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HomeMy WebLinkAbout036-1097-90-000 t y 2 7 \ j & ~ o \ 0 2 . � $ � 2 � ] � � U. ) \ - 3 ) X E J § § n «_ ) \ E § { \ & Q / § CL c b . 0 / 7 / E 2 I (D a E (D .� k0) (D c "IVA I / = g } ) k \ f ' \ 7 { > E % k co LO LO \ c § k J k ( \ \ § . ƒ / ; / ƒ a. $ \ \ : ) k k k z o k ! a a a IL z j \ § k k p 6 2 a)§ § / \§ § . ° g F / j ) ( § / lob., 7 k J ƒ / (D , ° 0 E / \ \ 2 £ / ¥ E E c { \ \ \ \ C*jo § ® S / 3 2@ » n r- r . o 2 g 2 2 $ ¥ 7 , 2 . \ § § ; k \ a q E E 2 CD \ § CD g $ : $ 0 z 9 9 (n ■ � 2 $ « k CL — , � " a » E ' § a § $ J a o U) 2 ,Parcel #: 036-1097-90-000 06/29/2006 02:01 PM PAGE 1 OF 1 Alt. Parcel#: 31.31.17.594B.595 036-TOWN OF STANTON Current X 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 JAMES C PRICHARD O-PRICHARD,JAMES C 1892 142ND ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description * 1892 142ND ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.404 Plat: 03/038-WESTVIEW(1956) SEC 31 T31N R17W PT NW NW N 22'LOT 18& Block/Condo Bldg: LOT 18 LOT 19 WESTVIEW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-31N-17W NW NW Notes: Parcel History: Date Doc# Vol/Page Type 06/18/1999 605263 1435/332 WD 07/23/1997 814/53 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.404 22,000 131,800 153,800 NO Totals for 2006: General Property 0.404 22,000 131,800 153,800 Woodland 0.000 0 0 Totals for 2005: General Property 0.404 22,000 131,800 153,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 137 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � 1 ,,,,,�,a TOWNSHIP `5 � / SEC. T j N-R Z�Z W ADDRESS � ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 3s �3m 41ak I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /Qd,,j ` Proposed slope at site: D SEPTIC TANK: Manufacturer: .5 �Liquid Capacity: Number of rings used: _Z__ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: 92, & Number of feet from nearest Road: Front,Side,o Rear, O f9 feet From nearest property line Front,OSideI @ Rear,0 feet r � Number of feet from: well (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: Trench: Width: � Length: Number. of Lines:�� Area Built _ Fill depth to top of pipe: ,3 Number of feet from nearest property line: Front, QSide, j Rear,O Ft _ Number of feet from well: /© Number of feet from building: (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: Capacity: Number of rings used: Elevation of 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 feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on Job: License Number: /s 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NW4- NA- S31 T37N-R17W MCONVENTIONAL E]ALTERNATIVE State Plan I.D.Number: 4) 4j J Ilt assigned) Town vb STant n ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 1 a (� v� NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Duane Thomp4 on Route 3, New Richmond, W1 54017 /o ,// _Y i' 8 _'3 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF,PT,ELEV. Name of Plumber: MP/MPRSW No Cnunty Sanitary Permit Number: catvin Poweu Jtc. 1563 St.ckoix 112805 SEPTIC TANK/HOLDING TANK: MAN TUBER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELE V. WARNING LABEL LOCKING COVER 1 PROVIDED: PROVIDED`. \/ (')'), t r%A_+ ��<.