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HomeMy WebLinkAbout012-1043-40-300 Wisconsin Department ofl:ommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 4' INSPECTION REPORT Sanitary Permit No: 479496 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jacobson, John H. I Erin Prairie, Town of CST BM Elev: Insp. BM Elev: BM Description: QQ _ Section/Town /Range /Map No: V l cis ( 18.30.17. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. (p, /ofa . S3 /C0 Septic jj 1� Benchmark Dosing i✓Q ( vm Alt. BM yvJkjC;, Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO I I P / WELL BLDG. Vent to Air Intake ROAD Dt Inlet O(� Septic N9 ' 97 6 01 5 Dt Bottom ( 4.43 q I Dosing 1 1 / i S 7 S � Header /Man. �lSg i6, ZCo � +;t� � Aeration Dist. Pipe (p Z7 too Holding Bot. System tv .Rz. PUMP /SIPHON INFORMATION Final Grade S , Uo 161 oT Manufacturer (/� emand St Cover r 6� tJO��( S GPM 5 •`d�p IQ6 'y� Model Number 3/ 1 L 3z . ,A / TDH Li Friction Loss System Head TDH 't - 7 Z, 3-6 17 o f Forcemain Len th / I Dia. Z I Dist. to well ! r' ..................... . SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of TrenchFA PIT DIMENSIONS No. Of Pits Inside Dia. Liquid ` Depth DIMENSIONS r„ r\ G e 4 \ SETBACK SYSTEM TO V P /LT BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of S tem: I -7 , �S� : UNIT 1Z `� Al Model Number. � DISTRIBUTION SYSTEM Header /Manifold YY i // Diptr(b) tionl�//p��/ (4 ,,1` , / Hole Si � r f x Hole Spacing Vent to Air Intake Length Dia 1 aTZ Lenth 4 Dia / Spacing 3 I Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over i Depth Over xx ded Depth of xx Seeded /So xx Mul ed Bed /Trench Center Bed/Trench Edges Topsoil E Yes 1 No es L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 / bb Inspection #2: Location: 1506 North County Road New Richmond, WI 54017 (SE 1/4 SE 1/4 1 T309(�17W) NA Lot 5 Parcel No: 18.30.17. 1.) Alt BM Description 2.) Bldg sewer length =5 - amount of cover = / Plan revision Required? [' ] Yes No �� ! �41 j Use other side for additional information. SBD -6710 (R.3/97) Date 1 Insepctor ignat Cert. No. Ili Safety and Buildings Division County m 201 W. Was ox 2 Madison, WI 53707 — 7162 Sanity Permit Number to be filled in Co.) /S'CQ�S /ll Sani ( �y Department of Commerce (608) 266 - 3151 Sanitary Permit .Applic to Plan I.D. Num r In accord with Comm 83.21, Wis. Adm. Code, personal info ation U 1 _ may be used for secondary purposes Privacy Law, sl .04(1 Xm) I vject Address (if di t than mailing address) 1. Application Information — Pies" Print AI formation J t:. p Kd & Arope Owner's Name ST. CR IX COUNTY el # L t # S Block #P a O Z ONING OFFICE )O 4hd 41c;k, Property Owner's Mailing Address operty Location � +, S � � SP ection A Ci , State / t5' Zip Cade Phone Number TX RAW �.t� S t )S_ ) - circl e) 11. Type of Building (check all that apply) �t� T _ N; RAE o& R 11 or 2 Family Dwelling - Number of Bedrooms 401, N / Subdivision Name CSM Number Public/Commercial o 1 Describe Use 02 `oC n ❑ State Owned - Describe Use ❑City_ ❑Village Vfownship of E r,, n ; III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner t IV. Type ofPOWTS Sy stem: Check all that a pply) ❑ Non — Pressurized In -Ground Mound ?_ 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressuri zed 1r Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑Leaching Chamber ❑ Drip ravel -less ❑ Other e p ' t� V. Dispersal/Treatment Area Information: Design Flow (gpd) Desi Soi pplication gpdsf) Dispersal Required (sf) Dispe al rea Proposed (sf) System Elevation h ft �2� S® erg 59) 3 VI. Tank Info Capacity in VTotaI Number M� facturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks cptic Holding Tank 1000 rs IX Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement — I, the undersigned, a4inue Ibility for iristapsVIK of the POWTS shown on the attached plans. P bur's Name (Prin Plum 's Signa re IVff PRS umber Business Phone Number t 'Z )S 1 Plumber's Address (Street, City, State, Zip Code) VIII&p6afy/Departraeut Use On proved ❑ Disapproved Sanitary Permit Fee (inc )odes Groundwater Date issued �(Nps) Surcharge Fee) � ❑ Owner Given Reason for Denial of + IX. Conditions of ApprovaUReasons for Disapproval YST l% 1 Septic tank, effluent filter and e w as per mangUemeD n i - w pF9g b dispersal cell must all be serviced /maintained nlumb_ 2. All setback requirements must be maintained as per applicable code /ordinances. Attach eomplete plain (to the Comity only) for the system on paper not has than gl/2 x 11 inches in sin SBD -6398 (R. 01/03) PI O �. JQ�r �Q.C��Scs rQ A oo� At Ah X ��, , 6 ; , , , v Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 06, 2005 CUST ID No. 220537 ATTN: POWTS Inspector CALVIN W POWERS ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/06/2007 Identification Numbers Transaction ID No. 1191165 SITE: Site ID No. 704011 John Jacobson Please refer to both identification numbers, County Road G above, in all corres ondence with the agenc Town of Erin Prairie St Croix County SE1 /4, SWl /4, S18, T30N, R17W Lot: 5, FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1037622 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; '• System: EZ -Flow Mound Component Manual, (N.6/03), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condh No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: -DEPARTMENT NO Reminders a • This system is to be constructed and located in accordance with the enclosed approved plans and with the EZ SEE CORRE FLOW Mound Component Manual (June 6, 2003). with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD - 10706 -P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat CALVIN W POWERS JR Page 2 9/6/2005 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 TITLE SHEET DATE: —05 PAGE_L_OF MOUND SYSTEM FOR A_a BEDROOM RESIDENCE This Plan has been prepared in accordance with the EZFLOW Mound Component Manual VERSION 2.0 (N. 06/03)and the Pressure Distribution Manual VERISION 2.0 SBD-10706-P. (N. 01/01) LOCATED IN THE S-t 1/4 OF THE SE. 1/4 OF SECTION -L2W, TOWN QN, R OF 1 - ST. CROIX COUNTY, WISCONSIN L - - 4 -S C's tv--- RECEIVES - INDEX PAGE I OF 8 TITLE SHEET VE T PAGE 2 OF 8 PLOT PLAN PAGE 3 OF 8 PLANVIEW CROSS SECTION PAGE 4 OF 8 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 8 PUMP CHAMBER CROSS SECTION PAGE 6 OF 8 SYSTEM MANAGEMENT PLAN PAGE 7 OF 8 PUMP CURVE PAGE 8 OF 8 CROSS SECTION OF E Z FLOW PREPARED FOR �'-\ j C"- 0y zo 0- /010w /-7 "` v 7 P D BY VED 20 T C"WERCe Li � 7 0 POWERS EXCAVATING INC. 1969 185 AVE. NEW RICHMOND, WIS. 54017 PHONE: 715-246-5135 FAX: 715-246-5135 CELL: 715-381-9920 � OF h 2 s E 1 4 0 tv � 17 (,-) n p(l.Cc ire -AQ C ro'I X �2uai YIRo'r1 �l Q `f Z. C?'t S ivy , A PO cep S � ���Pit ►y a�� cs,..,,, Imo'' � v*.S �• r� �a � b � �� � ��c�! fc► X !(a i�„g, p'f 9 4j /ar ��` r ' e e t) lam,. s Approved Barrier Cover A Material , Cap G Distribution Cell y .� Slope 3 Figure 3. Detailed cross - section of a mound D Cross Section Of A Mound System Using F E Z F- )))"For The Absorption Area F G b �� A Ft. H /a B Ft. K 9 -3 Ft. E1 L Ft. aA,9.c J spy 9 Ft. P osition i - Ft. of Force Main W aI t Ft. Observation Pipe ��..-- ..._.- -_.,._ .� a - ..._ ,...._ _ __._. -_ _...._. - .. - 1 wct� s nA i - -- ------- — --------- ------- - - --,] Distribution Of 1n U- s Pipe i Observation Pipe QA�1Cd�r +,� tw hey Pion View Of Mound Using A Bed For The Absorption Area DISTRIBUTION PIPE LAYOUT Page --V Place 4 holes on the top side of the pipe and every 5` hole on the bottom of the pipe. E xtend the end of each lateral up with the use of long turn or 45* fitting a point within six inches of the final grade. Terminate the ends of the laterals with a valve threaded final grade. � or threaded plug' Provide �� from for the valve, threaded cap or threaded plug. c Lateral MandDtd -- Lateral X x x xt2 — X X x X Lateral Len h Lateral Length Distribution Line t Lateral Access box SEE CORRESPONDENCE' - tom-- Force main r S � Hole diameter �S inch lateral ! inc Manifold //� ,I inches � - Force main - - "T— inches # of holeslpipe , Invert Elevation of Laterals 994 Ft. 4 CI VENT PIPE 22 MIN, ABOVE GRADE 5 WEATHER PROOF ? 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR I - NTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 -- - WARNING LABEL ___� 4 ' MIN_ 1 i� i 14LET t WATER TIGHT SEALS GAS- TIGHT i p�sd� A SEAL ! APPROVED _L_ JOINTS W/ CI 1 1 PIPE i ALM PIPE 3' ONTO r B i 3OLIDTO — i , ON SOLID SOIL ' OIL PUMP OFF ELEV . q0 FT. +►- -- — r' OfF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE LP 5 TANK MANUFACTURER: NUMBER 'DOSES PER DAY: TANK SIZES SEPTIC 4&Z GAL. DOSE VOLUME INCLUDING DOSE pQ GAL. FLOWBACK: /� f GAL. ALARM MANUFACTURER: 3 � CAPACITIES: A = INCHES = �.S`� GAL. MODEL NUMBER: 0� SWITCH TYPE: B = 2 INCHES = 33,5 GAL• PUMP MANUFACTURER: co s C = INCHES = /CjQ, to GAL. MODEL NUMBER- Gr,3Eo /r,� J_ SWITCH TYPE: _� '4- D = INCHES = /Sd rfi GAL REQUIRED DISCHARGE RATE GP � � UMP E ALARM WIRING AS PER ILHR 16.23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET +- MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . . . . FEET + ">0 FEET FORCEMAIN X �FT /100 FT. FRICTION FACTOR J f -r 5 FEET TOTAL DYNAMIC HEAD 43715 FEET i�. oel INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH 3& f l Ay .a r ,r y tt f t .• f rt } ! !, , f f ! t r - �n.rww wwwr� #ww�r+wwwwwwwn�wwww•_ -- •..,. � a #a�rrww ` .. rarw�.ww #wrrw,�rww� ■ iwwwwwwww= :sww = ��►r # .sw _ ■ww•.w. #.ws an =no on •• �iii #` N!www###wws #w## rrw iN =maw * .. ww C'ii #+►"M# #w"Z #wu# # #\i`llwwwlw ##i # #n ww�w #lww an �� #! #►:1IIw # www ww i, i�►t# # w# : i#nwis##!►`r#ww#w# •sir �..�r.�+ waft ®ww"n##ft:•swwvwwr�ww# �j�a�t###�.iwi��iw #!## Wlw�jnsft; m3 Z, OW&C\�.rlr►RM wrllifwiwOman %####w#r�:: i!!: r #w l;wwon # wwww •, w /#### w ##�,#�:�.:+�ww #w ww w w #i w w f ## ww#niw #w#w #w #ow #ww#w w■rwww w #w fr f at t !I , POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Jx 0f �A IM Owner Tarok Mancrfactrrar LO ti e cs rn vvr C� kA ° d vol. j O O tD gal Pe.mit a Saptia D pose; a3 Haklinp Tank l t, L O 40b D NA N,.rnber of loo D NA D Sods Dona Nolte t om• t 9 NErrriber of Pubic Feciy Units p NA Et1luern $VW cal / D`NA fttirnated tavesrage3 fir Emma f aw Model i� � o NA Design (pa?dc) .flow w tEstimated x � .5) 5 t? PLOW mwwtwturrsr G Lt C , lA Sol Application Raft + puriv Model Pty fit Standar trrfin tEf km t l D Pout Filter f� Fats, tM & ease (FOG) 530 mg,lL D 5art &Odmmcd Oxam Dwnand tSOCV 5220 rr�R (� NA ©>rlled�arrical Aeration 0 wetland S Seib iT+tif &t60 r+�• i3 ,Dim D Est= Pretreated Effluent OmWRty Monti* averaw Manufacturer 0 NA giodmnicai Oxygen Dentaui (SO 530 MIL D� Ce*&) O D Drip -Lkw Cl 'Total Suspended 5oNds (M) S30 �M KA 13 � tgrsv y) Mound Fecal Cogform (sl stdc Men) 00` cfu1l00rni Cl At- Maxirntxrn Particle Size Y. m die. ❑ NA D -NA OtIver :::�� �ONA NA •Values typical for dom�c � and septic septic tank effhna+t. E00: t3 NAM�!'l ENA1110E 36rVIOS event s) t 3 