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HomeMy WebLinkAbout032-1003-30-000 r 00 Q O oo N y O ~ O Q ~ I 0 N y c y 7 y y U) 7 Zn N O E ~ N z C E LL c a O V 'B 06 C Q N N I , 3 m (D 111 z N z p z y a co H Z N 0 O Z •V 0 z d c O Z fn H (D c ~ •o I'' O ` N N 7 N ~ N U) O • My ~ s O ~i p m o aa) Q w z co z o N n z N y 0 E N N 0 ca m V 06 C w O co c G G a a N U) N N a w O 3 3 3 a z o •r a a • ~ z 7 O U) •O CO N Vi U o rn rn l N a o E a CL m Y N CD h ~ < CIO m O CL O y to O (p N C o °O 3 o c E n E a c a) (1) EL V O o m 0 In E c ai O = co - o w rn C~ c? • 7~ m N O E S> N E N r y O O In V) O - 7 Con v eg k O. L d a. C5 C W V it d w C I I C w r~ E 2 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER(9 ADDRESS SUBDIVISION / CSM# YA LOT # A SECTION T3_N-R__LZ_W, Town of ~p/^~/&-A rf.T l~~r ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ScacE yo IY0445 6w J looo h L- 3 55' - 5,51 pM INDICATE NORTH ARROW t•fD0.O d • ~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole over. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: X S Liquid Capacity: /D00 Setback from: Well House `1t Other Pump: Manufacturer IVA Model# /VA Size )V/4 Float seperation /YA Gallons/cycle: N,4 Alarm Location SOIL ABSORPTION SYSTEM L /Wes Width: Length S~ Number of tsa-e es 1Z Distance & Direction to nearest prop. line: SOU?H' S.S Setback from: well: House 6y/ Other ELEVATIONS Building Sewer ST Inlet. 190,2,P ST outlet 10,Z.03 PC inlet . PC bottom Pump Off AIA Header/Manifold Bottom of system !9&j; Existing Grade Final grade 1&1.02.4 _ DATE OF INSTALLATION: 9y i PLUMBER ON JOB: LICENSE NUMBER: 32.a57 INSPECTOR: 3/93:jt Ldvrstdrfstnro p3rtrtf f t y, 2.31.19. *049EWAGE SY NFROIX County: Labor andsHuman Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary ermit P.,..OTX GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: ;MTTH OBE SOMERSET CST BM le v.: Elev.: BM Description: Parcel Tax No.: r~i 7tp1/00 M 0-12-1003-10-000 TANK INFORMATION EVATION DATA A9300370 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S~ Benchmark Dosing G~ Aeration Bldg. Sewer /0 Holding St/ Ht Inlet .5-0 /Od, 32-. TANK SETBACK INFORMATION St/ Ht Outlet Z Verit TANK TO P/ L WELL BLDG. A ir Ito ntake ROAD Dt Inlet Septic -3C V NA Dt Bottom Dosing NA Header / Man. .d& Aeration NA Dist. Pipe (613 22, It ~ Holding Bot. System cf~ 7V PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand k,~ -te, Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of / CHAMBER Model Number: System: 4-e ~S {,OR UNIT DISTRIBUTION SYSTEM Header/Manifold I Distribution Pipe(s) I x Hole Size I x Hole Spacing I 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 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 2.31.19.18,NW,NE,POLK - ST. CROIX 60 6.13- 6,13 Plan revlion required? ❑ Yes ❑ No Use other side for additional information. / ~7 l G SBD-6710 (R 05/91) Date • nspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , SANITARY PERMIT COUNTY DTRANSFER/RENEWAL UNIFORM P-kRMIT~* (PLB 67-T) PERMIT RENEWAL DATE: 1-10 -W PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER: /a- d/-y3 PROPERTY LOCATION: CITY: VILLAGE: '/a '/a,S ,,~2 J31 N,R E (or) TOWN OF: LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LA DMARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRESS: I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUM 'S SIGNATURE: I PREVIOUS PLUMBER'S NAME (IF CHANGED): d PLU BER'S ADDRESS: g,0/-7e4 REVIO S PLUMBER'S ADDRESS: L ` ~e L MP NUMBER: PHONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER: 5"1 L6 6,5'1 15-63 1 ATURE OF ZSI AGENT: JDATE APPROVE DISTRIBUTION: Original - County 1104 ~ Copy - Bureau of Plumbing Copy - Owner DILHR-SBD- 9 (R. 5(2) Copy - Plumber LIT pW- t) EN F1 0 U D 30 M covi-ap- peoposeW ~i aBs Iva ~83 ~ ~ S t~ / S eT. P+V~ Dr 17 SCAc9 /'=V0 r X56 r ~ EL ra x 51 s 6EPAGE 13E0 6" , siEEL p /oo - 02 $ ,4G2E ~Ji4/1C~L S~ Std Q~tAcu~~r6- F,0,0; D RA7 f: l'i ad3 ~R s/q.TH S-e6 U A44-e y rJ IECv T~, poc.