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SURVEYOR'S CERTIFICATE
I, Francis H. Ogden, Registered Land Surveyor, hereby certify that I
have surveyed, divided and mapped this Certified Survey reap located in
the SWl /4 of the SW1 and the SE1 /4 of the SW1 14 of Section 13, and
also the NE1 of the NW1 /4 and the NW1 /4 of the NW1 /4 of Section 24,
all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin,
described as follows: Commencing at the Southwest corner of said
Section 13; thence N1 ° 11'56 "E (Assumed bearing referenced to the West
line of said SW1 /4 of Section 13 which bears N1 0 11 1 56 "E) 359.49' along
the West line of said S 14 of Section 13; thence N74 ° 05 1 42 "E
1120.18'; thence S15 0 54 1 18 "E 45.00' along the Easterly right -of -way
line of Chippewa Path to the point of beginning; thence N74 ° 05 1 42 "E
1245.00'; thence S20 *15'14 "E 702.02 thence S74 0 05 1 42 11 11 1298.23
thence N15 0 54'18 "W 700.00' along said Easterly right -of -way line of
Chippewa Path to the point of beginning.
This parcel contains 20.435 Acres, more or less, being 890,132 Square
Feet, more or less.
Subject to easements of record.
I certify that I have made such survey, land division and Certified
Survey Map by the direction of the owner of said land, that such map
is a correct representation of all the exterior boundaries of the land
surveyed and the subdivision thereof made, that I have fully complied
with the provisions of Chapter 236 of the Wisconsin Statutes and the
Subdivision Regulations of Hudson Township and St. Croix County in
surveying, dividing and mapping the same.
Date: September 24, 1991 - � < • i�
Francis H. Ogden S -882 Job No. 91 -1918
Ogden Engineering Co.
��'�sC��'►sii 113 W. Walnut Street
,a� River Falls, Wisconsin 54022
FRANCIS H. OWNER AND SUBDIVIDER
OGDEN Charles Berres
5.882 - P48 Yellowstone Trail
RIVER FALLS, = Hudson, Wisconsin 54016
<.9 Ms. Qti 386 -5059
Sl1
L.EG END
ST. CROIX COUNTY SECTION CORNER MONUMENT, FOUND
• 1" IRON PIPE, FOUND
0 1" X 24" IRON PIPE WEIGHING 1.68# /LINEAL FOOT, SET
BUILDING SETBACK LINE
NOTICE: Parcel shown on this map is subject to State and County laws, rules and
regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before
purchasing or developing any parcel contact the St. Croix County Zoning Office
for advice.
I
VOLUME 9 PAGE 2512
1;
� 1
I
STC - 104
AS BUILT SANITARY SYSTEM RE
OWNER
ADDRESS 7�
SUBDIVISION / CSMJ T
SECTION T N -R W, Town of __� a ds-, d
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW;
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
� N
i
I
I y
M
m�
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
F
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: j�j,` Cg �'Cv �/ Liquid Capacity:1 & fpd
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons /cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length -�6r Number of trenches .3
Distance & Direction to nearest prop. line: wVt So
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header /Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: 9_�
PLUMBER ON JOB:
LICENSE NUMBER: - - -1��
INSPECTOR:
3/93:jt
I
Safety and Buildings Division
NVi scbmin SANITARY PERMIT APPLICATION 2 01 E. Washington Ave.
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. 5 7' i Ile
• See reverse side for instructions for completing this application State sanitary Permit Number
The information you provide may be used by other government agency programs AC eck it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL IN RMATION
Property Owner Name Property Location `�
T�aC IC .'
