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HomeMy WebLinkAbout032-1073-20-000 ti -o 0 4 0 3 0 a� h a � I o I 0 N I o I ?, I N O Z C LL O 3 � I a I I v °' (D Z O) 0 r O r IM Z a m O C C7 O z C y Z C E 9 N y j 7 O) G all O O o a�i N ZmZ � I Z M C N d O) a C — C a « c CL IM �V r U) ca ° z • 3 CL CL IL CL co co N J V Ili 0 0 0 i 0i o Z Qti (D r' o CID to d m (D O 7 aU }' E y y E Ai °o U a3i rn d L o TOE ^I N No c c a c°I V M M C Q C C co C N N O O �_ d N N � Z C 0 r _ CIO N O U • p r (!1 m O Z N F- �d fn - CL at a u a 0 C3 CL c t� A o R z 1 3 0 Parcel #: 038-1073-20-000 05/08/2006 05:07 PM PAGE 1 OF 1 Alt. Parcel#: 17.31.18.302C1 038-TOWN OF STAR PRAIRIE Current U 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-BELISLE,ANDREW L JR&SHELLY J ANDREW L JR&SHELLY J BELISLE 909 214TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *909 214TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 2.580 Plat: N/A-NOT AVAILABLE SEC 17 T31 R1 8W 2.58A IN NW SW LOT 1 OF Block/Condo Bldg: CSM IN VOL II PAGE 403 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31 N-1 8W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 809/302 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.580 32,900 160,200 193,100 NO Totals for 2006: General Property 2.580 32,900 160,200 193,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.580 32,900 160,200 193,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 138 Specials: User Special Code Category Amount I I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 038-1073-20-000 09/14/2006 04:03 PM PAGE 1 OF 1 Alt. Parcel#: 17.31.18.302C1 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): O=Current Owner, C=Current Co-Owner O-BELISLE,ANDREW L JR&SHELLY J ANDREW L JR&SHELLY J BELISLE 909 214TH AVE SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): * rimary s Type Dist# Description *909 214TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 2.580 Plat: N/A-NOT AVAILABLE SEC 17 T31 N R1 8W 2.58A IN NW SW LOT 1 OF Block/Condo Bldg: CSM IN VOL II PAGE 403 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 809/302 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.580 32,900 160,200 193,100 NO Totals for 2006: General Property 2.580 32,900 160,200 193,100 Woodland 0.000 0 0 Totals for 2005: General Property 2.580 32,900 160,200 193,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 138 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 F n v S3 CROIX CoUNITy r S ,SL R1� yv n', Q F I C IE D Awn sw CORNER CERTIFIED SURVEY MAP �. SECTION 17, ~ co QeiK '� T31N R18W ti COUNTY SECTION E CORNER MONUMENT � t�N_P_I.-AUEo LAbLQ_ .-T C7- c�-=��-1- _S 0029'03"E 674 .47' co -- , �� - '-'--WEST LINE OF SW I/47 \ly I/4. CORNER 9 NO007 12 W rL S 88050 34 E * �O� 270.91 ' A32 8.14' 5E CTfON 17, s`�6% a60 0 POINTOF BEGINNING T31N R18W 166, COUNTY SECTION EAST I RIGHT- OF-WAY a LINE CORNER MONUMENT 0 ~ o I CD 1 0 2.58 AC. M (D LEGEND * TD ti Q 2"x30" IRON PIPE, WEIGHING 3.65#/LINEAL FOOT, SET. N \8°36 \g9.61 O 1"x24" IRON PIPE, WEIGHING 1.68/LINEAL FOOT, UN PLATT ED' 9g 6 Z SET. a — — FENCE LAND 1 = N ~ U N PLA_T_TE D N LAND - I * 2 a) 0 N w- S w APPROVED 3 m 3.15 AC. V) w 0 0 JUN 29 1977 �%.�SooNs;.,,s, 1F co coMrR ve mss'`T, :* �`t''• W z 270 .97' N-�E e N 0°35 ' 38"W AND ZONWO t U1 122.12 148.85' 1 s `° APPROVAL OF THIS MINOR SUBDIVISIOS �3 �' DOES NOT MEAN APPRgYAL FOR SEPTA, o °�SU * 0 2.24 AC. ~ '' 08146414060% f/0 R!6 %�� 16 N o — SYSTEM. HFER TO H62.20 '� X4)153°02'15' M ASSUMED BEARING %�\ S 37013 X56"W OD `56 0 WEST LINE OF NEI/4 -SW 1/4 �*20 0 $$ N 0°3 5'3 8"W w- - �E- - - - ir z 317.12' gb v SCALE IN FEET 1 ° N 19 017'2 8"W $°�� 0 M 128 0 0 0 UNPi ATTE_D '0' �� q � °� 0' 200, 400, 600, LAND �� 2.04 AC. 10803 CD 157° Q \?s' OWNER $ SUBDIVIDER �o C7�26 \2 366' Ed Germain 100.00.00, \ Z (, S83013 ' �h\o 6, 04 LAND UNPLATTED Somerset, Wisconsin 54025 � �'.4•;` I I I g r ► NE— SW I 1 "*4 i This instrument drafted by Walter J. Gregory. W Volume. 