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HomeMy WebLinkAbout038-1089-30-120 Q (1) o c O °U~, o II I ~ I o I; I 0 N O O Z LL C O 3 ~ I I M ? Z jry co E V Z " o LL L Z y Nc,)Lwl am c 0 O z v c aUi z d' I ° ~ o ` O N N O~•j/~ N 47 I N O • a N O 1 ~ O 0 (D 0 Z co z = N z U') N I C0 E c N N H > In L R N 04 4) (D 1 0 Q •w w V C O N d i O 00 O _ o G a .0 O! F- F- F- 3 0 0- N Z Z °'000 FL CL O O O Z ° ~ •N ~,aaa ~ I 7 O V) N ~ J U a) rn rn } *-OVA p N y o 0 0) (D N d U 0 0 7 0 a0 co to O N iV r C) d Q} c,~ m O O N N Z. III 0 N C Q O I: C y0 C C E a 0) O 5 20, III U as ~Q,°ol a 7- =rr O m 07 - L L N N (y~~ L" a) F- F- _ o ao 0 It E E • ~V O N (4 O UJ v~ m ea E a L: (L r`I~t w E c c t A V a O in o DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUS.TRY? C DIVISION LAITOR BOX HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53969 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: ~TOW HIP LO T NO.:BLNAME: SW ~/4 NW 1/4 21 ~T31 N~R18xhrr Prarie n/a n/~> n/a COUNTY: OWNER'S/BYNAME: MAILING ADDRESS: St. Croix Robert Cook R.R.#2, Box 230, New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO. B EDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence 3 n/a Olew ❑ Replace 1-18-91 n/a ~XN RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U S []u RO~ `Iu S [_]U ❑ S ®U ❑ S ul~ conventional 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: class 1 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 11 BORING TOT,% DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.08 100.32 none >7.08 .83bn.1. 1.58bn.s.l. &gr. 4.67bn.c.s.&gr. B-2 6.84 100.15 none >6.84 .75bn.1. 1.17bn.s.1. &gr. 4.92bn.c.s.&gr. B-3 6.75 99.85 none >6.75 .75bl.s.l. 1.00bn.s.s.l. &gr. 5.00bn.c.s.&gr. B-4 6.75 98.78 none >6.75 .92bl.s.1. 1.00bn.s.l. &gr. 4.83bn.c.s.&gr. B-5 6.83 98.95 none >6.83 .83bn.s.1. 6.00bn.c.s.&gr. 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- P- P- se desi rate 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 96.60 E w I r E E 4,., 1vt 4-eF to >4~ pad" lot E E a 3 i E A.. 3 loll R--3 Y L- E V J I, the undersigned, hereby certify that the soil tests reported on this form were made by me in ac ! e 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 W E MPLETED ON: Gary L. Steel 1-~-~~ ADDRESS: CERTIFIC TON NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi. 54017 2 7 5-246-6200 CST SIGNA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS F R COMPLET, 115 SB - N To be a complete arid,, c_ i your rellor t rnncrst include: 1. Complete le-al descr 2. The ease sect:ion musts lY i! ihether this is a r,.rsiderace or commercial project; 3, MAX VIUM nui b " b, droorras t, c ornmercial use =fanned; 4. 1- t:,3w of t em n*_ s} 5. C eta the _ y rating bo A SITE 1,13 SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTE RE RUL r - T BASEL? ON SOII =".tITIONS; 6. PLEASE use t_ wiations 5 re for kno-iting I- cr'iptions and cor .-ng the plot plan; 7. MAKE A LEta T :gram ace y locating your ,ons. Drawing t.; s is preferred. A separate sheet ma, ised it des . 8. Make sure yot., f 'k and elevation ref( t are clearly shown, and are ,rmanent; 9. Complete a boxes r dates, narnes, ac 1r flood plain data, percolation ' :c exernp- -.1. tion If 10. If the info (such as flood plain, elevation) does not . place N.A. in the appr opr'=. box; 11. Sign the k re your cut i ent addr ess and your c, r raurraber; 12. Make legible copies and distribute, as reguirezl. ALL '~L TESTS MUST BE FILED kNITH THE LOCAL AUTV40RITY WITHIN 30 BAYS OF COMPLEE1 " N. CERTIFIED SOIL TESTERS ABBREVIATIONS FOR Soil Separates and T z Other Symbols st. Stone (.over 10" BP Bedrock - S<,~adstor,e cob - ;;obbie (3 . 