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HomeMy WebLinkAbout030-2041-30-000 § 0 7 CD . a k r \ 2 0 r � § � \ m � n � � \ o � $ � 7 � § � z / % z CL § / � o b � $ 2 § z 7 k g § $ B B k 2 ) S . k z 7 2 { z E 2 N M � \ f } � § 2 § f 15 @ \ o 2 c r z w § - z c 2 § } E } C14 e 3 06 k § k 2 ) / \ ) \ © k k k § 0 " a a a 77 � - 0 2 a) _ J-j 0 S m $ r �} Cl _ \ / 2 Cl) } } { z m \ E CL �\ '» -- % / uj o 2 3 g o CO } @ 'I j § a- 8 E � \ 0. �� co & / � 3 04 -� 2 04 Q 0 ■ 2 2 c) ¢ k § 6 �J Cl) \ z / } ) ( f 2 % a , " (L E § a k a § ( on 0 m 2 ,o 0 3 U 2639 P 313 +17 STATE BAR OF WISCONSIN FORM 2- 2000 7 7 1 8 9 9 Document Number `'WARRANTY DEED KATH ISTER OF DEED This Deed, made between Margaret Ann Webb ST. CROIX Co., MI RECEIVED FOR RECORD 08/17/2004 10t00AH Grantor, and Randel C. Simonsonand Ann M. Simonson, husband and WARRANTY DEED wife EXW 1 REC FEE: 13.00 TRAITS FEE: 727.20 Grantee. COPY FEE s Grantor, for a valuable consideration, conveys and warrants to CC FEE: Grantee the following described real estate in St. Croix PAGES: 2 County, State of Wisconsin (if more space is needed, please attach addendum:) Please see attached Recording Area Name and Return Address First National Bank of Hudson 307 Second Street Hudson, WI 54016 030 - 2041 -30-000 Parcel Identification Number (PITT) This Is not homestead property. (is not) Exceptions to warranties: easements, covenants and restrictions of record, if any. Dated this 13th day of August Y 2004 v' * * Margaret�nn Webb * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Margaret Ann Webb STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this 13th day of August , 2004 Personally came before me this 13 .,. day of August 200{{ above named Margaret Ann Webb 3 • .`,}• TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) whi,tz d - e g authorized by § 706.06, Wis. Stats.) ins d aclmowled ed the said. '• .•\�;': THIS INSTRUMENT WAS DRAFTED BY Heywood, Carl & Anderson, S.C., 1200 Hosford St., Suite 106 NotapfWicAtate Of WISCONSIN P.O. Box 125, Hudson, WI 54016 My Commission is ent. (If not, state expiration / date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) 0 �r`•5L ) • Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 INFO PRO (800)655 -2021 www.infoproforms.com 2639 31� Legal Description That portion of the North 364 feet of the West 605 feet and the South 296 feet of West 635 feet of North 660 feet of the SE 1/4 of SE 1/4 of Section 25, Township 30 North, Range 20 West, St. Croix County, Wisconsin lying East of town road through said parcel EXCEPT Lot 1 of Certified Survey Map in Vol. 6, page 1075 Together with a non - exclusive easement for ingress and egress located in the NE 1/4 of SE 1/4 of Section 25, Township 30 North, Range 20 West, Town of St. Joseph, St. Croix County, Wisconsin; being further described as follows: Commencing at the E 1/4 corner of said Section; thence S0 0 47 1 54 11 W along the East line of the SE 1/4 1314.28 feet to the South line of the NE 1/4 of SE 1/4; thence S69 0 53 1 29 11 W along said line 975.65 feet to the point of beginning; thence continuing S89 0 53 1 29 11 W 44.50 fee; thence Nally 86.79 feet along the arc of a 235.0 foot radius curve concave SWly whose long chord bears N62 0 11 1 06 11 W and having a length of 86.30 feet to the right of way line of a town road; thence N7 0 55 1 35 11 E along said line 30.36 feet; thence SEly 137.70 feet along the arc of a 265.0 foot radius curve concave SWly whose long chord bears S58 0 56 1 25 11 E and having a length of 136.16 feet to the point of beginning. ST. CROIX COUNTY ZONING DEPARTM AS BUILT SANITARY REPORT Owner Z E(1 >i_S 1 j2j, —/3 /3 Property Address x_2 9 2 City /State U/) sI1nr &2e' S fOi