2 Pace 403 101 gad z QwnTon 00 �11u s ti W 1YAOdJdd NK3W ION S300 NOISIAIaws HONIW SIHI 40 1dAO;Jddy 'XJ02aaD T aalTUM Aq paijuap ivauma;sut std 116! %'o� �,. w ,6Z' 901 ��;�� &o.p 3„Z£,OOobL N 6 9b-g81 9 ,00£ ,OOZ 001 00 99 0 6Z '901 6 % �\ 1333 NI 3 -IVOS M„OZ,L Z° 8 Z S \�\ \ \ £8' £6Z \ ONI8d38 03vynssv 3„99,£IoL9N \ \ � \ S32lOd OL'£ SZOVS uzsuoOSTAI `4asaau<OS gb•L9Z \ \ S NICiNOO OV08 31d/\18d UT-eUUGD pg M„99, £1 .29S \ ,ZI 'L81Z = HION31 OV08 2t gQ IlII Qgi 1S (iNV 2iw1U � \ 3 N 1-1 H31dW \\ \\ o i MS -3N N ,9 9 °�9 0 9 Z CD O N o CD W w W W- (11 o N (T W CD D !l1L114�w o,_ m AINMOD x1G,.- y N N O N L61 6Z Ni11` Z W W O 9 �- OD MS -MN OD °' m OD $- z ° LS\ aBnObddd _ W - o b �� 0 CD I N 0 — \ �\ rn g - o \ 3„95, £1° 09 N \ m 80'Z81 \ \ LS\ I n� M „ 9S,£1°09 s \ £ 91 '08 1 �.°D� N 9 5,£1°L£ OD b/I MS-Wl 3N ,3NI-I iS3M--,4 20 ° \ M 81 8 ` NISI 0 oo * 51 ,08 £I `LI N01103S O X99 N M„95,£IoL 83N800 WI M 0 N 5\20 \ I aD cD _ JNINN1938 6Z'lIZ ` Z 0'99 co o -40 iN10d 1 3„ I b, I I ° b9 N \� L0° 0 S w 0' 9 MS-MN , b b' 191 \ \ 3N1� AVM N M Ib II° b9S -_lHola_1SV3 —�b�I MS 30 '£ \ ,9 9 ` , Sb' 110103„£0,6Z°OS @: 3NI -1 1 3M M818 IN 1£1 b�\ 20 S�5 Ll N 01103 S ad0� 0- NMOl ONLLSIX3 3N2i0O Ms �\ 20oTl \ ' o - - - - - - - 3N1-1 HDIVN o dVVq A3Adns a31d11�130 PTT-,C 080338 SanS A1Nnoj X1080 Is J� 1 n f • i Form - STC - 104 r AS BUILT SANITARY SYSTEM REPORT 15%ar OWNER ��j �7.� ����,5�� TOWNSHIP r SEC. T _Z4 N-R±2( W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION - LOT LOT SIZE �- PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM low #4 �e4 s K s 3�� r 1 �\ 6 i 0 � Vex r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Tb Elevation of vertical reference point: /d Proposed slope at site: SEPTIC TANK: Manufacturer: Grj.e � ` Liquid Capacity: C' \ Number of rings used: Tank manhole cover elevation: f7 45' Tank Inlet Elevation: S�Tank Outlet Elevation: Number of feet from nearest Road: Front,Side, Rear, O f l s feet From nearest property line Front,0 Side laRear,O fprD feet Number of feet from: well e//building: /G5 / (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, Q Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: �j�G Number of Lines: Area Built:-� Fill depth to top of pipe: 3l , 02 p Number of feet from nearest property line: Front, O Side, Rear,O Ft . G7 Number of feet from well: Number of feet from building: (Include distances/on plot plan). AF- SEEPAGE lc d PIT �;1-3 3 71-2 0!� 5— 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: q d Inspector: Dated: D 0 Plumber on job: License Number: 3/84:mj r• l s .DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MA ISON WI 53707 �p� NW',SA,S17,T31N—R18W ZXCONVENTIONAL ❑ALTERNATIVE (It Plan I.D.Nu be, Town of S tar Prairie El Holding Tank El In-Ground Pressure El Mound 90th Stree t NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: t Andrew Belisle Jr. Route 1, Box 609B, Somerset WI 5402 9',?J, / 3U BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN'. REF.PT.ELEV.' CST REF.PT.ELEV.. Name of Plumber: MPlMPRSW No.: Coumy Sanitary Permit Number: Byron Bird Jr. 3318 St. Croix 106127 SEPTIC TANK/HOLDING TANK: MANUFACTU ER' ILIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: IWARNING LABEL LOCKING COVER �!r�l°�tl✓�T`+�/ �WV./ ��a ((�� �^ PROVIDED: PROVYE 5 ",4.0 YES ❑NO ❑YES�N0 BEDDING. VENT DIA.. VENT MATL.'. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: lau,ICING. I VENT TO FRESH ALARM FEET FROM LINE' 1 1� Ala wLEr ❑YESSNO. CZ- ❑YESNNO NEAREST low 100 Ix1L DOSING CHAMBER: MANUFACTURER BEDDING: LIQU10 CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED: ❑YES ❑NO E NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPS ��L BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER rA A' MARKING 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 NO.OF DISTR.PI PE SPACING COVER INSIDE DIA -PITS LIOUIU BED/TRENCH 1� TRENCHES �I ntnrERlAI' PIT DEPTH DIMENSIONS J�l 4. GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL. IND TR NUMBER OF PROPS RTV WELL BUILDING VENT TO FRESH BE OW PIPES AB«U�V'E CwOVER. ELEV INLET ELEV.END'. PIPES LINE AV AIR INLET tl '� :3 Lo �1 d�7 NEARESTO--► UJC1 W MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WE LLS ❑YES 1:1 NO OYES FIND DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. DYES ONO iDYES ONO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH T LATERAL SPACING GRAVEL DEPTH BELOW P11 FILL DEPTH ABOVE COVER TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLPPIPES WO-511TH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKING ELEV.'