10") (under ':TO11P. Sand Pf ,,o,atl€an R C ryled f4 F:n l e 11 csa<v Red sic! r Cry Loam fnat Mottles Sc - Sandy Clay . . ~"ith sic Silty Clay ff-f - few, s~,aint clay cc - ,arse pt Fiat nnm a :rrt Mickk- d p ;,..int HWL ?vc3ter level, Six general sor= textwe's rfcace water for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step i. securing a sanitary permit. The county or the Department may request verification of this soil test in the for to permit issuance. A complete set of plans for the private sewage system and a permit applic:n 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. ' . ~lQ7LGJ r9,Z'e~& t%52 1Z0 f~ v~ %-.-,4 z) ed 469255 rE:RTIFIED SURVEY MAP Located in part of the SEk of the NWh of section 21, T31N, R18W, Town of Star Pra:.rie, St. Croix county, Wisconsin. Ni Corner of a Unplatted Lands Section 21 North line of the SE} of the NW} of Section 21 o a a 7 i N8901715211W N890171521'W 178.49' r. - 834.001 M I W 9 ~ d, coil al ul 1 • AI _ o ~N N L l .I L; al .N + 1!'1 N A N 1- I I s i C o o n I oo f OWNER 21 en ; o i = e l . I Robert Cook y I u i 1t. R.' 2, Box 230 _ c 'New Rlchmohd, 4l1:` 54017 U o LOT 1 dog r_ I Q+ I 88,425 Sq. Ft. z N U 0.1 2.03 Acres b t O ~ I lA I fV W a., y 4M 4. L C O N A I O I F OWf L d .C S8901715211E r m 37.131 G N 7 ALEGEND d`e~ U ~A N 1 d County Section Monument -Aluminum o SO1°24'S811W S89o17152"E Cap Found 30 66 37.951 \ \ • 3/411 Rebar Found . 001 \ .e O 111 x 2411 Iron Pipe Set, weighing 1.68 lbs. per linear foot. 00 N Existing Fencelins r 4 ~ggQ9G'$0sa Z~ iA W b AILED - to Ig1.1 'n • I co I r MAY 101991 QD W C JAMES O'.CpNNELL " W yew t~ .Aw =1 W H nsord, ° pegisler Of Uee08 J I I d Wis. _ ; ooQ~N SUR'~ ' 7t N N M 1 .T I = I M 1 oil + APPRO11ED o N °D H ++1 t. ; 00 SCALE IN FEET O y I I MAY 10 1991 4. U*,l 0 100 200 300 c o` , > > ST CROIX C~ COMPAENEN81bEP1U~E v i ANDWW4C0WA M C. T. H. IICu S89°1015711E t 66.001 / Center of -I- - Section 21 VOLUME 8 PAGE 2356 This instrument drafted by Fran Bleskacek Proj. No. 81-21-190 IFORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION ~T . \ -N-R_JLW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 I ,r 614jt jk 3 2 e~J' i INDICATE NORTH ARROW I BENCHMARK: Elevation and description: Alternate benchmark / SEPTIC TANK: Manufacturer: 1►f etc ~rc~c_r"c,C~,.e Liquid cap. I Rings used: Manhole cover elev:~-Final grade elev:j> Tank inlet elev.: -Tank outlet elev.: -ff 9~1 No. of feet from nearest road:Front)~, Side , Rear Ft., e From nearest prop. line:Front , Side, Rear Ft. No. of feet from: Well Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: ~r Width: _Length ,2 Number of Lines:_.,;2 _Area Built-L Exist. Grade Elev. -Zro j Proposed Final Grade Elev. &062 ri Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear_.A_Ft.