r: e.?— $r a/4�'114,S 1 T Q�t ,N,R f�' E(orX
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
I�u dSv.tJ W rd ( , r "j ��.— f3 G 6lra 23 /,Z
I1. TYPE OF — BITI LDIN (check one) ❑ State Owned it� Barest Road Of
Public 1 or 2 Family Dwelling - No. of bedrooms o Town of a c'%
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo Q 2 l o! e d
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. E&New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
System System Tank Only_ Exl sting System ________ 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 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION: ?'! $'4. P
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) TC U. 8"T Elev t'on
� 2 fG• 00 Feet -rig Feet
VII. TANK in aalo s Total # of Prefab. Site ! Fiber- Exper
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank vQ f ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ I ❑ , ❑ I ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite eVage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (N tamps) /MPRSW No.: Business Phone Number:
4 r r
/ 1 %t )rn - 5,1C Plumber's A( dress (Street, City, State, Zip C de):
G
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
E] Approved ❑ Owner Given Initial Surcharge Fee)'
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
V isobnsin I n accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce - Madison, WI 53707 -7969
• . Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. ,- �, (f sro i e
• See reverse side for instructions for completing this application State sanitary Permit Number
The information you provide may be used by other government agency programs ZICb_eck it 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
T U C 'e c �'`" �r /a �va,S T y ,N,R/ E(or
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
/i dv cart) r. R/u ( f 7 ) 3g —E f?- G 51;1 /1tr' .1 / Z
11. TYPE OF BUILDING: (check one) ❑ State Owned !ty Barest Road
Pubic 1 or 2 Family Dwelling - No. of bedrooms � — 0 Tow OF t < J a 'a 1
III. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s)
1❑ Apartment/ Condo C -' ;2 G' '' l J d
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. g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
- _____System ________System ___ __________ Tank Only______________ Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑Seepage Bed 21 ❑ Mound 30 C] Specify Type 41 ❑ Holding Tank
120 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 []Seepage Pit 43 ❑ Vault Privy
14 ❑ System- In -FiII
VI. ABSORPTION SYSTEM INFORMATION: T1 4. F
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) f r xt • F S - Elevation r
/�.4 Feet I Feet
VII. TANK Capacity ! ;
in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existing strutted
Tanks I Tanks
Septic Tank or Holding Tank � X j .� Cw `�Q / - �` 1:1 1:1 El 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑
1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sevyage system shown on the attached plans_
P / tuber's Name: (Print) Plumber's Signature: (N tamps) /MPRSW N O.: Business Phone Number:
Plumber's Ac dress (Street, City, State, Zip Code):
IX COUN / DEPA RTMENT USE O NLY
❑ Disapproved . Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
-
[j Approved E] Owner Given Initial Surcharge Pee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety -& Buildings Division, Owner, Plumber - -
n
2
4 4'
y
O j
A ^ 731 n
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ACS' Q
i
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page I of :_
Divisioh of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and
p ercent slope, scale or dimensions, north arrow, and location and distance to nearest road. !
P P Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
�'' " ter- Govt. Lot 5 1/4c��&) 1/4,S 3 Tdr ,N,R �Q E (or)�V
Property Owner's Mailing Address / Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
AK& ar w " 15 I (7rs > �lG, r TA
ion New Construction Use: � Residential /Number of bedrooms � Addrt o to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow _1!5 gpd Recommended design loading rate _ : 7_bed, gpd /fF,-_,? trench, gpd /ft
Absorption area required t__bed, ft __trench, ft Maximum design loading rate b gpd /ft2._•___,f� trench, gpd /ft
Recommended infiltration surface elevation(s) � 1 _& ',_ -_;Q rG•GCi �( l.T /t (as referred to site plan benchmark)
Additional design /site considerations
Parent material � _r��1 —_ li.� ct 5 __ ____- Flood plain elevation, if applicable-- ft
S = Suitable for system Conventional r MMound In- Ground Pressure AT -Grade System in Fill Holding Tank
U Unsuitable for system [� S❑ U I A A ❑ U LZ S ❑ U HS ❑ U ❑ S L4 U ❑ S R) U
SOIL DESCRIPTION REPOR
Texture
Borin g # Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD /ft2
/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. /S�h. y, Bed Trench
�-
Ground 3 elev. -- - - -- A ✓- -- - --- - - --
Depth to — - -� -- -- - -- - - -- - — -- - - -- -
limiting
factor - - -- - - -- - - -- - -- - -- - - - - -- - __ --- - - - - -- - -_ --- - - - - -- - - - - - -- /20 in.