yeartia) 0 NA Condition of tardits) At wait Or" avert: 3 �e -,era t�y� �f to ,rowrr+e fudge and act rr e Q NA when combined Purnp out contents Of vi►hen the trip!, Mratar aHrrerr is aict(vMAd At bast once every': ® t1Naxbmm 3 vmm) O NA tnoRlthi'! ❑ NA clean At least COO every: effiuexnt fitlrsr S ��� � ts1 DNA inspect pump, pump cormew & alarm At isast once every: D NA Flush laterals and Pressure test At bast Once &vary = e1 D month(m) CI NA" At best once Ovary- E! D NA MAWTVU 10E W9TTSJCT1©NS cis shall be made by an carry o ns of the fopowin9 licenses a o srifi+cations: inspections of tanks and Baal POYVTS Qpsrator ipP�1. Master Pltxnber; Master Plumber Restricted Sewer. POWT5 inspector or or broken hardware, i fY►Y cracks or Tank inspections aunt include a Visual i�nspea<OM of the tankts) to Identify any n rr8 d ent on the c lea measure ttne vahane of con*wwd sludge and Oscan and a dwa for VW badt up or panned of effl n the W ound and surface. The eeilisl s be vb/ to the afflcrent levels in the o� Pip pomling of effkren to on o ground acsface. The pa nd of �huerd on the Wound � a � � and requires the invnediate notlfkaflon of the local regiatory mfitw l• When the c u aoeurn lation Of » and scum in WW traatermit, tank equals one- tturtf in, or mor of the tank volume, the entire contents of the tank shall be rarraved bV a SsptmgO Ssev'dM B and diaposed of in accordance >rvitfn edrapt&n' NR 111 Woconsin Adrrariisuartive Coeb. Of Of filters, r�ue+chs uead or pressurized cornponents, pretresUnOn' AN ottwer swvkms. wing but not &nked to the swvickV try a certified POWTS Maintainnr- units and any se r v icing at kttervals of 512 months, shag be PwfOmwd A service report sW be provided to the local rargulatory autwdy wk% n 10 days of cornpietlon of`wrf service event. slaw tzm2i STAIR UP AND OPERATION Page 2-M ?� For now construction, prim to use of the POWYS deck treatment tanks) for the presence of painting products, solvents or other that may Irivede the treatment prods ardfor the soil dispersal ceq(s). If high concentrations arm detested have the contents of the tank(s) removed by a septage servieft operator prior to use. System start up shad not occur when sod c anditions are frozen at the infiltrative sw wastewater win be P outages PUMP taroks may fill above normal highwamr levels. When power is restored the excess arAed to the Sspetsal C1111(s) in one kqw does and may overload there resulting in the backup or surface dechnarge of effluent. To avoid hire situ atimmn hays the sP. - to in of the punnp tank removed by a Seprtagq ServidtV Operator prior to nwtwg Power to the effluent pump or c ontaci a Plumber or POWTS Mabitoner to assist in rr:alrueaay opsnftW the pump controls to restore normal levels within the pump tank. >'uo n i 5 feet slope of ar Park over tanks and dispersal m park over, or otherwise disturb or correct, the area ty mound or at -grade "M gb&MVtjM am. p R f e �� duc c tion or elimination of the following from the wastewater strewn may improve the p Io and ,g t he He of the PO WTS: ! S: art y baby wi �t>s: so rns. canon swabs. d si ental fkm, diapers:.,., If fat; foundatiorm drain (sunup pump) discharge; fruit and lnsgetaW peeingsa', : OMNW herlmicidas: meet wraps; nwrdicatmons; oft; Paurtrng products, Pesticides; sanrtarY nepkrns; tampons; and water softener brine. ABANDOMMENT When the POWYS falls and/or 0 Permanently taken out of service the following steps shall be taken to inasee that the system is Properly and safely abandoned in compliance with chapter Corran 83.33. Wisconsin Administrative Code: • AN Piping to tanks and pits shad be disconnected and the abandoned pipe open ings sealed. • The conto of ON tanks and putts shad be removed and proparyr disposed of by a Septage Servicing Operator. • Attar pumpin ad tanks and pits shad be excasvatsd and ramw NO. Wavel or another inert solid material wd or their covers removed and the void space idled with CONTINGENCY PLAN If the POWTS fads and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable repla area has been evaluated and may be utilized for the location of a rel"cament soli absorption sYsteEn• The replacement am should be protected from disturbance and compaction arkd should not 1a: kdritqW upon by tegt*ed setbacks from exlethig and pl,oposed struetura, lot fines and wells. Failure to prolem the replacement area win raeult in the sitsed for a anew sod end sine evaluation to establish a =Amble replac area Rapidciero"t systems must corrmPlY with the rules in effect at that time. 0 A suitable rePkKwFwm area is root available dine to setback and/or soil limitations. Stirring advances in POWYS a holding tarok may be installed as a test resort to replace the faded POWYS. M identify a suiiabhs failure of the POWYS a a and site e eras. If no replacement area is available a holding tank as a last resort to .replace the failed POWYS. sysLerre may be reconstructed in place following removal of the tiomet at the frhtrat}ve surface. Reconstructiarts of such systems must comply with the miles in effect at that tune. < <WARIrNG> > SWM 'PU&W AND OTHER TREATMl3" TANKS MAY CONTAN LETHAL NI S ANDIOR MMUIViCMW OXYG. DO NOT Me A SEPTIC, PUMP OR OTHER TREATMENT TANK U"M ANY CRiCNTANCEIL DEATH MAY RESULT. RESCUE OF A POM" FROM THE INTERIOR OF A TANK MAY BE DWfK3A.T OR .E. ADDfrONAL PC>IMI/TS MBTAUER POWTS MAiKTAN EZ Pfwne S .J e . SEPTAGE SERVICMIC OPERATOR (PlNPER) LOCAL REAt"TONY AUTHORITY Marne F:; S� t Phone This docurrma was drafted by the staffs at the Grew tam. Marqueta a and Wamrainra County Zoning and � fal agencies in con>pamwe with efi "w Cwm 83 - 22tYHbllt}hd)&M and 83.54!11, 12) is 13). Wiacnroln Adrrrir imativve Code. Yp F P i � a S.. 0 OR p W ic ic A kr r m O c� L go o � � cp cu C 72 . go � to � �, • _K;�: � ' fey c. cr f,p � .. � ✓ I.f w.