Legal Description: g Lot Block j(,& Subdivision/CSM # '/4 .T�= t /4, Sec. ,Z, T3QN - RAW, Town of �'�r era PIN #,6 y/ 30 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1 -ZEie d Size ST/PC 1 Setback from: House gj' Well kQ P/LJ-612 Pump manufacturer 444 Model Alarm location (HOLDING TANKS ONLY) Seta Ve�to esh air intake Water Line Meter location Al SOIL ABSORPTION SYSTEM Type of system: 7/N5A//I Width 3 Length g; 7 ; Number of Trenches Setback from: House 86 Well P/L 300) _ Vent to fresh air intake i OD ELEVATIONS Description of benchmark 5a p o,-= �� r� —1��� 2 Elevation 0 Description of alternate benchmark Q7�/ 6; Ll i G- 6 AP M0,6 s Elevation 1,0 SAS Building Sewer ST/HT Inlet ST Outlet 2L M PC Inlet PC Bottom Header/Manifold `1 Top of ST/PC Manhole Cover Distribution Lines ( 1) ?1, 93 (2) 9L 13 ( ) Bottom of System (1) ?, , b 0 (Z) L9 y. 8 0 Final Grade ( I) A8 o/ 5 (2) . vde xy 9 3 ( ) Date of installation &A/ Permit number 3 j�?,j Z q State plan number /yx Plumber's sig ture aL icense number 2.2 Date/ / / Inspector Complete plot plan � r 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. 5 b PLAN VIEW CAcEr yo :3 `)C 57 Jly 3 Pe RvGrj N`pris Cr1 jGX /S'T /nrG. /Octi ' g 1 5'. i ? Welt_ 3ov w� / A2 y LIJCG � 300' So" 7- / L INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety'and Buildings Division INSPECTION REPORT St. Croix ' E NERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. 353228 Permit Holder's Name: []City ❑ Village own of: State Plan lD No.: Webb, Lewis Town of St. Joseph CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: . o 1 tM , 0 030- 2041 -30 -000 sir TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic is ? Benchmar # �� - 3•rfls o3,6 I� a' Dosing Alt. BM } fl� , 04.38' \ Aeration Bldg. Sewer 1 �)• Holding St /Ht Inlet Ok i I TANK SETBACK INFORMATION St/ Ht Outlet d t • h TANK TO P/ L WELL BLDG. Ventto ROAD 94 lRIe4 Air Intake Septic ';$ 66 �� 21 NA E04 Bette 44 Dosing NA Header/ Man. Aeration NA Dist. Pipe 1 .1 Holding Bot. System 12.00 .�1 PUMP/ SIPHON INFORMATION Final Grade 33 � 5.32 Manufa r Demand St cover 3•�s 1�•a Model Number GPM t IM & `t `?3.96 TDH Lift L Iction Syst TDH Ft Forc In Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM TRENCH Width Length , No. O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 $ � DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type of ► CHAMBER Model Number: System: voi , /oD 7119 0 OR UNIT DISTRIBUTION SYSTEM Header/Manifold it Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length Dia - LL_� Length Dia. �— Spacing 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 ersons resent, etc.) Inspection #1: ///43/99 Inspection #2: / Location: 1327 27th Street, Hudson, WI. (01/4, SE1 /4, Section 25 T30N -R20W) - 25.30.20.492E 1.) Alt BM Description St� 2.) Bldg sewer length = /S� o ,, - amount of cover = ( �Q � ? 19 � CAAKr. ^n 3) � 06`u P� dt U Uo+ kA �y t rte^ s 40 v s-. u.. •�LPadd� 6 � � W4 C SAW, 5 �� .�"� 9�"�� �`l 0.g k'� � Plan revision required? ❑ Yes �No q 6 Use other side for additional information. 2 Z 1 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: -'�. I ^^S^mm.. . ®a �....�- »,... -d.�w �. .:.,..ate ................ .....,.. x a 4 i I E e Safety and Buildings Division Vi scons i n SAN ITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 ' Department of Commerce In accord with Comm 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 81/2 x 11 inches in size. c o • See reverse side for instructions for completing this application State Sanitary Permft Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location r E 1 E va, 5 S T j , N, R , ,(d E (ort Property Owner's Mailing Address Lot Number Block Number Cit , State uo Zip Code Phone Number Subdivision Name or CSM Number t - O ( )s PE F BUILDING: (check one) ❑ State Owned [] C it y Nearest Road ❑ Village .