~ -Sr,Cjeoix 0-l'- R41'1741-10 ~'O/'/,RSET ~ /OZ 5 /1(~GU uJ/.Syo.~L? /'`7F'✓tsiv 7.26pS LLJ ` c z v> C. C E C G > ti ? Q - - ~ i r 6 a C c o 3 E T s _ c > o L m Q ~ N O a r > L 1 ~ ~L ~.C C ~ L c; Q a N s~ ~ a O C L 3s «Y ' o a t y m~ ^ U (r Lij O z v NaU LAJ ° E w ° Eo LL_ E _ O s -C N s a t O O. L O N ? Y LO LL T a N V E 3 m y 3 u~yi V. a E c m y c m oC o y a T E" ° O w a~- `3 s~ aE W °u CL e ° `-C L a O N m E t° 3 0 W -J a,s E E 2'y L O c d O u G m° _ C C E 3 y .C 7 y Ti L t 3 C d 1 1 W O 1 U s CC ~ ~ FL- ~ Q F- y o:-c m ~o v~_ of ~ ~ mom _y ~ a !R z LLJ c z Z z C) U p p p o CO z f- LMLJ acc mmmi 0 U) co ~ co J o °r ° O O a, w z o Ir ~ W 4 v U Q F- z z OJ O 2 ~ W J O o co Cc vi LL w W co Cf) Ll. w w v) I IZ ~ x a w N W ~ Cc a co MCC w O p w - W a cD Z 7:::~t a m n c) a_ coo 3 O ~ Q = F- o T-DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY 5y. Ct.6 ► STATESANITARY FjI # ly -Attach complete plans (to the county copy only) for the system, on paper not less than % 8% x 11 inches in size. Check If revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Rab&,;t Sr+^ 1 AM) Y. t%, S T~f , N, R / 9 ) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 9 Ashland N p n! p. CITY, RTE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5.s/by Mir .a ,VA 4/ II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned ❑ VILLAGE $G71g2 P • ~a 19 =N CA ❑ Public K1 or 2 Fam. Dwelling-# of bedrooms PARCEL 111. BUILDING USE: (If building type is public, check all that apply) b 3~ t73 -..3 a 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE ( OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.,~1 New 2. El Replacement 3. El Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 09 ELEVATION !SO 6#3"K y 7 /V /O g Feet /6.7, Feet VII. TANK CAPACITY Site in gallons Total # of refab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer 's Name Concrete Con- Steel glass Plastic App structed Tanks Tanks t"062~ -7 Septic Tank or Holdin Tank gw Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pr' Plumber's Signatur ( tamps) kfM/MPRSW No.: Business Phone Number: u dta2~ - I S 63 /S• ) CPA -SX_r Plumber s Address (Street, City St$te, Zip Code): IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanilyy Permit Fee (Includes Groundwater ate Issued Issuing Age t Sign lure (No mps Approved ❑ Owner Given Initial Surcharge Fee) 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 s 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, he 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, 61)8-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. .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 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 o1 standards. SBD-6398 (R.11/88) ~'1 of Ql4 (~~b sw. Lam. CaA..... .c 6 !