~ No. feet from well: No. feet from building 9 c~ f HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: INSPECTOR: DATE : - PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj 4q too ao Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lal~or and H;jrnan Relations INSPECTION REPORT St. Croix Safety and Buildings Division ATTACH TO PERMIT) LOT l Sanitary Permit No.: GENERAL INFORMATION SW4,NW4, ec.21,T31-R18,Co. Rd. C 149179 Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: Sanford B_ Johansen. Sta-r P-rai-rie CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 364A-20 TANK INFORMATION ELEVATION DATA jo//g TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic h ewqd, Benchmark g v / zep. et r fl 611/ Dosing o, 3p 3 Aeration Bldg. Sewer Holding St/p14 Inlet V Z91 2;2. 12- TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosin NA Header "k&& . ~ s Aeration NA Dist. Pipe ~3 17, 52 Holding Bot. System 7 zr da 59 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 57-1 ~~''4 r_ Model Num GPM C r 3.09 TDH Lift Lrictio System TDH Ft Forcemain Length Dia. I- :~Ist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length I No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type CHAMBER p ~ OR UNIT Model Number: System: v1 if. 1 9 DISTRIBUTION SYSTEM Header / Manifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length -CL Dia. Length ~ Dia. Spacing (10 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, ,persons present, etc.) J , 1 , LZ,e Plan revision required? ❑ Yes ❑ No Use other side for additional information. 2a SBD-6710 (R 05/91) Date inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: " I I i SANITARY PERMIT APPLICATION . 0 1 L H R In accord with ILHR 83.05, Wis. Adm. Code CM, STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. El check if r'evisioh/tojrev ous 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 ~ V- Sg;/4 N1 01/4, S a j T N, R 1 E (or) ' PROP TY OWNER'S M ING ADDRESy LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION N ME OR CSM NUMBER Sol ass *W. . a3 11. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE : NEAREST ROAD c~ G ❑ Public 1 or 2 Fam. Dwellin of bedrooms PARCEL TA . UM R() _ -ea a 111. BUILDING USE: (if building type is public, check all that apply) 3 ` _ _ a p 1 ❑ Apt/Condo l~ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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. Cy New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ Repair of an Systen,L 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 ❑ SpecifyType 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 jj REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) c~ ELEVATION <pl 61 / ~ / 4 Feet , Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glas Plastic App Tanks Tanks structed Septic Tank or Holdin Tank F"P+ Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft sites wage system shown on the attached plans. Plumber's Name t): Plu is S' natur . (No mps MP/MPRSW No.: Business Phone Number: CA1utY1 a~TS_ 7/S~ S/,> Plumber's Address (Street, City, State, Zip Code): /11(09 1 1 IX. CO TY/DEPARTMENT USE ONLY E /01 ❑ Disapproved San'tary Permit Fee (Include g roue Water ate Issued issuing ent Signatur No op" Approved ❑ Owner Given Initial op / 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 & 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, 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 13% 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 1V 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) NDUSTfiY, _ L)I~ l:,ltJl1 A1330-R, A N 0 PERCOLATION TESTS (115) MADISC N WI 3707 fUMAN RELATIONS (ILHR 83.0911) & Chapter 145) I.OT N0.:8LK. NO.: SUBDIVISION NAME LCic'A`IION, SECTIOfV:---- TOWNSHIP~~II~i~F~K--- 1 -1 SlJ 1/ NW 1 21 /j31 N/11184,11 1 Star Prarie 11/a n/a COIINTY: -OWN ER'S'SSBBLMMQ DAME: MAILING ADDRESS: St. Croix Robert Cook R.R.