— Public Dd 1 or 2 Family Dwelling - No. of bedrooms ar Town OF III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) • L zj 2_ C 1 ❑ Apartment/ Condo 6,7 O- —3 O -000 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. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System _______ System____________ _TankOnly_____ -- _______Existing Existing System ----- ____- ____ 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 0 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit t 43 ❑ Vault Privy 14 ❑ System -In -Fill pl 3 K — 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) go,jF1 Elevation To 'a . I V I.R9, 8 r Feet ,j P09 Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existing Gallons an Manufacturer s Name Concrete st oned Steel glass App. Tanks Tanks Septic Tank or Holding Tank QQ OMCWO ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I I ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plu b is Signature: (No tamps /MPRSW No.: Business Phone Number: ffj4o/A/' SC�171�7 umber's Address (Street, City, State, Zip Code). IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signa ure (No Stamps) Approved i ❑ Owner Given Initial Surcharge Fee) Adverse Determination �°?�•� !f X C NDI IONS QF REASONS R DI PPROVAL: 79 ZPj�_ SBD -6398 (R. 4/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber r — 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 praperly 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. Vl_ 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 8 1/2 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, iocaTion 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; frictionloss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; soil test data on a 1 15 - farm; 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. I -t--r , r , y I I 1 I I i -J_ T71 6: cd Q , . , - — -- - i j r I l --t I Sd : , I E I i ; 301 I f E - - i - - - i , f � i I -- - -- z, _� _ � , .�- . ( r { 1 _ � � _ � _ _. _ - ! '' ' 2 . —.. ... , ' , i � -- ! ' e 3 ' ; -1 � -_ i t } __ _. -- - +- - � - i � g i . -i- ! ' __ — t r t � F _a. i � � ; I_ � __.. }.__ __. - , r_ . -, _. �. f ' t . -. _ � .: T .�.. { _- ._... -_ .__.... .... ._._.. _ __ � ' PI } � } �- � �.. - -- -- - -} � 1 ... ... .. .... _ _... - __ - _. ! � 2 � 6 ! ; — ;_ f ,- 1 � # �. __ __ __ � � r a � - i � t - __ _ ..._ -. ,. ._- � -_ _ - -- - -- -- .. _. p . _ . � ... _ - — � __ __ - � _ f I . � � I i � 5 � � 1 �� �— - __ _ - -- — _. } - -� - _ _ _ t _ _ _ � __ ; _ - - - -- - - -- � _� + 0 _ � f � � _..-- _.- . -._._ .._ _.. (_._. � f � �. l . _ - -- - � -- -- I g I ! � } ' t � t } } � � I � � � � { - -- .._ - _ P f - — .. _� _ r _ , . - - - - -- - - - .. -, -. __ , 1 j. f � - - - _ k - -- _ .._ - -- - - -- - - -- -- - _ -_ - _ _ -_ ___ _ __ __ ___�__ t � r, _ -_ , . � � t - -- -- i -t. � ? � (( pC f _ -t � � E i � L _ . i i �__ { -f -_� -- ___ _. _ _ _ — - � i ` -� - . _ �_. gg , � � � � � -_ j .. � � f - � _ � i I I_. � � P j i ! � _ F III i � � 3 f I ..._ ` I E —+ � + � +- E -f- t _ _ .� ,_... � � - - -- -- - ° ; ! � E i � , �-- - _ . -__ . - _ -- _ -- - .___�t. ._ .____ ._.__ _ _. I _���- ---' � __r.__t ' I t � �- - - - - -- - _ , -_ rt __ _t __ __ - - - - _ _- -� — � t _ cJ . t � . a � � t'— _ 'f - -- t - - fi - _-- _.._ - ._ — - ..t.__� .. _. _ ... ``ft } i -- .. - t -- - ` - y - - --Y- t- -- r- + �. � i � � � � t -. � �- � � t � ( j } -._, __ . ...._ ..._. -.__. _..__ - �___ � i i . __. _ �- �. yr- -- -- - -._ �r t �+ -- , ._ -*___ _ _ I � � T T -._ _ __ _- � � -- , Y _ I i � _ � � �_._� i � -- -- -- -- -;—___ b - — ��. -. � I _. 