`per 1 i slit A 11' T I~ -ld ` 29, AH i r 1 i i 1 1 E c I R f . I I 1 r ~ 1 ~ Z I t ~j r 7 . i i j { i i OIL, ll-- ~('C)SS ~CC~IUt'1 O~ /'t IJt~ Sy Fto►h Alt 111111 ► And Obtatrallon Pipa S / Approvtd Vsnl Gap ►ilnimws 12 Above final Grads 20• t2' Above Pip' -4' Cast Iron To final Ora a Vonl Plpa Marsh lie Or Stnrhaik Cominr - lah 2' Apprapala Ova PIp► 01 61116.1106 PIPo a e - Tao 1 C' Apaapara Bonsai% Plpo ° Porioralad PIPS holar e ~Ga.gflnp Tarminalinp At Bottom of System Pau p o e D P1 no. 9 cA { o t, ~1cJ•, t l / SOIL FILL. DISTRIBUTI01.1 PIPE Y r APPROVED Sy)JpNETIC COVCR 2"OFhGGREG/ E - _/IIATERIJM. OR V OF STRAW OR MARSM HAy ELEV. oF` EE °bp18 0PAGGREGATE t 1) IS'rR15UT10M PIPE To bE AT LEAST - n2Y IUCHE5 BELOW ORIGINAL GRADE AQU AT LEAST LO INCHES BUT 1,10 MORE THAN tit MCNES BELOW FINAL GRADE M AmuM DaprH OF F-XCAVATIOP FROM ORIWAL 6gADR WILL BE a _ INCHES 'nN)MVM DEFT-Vi OF EXCAVATION r'RO^ Ok161WAL. GRnvf- WILL »C INCHES SIGIJCO: L1GCU5C 1,1uMBEit: is DATE' 110 O Labor scand onsin Hum n Belt oons use, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Divisnn cif Safetyb 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 St . Croix 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: PROPERTY LOCATION Robert Smith GOVT. LOT JA4 1/4 24E 1/4,S 2 T 31 N,R 19 M(a) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 969 Ashland Ave. n/a n/a n/a CITY, STATE ZIP CODE PHONE NUMBER OCITY QVILLAGE fWWN NEAREST ROAD St. Paul, I.N. 5514 (61x227-41018 north art Somerset Polk St. Croix New Construction Use Ij Residential / Number of bedrooms 4 [ ] Addition to existing building ( ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpolft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/Tt2 Recommended infiltration surface elevation(s) 98.80 ft (as referred to site plan benchmark) Additional design / site considerations n/ a Parent material outwash Flood plain elevation, if applicable n /a It S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL Hot. 01NG TAW U - Unsuitable fors stem MS ❑ U ❑CS ❑ U ErS ❑ U 30 S ❑ U ❑ S Ml ❑ S eu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Bourtcklly Roots GPD/ft tence in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerch 1 0-9 10yr4/4 none S1. m s z m .r g/w 2/f .5 .6 1 2 9-84 10yr5/4 none S. 0/sg ml n/a [a/ .7 .9 Ground 1t.16Qt. i Depth to limiting factor >8 i Remarks: Boring # 1 0-14 10yr4/3 none sl. mvfr g/w 2/f .5 .6 a 2 2 4-22 10yr4/4 none Is. 0/sg Ill g/w 1/f .78 Ground 3 2-80 10yr5/4 none S 0/sg ml n/a n/a .7 8 elev. 101.8Qt Depth to limiting >80,o Remarks: CST Name:-PleasePri►6ary L. Steel 175-246-6200 Phone: Address: 1554 200th, Ave., New Richmond, Ili_. 5/i(►1.7 Signalure: - - Date: CST Number: cstri 7208 PMEL I.D. # ••obert Smith Page 2 of Boring # Horizon Depth Dominant Color Structure nce GPD~ In. Munsell Qu. Sz. Coil. Color Texture Gi. Sz. Sh. Bw%by Roots 1 0-14 10yr4/3 none Bed 3 s q, CO. S. 0/' vw 2 14-84 1(yr5/4 none 'S M1 n/a n/a ,7 Ground elev. 103.00ft. i Depth to = limiting factor ZR4=_ i Remarks: Boring # yA`.~ 1 0-12 10yr4/3 none S1. 2/n/sbk mfr p/w 71f .5 .f~ 4 2 12-2 10yr4/4 none Is. (?/sg ml /w 1/f. .7 1.8 3 20-30 10yr5/4 co none . s. 0/s Ground 8 nl n/a na/ .7 :.8 elev. 102Q4 IL Depth to limiting facto i >8011 Remarks: Boring # 1 0-12 10yr4/3 none L. ?/m/sb)c mfr ,/w /f .5 .6 2 12-25 10yr5/4 none El sic], 1/f/si)k )k mfr g/w 1/f .2 .3 Ground 3 25-34 10yr4/4 none co.s. 0/sg ml g/w / .7 .8 103.(x1 4 34-84 10yr5/4 none co.s. 0/s ml na/ na/ .7 .8 Depth to failing IacW >>841_ Remarks• I! .Boring # 1 0-12 10yr4/3 none s].. 