� iiJ r.f �"S O � � �i•4.R��v r }, It CD C '=t �• t t - a- w on Q, G. S�LLyi7 CT .�+ G CL „� , ,� • � _ ' """ $ � N r, rye s W as --4 rn o W ° m �. Co e CO 0 m ° c Wiscon�{R. department of Commerce L SITE EVALUATION •I?i vision Safety and Buildings 1 Page--)— of Bureau of Integrated Services in, ordan ce�trl# t HR 83.09, Wis. Adm. Code 1��� .� Attach complete site plan on paper not less 1/2 x 1 Q ze. P t County include, but not limited to: vertical and horiz h" ference point (BM), directi St Crp / `t- percent slope, scale or dimensions, north air vK tnd in "is to n t road. Parcel I.D. # s7 CROIX d d — /Q Y.3 /ct) APPLICANT INFORMATION - Plea t n; Personal information . R 'awed Date ` 4 - you Provide may be used for seco �y ses (Privacy LavYr 1 7 I # Property Owner \, , Property Location , ,e raw 1 % M,, Wa 4ef Govt. Lot SLR 1/4 SE 1 /4,S T 30 ,N,R 1 E (or) 40 Property er's Mailing Address L Block# Subd. Name or CSM# `�-// 3 �K 1 b-r� �byS C'S Yh l�� (ou^ r wk City tate Zip Code P ne Number City ❑ Village Town Nearest Road << New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: /V/4 r Code derived daily flow gpd _ Recommended design loading rate � bed, gpd/fl • 5 trench, gpd/ft Absorption area required 76 bed, ft 3 74 trench, ft Maximum design loading rate + � bed, gpdHl ' � trench, gpd/ft Recommended infiltration surface elevations) 0 ft (as referred to site plan benchmark) Additional design/site considerations aa Parent material ,f 9Q r 6�? r Q C� Flood plain elevation, if applicable /Gl� ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ s (Z u Cd s ❑ u EIS ®U ❑ s ®u ❑ s ®U ❑ s ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ay - SL 2F54k >y,q1 c5 i h 1 4 , 2 9 --2 S�'c L 2�sk, k m��r C S S Ground 3 -? 2, 5 y /aJ� 5 Se.L ✓� �M �� �� , 27 VIN Depth to limiting � in. Remarks: 117 /�ari znr► 3 f 4 iS ✓�/X tf�li'�� Band 4,21' - 1 11- r03l�ne 5 c/- e- Boring # Z 2 - 6 -3 16YK S� /� 5,' L 2-JPs6k m 3 78 `7. / C 3d _X % s, z_ V71 _ _ P 2� Ground Depth to limiting f WO .— in. Remarks: J`► L CST Name (Please Print) S' ature Telephone No. fJ I Address Date CST Number Se q 6 �' UG �','clvn h J LJ 1 6q "2 //—/4 - ? aY 'r5p6-1° PROPERTY OWNER �o �` j �' P A4 ,7,P SOIL DESCRIPTION REPORT Page PARCEL I.D.# 0� Z - 1©�43 -2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench j /O 3 Z S�' 2 s�1' c � I •�_ 'Z - aye 5icL X56 K ms C S ; . 5 Ground L IY''\ 47' s� y� SGT -,� - ,v �'. Depth to limiting , factor L _de;� J in• Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) �3 To tin v N LIZ L , Z � �1 ®A�f-,a� P ' r VV 7- op "- j V xkG 136 rin� 2- 70 if3m CT,zl `� FROM: R &E LAND SURVEYING LS FAX: 715- 246 -4319 Nov -10 -97 Mon 10:53 PAGE: 03 CERTIFIED SURVEY MAP Located in port of the Soulhcael Quarter of the Southeo3l Ouarler of Section 18, low —hip 30 North, Range 17 West, Town of Erin Proble, St, Croix County, Wlsconsln, heing JOT 1, Cerlifted Survey Mnp Volume 3, Poge 786, Oocurnenl Number 356483 of SI. Croix Counly Cerlllied Survey Mup records. Prepored for orrd of the request of; OWNER: Rodne FAST R. end Julie M. Haffner FAS 114 CORNFr, 1586 Count lrunk Highwa "0" N: IINI C.4.Al. for f I l l SEC. fH -30-17 Ncw Richmond. WI 54017 y L;1,i3 (ALUM. CO. MON.) Orafled by Jerald i_ Larson G LN r �" �Nfx)'o2'bt O N 0p'02'S2 W 4.37' tar _ _� P. RONAW f. * South Line SL�4 -SET 4 Io JOHNSON _¢ r r. f L 'i; Q P-11Be AMERY. DETAIL A Z W Oo-• (Na Scale) <q �^ • I Np 3URJ CERTIFIED SUR_VF,Y,MAP'A •i •� LO 1 r414 "Ves N,• UNPLATT I VOLl1M_L'_1PAGE 155 FNU, RE -ROD N t /NE G:SM. 0.09 NORM I t O7 r N 8 '38'38' 729.83' i vr W LINE C- S AI. I Q: (R� N B9' 41 20" C 730.03') r� Z I 1 LOf ! or _j I 1 I ar ui W 1 n V, LOT 3 o 293,985 50, FT. ; M� ail I r t ' rn 5.75 ACRES 4P W Lli d 3 N 85 ' 1 0'53" W 9 In WI I 1 t t"yl 255.92 J AREA LOT 2 Q n r 3 7.1f7J' a i z S /�EDI� • 57,295 S0. f T. Z 0 1 ;� 1.32 ACRES `' d 11 - /LSE: rr U2f3Y. rrm A ! In L CO N?. Y. R/W LINE C. TT IL "G" 358.u3' u� v N 00'02'52`' V(- 9 p 6 R --_^ 89' 47 wZ.�YL S. LINE t � 187327' d 3E'f�d- 5£TJX - _ _ -- N R9�2.3LW 28,1 21- '� _ SOUntEASr CORNER SOUTH ! 4 CORNER 12 'rC rr ,SEC. 18- -JO -/7 SEC. 18-JO- CORNER 4 --------- "- (FNIJ. SUNVFY NA A. (FNO, SURVEY NA/L) c l.H "G UNPLA71ED LANDS NOTE: 1'he pareel(s) shown on this nmp is /arc subjeel to Slott, County and Township town, rules and regulr,kinns ( l.e. wellonds, minimum Ial size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. �Filr♦Q� 0 County Section Corner Monument of Record • Set I" x 24" Iron Pipe weighing a minlmrrrn of 1.13 pounds per linear foot. O Found 1 -1/4" Re -Rod O round 3/4" Re -rod N TH R - Recorded As 100' Building Setback Llr,e JOB p 97120 zoo 0 200 (- Prepared by GRAPHIC SCALE A & E SCAt.E IN FFET: 1 Inch = 200 feet LAND SURVEYING k CIVIL ENGINEERING Phone No. (715) 246 -4319 BEARING.,; ARF RrrFRFNCCO TO TIIE SOUTH LINE OF THE 109 Host third Street, 1 Box 325 SE 1/4 OF SEC11ON I$ TOWN-NIP 30 N -, RANOF 17 W. New Richmond, WI 54017 V4110I IS ASSUMED TO BEAR N 89 52'23" W. Sheet I of 2 Parcel #: 012- 1043 -40 -100 07/27/2005 02:03 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.17.284D 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * RODNEY R & JULIE M HAFFNER HAFFNER, RODNEY R & JULIE M 1532 CTY RD G NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1508 CTY RD GG OR SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 6.750 Plat: 0618 -CSM 12/3389 '97 SEC 18 T30N SM Block/Condo Bldg: LOT 3 3/786 9.50A KA LOT 3 CSM 12/33 6.750AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -17W (A t,oT S Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 789/557 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/21/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 6.750 900 0 900 NO Totals for 2005: General Property 6.750 900 0 900 Woodland 0.000 0 0 Totals for 2004: General Property 6.750 900 0 900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • � n rig c��, �,...