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HomeMy WebLinkAbout038-1085-30-100 o w °O M ~ O 6o m a� O Rr C0 V L h O O O O N � O Z: co 0) LO GL o x fC� U�O N O C C Z C N r� LL 3 a� °3 3 La N E <-0 = cc U M CL a) � w Li co E � � :: zN_ am Cl)N H Z c I O C z p i6 O Z m Z d o c O fA I.- rn d Z c E 72 a r) N rL U) a) O O •N d � L_ _ p N O z m z w N z w c cli N O Lo m O N O G Ii aQ zv °> _ � am o a a z •IV 3 a 11 y Oo CD E 0) rn CO) -j U O � ! } U o Z;5 O °D cl • 2:1 o o m e L IL V y Q1 ¢ cn o N y C 1V O O G1 D O O ff' M A C V a O rV\ iii M = N l�6 O N O ODD C O C c) 7 o N co •O am z 70 cc _� - co N O O Z a� (n EL IL ed• ed C m .2 d 0 r`Iw�l E 'c c r A c°� a � � aic°� Parcel #: 038-1085-30-100 06/03/2005 09:52 AM PAGE 1 OF 1 Alt. Parcel#: 20.31.18.354D 038-TOWN OF STAR PRAIRIE Current X', ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 I Tax Address: Owner(s): *=Current Owner * PAUL M&FELICIA A GERMAIN GERMAIN, PAUL M&FELICIA A 2034 CTY RD C SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *2034 CTY RD C SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 25.610 Plat: N/A-NOT AVAILABLE SEC 20 T31 N R18W PT OF THE N1/2 SE1/4 Block/Condo Bldg: BEING LOT 4 OF CSM 10/2860 25.61 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 2005 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 52,000 152,300 204,300 NO AGRICULTURAL G4 21.610 3,100 0 3,100 NO Totals for 2005: General Property 25.610 55,100 152,300 207,400 Woodland 0.000 0 0 Totals for 2004: General Property 25.610 55,100 152,300 207,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �o JAMES r 2 2 1994 Rvi teOff u S S24557 This Instrument drafted by Fran Bleskacek Prof. No. 91 07 194 Cr°bc(;p W1 a.D UNPLaTT`c Latic'S' N01°0 5'25"E O North-south 1/4 line of Section 20 ° �— _ NO-1005125"E 845.33' N01 051.2511E ��, 1691.78' 2730.76' —� 0 O + + o 0 ' I< O > > N CD / ko (D �0 I�j W) w00 O M J • 0 O tzi 00 � H O O O tt1i 6 Iv tzj rt a H Ip-h Q, / J0 >o 0 o� i OD 0) x tWi� f•1 rt 4b, ril �> i Iy m ro° w I_ (D \S' rya°p�•`y� kn Co Irn \6� CJ a fi O v k tt o ,. .. ( C yam° Z 0 (D rt M �o 0 �� o :j Dj -n°o os I y I A 0 m d \c \• / fD `� Z o ft• \Cy� ;� �\• ^ Bearings are referenced to the O / • J North-south 1/4 line of Section Fh 20, assumed to bear N01 005'25"E. ` i I (D 0 rt D D 0 0 0 O v \ x x x x 0 tzj t; m f to (0 to (a o°i to s = 3C _n �c�5 3 0. CD 41, 0 + N U .•`. IBC +w'...•. 7 0 rx- + 7r o VOLUME 10 PAGE 2860 Parcel #: 038-1084-90-000 06/03/2005 09:49 AM PAGE 1 OF 1 Alt. Parcel#: 20.31.18.353A 038-TOWN OF STAR 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 " PAUL M&FELICIA A GERMAIN GERMAIN, PAUL M&FELICIA A 2034 CTY RD C SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.940 Plat: N/A-NOT AVAILABLE SEC 20 T31 R1 8W PRT NE SE N OF HWY EXC Block/Condo Bldg: CSM 5/1413 AND EXC PARCEL AS DESC IN VOL 827/254&EXC PT TO CSM 8/2393&EXC PT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TO CSM 10/2860 20-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1030/209 WD 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LAN G6 1.940 9,700 0 9,700 NO Totals for 2005: General Property 1.940 9,700 0 9,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.940 9,700 0 9,700 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 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER (mot,!/ h4t!°1 49ler'/oOey TOWNSHIP a'h�/�ui� `G' SEC. ,�:;20 T f_�N-R/_ W ADDRESS �.,�� ��• ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t� od 7D 1°L. i;z a7 i9 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used i Elevation of vertical reference point: Op Proposed slope at site: SEPTIC TANK: Manufacturer: 14) 41e It : Liquid Capacity: / 4 � Number of rings used: ,----Tank manhole cover elevation: 9 Tank Inlet Elevation: Z Tank Outlet Elevation: 97 Number of feet from nearest Road.: Front,QSide o Rear, O e 0 feet From nearest property line ' Front.0 Side,('31 Rear,O zOa feet Number of feet from: well �, building: j ; (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: Liquid Capacity: pump Model: pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, 0 Side, O Rear,© Ft. . , Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 9 Trench: Width: '/'A / Length: Number of Lines Area Built:Ao Fill depth to top of pipe: 2iz el - Number of feet from nearest property line: Front, O Side, �(Rear,0 Pt ZkZ i `tea Number of feet from well: S/ Number of feet from building: .22 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: C"Vacity: —_ Number of rings used: Elevation nr bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of fe(it from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: / — Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NE, SE, 2 0, 31, 18W [k CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of STar Prairies Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPEC IO 4 IJATE' Urban Germain 2034 Ct . Rd. C, Somerset ,WI 54025 q-1,3 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Byron Bird Jr. 3318 ST. CRoix 128636 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER / �, PROVIDED: PROVIDED: b 11000 -1 I 91 r 81 MYES ❑NO [:DYES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: `` AIR INLET: DYES ENO DYES ❑NO NEAREST as 13®� 1 ' DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID i TRENCHES: TERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE rDISTR.PIPE I DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW;IFES: AB✓�VE C VER: ELryEV.INLET: LEV.E PIPE^S FEET FROM LINE: t AIR INLET: i e 1 1 5a I D E7�� Ql NEAREST� 60 G MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; [::]YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. I DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA. ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO N System on Retain in county file for audit. Reverse Side. SI ATUR TITLE: SBD-6710(R.06/88) C Zoning Administrator o as . e son SANITARY PERMIT APPLICATION 7DILHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY# STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than /4� P 40 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 I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. '- PROPERTY OWNER PROPERTY LOC ION r �h G -(•'? '/a %a,S T , N, R E(or PROPERTY OWNER'S MAILING ADDRESS LOT# -` BLOCU_ ,2 19Af e__ a er STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 3 ✓t __ IZI 1. TYPE OF BUILDING: Check one CITY �c � y„ NEAREST ROAD 1 ( ) ❑State Owned r./,VILLAGE �/a r ❑ Public NJ or 2 Fam.Dwelling#of bedrooms L TAX NUMBER(S) OO 0 III. BUILDING USE: (If building type is public,check all that apply) 3 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System 'System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2,ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE _ REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) /� ELEVATION Q , G ,l J Feet - �{S Feet VII. TANK CAPACITY Site in oallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks 1 Tanks Se tic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Sign re:(No Stamps) MP/MPRSW No.: Business Phone Number: Zc PluHMe;:4 Address(Street,-City,State, p Code): IX. CO—UNtY/DFEPARTMENT USE ONLY Ej Disapproved S itary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No Stamps),, til � ! Surcharge Fee) Approved El Owner Given Initial P� Adverse Determination c 5O X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly PIb-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 8'f x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) + APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ---------------------------------------- ----------- Owner of property f Location of property 1/4, Section Township Mailing address CD U Address of site , :�' ZZ2 P Subdivision name Lot number Previous owner of property Total size of parcel f?7f' S/ e-e Date parcel was created Are all corners and lot lines identifiable? >4 Yes No Is this property being developed for resale (spec house)? as _ No Volume &00 and Page Number � an recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 2_T D Q ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Regis r of Deeds, as Document No. ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature No. 21—S-1. Warranty Deed. (STATE OF WISCONSIN) P-,"Nb.d by Me claw Be* • 8billawy oti Form No. 1 Utz Inbenturet Made this tenth d of May , A. D., zg 52 wife Wbetween Wilbur W. Knutson and Viola Knutson the ' 'own of 8lchmond. St. Croix County, Wisconsin parties of the first part,and Urban Germain and Pauline Germain of Somerset, St. Croix County Wisconsin parties of the second pan. Witneooetb,That the said part ie a of the first part, for and in consideration of the sum of Nine thousand and no/100 ($9,000.00) Dollars . to them in hand paid by the said part tea of the second part, the receipt whereof is hereby con- fessed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, their heirs and assigns forever, the following.