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HomeMy WebLinkAbout020-1346-60-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SAM[TARY REPORT "- Owner :5 14 ✓l- k 114 1 L L P Property Address f o AR City /State 4 U1) Sm M w I S t/6 /L ((' Legal Description: Lot Block Subdivision/CSM # ND M E TIC '/4 �' /4, S ec. �, T?AN- RL?ff 9,, Town of UL D SO PIN # b 2-0 –13 Ye, o 0 SEPTIC TANK -- OSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer F IS (t Size ST/PC 1 004 Setback from: House 1L Well $ fir P2 t' 1 0 0 Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) ----- �y` Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: L FA C µ Width Length L �� Number of Trenc�es �---- Setback from: House L p I Well I P/L I Vent to fresh air intake i '7 ELEVATIONS Description of benchmark I 121 N E '-Ct ec . N E R S - 3 ° Elevation V 4, DD Description of alternate benchmark r`C- o f 2 U[ K 829 Rk.41104 2,0 It Elevation d 2 t G C ,d , L , Building Sewer 7• e� ST/HT Inlet �- i � Outlet 2a C PC Inlet g � PC Bottom Header/Manifold l 3 • Y' 2 l' 4 - 'Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation 0e / number © J State plan number Plumber's si nature ' '� /� J License number 4,T" 3Q Date Ins.ector Complete plot plan Or NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 7 4 - -- D2'vt � y �c T�rz 3 i I I 7�e�vc y 0 INDICATE NORTH ARROW i r Wisconsin Department of Commerce Count r PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes (Privacy Law, s.15.o4 (i)(m)j. 338808 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: MILLER, SAM HUDSON CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: �U O(� N �" 020 - 1346 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , /000 Benchmark 105 C - Dosing .6y 1 Aeration Bldg. Sewer q S I n Holding (9 Ht Inlet TANK SETBACK INFORMATION &/ Ht Outlet - Z 6� TANK TO P/ L WELL BLDG. Vent to ROAD 9>46t Air I e Septic ±/601 ± ' s e" y i NA om Dosing NA Header/ Man. -� -c,Z - 71, f Aeration N Dist. Pipe 3�6 Z a( H ding Bot. System $, 0O *- PUMP / SIPHON INFORMATION Final Grade p d Jy Manufacturer Demand Z S Model Number GPM TDH Lift Friction System TDH Ft m ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM q C6,4e,,�. c BED / Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM r .Z5 Z I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH Manufacturer: INFORMATION Type O // / MBE Mode umber: System: edoQ X1'6 C� f /Q0 /64 NIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length / - Dia - _� Lengths ,2 �Dia. AZ7 Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 11.29.19,1859,SE,SW 1015 LABARGE ROAD Q Q/f 8N( ,4•� o f '4cf -3 / r / / � in l S� /W ,-r LJJ 0�( (h2Gt / hG�f 1"Na CkJPel4f l eylf(/ Plan revision required? ❑ Yes $6 No Use other side for additional infor ation. t5 V� i SBD -6710 (R.3/97) Date Inspector' ure Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Al J k } F { a r o � s i B C ! t i t 3 t 3 S d i a n e , a 1 7 k P f # � i t } e^ j t � 4 f � i ' t U a r m«.- i s # { 2 { { t � n } { 9 g rt i } { # E f i ....Ww. a, E x 4 } . .e,._ .a. ....... z t fi x k o .. ..... ......... ... ..��... ,, a -n.,. m., ,.®,.....,.� - .-..o -w a ... a ,,. .... ,., b... llt t t pp I 'a g ' e .......P ..... .. .. ......» ,......_.., ,._. ,....._.,.s, _ _.. .... ,..._ , ,.,. �..,. . ... ,...F�...., _ ....,..., .... .. __.,... a.,. � ,'�., a ,... ..._ _. ,.._ . ..,.._ ._.� ...._.. - ._.,. ., ., .,. .a.a_ ...,.,_e ✓, ..,...,. -.. J * Safety and Buildings Division V SCOl1S %11 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. C 1�Oi k See reverse side for instructions for completing this application State Sanitary Permit Number Personal information ou p rovide may be used for y p y second purposes ❑ Check 3 Wv If revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N "�— Property Owner Name Property Location lo Skkfl Al I C. ( S F 1 S L t) 1 /4, 5 T Z , N, R/ E (or Priperty Owner's Mailing Address Lot Number Block Number Ci y, State Zip Code Phone Number Subdivision Name or CSM Number W l / To I LMO) Z7 4 9 7 0 vYJ - TY PE OF BUILDI (check one) ❑ State Owned ❑ Cit 1 Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms .3 E] v ow a n OF 7 L110 6 O lV 1_4 004 k(i – Q 0. 111. BUILDIN USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 0 ZO – / 3y((o to p t�0o 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 box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System __ __ System____ _________TankOnly______________ Existing System ________ Existing Sys B) ❑ A Sanitary Permit was previously issued. Permit Number 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 Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit � / / L k X ��O' S 43 ❑ Vault Privy 14E] System-In-Fill F S/D w //y®FZ. ,wl4w ed/g C V ABSORPTION S YSTEM 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.) Pro sed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) o # Elevation r _ F ,>2 , 'O —~ I d. Z .r Feet 4 ? S . Feet Capacit VII. TANK in Ca allo s Manufacturer's Total # of Prefab on Fiber- Exper. New Existin Gallons Tanks Manuf Name Concrete st ucted Steel glass Plastic App Tanks Tanks Septic Tank r nk ��d s ❑ ❑ ❑ ❑ ❑ Li Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu tier's Sign ps} MP /MPRSW No.: Business Phone Number: Plumber's Address Street, City, State, Zip Code): vNTF fr'-O 4uo u) / S`lli` IX. COUNTY / DEPARTMENT USE ONLY [] pP v Dis Sanitary Permit Fee (Includes Groundwater ate Iss Issuing Agen ature (No Stamps) J4 Approved E] Owner Fee) Owner Given Initial '1S' M �r�� g I Adverse Determination P� 2 W2 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Z a o- . $BD- 6398 (R.11197) 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 a 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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 81/2 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 contamination investigations and establishment of standards. S S�CA4.0 C I-ect4 f) -/ t4,k 0 a s ys7,N E #'7 e* O t F AV H E 'S "X4 8 T,01 Fl 4- �l 'Cot 13,m, 7- A9k 09 /VA (C ant fe F 0 � �_ >� I L o oR N4C T*k i c �p c N T x co () CO y rn I& ca C c �nT.T - a c' � S T x a, co c o 0 0 U) "s NJ ca ti (D a m a co °. i E '- aa) Cd C4 a) c o ai z OF c cu co cn O co 4 v� c a — cu a� E a, o x o� 5 p c U C "0p E aci co co v� 'o v> > a O 4) N N o 'er o =, N u n E = U a V U — • • • • {� 1 XXX V \� � 1 5 11 N W 1 N " a v ~ lb T�o o ®� q o v y o a s Vs J�7 � 4 • > lJ o � a � C 0 • Z (n(.0 w I LU L v 3 OLL �S �"� r n E p m Z, 1$ m 000 CW a� " . v c 00 � CL co o W Zll y . � co O O ((1 C t[ LJJ U E Q. 3 Ng a W U T 15 v Go T .. lT cn Vvisconsin De altment of Commerce p SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Envnuruueuhet I3y Dcsi�f Attach complete site plan on paper not less than 8' /a x 11 inches in size. Plan must County include, but not limited to: vertical and horizon oint (BM), direction and SL Croix percent slope, scale or dimensions, no ro to o d distance to nearest road. L / Parcel I.D.