2/m/sbl: rafr /w 2/f .5 .6 2 12-22 1Ovr4/6 none ` 1Cl 1 f sbl; mf ~ # Ground 3 22-30 10yr4/4 none 1s. 0/s Pa f elev. 4 30-80 10yr5/4 none 102.00 it co.s. 0/sg n/a n/a .7 .8 Depth to limiting - - factor Remarks: W-e330(11M/92) - - STEEL': SOIL SERVICE 1554 200th. Ave, Gary L. Steel W`'`OW C.S.T. 2298 P.obert Sr.0.0i New Richmond, WI 54017 MPRSW-3254 NW'-:NO.- S,?-T31N-R19W (715) 246-6200 town of Somerset C-0 r, 17 -Ioo .t J /I ~O f I> C~y r 2~' ' 11~' )00r+ J W (;-1i-v I'. Steel s?-~ ~-c~Z x STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1 ROUTE/BOX NUMBER 9 &I (q3)N \ a via, .Q ~r e.. FIRE NO. CITY/STATE Srt i Pia 1/Y\ v. 1~,7$J' ZIP J~Jr _Z2 PROPERTY LOCATION: &(d,)1/4 /4, Section , T N, RW, Town of sa.-ner-% ,I , St. Croix_Coounty, Subdivision WAr , Lot No. !Y 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 $3000 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 systems properly maintained. The property owner agrees to submit to 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 form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements ag to maintain the private sewage disposal system in accordance with a standards et forth, herein, as set by the Wisconsin Department of ion form must be completed and returned to the St oix ou Zoni fice withi 30 days of the three year expiration date. SIGN DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT ETC - 100 (s) of This application form Is to be completed in fu and signed by thein delays of the property being developed. Any Inadequacies will only result the permit issuance. Should this development be intended for resale by owner/contractor,(spee house), than a second form shoals be r etained tand he completed when the property Is sold and submitted to offi with appropriate deed recording. Owner of property ----R t b& r:- m 5 rn ; tin Location of property ~W_1/4 x/4, Section T 3 N"R-(~-w Township .Scs~a Mailing address -W, 9- qSAj4nd- -A u4k. SS Address of site ~1 ~P G~7f S^~ k. © " Subdivision name -y/ Lot number AIIA Previous owner of property n A d Total size of parcel oZ qtr` ~-`r x'3 Date pastel was created d 19 Are all corners and lot lines Identifiable? _Yes Is this property being developed for resale (spec house)? Yes 0 Voluse d~ and Page Number 46a as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DRRD which includes a DOCUMENT NUMBER, VOLUME AND PAGR NUMBER, and the ORAL OF THE REGISTER OF DRRDS. In addition, a certified survey, It avallable, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Ceitlfled Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION i(Ve) certify that all statements on this form are true to the best of my (out) knowledge; that I (we) am (ate) 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. S Q 13 9 V f and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained a aeyrtent,,~to run with the above described property, lot the c ant Sam has been duly recorded In the Office of Co t Re s s Document No. stare of Signature of Co-Owner (I1 Applicable) ' G a of Signature Date of Signature 1-_.- nn VOL 1029PAU 6?4 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 - 1982 TN1a sPACE RESERVED POR RECORDING DATA LAND CONTRACT .A g Individual and Corporate 504395 (TO BE USED FOR ALL TRANSACTIONS WHERE OVER - 825,000 IS FINANCED ANDI ACTIHER NON-CONSUMER C G Vt~'_! OFFICE ' CR0' CO., %M Contraet, by and between __-Donald__J___Nnr_tDn__and--------------- Fl orence__M.