4. -... _.. _. ._ -_ -. .... - .._ - _.- I ' � �� t _- 1 ,... ._.� ..- �.. --! '. � - i - ' .._. _._ _ _. _ -- � ._..� ___.. __ -..__ a - � � i E i i 1 — i } � � � t � i � r — —; — - j s � � I � y � 3 i _.� r., � _. _ ,. _ _ ., f__ _ _ _ -- .1.__. � � � _ _ � � - _ I ; � � f i C I 1 5 __... s i i �_ � ,_ T -_ .. _ t... -- • - - - �- - — - I — -+- - -- � ! a i � s � � � i i _ — .- } -. -__ _._ _ _- _..._ � 1 '. � . i T .. __. _. - -. -...__ ' -.._. .... ..- j � E Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code r Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and �V, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # e3 v 5/1 — D " 6 6 0 APPLICANT INFORMATION - Please print all information. Re iewe d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /` lr— Prope2 Owner Property Location 4 ° c� r r @ b b Govt. Lot � � 1/4 s�- ;1/4,S aS`T�a ,N,R ao Vl Er) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /3.) aa $t. GS City State Zip Code Phone Number >/ ❑ City ❑Village • Town Nearest Road '71r 4 ❑ New Construction Use: IgResidential / Number of bedrooms Addition to existing building XReplacement ❑ Public or commercial - Describe: Code derived daily flow _VS gpd � Recommended design loading rate — bed, gpd /f1 g— trench, gpd /ft Absorption area required ( 'V3 bed, ft trench, ft2 Maximum design loading rate _bed, gpd /ft gp trench, d/ft Recommended infiltration surface elevation(s) ' // y // � �� • S'Q� Z ,, , 8 1 ,O " ft (as referred to site plan benchmark) Additional design/site considerations S 7PA Trs.��es /cEGOrnw,Be✓ Parent material � t�Ias °� Flood plain elevation, if applicable 1Y0 ft S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding Tank U = unsuitable for system ®`S ❑ U [5's ❑ u (* ❑ u Lis ❑ u ❑ S 5 ❑ S [9 u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munseli Qu. Sz. Cont. Color Gr, Sz. Sh. Bed ,Trench s e 2 4 Ground 3 10 elev. Depth to limiting (�b •�`t` c(Z factor f'f&—in. Remarks: Boring # �m i- M CS 3 • r . Al " Ground elev. y3 ft. 5r- S I.5 Depth to limiting factor 9 Remarks: CST Name (Please Print) Signature Telephone No. Address / 1 Date CST Number f/6tf w r �tr , O►•'►!lf SL ©.1 f� �f a > yd �e SOIL DESCRIPTION REPORT PROPERTY PROPERTY OWNER Page PARCEL I.D.# ©30 -'D0 Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench L 9V O we 9 -1K """"_ "" / arks 6 r� �1 Ground ®' l, 0 +�.$ l� C I'�l Tv �✓ �-7r' �S h (o elev. � 3.36 ff. y Depth to 9 /� limiting f tqr �yZ Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) _ ; , 1 I � � -- _ c elo I f i , y � D b.., �,....' I I �,•�� ,��, I S� god _ <�'S`�5�,� .. ��' __ - - - - r ._.: I � : I � j. � _ _ ._ __ _ __ _. . __ _ � _ i . _ _ � _ , - . i �' � �, ��, � ,, , ,, -- - _ _ f r ,, '' _ -._ � ! _ ! _ _ �_ ! -_ � _ __ _ r .. _- I - i I I I � _ �� � � � � � i I � � � t � � I I I � - �. - -- �- ', ', j r ' � - 1 � - - - --- -� i :, i I li, � _. I � -, I F-- i. _ _ - : I I __ _ I_.. i � � _ - I i _ ._ ... i '. � I I I ! � ' I : � , i I �- I i i i I I .- -__._. i � -_I_.. i_ -_ � -_. ,_... _ ... .._ t _ _. i � .. I �_ - ,. I i : i i i I I i - - - �. �._ l i i ', i_ I. .. � _I. - I I I I 1 � __ i ! i 4 � I 4 ... -._ _ __ �__ _._' -. - - _._ _. .__ " -__ j �. I � i I I i � '. � � - I_ I �� i I .. i : ' ! I.. _ + : i f i, �- f � I , { _ �.___ _I. .___ �._ 1 _i -- _. -L_ .. _.._ �_ -_ _ -. -_. __ � i i I I I !- I -- 4 - i -- - - : I � � i i �. I � ' i { _ � ._ _ _ I � - ' j ' i - _ _ .. __ i '- r -+ r. : � ; __ � �i � � i _ _ ___. _ ; __ ` � �. i �_ � r r -- �. � - � -- _.- _.. - -- �� -- . -�- 4 ,._.�_ I h f ', I � I ' ' � i �I i � ,_. _.. I. I I i -._. _.. _. I I.. __ - _.I._ �. .. j. _. .. _. _ � -_.