# APPLICANT INFORMATIO Se t a ation. Reviewed By Daie Personal information you provide may u or seco (PlrvBOy s. 15.04 (1) (m)). Property Owner Property Location. MILLER, SAM Yr i Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owners Mailing Add re 5 G' = _ Lot # I Block # Subd. Name or CSM# , jr j TROUTBROOK RD ' y. �_, 16 Homestead C f ] City E] Village ®Town Nearest Road Hudson / 3156 -86 �.., Hudson Labarge V ! New Construction Use: Ve t of bedrooms 3 ] Addition to existing building [] Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpdfff? .6 trench, gpdfff? Absorption area required 900 bed, fts 750 trench, fIz Maximum design loading rate .5 bed, gpdfftz .6 tr ench, gpdfftz Recommended infiltration surface elevation(s) 94.5 ft (as referred to site plan benchmar Additional design / site consideration These are additional bore holes for a test that was completed on 8/19/98 Parent material Loess over outwash sands Flood plain elevation, if applicable ft S= Suitable fors stern Conventional Mound iii - Ground Pressure AT -Grade g System in Holding Tank U= Unsuitable for system ®S [I U I ® S ❑ U I ® S ❑ U ( [I S ® U [IS ®U I ❑ S ® U SOIL t)ESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/f? Horizon in. Munsetl Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistenc Boundary Roots Bed Trench 1 1 0 -40 10yr3/2 - sil 2msbk mfr cw 2f .5 .6 2 40 -57 1Oyr4/4 - sl lmsbk mvfr cw if .5 .6 Ground 3 57 -61 1Oyr4/4 - is lmsbk mvfr cw 99.1 ft 4 ( 61 -90 10yr6/4 - s Osg ml - - .7 .8 Depth to limiting fACtor >90 Remarks: 2 1 0 -24 I0yr3 /2 - sil 2msbk mfr cw 2f 5 .6 2 24 -36 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground 3 36 -50 10yr3/4 - A lmsbk mvfr cw - 5 6 elev 97.9 ft 4 50 -88 7.5yr6/4 - s Osg rw - - .7 ! .8 Depth to limiting factor >88 10 Remarks: CST Name (Please Print) Signature: - Telephone No, Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # I432 120th Street, New Richmond, WI 54017 9/14/98 227387 61 PROPERTY OWNER: MII LER, S AM SOIL DESCRIPTION REPORT s, Page 2 of 3 PARCEL 1.6 Environmental Bv Desi Depth Dominant Color Mottles re Horizon I in I Munsell Qu. Sz. Cont Color I Structu GPD/ftz Texture Gr. Sz. Sh. �onsisten ce Boundary Roots Bed Tren ch 3 1 0 -11 10yr3/2 - sil 2msbk mfr cw 2f .5 .6 2 11 -24 10yr4/4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 24 -96 7.5yr6/4 - s Osg ml - - 7 .8 99.9 fit Depth to limiting factor >96 Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to . limiting factor Remarks: Ground Kiev. Depth to limiting - factor Remarks: ENVIg ONMENTOL BY D E51GN 1432120 STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 PROJECT NAME HOMESTEAD � , � PAGE 3 DESCRIPTION SE 1 / SW %, SECTION 11 T 29 N. R 19 W TOWNSHIP Hudson C St. Croix Wisconsin 4 D-- p �r►2 S ��hiMc,r j a p S% g1°P� 0 �� 6 3 acc- es i-- 0 SCALE 1" _ 4-) Tom Nelson BM 1. (3a�� o� ��e� „a/ c ��pbo \oo' 227387 BM 2. (�as< u -E- e �� (`� 6b q 3 d Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code E n vironm ental By Design Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must Coun include, but not limited to: vertical and horizon!! rpfere oint (BM), direction and St Croix m percent slope, scale or dimesions, north ivf, no 60 ' distance to nearest road. ,; t.