— Q . eEARwos ARE REFEItWCEA m � j a j THE SOUTH UNE OF THE BE $ OF SECTION 18 7M, 1"7W, WCH IS ASSUMED TO BEAR NO W23'W. w I I c au - OWNED BY OTHERS 5w 50 0 '02 52 W 25L p , 8 •N00�02'5 ------ - - - - -- ro 214.22 X 1 4 � 0 i N00WSrW 207.20' m I Icz ______d I I I ® r+ , • I 1 4 11 1 w air r i •d i� C �! i 12 Z ICI •�- �` � ii 31 J ........ � ............... S .. i slit I !aS►ap �'10 ice; � N .�, 90 0'03 E 37 8.OS w p�pprp� -E A .d C.T.N. "QQ" UNPLAT E® IO CLS _ -# , 0Y HERS_ 'li>_ v r SHEET 1 OF 2 SHEETS Parcel 0: 012- 1043 -40 -000 07/27/2005 02:02 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.17.284C 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * FINSTAD, RANDALL J RANDALL J FINSTAD 1586 CTY RD G NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1586 CTY RD G SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.320 Plat: 0618 -CSM 12/3389 '97 SEC' 8 T30 -PT SE SE Block/Condo Bldg: LOT 2 3/ 86 9.50A NICA LOT 2 CSM 12/3 1.3 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -17W Notes: Parcel History: Date Doc # Vol /Page Type 07/20/1998 583242 1341/297 WD 07/23/1997 789/557 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/17/1998 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.320 7,300 127,300 134,600 NO Totals for 2005: General Property 1.320 7,300 127,300 134,600 Woodland 0.000 0 0 Totals for 2004: General Property 1.320 7,300 127,300 134,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel ##: 012- 1043 -30 -000 07/27/2005 02:02 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.17.2846 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner ROSENOW, HAROLD D & JOAN M HAROLD D & JOAN M ROSENOW 1514 CTY RD GG NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1514 CTY RD GG SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A -NOT AVAILABLE SEC 18 T30N R17W LOT 1 OF CERT. SURVEY Block/Condo Bldg: MAP IN VOL I PAGE 155 ORD 10 AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -17W Notes: Parcel History: Date Doc # Vol /Page Type 09/04/1998 586567 1355/097 WD 07/23/1997 711/454 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 8,000 57,500 65,500 NO AGRICULTURAL G4 8.000 1,000 0 1,000 NO Totals for 2005: General Property 10.000 9,000 57,500 66,500 Woodland 0.000 0 0 Totals for 2004: General Property 10.000 9,000 57,500 66,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a ll -I ji� Y I t �ihc�cvv pax iq PO ST. CROIR COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND q OWNERSHIP CERTIFICATION FORM Owner/Buyer J�Q� r , Mailing Address 1-7a hd Property Address (Verification required from Pl g & Zoning Department for new construction.) City /State Parcel Identification Number 1 _ j ob Lqr LEGAL DESCRIPTI 3) ON Property Location SE a/, , � � Yo , Sec. PI � � > T 3a N R J `�W, Town of �r „r\ V Subdivision ,s#S Certified Survey Map � ' t- or , Volume ,Page # Warranty Deed # � �' l f 1 Volume Z ! , Page # 3 T Spec house yes Lot lines identifiable G no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its p premature failure to handle wastes. Proper maintenance consists of the system can affect the function of the septic septic every ank as a treatment stage in the pumper to disposal system Owner . What you put into responsibilities are specified in §Comm, 83.52(l) and in Chapter 12 - St. Croix Coun Sa maintenance h' tary Ordinance. The Property owner agrees to submit to St. Croix C ounty Planning &Zoning Department a certification fa owner and by a master Plumber, journeyman plumber, restricted plumber or a licensed form, signed by the wastewater disposal system is in Proper operating condition and/or (2) after inspection and pumping (i f necessary), the on -site less than 1/3 full of sludge. P mP in g (i ary }, the septic tank is Uwe, the undersigned have read the above 1equirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge, I/we am/are the owner(s) of the Property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE APPLICANT DATE *** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** nclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if eference is made in the warranty deed. REV. 08105) U 2731 P 031 784c341 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 01/13/20 @5 10:00A?I WARRANTY DEED EXEMPT Il THIS DEED, made between Rodney R. Haffner and Julie M. Haffner, husband and wife ( "Grantor," whether one or more), REC FEE: 11.00 and Bruce Bor en and Judy Bor en s tenants in common with TRANS FEE: 234.00 E Bore en, a_ COPY FEE: John H. Jacobson ( "Grantee," whether one or more). CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interestsitl -St.