- � � i . _... _ r -�--- �- �. � - j � �, i � ._ _._..._ i -. .... - - - -5 - - - .. .. - - � 1 _�,. i. _._ _I i : � I � � i � �: .. _- k- .. �- ,. � '. - -- i t � . I I i , 1 i '. I �I � I �i : I I, : -.. ,, _ -_. __� - � - � -- :-- � � - � I- -.... ___ - - 1 I -- f r - i. � j.. L._.__ �. � i I ' ', i I i r I I ' - -- - - - - - -- - _, - - � L I � ,-- ;_ ___ f I ; f I- I � � ; � _ � __ , I � _ _ _ i ,. _:__ � � � , _. i I I I .. � � , I I ; I _ �_ i i I , ' - -- � L : � ., .. i _ !, � ' _ � __ -+ , 4 I _ _ _ ' - -,- -- - � _ ,- � �� �. I � _ I f I : I i .: ; __ -- - '.,. '. ', I ' ', I i I - � � - - I - __ __ _. I - � - - - -_i i� - � � I -- �.._ � __ I. � _' :. i ... ' __. 1 ..__I I. -_ i_.___. �. _- i i � - :. i '. ', I I I � i I : � :, - - ._. �. _... i L. -_.. I -- i �- -- I L i F j __.. I _ _ __.. I ' I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L C GU / S ZW e R B Mailing Address 132 'g sl Property Address f1 46014 ; .' G[/�° - (Verification required from Planning Department for new construction) City /State 141d Sow Parcel Identification Number 6,30: X90 3D — D LEGAL DESCRIPTION Property Location S SE '/4, ,5'= ' /., Sec. �, T 30 N -RfLW, Town of Subdivision Lot # Certified Survey Map # _ _ , Volume , , . Page # T 70 S� Warranty Deed # '3 Ill , Volume 4 Vg , Page # Spec house ❑ yes 0 no Lot lines identifiable ( yes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT 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 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Leyil5 a"�eaQ residence located at: -5,�F - 1/4, _ SE 1/4, Sec. , T 3 N, R " W, Town of S1�bs - Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes I Capacity: 000 Construction: Prefab Concrete – Steel Other Manufacurer (if known): Ag f Tank (if know p): a rps 7 0/!r U/k �CFf/7 �i (Signature) (Name) Please Print ff e !2j - 40 92, / 7 (Title) (License Number) / -/D (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspection opening over outlet baffle) Name 66/V -UiN c cel - 71 / Signature MP 5/88 DdCUMtNT:NO WARRANTY REEK e • STATE OF WLSCONSIN —FORM 1 �'� 8 'MO irACt nmvm dolt UCO"M DATA THIS INDENTURE, Made this .... ........... .......... . -day of ....... -.................... ................. ............. REGISTERS OFFICE A. D., 19-22-..., between .... JAA.A. IRSd. .Aa --- Xo.a.trQhry.z...axifl... . -.... .e........- .................. ST. CROIX CO.. WIS. _ -EQla obr3tS,._h> 1�b d.. send.. Wife......ao...1QlAt...te. tg,....w1d....e..Aoh.... RSC'd for Record this__14th o. Ana:.. ri ght .................. _--- .............- ...- •-- - - - - -- - - - -- -- -- - ................. -- day ot__214v ----- A.D. • ....... _........,._.._...._...: .............................. par of t fits rt and �-. �- - -Ye M. �eirie �e6�i' aria Margaret - Ann eib, �Iusband and wi. .�(��� - as �joint .. .........._ ......................... ............ - Reg to of aedf pardAJ3 ...... of the second • part, RETURN TO W f. t n e s s e t b,. That the said part 3.e.s ..... of the first part, for and in consideration of the sum of .One...Dollar-.. and --- o-ther.-. goad ..and-- saluable ... ennsideration -- •I.....• - -- -....•--- ................ y _...__.......� ................. part, .............................. ............................... ....to......them ..........in hand id b the said rt..i0B..of the second the receipt whereof is hereby confessed and acknowledged, haV @......