#2, Box 230, New Richmond, Wi. 54017 JSE - - DATES OBSERVATIONS MADE ~PENOOLA I ION I e.5`f S NO. BEDRMS.: COMM- E TAB DES~RIPTION~ TUFT EE-MZ'l-P'I'1l~NS_ Residence-~ 3 ri/a ) t~►1ew ❑Replace 1-18-91- n/a RATING: S= Site suitable for system U= Site unsuitable for system _ OENfiONAL : MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ICNV cx cS El U HAS OU ~ S El U OS ®U1~ S ©U conventional DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested Brea is in the class 1 n/a f under s. ILHR 83.091511b►, indicate: Floodplain, indicate Floodplain elevation: - decimal' PROFILE DESCRIPTIONS page BORING TOTS(~ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, I E:<TURF, AND DEPTI I NUMBER DER11i~F1•d, ELEVATION OBSERVED ES IGHES TO BEDROCK IF OBSERVED (SEL ABBRV. ON BACK.) B-1 7.08 100.32 none >7.08 .83bn.1. 1.581)n.s.l. &gr. 4.67bn.c.s.&gr. B-2 6.84 100.15 none >6.84 .75bn.1. 1.17bn.s.1. &gr. 4.92bn.c.s.&gr. B_3 6.75 99.85 none >6.75 .75bl.s.l. 1.00bn.s.s.1-. &gr. 5.00bn.c.s.&gr-. - B.4 6.75 98.78 none, >6.75 .92bl.s.l. 1.00bn.s.l. &gr. 4.83bn.c.s.&gr.- - B_5 6.83 98.95 none >6.83 .831)n.s.l. 6.00bn.c.s.&gr. - - EB PERCOLATION TESTS TEST DEPTFI WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES PEFi INI;]I NUMBER INCHES' AFTERSWELLING INTERVAL-MIN. PERIQD.1PERIOD.2_- P se desi rate - - PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what art; 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 feicent of ]and slope. SYSTEM ELEVATION 96.60 k• ~ r ~ t 3"~ ~ i , I i ~ ~ 1. t t QtJ~~- to yy)► y~ ` -F 5 3 f 4t (p 6 4 l0~ .31 tip, TN I w i I la 15 ~ j I i i I I I ; I I, the undersigned, hereby certify that the soil tests reported on this form were inAde by me in accord with the procedures and methods specified in the Wisconsin Imr'nistrative Code and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. At , NAME (printl: TESTS W MPL_ETED ON: Gary L. Steel 1-~~E ADDRESS CERTIF~C~T ON NUMBER: PHONE NUMBERIoptional►: 1554 200th. Ave., New Richmond, Wi. 54017 ~`j 715-246-6200 - - - CST S I G N A E : L DISTRIBUTION: Original and one copy to Local ALI IIty, Pr r• n d Soil Tester. (]II IIR SBO6395IR. 10/83) '1FR 1 I I ~ ~ I ~r I I ~ ~ I ' I I I I ' I I ' i . 1 ( I I I r , I I k ~ I vL' ifFl tt~` I I ~ 1 1 I i I I I I ± I 1 ~ I I r t 1 -r t i I I I/ _ , I I i I I I i j..K~Jd}~~ j I I j I i - I I i I k - I- - ! I I I I ~ I I 6 i I 1 I C I I , 1 j I , I ~ j i I ; i _ I ~ r I 4 1 i I f ~ I I I ' I ~ I I I I ~ ~ I ' I i i I L_ I I ~ 1 1 I I I I I 1 I I I ' I ~ I r , I I i ~ i ~ I I I I I , i I I I- , I' I I ~ I I ! 1 I I , -4 t , I ~ + I I , I ~ I ~I T I f I I ! I i ~ , f I- I 1 I I I I I I i 1 , I 1 I I I I _i I ~ 1 ~ I I I I , I I I 9 I I I Q i 1 I I I I _ I _ 1 i I L I I - I I I-, - I t r , I i ' , I i j I l t } r ~ i I I I r _ i I t- I I F f • i 1 I I t-- t i I l I , , I , r I ~ I I I! i~ ~ I I ~ I I I it 'I i ! I I I I I I i j I 1 ! ! I I i i I I i i I ~ I I I I ~ j I ~ j r • I I j ' ~ ~ J ' L i I t 1 - 1 F I I t I I t f 4 I I I I ~ I i I MUSS ~ S~C~IUr1 01' /~l Ur17 ~~S~~n-~ A~"g Ave e{y_ FrarA Air Inlalo And ObearY0llon pip, Q . 1 Approrid vent Cop flnllnm-l 12d ADOra o Gred. 20. 