--C is Name and Rewm Address please attach addendum): That part of SE ' /4 SE ` /4 Sec. 18- T30N -R17W described as follows: Lot 3 o f _ 1 Ora_ N,0 Certified Survey Map recorded in Vol. 12 of Certified Survey Maps, page 3389 as : �: +'INEY AT LAW oc. No. 569105. St. Croix Co unty, Wisconsin. P.O. BOX 359 HUDSON, W154016 012 - 1043- 40 -I00 Parcel identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated / l ( 10 (SEAL) u (SEAL) * *R ney R. sifn {SEAL 7 , (SEAL) * *J M. Haffner AUTHENTICATION ACKNOWLEDGMENT Signature(s) Rodney R. Haffner and Julie M. Haffner, husband a wife STATE OF ) authenticated o - ) 10 ) ss. ` COUNTY ) U� *Kristina O land Personally came before me on , TITLE: MEMBER §TATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2093 STATE BAR OF WISCONSIN FORM NO. 2-2003 r Type name below signatures. INFO -PROT Legal Forms 800. 655 -2021 www.intoproforms.con; N rj 0 � ._► �� w� l� Q p ��f*1 C C Fn g � ob i, s z 8 L2 z o m 6 S Q> D � 9 V CA 0 o i OWNED B I N00'02'52 "W c 235.15 50' 50' z � r NOOro2 252.E T ` IOo'� Z s I co Io Niwi�;� N1 �w�r Nl�l O cn m I o I o n I I� CA .w N 1 8 . ' `NOOro2'S2� - - - - -- Q Z 214.22' ^� Z - - - - -- X S N00'02'52 "W 257.26' Q t� "� M 10 c: �p a. 0 co V� � W I I m� kr ICI" i'♦I N o� o m IQI�' 92 i ' I�I� ; ■ W :v�N IPid a m `l v Ip , : . 0 r• �N I�SI� fi n,. w o 9 v w ICI.• I� in c > � 01� C Ilo 1 a o' w �� N � 9" s,� - ................. ................ -n . I m ,� z �� of d ,�S�s r ao'�,�� N co 8 ~ UI w Gj ` 143.55' �' 232.50' a z ° z "' _ S00 "E 37 6.05' w Noo' "E �^ — — —— 2651.41'' ao� - gz -I C.T.N. "GG" A r o � z -3 s -q --i IQ UNPLA77ED LANDS r> OWNED BY OTHERS 53 91 MM � C)o z � —. � V Z " 1 o O Q m g j! po pp a z m V V � SHEET 1 OF 2 SHEETS CERTIFIED SURVEY MAP NO. 1 55 P ST. C COUN a Located I..n the Sol of the SCI( +, Section 18 S Ty URVEYOR'S RECORD T30N, R17W, Town of Erin Prairie, County of St. Croix, Wisconsin UN PLATT E • � � _PLATD LANDS h • NORTH • 79270' o 9 100 Z' v Z J. LOT ONE J V , I p �' W- 435,600 SG. FT. W . �.. 10.00 ACRES f O r • 3 In W Q' O ,� • N n �,,� N d.. V N p 4. Z. CD 0 y ° o , NORTH LINE SE-LSE- M \�0 �e��O`NGS 0 3� EAST .LINE OF SEC. 18 89F3M 9 SECT I ON 1B 9 O 0 2 - 543 00 SOUTH 792.70' RAIL ROAD SPIKES .. SE COR. SEC. 18 UNPLATTED LANDS T30N, R17W .. .... .. .. SRO REF. TO THE EAST LINE OF LEGEND SCALE NORTH' T30N, RI7W AS ASSUMED 0 11/4" x 30" ROUND IRON ROD I" a 200' WEIGHING 4.17 LBS /L.F. 200 150 100 SO 0 100 200 400 I John F. Klovni.ng, Registered Land Surveyor, hereby certify that I have surveyed, divided, and mapped a part of the Southeast one quarter of the Southeast one quarter, Section 18, Town 30 North, Range 17 West', Town of Ervin Prairie, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the Southeast corner of said Section 18; thence North 543.00 feet along the East line of said Section 18 to the point of beginning. ThenceSouth 89 0 43 1 20" West 556.54 feet; Thence North 782.70 feet; Thence North 89 0 43'20" East 556.54 feet to the East line of said Section 18; Thence South 782.70 feet along the centerline of County Trunk Highway "GG" the East line of said Section 18 to the point of beginning. Said parcel containing 10.00 acres more or less. That I have made such survey, land division and plat by the direction of Hank and Judith Broekpahler, owners. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of the County of St. Croix and the Town of Erin Prairie, i.n surveying, dividing, and mapping.the same. Dated thislday of 3LpjVp 1?75 _ 1 1 \ �./ " .,//( �� / • / ^ tic' `E JOHN F. KLOVN1f\JG = �O S 1 o8s J •► i • O 4 � 9 lIRtAt�l.a� 1 r,. ,, "` Volume 1. Page 155 -'�1 r ,� �� ERECEWRR O COUNTY WISCONSIN . .... P ANN G & ZONING DEPARTMENT s� Oa OUNTY GOVERNMENT C R 11456 1101 Carmichael Road " NU COUNTY udson, WI 54016 -7710 OFFI 5) 386 -4680 Fax: (715) 386 -468 APPLICATION FOR MINOR SUBDIVISION M N 0 0 8 g. The submittal deadline for certified survey maps is the 4`� Tuesday of the month two months prior to the month of presentation for approval by the Planning & Zoning Committee. Property owner: John Jacobson Agent (if not owner): Mailing ddress: 1218 172nd Ave. New Richmond, WI 54017 g Mailing address: Daytime 715- 381 -8894 Ytr phone: Daytime phone: Property location: SE 1/4, SE 1/4, Sec. 18 , T. 30 N., R. —JZ_ W., Town of ERIN PRAIRIE Number of Lots: 2 Total Acreage of Lots: 6.748 A c Size of Original Parcel: 6.748 A c Zoning District: Ag- residenti 012 - 104340 -100 18.30.17.284d Computer #: Parcel #: Surveyor: Douglas Zahler Mailing address: 2920 Enloe St. - Hudson. WI 54016 Make a sketch in the box showing how the new lot(s) fiat within the originals parcel. Z 3 J C+'f I certify by my signature that all information presented herein is true and correct to the best of my knowledge. I hereby request the St. Croix County Planning & Zoning Department to process this application according to Chapter 18 of the St. Croix Zoning Ordinance. Signature Date ❑ Xner ❑ AuthovKed Agent " ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** One (1) copy of a "concept' map are to be submitted for staff review. The applicant/agent will be notified of any required revisions. Once the "concept' corrections are made, an official minor subdivision application may be submitted. ])TOTE. ONLY COMPLETE SUBMITTALS WILL BE ACCEPTED f$ Applicable Fees (Noted Below) ne (1) copy of the preliminary certified survey map ownship Approval (A copy of the map signed by the Town Chairman or a member of the Town Board) copy of the soil test for all proposed lots not having a residence