-'� DYES ❑NO ❑YES �NO BEDDING: VENT DIA.. VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING:JVENTTOFRESH' ALARM LINE AIR INLET: rr IFEET FROM ^� ❑YESNO .i. ❑YES NO NEAREST 1 C �� DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL r7MPr SIPHON MANUI ACTUREH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ENO YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER F PHOPE TV WELL I BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FRO M LINE AIR INLET PUMP ON AND OFF) EYES ❑NO NEAREST Iw SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I I N(.l H JIIIAMI 1`1 11 MATT 11 ING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: _ WIDTH LENGTH UISTH PIPE SPACIN(, COVER INSIDE UTA SPITS LIQUID BED/TRENCH THNCHFS M EHIAL: p17 DEPTH: DIMENSIONS 2 S 2 IN1,111 —�» GRAVEL DEPTH FILL DEPTH UIST H.PIPt DISTR PIPE DISTR PIPE MATERIAL NO U_TH NUMBER flF :PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES f ABOVE COVER Et EV INLf f ELEV END ^^ (� PIPES FEET FRDM LINE AI�R/INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ONO SOIL COVER ITEXTURE PFHNIANI NT MAHKIHS JOBSEHVAIFON WELLS _ EYES 1:1 NO _❑YES ID NO BD DEPTH OVER TRENCH BED DEPTH OVFHTRENCH E IDEPTHOF TOPSOIL SODOFD EUFU JIVIULCHED CENTER EDGES ❑ SE DYES, NO ❑YES ONO []YES ❑NO PRESS URIZE�D+r DISTRIBUTION SYSTEM: BED/TRENCH WIOTH LENGTH TRENCHES LATEHAL SPACING IGHAVIL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS, -:.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH DISTR.PIPE DISTHIBUT ION PIPE MATERIAL&MARKING ELEVATION:ANt3 '.ELEV_ ELEV. DIA. ELEV. PIPES DIAJ ' DISTRIBUTION 1111FORMATI HOLE SIZE HOLE SPACING DRILLED COHHFCT LY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES F-1 NO DYES ❑NO COM NTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LRIOE ERTV WELL: BUILDING:ET f/1 ❑YES ❑NO ❑YES ❑NO NEAR ST ' ,acl 191 -7,2g SQ , 0 o, Sketch System on G Retain in county file for audit. Reverse Side. � 5 1 SIGNATURE. TITLE. DILHR SBD 6710 (R.01/82) Zoning lldmtinc�sxtcaUn DILHR SANITARY PERMIT APPLICATION COU l In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT## a 5� —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES �NO PROP TY OWNER PROPERTY LOCATION AIA) t/a /a, , N, R (Or PROPEaTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK UMBER SUBDIVISION NAMFi CI ,STATE ZIP CODE PHONE NUMBER 17M CITY N AR ST ROAD,L E OR LANDMARK VILLAGE: II. TYPE OF BUILDING OR USE SERVED: • dab " 7 Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b.Y Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. I Seepage Bed b. ❑seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minu s per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Z a ' a I err Feet LJ Private ❑Joint El Public VI. TANK CAPACITY Site in allons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. u INFORMATION New xisting Gallons Tanks oncrete glass App. Tanks Tanks structed Septic Tank or Holding Tank ❑ __S Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ Ei VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's ame(Pn PI er's Si atur (No mps) MP/MPRSW No.: Business Phone Number: ber s Address(Str 'et,City,Sta Zip Code): Name of Desi er: VIII. SOIL TEST INFORMATION Certif• d S it Tester T)Name CST## CST' DRESS(Str et,City, te,Zip Code) Phone Number: 1 IX. ml /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Is wing Agent Signature(No Stamps) t'Approved ❑ Owner Given Initial charge Fee ��/ Adverse Determination �'DU 16-3��� U[� n a X. MMENTS/REASONNS�FO�R DISAPPROVAL: U SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984. 