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
in. Remarks: -- - --
CST Name (Please Print) Signature Telephone No.
t
Address Rite CST Number
Ift ' t C
e
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Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 299036
Permit Holder's Name: ❑ Uty ❑ Village Town of: State Plan ID No.:
BENEDICT, STEVEN j� �� SO
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
020 - 1018 -20 -000
TANK INFORMATION ELEVATION DATA A9700353
-- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ; , C. },; . y : Benchmark p J<D
Dosing C
r?�
Aeration Bldg. Sewer
Holding St/ Ht Inlet /
TANK SETBACK INFORMATION St/ Ht Outlet / 6
TANKTO P/L WELL BLDG. Air to
i ntake ROAD Dt Inlet
ir
Septic NA Dt Bottom
Dosing NA Header / Man. qs
Aeration NA Dist. Pipe
3-3
Holding Bot. System 3ys s� -vat,
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Fric System TDH Ft
Forcemain L gth Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length, , No. f Tches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS U ren DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type Of lx"4-) gs , Moe Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air intake
Length Dia. 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 [I Yes ❑ No C] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.) o 6
LOCATION: HUDSON 13.29.19.86,SE,SW 921 CHIPPEWA PATH LOT 5
.,
< r
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R 05/91) Date Inspector's Signature Cert. No.
^: Safety and Buildings Division
v ■'rir,. SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. -fir et-', X
• See reverse side for instructions for completing this application State sanitary Permit Number
agga3
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
& 1e__t1 114�� 114, T �/ r N, R/¢ E (or)&T
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
u c( Se tJ
1 -5 - YBIG I ( 7/5 C 5' /22' ' 4
II. TYPE OF BUILDING: (check one) ❑ State Owned o it age Nearest Road
Public 1 or 2 Family Dwelling ❑ Vll - No. of bedrooms Town OF A r "s' .� C h G�!✓�L .�TJ
In. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 F1 Apartment/ Condo � I�f 2
d
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 0 New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Existing System - ---- _---- 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 Q Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
�,/, GO 75`j 7 Feet 9l' l Feet
capacit
VII. I NFORMATION in ga llons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic Exper.
New Existin Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank ` z (!►' ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No S No.. Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
7 1 G c �% ,I % : ,` G '
IX. COUNTY / DEPARTMENT USE ONLY
(Induces Groundwater ate Issue issuing Si e N am )
Disapproved San r Per tF�
Surcharge fee)
g en g
)R
Approved ❑Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS F DIS P�P_RO AL:
SHD -6398 (R. OS/94) DISTRIBUTION: original to County. One copy To: Sarety & RuilJings Di —ion, Owner, Plumber
i aeeek ._e o,4 e-
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I
INDUS T TR Y, OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
INDUSY, DIVISION
LABOR AND PERCOLATION TESTS ( MADISON W 7
HUMAN RELATIONS
(H63.0911) &Chapter 145.045) i
LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME:
' '/4 J2 N E (or s
S UN OWNE (LING ADDRESS:
< O
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERC AL DESCRIPTION: PROFI L DESCR TIONS: PE ATION TESTS:
�esidence New ❑Replace
3 ! /Z A
RATING: S= Site suitable for system U= Site unsuitable for system
CONVEN I a U : MOUND: ❑� IN- GR - URE: SYSTEM- IN -FIL OLDING TANK: RECOMMENDED SYS EM:(opt" nal)
EiS �LJS S U S ❑ S +LJ�
If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Fl elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBS E RVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
13- B - � o S Z >/o s IV Alr ' msw r "- "`S
B- 3 z > a
B- Y . r ?gy 'T5 /'13r, /✓ ' A
jB-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER! PER INCH
P-
P_
P_ r--
P -.
P- C
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 ELEVA f N yes.
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I, the undersigned, hereby certify that the soil tests reported on this form were made by rn in actor rote ures me o s specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print). TESTS WERE COMPLETED ON:
Licensed Perk Tester & Plumber
#3233 #3289
ADDRESS: CERTIFIC TI NUMBER: PHONE NUMBER (optional):
ROBE S, WISCONSIN 54023
Phone 749-qfisfi CST SIGNATURE:
ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
i R -SBD-6395 (R. 02/82) — OVER — -
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS 5 8 0 t04$ A'K-
PROPERTY ADDRESS fal Cy /,-9°,E7A.;X X;�-,-A/
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE _ VAS -� sy/&
PROPERTY LOCATION 1 14, 1/4, Section I Z T � �f N -R
_ _1Y
TOWN OF kodsco ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP , VOLUME c? .,PAGE �� i,Z LOT NUMBER u
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 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 60% 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater 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.
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 DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expir t'
SIGNED:
DATE: l 7 G
St. Croix County Zoning Office
Government Center — Slv 7VC s I`/�
1101 Carmichael Road �G(J /� p�- � 7 11/93
Hudson, WI 54016 `
OA'- ZT,�� S w
r �C/W
IVC VV a` TWC NA) �� o � ��
` 8 T C - 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.