on the lot (soil test location to be shown on individual lots) General Zoning Notice Statement MA7 DOT certification letter if the proposed lot(s) abut(s) a state highway N JQ Road Plans (if new roads are proposed) Check list from County Surveyors Office Slope & Driveway Disclosure Statement PAU Conditions of Plat Approval Statement (if applicable) (I/&I If required, wetland delineation is to be done by a professional and maps will be reviewed by St. Croix County staff. Ut Applicant shall flag all property /project corners and mark flags accordingly. A final map, reflecting all requested revisions, as well as town approval and soil test if required, must be submitted 10 days prior to presentation to the Planning & Zoning Committee for approval. These deadlines are firm. COUNT USE ONLY *Application Fee $400 $400 *County Surveyor Review Fee - $75 per lot or outlot $150 * These fees are mandatory at time of submittal Road inspection fee - $400 Erosion control inspection fee $200 Subdivision Variance application fee $500 Re- submittal fee - $400 Subdivision re- inspection fee $200 T9TAL -PEES P AID $550 17ATF PATTI �] � .��.,� /J ,� - Application accepted and complete: B y Zoning Map Number: Parcel #: 012 - 104340 -100 09/13/2005 05:08 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.17.284D 012 - TOWN OF ERIN PRAIRIE Current *1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner O - BORGEN, BRUCE & JUDY BRUCE & JUDY BORGEN 1217 172ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 1508 CTY RD GG OR SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 6.750 Plat: 0618 -CSM 12/3389 '97 SEC 18 T30N R1 7W PT SE SE LOT 1 CSM Block/Condo Bldg: LOT 3 3/786 9.50AC NKA LOT 3 CSM 12/3389 6.750AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -17W Notes: Parcel History: Date Doc # Vol /Page Type 01/13/2005 784941 2731/034 WD 07/23/1997 789/557 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/21/2003 Description Class Acres Land mprove Total State Reason AGRICULTURAL G4 6.750 900 0 900 NO Totals for 2005: General Property 6.750 900 0 900 Woodland 0.000 0 0 Totals for 2004: General Property 6.750 900 0 900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �- K SURVEYO " o P(. EB 1 6 19018 569105 T. C ROIX COUNTY R'S RECORD CERTIFIED SURVEY MAP Located in part of the Southeast Quarter of the Southeast Quarter of Section 18, Township 30 North, Range 17 West, Town of Erin Prairie, St, Croix County, Wisconsin, being LOT 1, Certified Survey Map Volume 3, Page 786, Document Number 356483 of St. Croix County Certified Survey Map records. Prepared for and at the request of: OWNER: Rodney R. and Julie M. Haffner EAST 114 CORNER 1586 County Trunk Highway " G" - W. LANE C.S.M. LOT 1 SEC. 18 -30 -17 �Jl New Richmond, WI 54017 3 (ALUM. CO. MON.) N. LINE Drafted by. Jerald L. Larson C T. G " S. LINE C.S.M. LOT 1 I 1 j N 00' 02' 52" W O N 00'02'52" W !�i 4.32' W: t 48.93' 6' Sou Line \� SEf 4 –SEl 4 0 A 1 — � .. C. T.H. "G - R DUIH 61997 ► 2• DE 7A' A IZ� L R� C � e,d (No Sco%) co w� 3 W ` I CERTIFIED SURVEY LOT 1 - - - -- 3� U UNPLATTED ( VOLU_ME 1 P_A_GE_ 1 _55_ 5,7 I LAN FND. RE –ROD N. LINE C.S.M. 0.09' NORTH V LOT 1 N 89'38'36" E 729.83' L LI' C.S.M. (R= N 89' 43' 20" E 730.03') OI Q I I LOT 3 Jc. (_ M t N ;/ � Z i " . N 293,965 SQ. FT. Q v - ", 61 Q 6.75 ACRES /O Pro W: J 1 0) � j l ° d 3 N 85 '10'53" W I 1 II to � w N 255.9 ' AREA LOT 2 ~ I Z N 57,295 SQ. FT. S HED ® N Z 1 Q 't' HSE. �v 'n 1.32 ACRES d I Z DETAIL A Lr Z �, N °o S. 1/NE C.S.M. . ' 4b W (� N'L Y. R W LOT 2 LOT 1 �h Z L /NE C. T H. "G" 5.00' N 358.03' 6 N 00 – 9' 013.93'-- Ah_ . y - _48.93 _ R= S 89' 47 43. S LINE ' 1873727' -' ` - b1�.9�`� S - -N 89 W ,M6.21=– '� SOUTHEAST CORNER SOUTH 114 CORNER C. _T. H. "' SEC. 18 -30 -17 SEC. 18 -30 -17 -- --- - - - - -- (FND. SURVEY NAIL) (FND. SURVEY NAIL) C. T.H. G" UNPLATTED LANDS %am* NOTE: The parcel(s) shown on this map is /are subject to State, County and s( Township laws, rules and regulations ( i.e. wetlands, minimum lot size, access "lee to parcel, etc.). Before purchasing or developing any parcel, contact the St.. Croix County Zoning Office and ,6& Appropriate Town Board for–gaAW. ;��'. te a► LEGE NCoD N unty Section Corner Monument , � y ��q�! of Record APPROV • Set 1" x 24" Iron Pipe weighing a minimum of 1.13 pounds per NOV 2 6 X 97 linear foot. O Found 1 -1/4" Re –Rod O Found 3/4" Re — rod ST. CROIX COUNTY N - M R= Recorded As Comprehensive Planning • • • • 100' Building Setback Line Zoning and ' Parks Committee 200 0 200 JOB # 97120 1 Prepared by: If not recorded A & E within so days of GRAPHIC SCALE q***4 LAND SURVEYING & CIVIL ENGINEERING approval date SCALE IN FEET. 1 inch = 200 feet Phone No. (715) 246 -4319 approval shall be BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE 109 East Third Street, P.O. Box 325 null and void SE 1/4 OF SECTION 18 TOWNSHIP 30 N., RANGE 17 W. New Richmond, N 54017 WHICH IS ASSUMED TO BEAR N 89'52'23" W. Sheet 1 of 2 Vol. 12 Pace 3389 0 CERTIFIED SURVEY No. 0 ass �s� 7E36 Part of the Southeast 1/4 of the Southeast 1/4 of Section 18, Town 30 North, Range 17 West, Town of Erin Prairie, County of St. Croix, State of Wisconsin, described in Volume 3 of Certified Survey Maps, page 786 as Certified Survey No. 786 n� ST. CRO /X COUNTY CERTIFIEBU URVrY MA 6 do 11 �2 ST. CROIO NTY p� f' 1 R CO RD L F UNPLATTED CERT /F /ED A,,, , , S — "'EY0RN I a X7 1979 o , ao mqu LANDS i MAP i qvk *ads co 33 206.49' 523.54' �Q s N 89 43' 20" E 730.03' xo,• v Ui LOT 1 8.10 AC. + EXCLUDING R /W. J ' h; = 9.50AC.T INCLUDING R /W. N I GAR. BRGS REF. TO THE Q ; 0 0 EAST LINE OF THE SE 1/4 J• Z ��te 33 OF SEC. 18, T30N,R17W, j �- A ASSUMED BRG. NORTH. HSE Olt, i�ae 1� y\� SCALE IN FEET 6y. 