__Nnr_tony--his_.wife-------------------------------------------------------------- ti c` Tur Btro+d - - - - ("Vendor", AUG 2 4 1993 , whether one or more) and---ROber:L-M---Smi: h.-,and--Debrch_A.-------_-_----- Smi #,h,- lais--wife-,- as- joi-nt-te-nan-ts- M ("Purchaser", whether one or more). Lai Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- tvaw No Dames formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in----------- St___Cr-01X-------------------------------------- County, State of Wisconsin: RETURN TO Co' - Tax Parcel No. The Northwest Quarter of the Northeast Quarter (NWT NEI) of Section Two (2), Township Thirty-one (31) North, of Range Nineteen (19) West, EXCEPTING therefrom that part described as follows: Certified Survey Map, Volume Seven (7), page 1853, in St. Croix County, Wisconsin. Fin This is._mt.......... homestead property. Ajk (is' not) Purchaser agrees to purchase the Property and to pay to Vendor at heir reSi dence the sum of $__28;QQ0..00---'--------------- in the following manner: (a) 5 >f_QQQe 00---------------- at the execution of this Contract; and (b) the balance of $21.000A0 together with interest from date hereof on the balance outstanding from time to time at the rate of --------2------------ per cent per annum until paid in full, as follows: To be paid in monthly installments of no less than $233.29 each commencing September 11, 1993 and continuing on the 11th day of each month thereafter for a period of five years. Both parties understand and agree that this contract calls for a balloon payment of the entire unpaid balance five (5) years from the date of this instrument. Provided, however, the entire outstanding balance shall be paid in full on or before ex----5_.years--__-__- W" froma_the__date__Df-_this ,xWiXXXxKxaXX*&&mY cMxxxxx instrument. Following any default in payment, interest shall accrue at the rate of .---___9 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). X X X X X X X X Biiil~.(~ elE)G1Gi4~t~$ ~fTXRdbi~lills Naj¢i(dfeX ~ I~X~UbI<df~14~ X~iS~d4Xa41~K17[i~>i~+l<iX17s~$C ~ d4t~Sl~ol4~4~6Kx XyyXXX XX)Wt~9EDQQC~~((~FkkiFX~7RRrX~~i(~@l(9~9~1~iGX4(9@X9QX4PX~(iRRDL~➢@➢i►RX9f¢(R~72llD~~(7NJ~R~DUQI~~R~f ~Q~3t~s]CIiQ~1t0(~A~X9iX~d~C~9~1~DQXrX XXXft)061(X#*X*%0X" X= X Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after Septetoher--- 11--,19-95... 4u* XXXAk9tX)MKK.*X)MXIKNWAM X9dXXIKX94XVdXWX)toa>' XPUCx*eiMXOO(3()WOXJtXXXX In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: none Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall beentitledto take possession of the Property on---- the_.date__pf_-G1os!ng----------- xx*x------ *Cross Out One. LAND CONTRACT- Individual and STATE BAR OF WISCONSIN Wisconsin Legal Blank CAI. Inc. Corporate FORM No. 11 - 1982 Milwaukee, Wis. oao. - [ i 'UN WA04 Upuw•FAj `u aUa 0+44b - ayUAUCUUJ pUU tUeP1A1PU1-1JV "JkUJ ut1b'1 _ A`11 win;aaSjte~2-~^R1 eso(a4 paqaFid io pads a4 P[nogs 64Fosdaa bas ac HmaBFe saos" jo wa[sm ~V As C> 6i - Q PA : elieP Salksoaau PU Jae UOtleatdxa alels 'IOU ;I) _ luausuxaad st uotsstutaaoo By~i gloa 'pa2palmouslag ao palum uaglnu aq -Sstu -sean~ett$tg ) stAS `Blunoo $ . ►1 tlgnd Baeloll ` uaaiS `OL£ xo8 ~J 3 L8ti5 IM - { Mel W Xauao-ii V ` N6SN38 ;K 39b039 As a3izmHo SVM 1N3wnUJ.SN1 SIHJ. •ounes aql p2p jAtOUemg Pt juatjt~tlsuz 2uio2aao; Dial palnoaxa 04 ` - ^ x, - -;t esAd l ail `ol umou3l aut of ~ ? 5 CSIVIS '91M `90'90L § Bg Paztaoglns .