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over years of steady negotiation and public debate. The groundwater bill Ground &t9T included the creation of surcharges (fees) for a number of regulated practices which Wisco i 1'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reast@ is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) T�/�/,,�>� HA)zes 0#44 E G6 e �8 t a, Ott #A&r- 16 4I•Y . t`� A. FfnM Ak III And OburuAllon Plpn t Approved Vent Cap fir , - yVV/I % Mlnlmwn 12'Above •. Final,l Grade _ r r a: t i�L •fir t ti' t tt 4 Y r r 20-42"Above Pips ♦"Cost Iron y5 a To Final Grade Vent Pips Al All iwy Or Sy"IqAqg,.qoj. �, MM 1 rg!!�" V .4 . 0 *1 d, Welrlbulion --Tee Pipe "--.6"Abalra Perforated Pipe below a z } v x � Col Terminotiml As a �� 1 mollem of system 1{ S n, t t � •t r ' Pau n P y: r 'SaFfVr. " SGN L 'f I LL azi„s' OISTRIBU'I'10►.1 PIPE • . s APPROVED SyMT1±�Y1� '. OF 9•T • M TLRU►� � �t� „r• i �r r tt (e'qC���-c^_i�r`iAGGRF:GATF ; ry� F�»;'��/i.��' y fit. h.; •!�rA. .fr V� 311 1 ,a p15"ratA1lT1rJAI PIPE TU BE AT !..EAS HEI.Ow ORIGINAL GRADE <•' Atltj AT L.EAST20 I1�1f_NF:." NUT I.10 MOKG. TNAK1 X12 IRiLii.J.5 BELOW FINAL GRADE r� s.� Ar.,; 1"W"UM DF-101 OF EXeAVAT►o0 FROM b i&wAt 60AIM WILL eE �ZIl� ►ucMES' . ek `,'> MrMIMUr� rH O �XC�t�A1i�IU n I 1t,�,IKA6'1 � WILL aE INCHES x ASP F FROM ,' 6 4. x LIGEUSC AJUMBER; 4 DATE Ir'• DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 ) HUMAN RELATIONS \ / MADISON,WI 53707 • 4 w (H63.090)&Chapter 145.045) LOCATI N: A.- SECTION: / (or TOWNSHIP/ LAW4C4P1kHTY: LOT O.:BLK. SUBDI ISION NAME: N 1 ,4 S' ICOUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.B DRMS.: COMMERCI DESCRIPTION: PROFILE DESCRIPTIONSTERCOLATION TESTS: Residence ❑New WReplace Il RATING:S=Site suitable for system U=Site unsuitable for system CpNVENTIONAL: MOUND: IN-G�ND--PRESSURE: SYSTEM-IN RECOMMENDED SYSTEI,A:(optional) LOS ❑U 19S DU S U S U S U11�1z1 !/ If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,A DEPTH NUMBER DEPTH 14. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B- .� B-_3 B- B- B- d CF PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER lNeME-S AFTER SWELLING INTERVAL-MIN. PERT D 1 PERT 2 PERIQQ,8 PEJR INCH P- p_ Jr- �l P-_ P- e 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" 10 i z � d w / 15� � 4 3 i I _ f E i t i [ 0 0 a ( I I j sf e I J. 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 Wisco sin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. I NAME rin TESTS WERE COMPLETED ON: )MT ,/Z P_/_11—& A SS. CERTIFICATION NUMBER: PHONE NUMBER(optional): 3 4L SL:V�f f 7 I �- CST S Iq N AT URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 5395 � To be a complete and accurate soil test,your report roust include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or co rnmereiai use planned; 4. is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shuY,,vn here for writing profile descriptions and completing the blot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all app,opriate boxes as to elates, narnes,addresses, flood plain data, percolation test exemp- tion, if appropriate; 0. H tits; inforrnation (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and Blare your current address and your certification number; 10, ivlrake legihie collies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR C ERTIFIED SOIL TESTERS Soil Separates and TextU es Other Syrnbols {t -- Stoni! (ov:r 10") BFI _.. Ge>diock robe Cobble; (3- 16") SS Sandstone gi _.. Gravel (under :3") LS — Limestone sand klG1 f - High Ground eater cs C rr a,s e Sand Pew r'e!r,olatior Rate reed s — t edliurn `amid k°' — . is F ,rye Sad Bile, __ Building Loamy Sam! > — Cheater Than si - Sandy Lcaasx Lass Than — I_oana Bit -- Blm3,,ern sii - Siit Loans BI Black s — Silt. G — "fray r c, __ Clay Lozarr� Y -. y"e€kov=u ;c, `-tidy Clay Loarn R -_. g1rc - s;ci -- Silty Clay Loans mot — Mottles M< S,ndy Clay tor;' v,/i0-, Silty Clay fff ft iv,', fine,faint '�-c -.... C day cc _._ C'OnIr?lon, Coarse I .