�`� n Parcel I,D.# APPLICANT INFORMATION l�le�se p tt all don. Reviewed By Date Personal information you provide may be for {� (P y. s. 15.04 (1) (m)). Property Owner r Property Location MILLER, SAM �- r; ( ??� ! -., Govt. Lot SE 1/4 SW 1/4 S 11 T 29 N,R 19 W Property Owner's Mailing Address s�-._`.s ycc�tX Lot # Blodc # Subd, Name or CSM# TROUTBROOK RD 1 WY 16 Homestead City S . e-' "'Zip ( ;N�1 b \ ° City ❑ Village ®Town Nearest Road Hudson f l_. 386 \ Hudson Labarge New Construction Use: er of bedrooms 3 ❑Addition to existing building ❑ Replacement E] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate i bed, gpdff ' trench, gpd/ft Absorption area required bed, fF SQ, nch, ft Maximum design loading rate _c� bed, gpd/ft - 8 tr ench, gpd/fl? Recommended infiltration surface elevation(s) ft (as referred to site plan benchmar Additional design / site consideration P Parent material Flood plain elevation, if applicable ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ®U N S El ❑ S ®U ❑ S ®U ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ftz Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ! Trench 1 1 0 -15 l Oyr2/ 1 - sl 1 msbk mvfr cw 2f .5 .6 2 15 -36 10yr4 /6 - sl lmsbk mvfr cw if .5 .6 Ground 3 3640 1Oyr4/3 - sil 2msbk mfr cw if .5 .6 elev 4 40 -48 7.5yr6/4 - s Osg ml cw - .7 .8 Depth to 5 48 -54 2.5yr4/6 - gs Osg ml cw - .7 .8 limiting 6 54 -82 7.5yr6/4 _ s Osg ml cw - 7 i 8 factor " 7 1 82 - 96 7.5yr5/4 _ s Osg ml Remarks: 2 1 0 -11 1 Oyr2/ 1 - sl 1 msbk mvfr cw 2f .5 .6 2 11 -22 10yr4 /6 - sl lmsbk mvfr cw if .5 .6 Ground 3 22 - 7.5yr6/4 - cs Osg ml cw - .7 ; .8 elev 4 28 -56 7.5yr6/4 - s Ogg ml cw - .7 .8 Depth to 5 56 -84 7.5yr5/4 - s Osg ml - - 7 8 limiting facto 1 I NC Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson �� 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 8/19/98 227387 63 'PRQPERTY 6WNER: 1vIILUB SAM SOIL DESCRIPTION REPORT ®Page 2 of PARCEL I.D.# Environmental By Design Depth Dominant Color Mottles Str ucture GPDIffi Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. onsistence Boundary Roots Red Trench 3 1 0 -19 10yr3/2 - s1 Imsbk mvfr cw 2f .5 .6 2 19 -25 1 3/4 - A Imsbk mvfr cw If 1 5 .6 Ground elev 3 25 -96 7.5yr5/6 - s Osg mi - - .7 .8 Depth to limiting f �, t.$ 0 -b Remarks: 4 1 0 -13 10yr3/2 - s1 Imsbk mvfr cw 2f 5 .6 2 13 -37 10yr3 /4 - s1 Imsbk mvfr cw if .5 .6 Ground elev 3 37 -72 7.5yr5/6 f - s Osg m1 cw - 7 8 4 72 -75 10yr6/3 T � � cl 2fpl mvfi cw - np ! .35'6 Depth to 5 75 -104 7.5yr5l4 - s Osg ml - - .7 i .8 limiting factor 72 -75 Remarks: 1 0 -9 10yr3/2 - sl Imsbk mvfr cw 2f .5 .6 2 9 -30 1Oyr4/4 - sl Imsbk mvfr cw If .5 ! .6 Ground elev 3 30 -92 7.5yr6/4 - s Osg n l - - 7 8 Depth to limiting factor `, Remarks: Ground elev Depth to limiting factor Remarks: E BY DESIGN 1432 120th STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 i PROJECT NAME HOMESTEAD PAGE 3 DESCRIPTION SE % SW Y, SECTION 11 T 29 N, R 19 W TOWN SHIP Hudson COUNTY St. Croix L l� T q �creS ev 48 A d8 �0 2° 4M 1\ SCALE 1 ii = �(� L.�- s .� � ( 1 Tom Nelson BM 1. �- o f C•o r f\ e R l o o cs 2605 BM 2. Tr , 1 o c��. w h�.