42' Abore Plpp -4" Carl iron ie FIn01 Orade Vent Pipe ►saen He Or SrniMlk Co atop uin 2' ApOrepele Oren PIpO Dl elr lbullon Plpa o 0 0 - Teo s B' Aparepola Beneath Plpe ° Perlordled Ply, b.1'. o -'Cagllno Tarnlnallnp At BOIIOm Or STelem r/ODD 1 Pro o)eD Pins J rs%cl-( LIt)J ton / SOIL FILL DISTRIBUTIOi.1 PIPE r APPROVED $yNPAETIC COV[R r ° 2" MATERIM- OR 9" OF STRA4J o~AGGR~GATE ~ ~ • - OR MARSH HAy ELEV. OFD=a4~4~ EE Y I.rOFlz-P-% AGGREGATE DISTRIB'JTI,DW PIPE TU BE AT LEAST IAJCHES BELOW ORIGIAIAL GRADE AAIU AT LEASTZO IUCHE-r BUT 1,10 MORE THAI) 42. INCHES BELOW FMAL GRADE MAXIMUM DaPrE{ OF EXCAVATIOP 1fi(OM OKIGWAL 6RADF- WILL BE Yp IMCHES 11 NIMUM CKFrti OF EACAVATIC" r'F\OM. CA, 16WAL (jR^vF- WILL BE INCHE S SIGIJEO: LICCUSC I.JUMBER: DATE: - TTo 1-4 DOCUMENT NO. WARRANTY DEED THIS SPA(:E RCSERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 471279 VOL yo. PAGE1 REGISTER'S OFFICE ST. CROIX CO., W1 Ij Robert-_J_. Cook and Ma_rjorie_E. Cook, husband__ and_ wife; Recd for Record Theodore J- - - Cook and Susan DCook, husband and -wife, JULO 1991 - - I' and_Gary__L_._ Cook__and__Nancy_ J_ _Cook,__husband and wife at 8:30 A. M - asonveys and warrants to COY Johann en,-husband-and w1f.e., _ as_ mar-ital - _gr op.er_ty --Stith........ Register of Deeds rights. -Df--survivorship-------------- RETURN TO it Century 21 Somerset - BOX 416 Somerset W. 54025 the following described real estate in St--.Croix........................County, State of Wisconsin: Tax Parcel No: Part of the Southeast Quarter of the Northwest Quarter (SEJ of NWJ) of Section j Twenty-one (21), Township Thirty-one (31) North, of Range Eighteen (18) West, described as follows: Lot One (1) of Certified Survey Map filed on May 10, 1991 in Volume "8" of Certified Survey Maps, page 2356, as Document No. 469255. II,I FEE This ls_not---------- homestead property. I (is) (is not) Exception to warranties : Dated this 29 day of - June 19.91_.. j C (SEAL) ----(SEAL) Y)4 4_ - - Robert--J k Marj. .ie E. Cook --------------------(SEAL) . ...(SEAL) A,L-neod~ Co * Susan D. Cook - ) (SEAL) t~ (SEAL) TICATION y JA~ OWLED MENT Sigi?:~Rture(s) STATE OF W U IN ss. CTOX County. I authenticated this .......-day of 19.....- Personally came before me this 29-------- day of June 19.91... the above named Robert__J.__Cook,--Marj y.ie--E-'--Cook--------------- Theodore -J.Susan D_. Cook, Gary TITLE: MEMBER STATE BAR OF WISCONSIN L. Cook and Nancy. J. Cook - - - - - (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the i I foregping instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY L' ~ Rein_stra,_Van Dyk & Needham, S.C. ` s 201 South Knowles Averiue; $ox TZ7 ary---- B-a1_la!"OeQ!?----------- New--Rie4uiand,•-WL'"'.544L7 Notary Public ..--St. Croix- ---•-•---County, win (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) ) date: ----_!p i'> 19-~ "Names of persons signing in any capacity should be typed or printed below their signatures. . it WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Malik Cu. Inc. FORM No. 2- 1882 ~l ii ~r,.ukoc, wie. l APPLICATION FOR SANITARY PERMIT 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 issuapce. 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~~4,~~.4~.P.r3_-:~~ T N - R W Location of Property 3%, Section Vwnship Mailing Address 'J Subdivision Name 4-11 Lot Number 11 Previous Owner of Property _ T Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes A No as recorded with the Register of Deeds Volume and Page Number ~ INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 1. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, lreferencesutosa CertigiediSurveyys of the reviewing process. If the deed description Map, the the Certified Survey Map shall also be required. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ _ PROPERTY OWNER CERTIFICATION 1 (We.) eentZjy that att 6tatement6 on this 6olun ane true to the beat of my (own) know.Zedge; that I (we) am (ate) the owner (d) o6 the pnopvtty de c abed in th A .in6onmation 6onm, by ViAtue o6 a warranty de drecorded in the Ob6.~ee of the County RegizteA o6 Deeds ad Document No. ; and that I (we) pnedentty own the pnopoded .6 to bon the detva e p d aydtem (on I (we) have obtained an eu ement, to nun h the above dedcA ibed pnopenty, bon the, eon,dth.u.cti.on o6 chid dydtem, and the dame had been du,Zy neeonded in the 066iee o6 the County Regizten o6 Deedd, a.b Document No. _J SIGNATU OF OWNE , SIGNATURE OF C R (IF APPLICABLE) DATE SIGNED DATE SIGNED 3 CERTIFIED SURVEY MAP Located in part of the SEa of the NW4 of Section 21, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. Nk Corner of - FO Section 21 Unplatted Lands N N ! M O North line of the SQ of the NW{ of Section 21 N N89°1715211W N89°17'52"W 1 178.49' C1 It o i 834.001 N I N W ++I 071 ~ •1 L 7 V N c7 1 d l O N 10 I OII 1y0 H N I _ I In ~1 0.1 • w m N 1 co OWNER I 7 I 0 0 .--1 i ~ r Robert Cook o r_ Route 1 :3. 1 Somerset, WI 54025 v U 00 C, C N r-• I o~ LOT 1 o C Co (4- Ln c l ~t I O O •-N - I ,/7 L 3 -7' 88,425 Sq. Ft. = c 2L d .03 Acres z .o CD s o 41 U7 1- I la7 1 N W N M 1 ~ O 1 t0 1 ~ ~ C O f0 ~0 I • 1 W - L N e 1 1 r ca ro c QI 03 cn 1 „ S8901715211E ri W -W0 37.13' \G c A \\4~ LEGEND 41 \ ~ U E \ ~7 B r County Section Monument - Aluminum o ~ \\°o Cap Found S89°17 5211E z S01°2415811W 37.951 \ • 3/411 Rebar Found .00' \ \ 66 O 1" x 24" Iron Pipe Set, weighing ~ t F the rar linear foof, a o ~ . d ~ to c 0 4J f 4,9 I w y .~i r1 f/1 C) M N W Y~ Az Ora ~ r. 4 N = 0~C r1 r Z p W Flt-`I)0~i.i, c I I W C!; to (j, ,p I ¢ f~D YVSJ. ••r O'ge 3C S CL O~ tZ l _ N N o d I i S 07 en I > I O~ I N Lr7 - 00 a..• 1 O I d l of NI ~ C'J I SCALE IN FEET o `-`o' rn 1 v 1 1 rnl JI M 'v •O I I N d 1 1 O -0 14- 01 0 100 200 300 4.1 0l I yl V LI 1 O NI I U I 0°7 C.T.H. 11C11 S89°1015711E 66.00' / Center of F Section 21 This instrument drafted by Fran Bleskacek Proj. No. 81-21-190 ' Cn ' H 9 r S T C - 105 9 H T ' o SEPTIC 'TANK MAINTENANCE AGREEMENT St. Croix County z d a . H OWNER/BUYER ~,~p,t~b~/~_51 rn ROUTE/BOX NUMBER zo Fire Number CITY/STATE A,L ZIP PROPERTY LOCATION: Section z2? , T~TN, R Ids W, Town of St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in I its premature failure.to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you ptlt into I( the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for amaximum 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 systems properly maintained. The property owner agrees to submit to St. Crbix County Zoning a certification form, signed by the owner and by a master.plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (.if nec- essary), 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. 0 z 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 Depart- 'z ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED 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.