'h e a� 0 6 1 . R dj _ 4 S 89 4 ' 43" W 613.03' O -P" 5� 150' 0' 150' P.O.B. /► T u gi S89 0 47''43 " W p- EXISTING IRON ROD -- 150.00 - •- 3/4 "X 24" IRON ROD 1.502 LBS /L. F. UNPLATTED S. E. COR. - SEC. 18 ......• • ••••• T30N,R17W RAILROAD SPIKE LANDS I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify that I have surveyed, divided and mapped a part of the SE4 of the SE- of Section 18, T30N, R17W, Town of Erin Prairie, County of St. Croix, State of Wisconsin, more particularly described as follows: m er o Commencing at the Southeast corner of said section; � `yG�^IS' i Thence S. 89 47' 43" W., 150.00 feet; Thence North 50.00 feet to the point of beginning; Thence S. 89 47' 43" W., 613.03 feet; : lon Thence North 492.03 feet; S Thence N. 89 43' 20" E., 730.03 feet; ' Thence South 375.96 feet; ; Smoak N Thence S. 44 53' 51" W., 165.76 feet to the point of beginning. .� Said Parcel contains 8.10 acres, more or less. tiQ 8 R��► U That I have made such survey, land division and plat by the direction o y. Brock - pahler. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutues and the subdivision regulations of the Town of Erin Prairie and the County of St. Croix in surveying, dividing and mapping the same. a.. DATED THIS Z _ DAY OF 1979. 2!�4� ' - '. 1 0 ' 0' � — '.� i THOMAS G. KUEST R, Registered and Surveyor APPROVED Q APPROVAL OF THIS MINOR SUBDIVISION � APR 26 DOES NOT MEAN,, AFtROVAL FOR 1979 BUILDING SITE OR, SEV CSySTEM, Volume 3 Page 786 REFER TO H62.20. ST. CR -�;X C -OU 'e y COMPREHENSIVE PARKS PLAN.JNG AND ZONING COMMITTEE ri Al q /;//7q 4 1q cf, 0 $ �� � � � _---- •fir AK 10 O �MM rm IS AMM WM NWWZrOL OWNEDBY Ir i i jt�•� NOR 1 M46 ilia � � NOOtOei'S!'M►?�T.aO' � � �'` 1 1 100' f i.►i� C w r . r - 37 - p M. OW OTHM- v v SHEET 1 OF 2 SHEETS • 872? VOL 20 PAGE 5074 _ KATBEW H. REGISTER OF DZEW ST. CROIX CO. _t�J_ O 0 0 B RECEIVED FOR 09/23/2005 =1 N c'z c . ^ .^ CERTIFIED SURVEY HAP �ji wok g m REC FEE: 13.00 ,+ c o' n � v o v A COPY FEE 3.00 g4 F °°� 8 sh . �V� I " z v M z z S Tg o 20 �� ' m ° z v_ ° r BEARINGS ARE REFERENCED TO o m 6 m m $ g THE SOUTH LINE OF THE SE 1/4 o OF SECTION 18 T30N. R17W, WHICH g 8 IS ASSUMED TO BEAR N89 "W. \D m B > _OWNED BY 07HERE N00- 02 -52 "W ' I p 50' 50'T z o ¢ 235.156 N00 o 02 52 W 252.46 I o I l I N I Nim i�i(1�i0 I� I� �w m r- N wloo I l�1 I� ID m I I �> 8 I N00.02'52" ------- - - - - -- Q m N 214.22' i v!� c) N00'02''5rW 257.26' co g '11 IO° IC ..� w ZZZq z OD 4 00 �� AI-v -(�� I�I� ice' v r.� iQi� m��m ID I • ( N oa - v i oo r�� loo l� i= w � �'� N IG�I F- o <M (A I i (� oOno min I 01) ��� "� � W ���`� � °�� y I Iic m C � � I�lo v 1010 �N z ���� NZ� o m o z I rn o f d %1 43.5 ra° o 5''x' �I 232.50' y z "' _ S00 "E 37 6.05'` NOO WOO " E v 9 W V 2651.41' TJ t++ z C .T.H. "GGll 0 9 _(59WC0 G;1ER X "co H z N w Z N '0 S rg j , vos� c Q4_ RN � � 9 < — �4 —, Jc- m rn O N czi V V SHEET 1 OF 2 SHEETS Vo1.20 Page 5074 I CERTIFIED SURVEY MAP LOCATED IN PART OF THE SE1 /4 OF THE SE1 /4 OF SECTION 18, T30N, R17W, TOWN OF ERIN PRAIRIE, ST. CROIX COUNTY, WISCONSIN, BEING LOT 3, OF CERTIFIED SURVEY MAP, RECORDED IN VOLUME 12, PAGE 3389, AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. PREPARED FOR: JOHN JACOBSON 1218 172ND AVENUE NEW RICHMOND, WI 54017 BRUCE BORGEN 1217 172ND AVENUE NEW RICHMOND, WI 54017 SURVEYOR: DOUGLAS J. ZAHLER S & N LAND SURVEYING, INC. 2920 ENLOE STREET HUDSON, WI 54016 SURVEYOR'S CERTIFICATE I, DOUGLAS J. ZAHLER, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT BY THE DIRECTION OF JOHN JACOBSON AND BRUCE BORGEN, I HAVE SURVEYED, DIVIDED AND MAPPED PART OF THE SE1 /4 OF THE SE1 /4 OF SECTION 18. T30N, R17W, TOWN OF ERIN PRAIRIE, ST. CROIX COUNTY, WISCONSIN, INCLUDING LOT 3 OF CERTIFIED SURVEY MAP VOLUME 12, PAGE 3389; DESCRIBED AS FOLLOWS: COMMENCING AT THE SOUTHEAST CORNER OF SAID SECTION 18; THENCE ALONG THE SOUTH LINE OF THE SOUTHEAST QUARTER OF SAID SECTION 18 N89'52'23 "W A DISTANCE OF 150.05 FEET; THENCE NOO'07'37 "E A DISTANCE 48.93 FEET TO THE SOUTHEAST CORNER OF SAID LOT 3 AND POINT OF BEGINNING; THENCE N89'52'23 "W A DISTANCE OF 358.03 FEET, THENCE N00'02'52 "W A DISTANCE OF 214.22 FEET, THENCE N85'10'53 "W A DISTANCE OF 255.92 FEET; THENCE NOO 02 - 52 "W A DISTANCE OF 252.46 FEET; THENCE N89'38'36 "E A DISTANCE OF 729.83 FEET; THENCE S00 03'07 "E A DISTANCE OF 376.05 FEET. THENCE S44'48'58 "W A DISTANCE OF 165.59 FEET TO THE POINT OF BEGINNING. CONTAINING 6.748 ACRES (293,955 SQ. FT). SUBJECT TO ALL EASEMENTS, RESTRICTIONS AND COVENANTS 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 THE PROVISIONS OF CHAPTER 236.34 OF THE WISCONSIN STATUTES AND THE LAND SUBDIVISION ORDINANCE OF ST. CROIX COUNTY AND THE TOWN OF ERIN PRAIRIE IN SURVEYING AND MAPPING SAME. 'as - kL 2 mss"' o� WISc S U N LA ZSUR • N S 145 ATE *D il 2920 ENLOE ST. y ip HUDSON, WI 54016 * (715) 386 -2007 Ski EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES AND REGULATIONS (I.E., WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF ERIN PRAIRIE FOR ADVICE. ' % m R1 VE© cou rrnr ma az« 15EP 2 2 2005 If not recorded within 30 of approval date approval #hall be nu ll an d THIS INSTRUMENT DRAFTED BY: CASEY CRISP JOB NO. 6539 -01 DATE: 07/21/2005 SHEET 2 OF 2 SHEETS Vo1.20 Page 5074