�� f �s��ah S r . • 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer fSz4-.1// Mailing Address X Property Address .5 z_ e17 e. j fe4D /9 (Verification required from Planning Department for new construction) City/State h t1 Parcel Identification Number © `/ 3 `1 ' �vQ LEGAL DESCRIPTION Property Location E. '/4, _'5 ") '/4, Sec. t �, T 9 N- R of 005D k zSubdivision D /�I .s 7�+ �11� , Lot # Certified Survey Map # - ` CJ t I/ , Volume , Page # Warranty Deed # .5 Z `/ , Volume </ , Page # _ Z c Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE ImpzWer 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. I The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce acid the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the three year expiration date. � c ATURE bF ICANT DATE : OWNER CERTIFICATION 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 rapthy 4escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. / /S I ATURE O PLY NT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed M%1 , 0 8 1 if.ul I plfll'll•s 1.11' MMhI'M•1 Ma' t u1 , 14 4 2 736' Vo UNPLATTED ' AND$ "p" LIME Of THE 81/2 Of THE 0wW ® SA9'3S'SO 2448.54' Cos _640.00 -• ' D71 20 b, Lr►Aala � •• M311 90. R �•3 d• / p ` ' I A40 ACRES �# 12.0{ AC. ) " FT lai,l62 /0.►T) .. 13.24 AC.) `• t 1141,259 SO. FT.) Q• ��• &, 1ee9.01 . J �h I �• ..' 1 w.w so ►T 114 K 1 4 / C06�4,^ Fs Of '�• loon of 17 0 44„m sa / 8 ' 2.34 ACRE, x 18 / tll t / /�� N. �` IW,4aJ as 2100 A[0 a 8T ? /^ \ ir OTC•• 2 •7 01 / 2107 ACHE! W f J �• W xi •� / F O%iv so-FT R , • I 4 N YI J 8 6 00-CO* 722.03' w _ ) 4 ' C % _ � as rATCD 3 h�� ' rq0• 03.9 wl 720.9 w 44 V' 400.94' K4 yx ►� Mb 23 .4 614 C ZM ACRES l il 947 J il�� / ✓v IS J ~� • s • �a I 26 � I � L t I0I,l00 90. R. s 1 3 Aa ACRES / ,j t p JCn[t L30 scat as ON la a 104.474 90. R / w2 09.92T X?. T. 104,290 90 rt. 1 1442 01 0M 's 07 010 p 1 a 190131 / \011 8 2 �\� � ' M.01 4002t' - U71.0T= ��� u. 1 1 KM 299.49' 4 I ysd N89 2378.39' 9ovn" uK a TK SW 114 \ \ f 1r t FROPO�EC P- 4T OF GFkASS R,41VG= -- - - - - -- - - -- -- •• + '�.t (_'�• STA1t. UAR tiF WISCONSIN 1'OR11 I - 19b2 WAJFVI OEM This Deed, n,rd , Lrtwren Rona It L. t. i 1 1 ie and Nao :'J R. Millie, husband and h' A R t;ran:�r, 10:30 A. .,mt yam 1. `tiller, a single. person , • Gr•Intec, �VitIIESSeth, That ;he :aid grantor, for a valuable eonsiderut.un co.iV.•,:c t., t;r:uitee the fullowu g dcs.ribed real estate in J. Croix (aunt), State of wiscunsut: See attached description. Tax ► .ircrl No: ... ............................... . TRANSFER This is not- homestvAd property. (IS) (is not) Together with all and singular the hereditaments and appurten..nces .!.creunto LL. nging: And Ronald L. Willie and Naomi R. Willie uarrant.. that the title is gaud, iodefe:..ible in ° ee simple and free aiw clear .,f en.uml-n.n.es except easements, restrictions, and rights -of -way of record, :.nd %ill variant and defend tie Fume. Bated till. d ay of March 1 96 (SEAL) C rrvr 4 c� L• t t' �� �<L (SEAL) • Ronald L.. Willie (SLAL) / :scyrr <e- - I G LC4 (SEAL) . :Naomi R. Willie AUTHENTICATION ACKNOWLEDGMENT Signature(s) ..... _..... .. STATE OF %%ISCONSIN ..- ...- _ .................... ..... _S.t..CrQ1X ...... .County. , authanticatcd this . .....day of _ _ ......, 19..... Person" -. came before me this -LrD -.. ... .day of .............. ...y- ar.rh., i9 9 -4.. the above named .a... i' l'ie...and .................... •. _ ... _. _ ..va.omi .. ... . ... ..._ . . ft ....l?il.l.i.e .... _. . .... ......... -' TITLE: NIENIRER STATE BAR ( WISCONSIN ..... ............. ........ ............................... (If nut, .. .........._ ............................. authorized by ; 7uti.0;, 11 SL't'.) to me known t,, be the per,-n .S.. .... who executed the foregoing instr .nient and- . yykpowlcdge the same. THIS 'V aTp Ubt[Nf WAS C.. '.t :ED hV •.��, C. L. Gaylord,- Atto -rney c� River Falls, h-1_ -„54022 � Not., P 114'. `.- • f� -"S /t � � .. County, Wis. I '�i'!wat.r, - ne,y he :mU;cnti(%,ud ur :.. {.n,%1c,11 cJ. I—th Nly ComoiiS .kilin iyr p&rn l)tnhnt. (lf I ndt, .tale expiration r: ant i:.•r,.:ary.) } r! 19 date: 4 � ) .� I . J NAnkA\TV Dlt.D aft. is \It OF w114'41\'IN I 1''UkN :r•. I — IYl: ll.�.•R Nr A parcel of lano located in the SE-1/' the S1; -1/4 and in part cf of the SV-1/4 of Section 11, To+.r.shiE 29 North, F<,nte 19 ve:t. 10:.n of Hudson, being further descrited as follows: beganriing at the S -1/4 corner of said Section 1l; thence K69 29'03 ";;, along the South line of the S1•: -1/4 of said Section 11, 237F.39 feet; thence NO2 2P 06 "h 1322.62 feet to the Nerth line Of the 5 12 G L h e S 1; - 1 /` of SccilOn 11; LF.Er�E o the c rt said North line, 2446.4 fEEt to the North - Scuth 1/4 line of said r � SectiOr 11; thence S00 34'I6 "w, alone said Ncrth -South 1/4 line-, 1325.65 fEet to the point of bEg,innini. ParcEl contains 73.32 azrEs (3,193,674 Square feEt) and subject to all ease.Ents of record. Together with and subject to an easement for ingress and egress located in part of the EW -1/4 of the S1; -1/4 of Section 11 and in part of the SE/4 of the SE -1/4 of Section 10, all in Township 29 Korth, Rance l9 West, Town of Hudson, being further described as folIow•s: Corr:r,encin- at the S -1/4 corner of said Section 11; t�, nce hi 9 29'03 "w, along the S uth line of the S4; -1/4 of said SEc,:_.. 23;c.3� feet; thence NO2 "1; 1256.54 feet to the poirt of bcg.inninj; thence continuing NO2�26'06 "M, 66.06 feet to the Korth lint of the S -112 of the Sty' -114 of said Section 11; thence N6) 35'50"w, along the Korth line of the S -1/2 of the SW -1/4 of said Section 11, 179.26 feet to the NE corner of the SE -1/4 of the SE -1/4 of Section 10; thence N59 41'39 "k, along the Forth line of the SE -1/4 of the SE -1/4 of said Section 10, 1316.24 feet to the Wes a line of the SE -1/4 of the SE -1/4 of said Section 10; thence S00 25'39 "1,', along said {Vest line, 66.00 feet; thence S69 "E, on & line being 66 feet distant Southerly a,-,d parallel to the North line of the SE -1/4 of the SE -1/4 of said Section 10, 1116.32 fEEt to the E line of said SE -1/4 of the SE -1/4; thence S69 "f; on a line bein 66 feet distant Southerly and parallel to the Korth line of the of the S1; -1/4 of said Section 11, 162.54 feet to ifs oint Of beginning. Parcel contains 2.2i acres (9S,9 -6 Square Feet and is sut to right -of -way for tovn road (SCOLt P a d s::tjEct to all easerents of record. .op„) ar. forearir t., d l N (`l .►-' 4 O et , A N Ss. 89 .. ~ 3 a N -4 ° �� c °' ca cQ ° V a' r A .6 4) c c `N 2 0 p �W � ca 0 Z Q I ,`,� k il Go •� y N i r� O, W w 0 \U C, \� � � Q � � V — , � °0 V Cl) .•r 6► 6 1 I de cc O N �� co \ _ 0 a 6 901 Z ,sz °t IN f � I � W o � ►.• o � W ct i U ° lb � ow \ a) � U op` . O p N C„ O O r n CO Q S ... 6 N O P. v� O v1 .-�Mh V1 NI�N M1��00Z M N p ...� O O o0 � O .-� V O N 00 Co it M .� �`1 .. o t a - 7 "aa e,� _ > '«. o 0 o „ ees�.00?3 a oo wwo _ E c: 00 O O 00 8 W 5 0�8 CIO 48 �, � •� JA cr SON 0 o°�c 808 8 °g ° H w0 ' y = ID zi z O b _8z a A. Rl c O O L1, W w L1, . p e C, c E