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Owner of property jTry— �N �. 39'k39 /��14 A
LOCATED IN THE SW1 14 OF THE SW1 14 AND THE SE1 14 OF THE S141 14 Or SECTION 13, AND
ALSO. T11E NE1/4 OF T11E NW1 /4 AND TILL' NW1 /4 OF T11E NW1 /4 OF SUCTION 24, ALL IN
T29N, R19W, TOWN OF RUDSON, ST. CROIX COUNTY, WISCONSIN
Address of site S.'P
Subdivision name Lot no. S
other homes on property? // Yes `t, No
Previous owner of property cIlA
Total size of property 20 iOrAtS'
Total size of parcel ZO ACA5
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house)? Yes X No
Volume .f_ and Page Number .2-4 as recorded with the Register
of Deeds.
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INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
c � _
ignatu a of Applicant Co- Applicant
Date of Signature Date of Si. na ure
STATE BAR OF WISCO%Sit FORM 1- 1982
t.rr ,
WARRANTY DEED
DOCUMENT NO.
} This Deed made between Charles T. Berres and
_ fora Mae Berres, husband and wife REGISTER'S OFFICE
ST. R CROIX�CO.. WI
oo'd for Grantor,
and Stev J Ap and Dana h Benedict, AUG 19 1997
hushand and wifp as survivorship marital 10:20 AM
Grantee,
Regl of Deods
Witnesseth, That the said Grantor, for a valuable oxwAtmao
Conv to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RE DATA _ �?
County State of Wisconsin: NAPE AND RETURN ADORES - --- —` -- - .e
Lot 5 of Certified Survey Map filed July 580 lw l�v�
28, 1992, in Vol. 9, Page 2512, being 20.435
acres, more or less, subject to, and together
with, easements, restrictions, reservations
and rights of way of record. L
o - 4
0 .) 0- & - 4 7-96 o � odo i �
� man rig' • cx� o � le
K (This deed is given in satisfaction of that PAC El1�ENTIFICATIpNNUMBEH
r certain Land Contract between Grantors and
Daniel R. Hildebrandt and Nancy C. Hildebrandt dated September 29, 1992
and recorded October 1, 1992, in Vol. 972, Paqe 97, as Doc. No. 489282,
the Vendees' interest in which was subsequently assigned to above
f Grantees on July 15, 1994, in Vol. 1087, rage 339, as Doc. No. 519161.)
* e
This 1 53 not homestead property.
(is) (is nu)
Together with all and singular the hereditaments and appurtenances thereunto 13elonging.
And sharI PS T. B r es and Dora Mae Be-res
warrants that the title is good, indefeasible in fee simple and free aM �-krz: of encumbrances except
I
and will warrant and defend the same.
' Dated this 15th day of August 19 97
(SEAL) cL� per• (SEAL)
a 1 T. B
•
Charles erres _
(SEAL) ^ Y (SEAL)
ora M e Berries
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Charles T. Ber and State of Wisconsin,
Dora Mae Berries
_County.
authent' tedt s 15t da of August 97
Y 9 , 19 Personally came before me this day of
_ 19 , the above named
• Alex S. Kosa
11 - 1 LE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by 4706.06, Wu. Stets)
to me known to be the person who executed the foregoing
instrument and acknowledge the same
w THIS INSTRUMENT WAS DRAFTED Y
8
�r
Alex S. Kosa, Attorney —�
Hudson, WI 54016 Noitary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are n-x My commission is permanent. (if not, state expiration date:
necessary.)
• Names of persons signing in any capxay should by Itprd or printed below
STATE e,ct �4 MT- Sko�SiN Wiscomn Legal sank Co.. Irk;
W'ARRANIY DFEU Fors `o. 1 - IW2 Mih4e,J,ee. We.
Y
�4.
CERTIFIED SURVEY PAP
LOCATED IN THE SW1 14 OF TIIE SW1 /4 AND TIIE SE1 /4 OF TIIE SW1 1 4 Or SECTION 13, AND
ALSO, THE NE114 OF TIIE NW1 /4 AND THE NW1 /4 OF TILE NIJI /4 OF SUCTION 24, ALL IN
` T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN
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