--_F---------------------- '3ou 3I) • -'Cl ' - = . - =r----------------------- - •,./L! i~ktm S lk qj k~S NISNOOSIAS Ao UVEI a1vis 'II~gKHR : TULL - - - - - - - - - - - - 'd eaga0 We 411WS ~NF= pue2944«! skk Zuo~,ao " a~ua,~o N W -----l-- LJ ~_Pue_ uo~.aoA--- ~--p-~~uoQ_ patnsu eeoge Dill 6I d ;o Bep-------- still out aao;aq ourea ,SIlieuosaaapap ------61 '--------------------------30 Sup-------- still paleatluaglne Bltnoo • auane •ss MISxoOSIAA ,d0 alvis (s)aanleu2tS iHaiq oaazmoxxoe 11IO11V011NKHSIIV girls eagan uo~aoN - a--aa-a - - • Nvas) ;~,I-,TW.(Av 4;;z1 ,-'v- ('1eas)----------------- - o ---------------S--: W ~aagoa , uo~.oN C Pleuo 4;~~ 0 (zdas)---------------- (zvas) } - - l I $pd---- - - - - ;o sup " ` - - st~Il PalsQ l ;oaaag lflau4lUln; ut opetu aq of Peep Dill ;o uotlnoexa eql ut u? [ of a2s pus fins eql ut slg2ta pealsatuog assalaa of utaaaq sutof uotlsaaptsuoa elgsnlsA a Jo; aopuaA ;O a ods ail ;o aaumo us IOU ;I) •Jassgoand pus aopuaA ;O sU2188s pus saossaaans 'saetlsluasaadaa Is2aI 'sataq l ;o alga q Bql of eanui pus uodn 2uiputq aq llsgs losaluoo still ;o sulaal HV •Jasggoand ;o line; Jo luenbesgns aaglo ,Sus 2utAp m inogltm ling;ap Aug antem Beut aopuaA •lagaluoo still uo apgut sluatukod paaeptsuoa aq llsgs aassgaand Aq oputu os sluatmdud IIe pug os op of slts; aopuaA it 9a2e2laojq Dql of Alpeatp sluatuAvd gans Aug o4vat Bsut aassgaand •laealu o0 stgl Japun anp uagl slunouts aql ;o luataXiod Slauttl sa3ptu aassgaand papteoad 'Agaaagl paanaas alou Aug aapun ao (Jasegoand Bq palusa2 92s2laout Aug ao; ldooxa) losaluoo stgl ;o algp aql uo Blaadoad aql 4suts2ie 2utpug4s1no a2g2laout nug aapun anp uagm sluaut,Sed Ile a3letu llegs aopuaA •amlou lnotlltm uotldo s,aopu9A is `Iln; ut alggBgd pus anp eSlalstpatuuxt atuooaq llggs lomquoo still aapun elgsBsd aousleq 2utpugl94no aatluo Dill '4uasuoo ualltam s,aopuaA lnogltm anus Saeuoa so alias 'ae;sueal gans Aug ;o Juana aql uI •aassgaand ;o ssaupalgapui its ao; Bltanaas ss Slalos losaluoo still aapun lsaaalui s,aassgo3nd ;o 4uatuu2tsss so D2pald s st paAeAuoo lsaaalut aql so lln; ui plied lsat; st losaluoo still aapun olggBsd aouslgq Sutpuelslno aql aaglta ssalun aopuaA ;o luasuoo _ ualltam Jotad Dial lnogltm (,Siam aaglo Bus ut so asieal utJal-Suol 'uotldo Bq ao losaluoo still aapun slg2ta s,aasegoattd ;o Bus ;o 4uautu2isse ,Sq) Blaadoad aql UT lsaaalui elg8ltnba ao ls2al Aug BaAuoa so Has 'aa;sugal IOU llsgs aassgaand laaatP Ilegs lanoo Dill ss patldds pus plaq eq llvgs palaalloa os uagm slgoad pug 'sansst 'sluaa gans pug 'uotlos gans ;o Bauapuad aql 2utanp Blaadoad eql ;o slgoad pus 'sansst 'sluaa eql loalloo of 'lsaxnut psalsatuoq 2utpnlout ',Slaodoad eql ;o aaeroaaa it ;o luauilUtodds eql of sluasuoo aassgaand'logaluoo sigl ;o eansoloaao; ;o uotlos Bus ;o Bauapuad 8gl 2utanp ao !jUattaauamutoo aq1 uodn juaut2pnf Aug ut papnlout aq Veils pus 'paaano -Ut se °aassgaand Sq ptgd pus Igdumad of pappg ail llstls eauapte9 91111 ;o sasuadxa pus mel Aq paltgtgoad IOU lualxo aql of (lou ao palegg zaglagm) aapunaaaq ApatuaJ Aue-aaaopta of paJanout aopuaA ;o seal s,SauJOlls olquuossaa Butpnlout sasuadxa pits slsoo IIe pug uotlie2tltt ut pansand uagm pug ;t aopuaA uodn Sutpuiq aq Bluo ll8gs satpatuaa 2uio2aao; oql ;o Bus ;o 11014001a us 'aopuaA 36 suotlag Jo sluaulalels ualltam Jo Igao Bug But'.tpuglsgltmlolg •anogg (AT) ao (it) ' (t) aapun uotlae Bug ;o Bauapuad aql 2utanp slt;oad so sansst sluaa Bug halloo of paluiodde aaetaaaa g OAgg pus Blaadoad eql ;o uotssassod tuoa; palaafa aasi3gDand oneg Agin JoPuaA (A) PU8 :1U831 I. IUSISUI SI JBSS Dan o saa ut aIge1tnba aill 3. g d 3 l al uoI1ail t . 