. ELEV.. DIA.. ELEV.. DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO 1:1 YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. NUMBER OF PROPERTY WELL: BUILDING. S INEARE FEET FROM LINE 1 3 DYES ❑NO DYES ONO S T qj 4 5 �� � .7Z 3.33 7,34 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710(R.01/82) I SANITARY PERMIT APPLICATION COUNTY�c DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# –Attach complete plans to the count co 10619 '7 p p ( y 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 JINS11 NO PROPERTY OWNER PROPERTY LOCATION -I^etj T a)'/a G(l '/4, S 17 T , N, R / E (or PROPERTY WNER'S MAILING ADDRESS LOT N ER BLOCK NUMBER SUBDIVISION NAME 0 6 d CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, KE OR LANDMARK TOWN BI L W c .002­4 i-- VILLAGE: '51 II. TYPE OF BUILDING OR USE SERVED: 9" - = 1073 -C�V t=7/ Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): " �a III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. W New b. ❑ 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. 9 Seepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): p�CJ — ����'ZFeet Private ❑Joint ❑Public CAPACITY VI. TANK ##of Prefab. Site Fiber- Exper. in allons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xistin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank Q G El ED Lift Pump Tank/Siphon Chamber ❑ El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: 460n PlumbqKs Address(Street,City', ate,Zip Code): Name of esigner: I VIII. SOIL TEST INFORM TION Certified Soil Tes er(CST)Name CST## CST's ADDRESS(Streqt,City,State,Zip Codo) Phone Number: 5— o 1 Air IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S�itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial �q+�' �,+� �h �S'��rcharge Fee /Q �p Adverse Determination ��tJ.�/v T" as.00 �//�00r(J • X. COMMENTS/REASONS FOR DISAPPROVAL: 0," by '1 Ya'lary ns 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.PERMIf ., = 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'tog3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the Y 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; 11. 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; a 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 2 years of steady negotiation and public debate. The groundwater bill Ground .SBf included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that x bused is used in your building is returned to the groundwater through your soil absorption 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) 1 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 �^�. Location of property 1/4 S L'j 1/4, Section T_j_j N-R_16 W Township V..,< Mailing address OAT' - - Address of site Subdivision name Lot number Previous owner of property -]-Alm d 1- V;'0-0 Total size of parcel ) Date parcel was created 7-7 V Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes N0 Volume and Page Number 3 U 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 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. (o�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 bee y corded in the Office of the County Register of Deeds, as Document No. U �/7 ) . Mn, v L gk�� Signature of Owner Signature of Co-Owner (If Applicable) ,T= 16-it Date of Signature Date of Signature I' DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA JI WARRANTY DEED 436797 eou 899 NaV R REGISTER'S OFFICE ST. CROIX CO., WI James R Booker and Mary L . Booker , husband Recd for Record and wife ASjoint tenants MAY 21988 " al �M conveys and warrants to Andrew L Belisle Jr 9:26 and Shelly J- Belisle , husband and wife as • (� p a r t i a l p�nn e r t y Regtr<ter of Deeds RETURN TO the following described real estate in St Croix County, State of Wisconsin: Tax Parcel No: Parcel A : Part of the NW$ of the SW; of Section 17 , Township 31 North , Range 18 West , Town of Star Prairie , St . Croix County , WI , described as follows : Lot 1 , Certified Survey Map , recorded July 71 1977 , in Vol . 