__ Peat Prim -- Many,medium d — distinct P prornfnei"tt HVVL — High water level, Six gerieral soil textures surface water =or lir,erid waste disposal BM Bench Mark VRP - Vertical Reference Point I TO THE OWNER: This soil test report is the first step in securing a sanitary permit.The county orthe Department may request verific=ation of this soil test in the field prior, to permit issuance. A complete see of plans for the private s ,vaC( syster7a <and a permit application must be s.ibmitted to the appropriate local authority in order to obtain a peirnit. The sanitary permit must be obtained and posted prior to the start of any construction. 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 Duane and Marcia R. Thompson Location of property NW 1/4 NW 1/4, Section 31 , T__32`N-R_7 _W Township Stanton Fire # 1892 Mailing address Route # #, Box 72 New Richmond,_ WI 54017 Address of site same as above Subdivision name Plat of Westview, Stanton Township Lot number 19 & North 22 feet of 18 Previous owner of property William Paschall (Durand Federal S . & Loan) Total size of parcel Date parcel was created 30 to 35 years ago Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes x No Volume 823 and Page Number 15 as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, 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. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all tatements 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. 441486 ; 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 t County Register of Deeds, as Document No. n ) . gnature of Owner Signature of Co-Owner (If Applicable) Date of Signature Dat6 of Sign tune STC - 105 i SEPTIC TANK MAINTENANCE AGREEMENT I St. Croix County OWNER/BUYER Duane and Marcia R. Thompson ROUTE/BOX NUMBER Stanton ## 1892 FIRE NO. 1892 CITY/STATE New Richmond, WI , Route ## 3, Box 72 ZIP 54017 PROPERTY LOCATION: NW 1/4 NW 1/4, Section 31 , T 31N N, R__17_W, Town of Stanton , St. Croix County, Subdivision Plat of Westview , Lot No. 19 & N.22ft. of 18 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 Office within 30 days of the three year expiration date. SIGNE DATE / l/ St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 r (715) 386-4680 Sign, Date, and Return to above address it I_ 1MIr SFACE 110"WSo too 06c"DINA VIA" ' ' { wsstsAnrx uetcu DOCUMENT NO i STAYS OF WISCONSIN•FORM 3 ,i 8�3 . � 44148 �a�c � KC'WERS OFFICE t]I This indrntuee,Made ehia.........:... ......._...... day of ....Jt•})Lta)absa.......... SL GROIX CO., WfS„ 1 i6ed. Igor Record two 19th t A. D 19_11., between LZU�t��..��: 1�...5t�y`.�: a..t �_ ��.. .._ .»» : i ASSOCIATION ............. __...... a Corp.. duly organised and existing under and by day Of Sept. A.D, 1918 virtue of the laws of the State of Wisconsin. located at..��-s�...�.f�ILS�..f�k<C1tiCa••l�lu��• 8:30 p AL Wisconsin, ?arty of the first pall, and ..j).U.1,=..NA +3J 1L�.�'itlJsl..�•...r-h�u��l`. ...:' survivJrsh •niarit�l..P.ropc>rty..._......_...............----._._...._.._.._..... _ r;: _..__..--------------- �� 1 part.! S.._._........ of the second part. Witneueth, That the said party of the first art, for and in conslderationof the sum staruera P Of... )e jhousand..Nine•Hundrec� [�c?liar. and na/.100._1 4y:yU0) TO to it paid by the said of the second part,the receipt whereof Is hereby*ollfessed and as given, �lantal, bargained, sold, renvisrd, releate,l, alone i, ennve•yt, 1 and con acknowledged,h - 4tmed,atad b!these Prevents does eve,gtaat,bar ain,sell,remise,alien,convey,and confirm unto of the second post__­ r ........._......_... heirs and assigns forever,the following described real estate,situated Ca the said part_.ies _---. po St. Croix _.._....... _.......... .................State of Wisconsin, to-wit: the Court of..._..___ ..._.._........ Lot 19 and the North 22 feet of Lot 18 of the Plat of Westview located in the NW1, of NW4 of Section 31, T31N, Range 17W. TRANSFER FEE 4 if Q f ([F NECESSART, CONTINUE DESCRIPTION 0.4 REYERBE BIDE) 1 Together with all and singular the hereditaments and appurtenances thcreucto beionging or in any wise appertaining; a..d all the estate, rigbt, title, interest, claim or demand whatsoever, of the said pare of the first part, either in law or equity, either in possession or expeeuuey of, in and to the above bargained premises, and thtdr here.litaments and appurtenances. I To have add to hold the said premises as above des abed with the hctrdi,amcr.ts and appurtenances, unto the s::IJ part-1e.5.............. of the second pat(. sad to..__,31_WJL..._......................_..... .......... heir an l assif,rts I UHEVLR. And the said Durand Federal Savings,3c L�;fin Assoc! tfon..........._.-.._........_............................._...__.._----......._.._ ,..-------.._.. of the patty of the first part, for itself and its sucressots, does co••rnant, gram h.tlgaut and scree to and with the said part. IeS second part, .•their _---,•_....-.........................._............. heirs an l ass;ens, that at the tirne of the ensealing and delivery of these presents it is well i seized of the premises above described, as of a good, sure, perf,ct, absolute and indefeasible estate of inheritance in the law• in fee simple, Excepting Easernent,, and restrictions of record. and that the same are frre :nd clear from 311encwnbrantes csl,ttecer, ...........P. ...1's. ..•_..- -- _•••• and that the above bargained premises In the quirt an l p-a:; 01e posacc ion of the said part..._-t 5_...... of the srcnnd part _tflelf- heirs, and assigns, against all and every person or petxm, 1.^.,.11y cla.r.,inc the whole or any part thereof, it will foarrr WARRANT and DEFEND. In Witness Whereof, the said .f�hS.Q.Ia.J.l.11?p._ .- _._............. . party of the first part, has caysetl these presents to be si nevi h} Noe l_F,. Holi,ntit:0.__.............. - -." its President and countersigned by.......50Q? 1._H.;Inticn its cccto car), at 3G8 Third avenue West, I)Uraflrl \', roan, ac"1 ifs o'tpnr.lie seal to i+e (urtrnli, Alnt,Lrthis a.4ih....-....__.. day of.......�ePTE.frlbCr A. U, 19_ .. _ '` p rn f SIGNED AND SEALED IN Pkf.6t;hCF. OF 1)1 �.rlt l) I_L�F \L yt)s'!seas LUt%N A.SSOCIATIO f �t.�t al• ma.. .. _.. No,•I F. hiohnbec h • _. 1 STATE OF u':",(:(),�, N .......... . - .. County. I ' th tic i'ttc Sober A 1) h)_ Pers'Inally rame k lore nx, th:s of -'''�: ��' -it�lifif)<<'k ! 4•r,r. -.,t tittt,'t., i. 11.Itac '1 S'�ttttrf of the abovr nvrnc'i Cnrpor.tt-tm. to n mien t�, F.r ti,^ ivr ... ,"w• i 1 t i t hr president an.l ;f s'id (­TI. { said corporation, by its autitr-,tv. THIS INSTRUMENT WAS DRAFTED BY •• 1'.,tl I.t ,1. i� � :''• t t. 6Falr J rt�' r & Lti,rn �ti,n• 1. lss i i ?t r.. 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