011!1-49inb is ut alltl uo pnolosselaeJluoo still aeoulaa pug pug us lie v aluoo still eaeloap Bieut aopuaA (At) 3o :;oaaagl uoilaod Aug ao aotad a s g q a a n d ptedun aatlua agl Jo; mill lie ans Bsut aopuaA Q p) ao :,Souatot;ap Bus ao; alqutl aq ll8gs aassgaand pus ales lgtatpnf lie pauotlan8 aq 11egs Blaadoad ail Juana gatgm ut 'aapunaaaq anp slunouts Jaglo pus llng;ap ;o alep Dill uo loa;;a ut a3sa Dill is uoaaagl ls9aalut gltm 'aauglgq 2utpuglslno oatlue Dill ;o luatu,Ssd lin; pug alietpaututt Iadtuoa of logJluoo still ;o aausutao;Dad at ;toads ao; ans Bsut aopuaA (tt) ao (tttaapea of slte; Jasegoand ;t Blaado3d aql ao3 leluaJ sg pug lasaluoo still Ili;in; of aanlte; ao; so2eutgp palgptnbtl as palta;aao; aq Ilegs aassgaand Bq plied Blsnotnaad sl unou ,a lle lu9Aa gatgm ut) aapunaaaq anp s;unoutg aaglo pus olup gans uo laa;;a ut also oql is llnie;ap ;o algp aql utoa; uoaaagl lsaaalut gltm 'aauglgq 2utpus4s4no aJtlua aql ;o luaut,Sgd lln; s,aasugoand uodn pauoiltpuoo aq 04 uotldutapaJ ;o Bltnba Bug tlltm eansoloaao; latals g2noagl -5pvq ,Slaadoad aql aaeoaaJ pug Blaadoad aql ui lsaaalut pus 91111 'slg2ta s,aassgoand pus lagaluoo still alsutuzaal 'uotldo stq Is ',Sett aopuaA (t) :Bltnbo ut Jo mill Bq paptnoad asogl of uotltPPie ut (meI Bq papteoad suotlgltuttl ,Sus of laafgns) satpamaa pus slg2ta 2utmollo; eql aesq osls llugs aopuaA Put' '(saetem Bgaaaq aassgaand gotgm) aotlou lnogltm pug uotldo s,aopuaA Is `IIn; ut olquAed pug anp ,Slalstpauttut autoaaq llegs Imaluoa still aapun aauglgq 2utpugls4no eatIua aql uagl ' (pate Pat;tlaaa ,Sq paltieut ao ,Sliguosaad paaantlap) aopuaA Bq ;oaaagl aatloU ualltam 2utmollo; s,Ssp ----09-- 3o potaad a ao; sanutluoo gatgm aassgaand ;o uo1lie2tlgo J9glo Bug ;o aousutao;aed ut ling;ap 8 ;o Juana eql ut (q) ao a1up anp pat;toads aql 2utmollo; s,Siep -09 ;o potaad g so; sanutluoa gotgm lsaaalut ao lsdtauiad Bus ;o luaut,Sgd eql ui ling;ap a ;O Juana Ogl ut (s) pug eauasso aql ;o st outtl l8g4 saa32g aassgaand - p~t6~a:1'•--} sa~t--~uts- S~~ tt8dt8SL8 t1 - #02E`QI?S--- :idoaxe pus 'aassgaand ;o llns;ep ao low Dill Bq palsaza saausagtanoua ao suetl Bus ldeoxa 'saouieaquunaus pug suati Its ;o Jealo pus Sea; 'Blaadoad etil ;o 'aldtats ae; ut 'paaa BlueaasA& s 'aassgaand eql Ol JDetlap pus elttoaxa 'pUeu zap uo HIM aopuaA 'pagtaads aeogs aauustu atll ut pus sDu¢il aql is petuao;.ted Slltt; eq llsgs suotltPuoo no pus pled Blln3 aq IIsgs s,Sauom Jaglo pus 1saJalut gltm eotad ase4a3nd eql asgo tit legl 9893813 aopuaA •Blaodoad atll 2urpegia suotleln2ea pug seousutpao 'smsl Him gltm Aldtuoa of pug 'laealuoo still ;o uatl Dill of aotaodns Bum moJ; aaa; Blaadoad egg 'daasl Ol 'amclax pus uotltPUOO algelueual pool ut Blaadoad aql d"31 of ~Blaadoad oql uo pallttttuoo aq of elsem molls aou alssm ltuttUO3 Ol IOU 84uguOA02 Jasggaand •algtssa; Bllsattuouoaa aq of atedaJ Jo uoclgaa;saa Bill sUtaap aopuaA eql paptnoad 1pa2stttep Blaadoad agl ;o atedea ao uotlgaolsaa of patldds ail hags spaaaoad aausansut 'Sutltam ut aaJ2e estmaaglo aopuaA Pug Jasega3nd ssalun •aopuaA pus satttsdttoo aausansut of ssoi ;o aatlou ae18 Blldutoad iliegs Jasbgoand •aopuaA gltm paltsodap aq Neils BlJadoad aql 2utaeAoo satotiod lie ;o lvut2tao aql '$utltam ut saaa2e astmaoglo aopuaA ssalun 'pus 1100-10411T 9,aopu8A Dill ;o JOAN; III asctgio paupusls eql utsluoo Ilsgs satatlod eqs •enp uagm sutnnuoad aausansut aql Sgd hags Jasatioand •loealuoo still aapun pamo aauslsq Dill usgl saotu lunomu us ti a2ga9Aoo Dainboa IOU iiiegs aopuaA lnq -F -U-$ ;o tuns Dill ut 'JOpu9A Bq paeoadde mansut g2no3gl 'aausansut-oo lnogltm 'DJtnbaa Asia Jopu9A s8 spaiezeq zeglo gans pus sltaad 93saaeoo pepual -xe 'Dag Bq pauoimoo a2vump ao ssol lsuts2e peansut kpadoad agl uo sluatuaeoadtut Dip daeal lisgs z";)ancl •luatu,Sed gans 2utmogs sld=91 pugmap uo JOpuaA 04 Jaetlap of pus It ut lsa3alut s,JOpuaA uodn ao Blzedoad agl uo pateal sluourssasse pne same ns anp uagm Bed Ol samutoad aassgaand ~s35%d of 10A. F , Vis.'on department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of LaAor 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 St. Croix 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: PROPERTY LOCATION Robert Smith GOVT. LOT r1[.~ 1/4 tZ 1/4,S 2 T 31 N,R 19 Sfor) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 969 Ashland. Ave. n/a n/a n/a CITY, STATE ZlP CODE PHONE NUMBER []CITY []VILLAGE )RDWN NEAREST ROAD St. Paul, RIN. 55104 (61x227-4488 north art Somerset Polk St. Croix New Construction Use P4 Residential / Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate *7 bed, gpd/112 ' 8 trench, gpd/112 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bad, gpd/ft2 '8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.80 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material outwash Flood plain elevation, if applicable n a it S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem OG ❑ U ®CS ❑ U EICS ❑ U 1 S ❑ U ❑ S Ou ❑ S No SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed N" I x:M 7- t 1 0-9 10yr4/4 none sl, m s m Tr Q/w 2/f. .5 .6 2 0-84 10yr5/4 none S. 0/s- Ml n/a a/ .7 .8 Ground 1C6~ Depth to limiting factor >84" Remarks: Boring # RU 1 0-14 10yr4/3 none sl. 2/ms/bl; mvfr g/w 2/f .5 .6 .h 2 2 4-22 10vr4/4 none ls. 0/sg ml g/w 1/f .7 .8 "I amml 3 2-u0 10yr5/4 none S 0/sg ml n/a n/a .78 Ground elev. 101.8 i~ 801 ~l :r+ tl~arks>' e: ease Prin~ary,Steel 175-2.46-6200 Phone: Ad ss 15 54 200 h;J Ave., New ichmond, Tali. 54017 Signature:~ Date: CST Number: \ 8-10-93 cstrl 2298 PARCEL I.D.# l,obert Smith Page 2 of 3, Boring # Horizon Depth Dominant Color Mottles in. Munsell Qu. Sz. Cont Color Texture Structure } -14 lOvr4/3 Gr. Sz. Sh. Consistence Boundary Roots GPD/ft 0 tL'3 1 none Bed mach s 14-84 10yr5/4 none .5 co.s. 0/sg Ground n/a n/a .7 elev. 103.00ft. Depth to limiting factor >84„ Remarks: Boring # 1 0-12 10yr4/3 none 4 2 S1. ?/ry/sbk mfr .,/w 21f .5 .6 12-2 10yr4 /4 none Is. 0/sg ml 3 20-30 10yr5/4 /w 1/f. .7 '.8 Ground none co, s . elev. 0/sg nt n/a na/ .7 .8 102.04 ft Depth to limiting factor >80" Remarks: Boring # 1 0-12 10yr4/3 none L51 2 12-25 10yr5/4 L' 2/m/sblc mfr ,a/w 2/f .5 ' '.6 none sic]- 1/f/shk mfr r/w 3 25-34 10yr4/4 1/f •2 .3 Ground nave co.s. O/sp elev. 4 34-84 10yr5/4 g/w a/ .7 ,8 none co.s. 0/s ' Depth to na/ na/ .7 = .8 limiting Remarks: .Boring # 1 0-12 1 r4/3 w.. none 6 S1-. 2/m/sbk mfr /w 2 12-22 lOv 2/f_ .5 .6 r4/6 none icl 1 f sbl; mfr C, Ground 3 22-30 10yr4/4 none elev. Is. 0/s P11 ,r5/4 w 1 F 102.00 it 4 30-80 10y none 9 co.s. 0/sg ml. n/a n/a .7 .8 Depth to limiting factor Remarks: 3BD-8330(R.05/92) ~ r STEELS SOIL SERVICE 54 0 15. .0th. Ave. Gary L. Steel C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 Robert Saith (715) 246-6200 Nid-:NEB S2-T31N-R19W town of Somerset 6m:- aA E) 0 w/ o , ~.o p4-&v(fs 90 ' 'Ae 28 :ze -30 1 T ),00,4- yc~- k. Gary L. Steel 5-10-93