2 , page 403 , as Doc . No . 341381 . Parcel B: A Non-Exclusive Easement over the private road described in Certified Survey Map , recorded July 7 , 1977 , in Vol . 2 , page 404 , as Doc . No . 341382 . WFFF � p This is not homestead property. (is) (is not) Exception to Warranties: Easements of record. Dated this 22nd day of April 19 88 (SEAL) (SEAL) 6ames R . Booker (SEAL) f^— (SEAL) Mary L . Booker AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ( SS. S r—L'URO / el' County. J authenticated this day of , 19 Person 11 came before me this C26 of 19 the above named iyyl r2 a /2.. e TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person_who executed the authorized by§706.06,Wis.Scats.) fore oing instruppent and a knowledgQe the same. THIS INSTRUMENT WAS DRAFTED BY L S CjAA Acorn Realty , Inc . 245 Main Street Somerset , WI 54025 Notary Public County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission i permanent. 4f not, state expiration are not necessary.) date:— S , 19 .) 'Names of persons signing in any capacity should be typed or printed below their signatures. NTF 2280 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 1075,Green Bay,WI 54305-1075 Form No.2—1982 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L_ &L�x P ROUTE/BOX NUMBER " b bi b FIRE NO. CITY/STATE Sbyne_(SeL ZIP PROPERTY LOCATION: VW 1/4 1/4, Section � � , T__�_N, R_�`W, Town of 4ry e10,;✓, , 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 Office 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 r (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING', INDQSTRY, LABOR PERCOLATION TESTS (115) ""r IVISION RE HUMAN RELATIONS P.O.P,O. BOX 7969 (H63.090) & Chapter 145.045) 6e�I.Sle. MADISON,WI 53707 ;:7ZI TOWNSHIP/MUNICIPALITY: T 0.:8LK. 0.: SUBDIVISI N NAME:S I �!BU TY: OWN R• R E: L OD SS: USE NO.BEDRMS,: COMM D R TION: DATES OBSERVATIONS MADE Residence I PROFILE 1 E S: WNew ❑Replace 11 RATING:S-Sita suitable for system U-Site unsuitable for system /7,C 72SENTI NAL. MOUND: IN-GROUN❑11 ©� ❑� M-IN-FILL HOLOI G TANK:RECOMMENDED SYSTEM:(optional) u Ma, Du as If Percolation Tests are NOT require DESIGN RATE: under Percolation eats are indicate: If any portion of the tested area is in the IV I Floodptain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL. P HT R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTH JU ELEVATION OBSERVED I H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B. 7 > JIRJ p. « B_ IIQ A > B• O > B_ PERCOLATION TESTS TEST NUMBER INCHES FTERSWELOLING INTERVAL-MIN TIME DROP I WATER LEVEL-INCHES RATE MINUTES 1 _ PF � _ P/ PER INCH _P- P. �� 3 P. > 7 O.. P. P. 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the licit:ontai and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and pnre.im, 0 land slope. SYSTEM ELEVATION 1, o , I Gsl -3 IN .I _. 07 . I.. i I i. Ty, - -- I. t E .... ; i th i 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 Wiscormirs administrative Code,and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. VAME rint : ^ TESTS WERE COMPLETED ON: v 2' C53 4DD)_ - CERTIFICATION NUMBER: PHONE NUMBER(npunn,IT CS)Y:-§IGNAl"UR )ISTRISUTION:Original ar•r1 nne copy to Local Authority,Propet.v Owner wid Soil Tester- ' 11LHri•S1313-6396 01.02182) - OVER - PLOT PLAN //PRflJCT_ Ri��^ � f� S l< ADDRESS 1/4/S/,7/T N/R /I(W TOWN r COUNTY o��t MPRS Byron Bird Jr. 3318 DATE BEDROOM '2 CLASS PERC CONVENTIONAL( IN-GROUND ESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA _� PERC RATE ZZG' BED SIZE L Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. 0 Borehole Q Well Scale Feet O Perc Hole System Elevation 11 ll Uent 12" Grndp it 01(p TYPAR COVERING 2" 12" 3' 4 8@ O 3' 3' 0 3' I 6" Sewer Rock 12' 18' U._ d°r Oak. 151,E Al qa �; �/ do