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 partAO.E.of the second part,.tbeilfbirs and assigns forever, the following described real estate situated in the County of ............and State of Wisconsin, to - wit: That,pertion of the North 364 feet of West 605 feet and the South 296 feet,'of the West 635 feet of North 660 feet of the Southeast Quarter of Southeast Quarter of Section 25, Township 30 North, Range 20 West, lying East of Town Road through said parcel. TRANSFER $� FEE (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditament, and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said part:ies.of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said partlflfl..of the second part, and to . thair-- -heirs and assigns FOREVER. And the said...._. .. ...... eon rd_ Kostohryz -- . and.- Jill_J....- Ko.stohryz_..._ his -- wife - ._._- ----- ---- -- --- __._._.......__ -•_.. ...-----•- ----------- ---•- --------...... ...-...................----- --------- ------•- ------- - -. ...... •--_--- ------ ...... ... .......... .--- - - --------...... .. _...---...------------ .... -....---------..... ......... ......- for .... ....... .................... their _.... ................. ............... heirs, executors and administrators, do. .............. .covenant, grant, bargain, and agree to and W th the said part.;..@0..of the second part ....... MIP3, _ .............heirs and assigns, that at the time of the ensealing and delivery of ,these presents eyare 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 encumbrances whatever_ .............................................................. 1_ : ................ . ._ ............................. .....I......................... °---_...... ............................... .............. . • ............-. .....................- ....... -- --.......... ......_...._:....._.........,.. - -- - -- - ...... ----• ................. ................- •-- ------ -- --- - -................- • --• -•• ....... •.. -- -- -- ....... ....._...._.......I... - --- .............. ....... - - ---- . .....-- ....................._.. ................ and that the above bargained premises in the quiet and peaceable possession of the said partidS...of the second parttI10 -i leirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof,.....theY....will forever WARRANT AND DEFEND. An Witaese Whereof, the said part.if311..of the first part ha VB _.hereunto set.....thairhand...fl._..and seal. d ...... this..j4.th..-" day of ... ... •:- .J.U1Y ..... .......... A. D., 19..7.2...... SIGNED AND SEALED IN PRESENCE OF SFAL)' Leonard.. A ........... tohryz...... . t PSf - 7 - 11 �... (SEAL) �- ill J. Kostohry ---• ....... ............... ......... • - - -... --•---••---............ .. ............................ ........................................... I.................... ......... (SEAL) .'..,�.. .... . .. ..................... ......_ .................. . .................... ........... (SEAL) _ ............. _ .......................... ................... _ ....... ... ;a STATE bF WISCONSIN, 1 MAX ._ ..... ._.. Pero"y•came before me thhL.._.._..... .loth ...........................day of..JU Y........_..__-.................................. .. *'.- ....., A. D., 19. 72... the above�tigled.,... -- __ Isoasrd__..._.KoetohrYz and..J, �,..�T..._Koetohr3'z,...hie wife- ............. r ., __......... _ � _.._ .. ...................- ..--- - - - - -- .... .- ...................... to Ine known t9 be tha,penon e_..__.who executed the fo g' tul ackn w ged the same. z s e1A eat�x ................... I Tbis inetntmenj dmfted b _ ... _.... y i R 3 t. otary Publtc_ Croix _ - t aunty, Wis. s A� VS�.� . . Aleir 511+:,A.ftiSl.Y»$1L. y r +A . .! My Commission (Expires) (Is)... . (/ssesess N.fl (I) elf an IYlsessula / /sesWes tt_at up IM4YSNpla es N teesrded shatl•tusre Olalal= ltsated ere gowrteus t6sresa the Hems, of 00.Mt 0600 Msestess, wltasew esd ON=y WARRANTY 01111ID —STATB OF WISCONSIN. 1roRSm 3 48U. M ■. e., nuu ce., ruuau