- -_ described real estate, situated in the County of St. Croix and State of Wisconsin, to-wit: The South half of the Northeast quarter (S* of NEJ); the North half of the Southeast quarter (NJ of SE+) and the Southeast quarter of the southeast quarter (SEJ of SF,+), all in Section number twenty (20). Township number thirty ene (31) North of Range number eighteen (18) West. y � Y T ♦ 1. .! .�,, y_. } r • r•� rYy V.b'�I IJM� �}} 'f Cogetber with all and-singular the hereditaments and appurtenances thereunto belonging or in anNWM appertaining; and all the estate, right, title, interest,claim or demand whatsoever,of the said pan too of the first part, either in law or equity, either in possession or expectancy of,in and to the above bargain- ed premises, and their hereditaments and appurtenances. Co babe ano to botD the said premises as above described with the hereditaments and appurtenances unto the said part is of the second part,and to their heirs and assigns FOREVER. Zna the oafo Wilbur W. Knutson and Viola Knutson for their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part ies of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple and that the same,are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and pawealik possession of the said par$ies of the second part, . their heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof they will will forever WARRANT AND'DEFEND. in Mftneoo Wbereof, the said parties of the first part have hereunto set their hand s and seal this tenth day of May ,A.D., r 52. Signed and Sealed in Presence of � .r V. nu s n __ (Seal) _ � (Seal) __ •_ -C:F, Xontr an A.d'f2 (Seal) ola Mdutson _....._..... _ (Seal) (/Sb,frley Vbh3ison Mate of Mfoconofn, Ss. St. Croix Count Personally ame before me this tenth d of ..Mag_ , A. D., r9 52. c day� 'I the above named Wilbur W. Knutson and Viola Knutson, his wife, to me known to be the person s who executed the foregoing instrument, and acknowledged the same. 2 Notary Public_ St. Croix County, Wis. My commission expires Atiril 1I �. D., r9-5-6- i j X'!4 - I } 4:a 4 ps k. I Iw< Fj ll" x Qj 00 .. a. 1, L41 w ; d o u a► w o E 1-4 to qj 43 to r 71 � v STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER �� ROUTE/BOX NUMBER D7` FIRE N0. CITY/STATEG� �S�L �� ZIP ��� PROPERTY LOCATION: S J4&fik /V C 1/4, Section T j�j N, R W, Town of G'Q N Za (2- , St. Croix County, Subdivision , Lot No. 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 and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning ffice within 30 days of the three year expiration date. / SIGNED DATE — � St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF SAFETY& B I INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION LA60R AND PERCOLATION TESTS (115) MADISON W 53 07 HUMAN RELATIONS (ILHR 83.0911)& Chapter 145) LOCATION: SE TION: NSHIP/ NICIPALITI;: OT NO.:BLK.NO.: SUBDIVISION NAME: '/ '/ /T N/R/ E 1 --- COUNTY: MAILING ADDRESS: Grb t Go.G oin e� GtJ , y o USE DATES OBSERVATIONS MADE,2 6 NO.B DR : COMMERCIAL DESCRIPTION: Residence I y �.� ❑New �*eplace RATING:S-Site suitable for system U-Site unsuitable for system 12X sZ,r`G.t/ d,�/G'j ' l p ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:loptional) sou [ZS ®s ❑u os u as u s� If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.ILHR 83.09(5)Ib),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) O�ic� L B- / B- B PERCOLATION TESTS TEST D PTH _ WATER IN HOLE TEST TIME D WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 P RIOD PER INCH P- P. a �. P- G 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 9�1� I V_ ei Fr ol Al I ' TH A _ - _ - 4 1 i _L ttT 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the 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 WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHON NUMBER(optional): CST SIG TU 'DISTRIBUTION:Original and one copy to Local Authority,Pr perty Owner and Soil Tester. DILHR•SBD43951R. 10/83) —OVER — PLOT PLAN PROJECT ADDRESS 14` �Q/T �a� COON S� TVI RS Byron Bird Jr. ; DATE � �i BEDROOM CLASS PERC-�� CONVENTIONAL�IN-GROUND SSURE IO CONVENTNAL LIFT MO NU D HOLDI TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE 10 HOLDING TANK SIZE ABSORPTION AREA t„_ PERC RATE — BED SIZE „L�Z,�S � Benchmark V.R.P. Assume Elevation 10 'Location of of Benchmark * H.R.P. M Borehole Q Well Scale = Feet O Perc Hole System Elevation Uent 12" Grndp TYPAR COVERING_ _ 2" 12" 3- 4 6' 0 3- 1 6" Sewer Rock 12' ev 9 �L. r o � L 0 i c 5,f � e, a 1 3 i Go �