homestead property. 1LJ, (is) (is not) 4. Exception to warranties: record,tif any. trictions and rights-of-way of r„ r S Dated this .................................1. day of 19-.9 i 011 C (SEAL) M, Robert William Swanson • . (SEAL) e -------(SEAL) 1;. h s 1 AUTHENTICATION ACHNOWLBDGUBNT STATE OF WISCONSIN Signature(s) a& St. Croix . County. 19 June personally came before me day of authenticated this ---__.--dsy of 19A the above named - --Robert-'Ailliam Swanson-- • - TITLE: MEMBER STATE BAR OF WISCONSIN wh o executed - xecuted the (If not, authorized by 1 706.06, Wis. Stats.) me known to be the perso w 1 0 instr nt~and a wled the same. THIS IN.+TRUMENT WAS DRAFTED HY n~` (l-~