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HomeMy WebLinkAbout020-1339-10-000 ST. CROIX COUNTY ZONING DEPARTMENT /, \.,,>" AS BUILT SANITARY REPORT V � � Owner ' Property Address - ` ST CRax City/State V > CCOUNTV ; \ 7QNINGCFF0- / Legal Description: Lot Block - Subdivision/CSM # ,!j� '/a , ' /4, Sec., , T2LN-R.Z W, Town of PIN # n - 7 e 22 . 2- r=- SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/ / Setback from: Hous Well P/LQ Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width 1,2 Length 5 Z Number of Trenches Setback from: House Well P/L ,m_i Vent to fresh air intake � �Q ELEVATIONS Description of benchmark Elevation I Description of alternate benchmark Elevation 4 Building Sewer �� .7:Z ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () 9�i/ () ( ) Bottom of System () 99 . ZZ () ( ) Final Grade O �4?, 4 O ( ) Date of installation T - 1 V 0 Pe it number . - ?.QII& 1 9/ State plan number Plumber's signature License number /.� Date / Inspector Complete plot plan � r � 1 NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horiz 1 reference points to center of septic tank manhole cover. • Show alternate benc , if applicable. ►i PLAN S9 �uF/Z a3' 5� a� INDICATE NORTH ARROW So' 3 SANITARY PERMIT APPLICATION Safety and Buildings Division 201 W. Washington Avenue Visconsin P O Box 7302 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 81/2 x 11 inches in size. 1 • See reverse side for instructions for completing this application State Sanitary Permit NN,uumtber Personal information you provide may be used for secondary purposes Check if revision to previou j application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Prope Owner Nate Property Location 1/4 1/4, S�� T , N, R E (or� Property nei's Mailing Add Lot Number Block Number City, t e Zip Code Phone Number Subdivision N4mg or CSM Number Sum M II. YP BUILDING: (check one) ❑ State Owned ❑ L ity Nearest Road ❑ Village Public 10 1 or 2 Family Dwelling - No. of bedrooms Z Town OF ✓/ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) O a O + /6 3?- /0 1 ❑ Apartment/ Condo kq- 1 2 486 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sates/ 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. X New 2 E] Replacement 3_ ❑ Replacement of 4. E] Reconnection of 5. [] Repair of an - ----- SYfstem -------- System Tank Only _ __ _ Existing System _________ExistingSyrstem B) ❑ A S anitary Permit was previously issued. Permit Number `r 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 E] Seepage Pit �� y 43 ❑ Vault Privy 14 ❑ System -In -Fill 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/da /sq. ft.) (Min./ rich) Elevation 44/z OL „-,? 71,11 Feet Feet VII. TANK Capacit gallon Total # of Prefab Site Fiber- Plastic A INFORMATION an Gallons Tanks Manufacturer's Name concrete co " steel glass App. p. New Existing strutted Tanks Tanks 1 2 1 Septic Tank or Holding Tank d fC� ❑ ❑ ❑ Cl ❑ Lift Pump Tank /Siphon Chamber El 1:1 El 11 ❑ El VIII. RESPONSIBILITY STATEMENT I, the u dersi ned, assume responsibility for instAlation of the onsite sewage system shown on the attached plans. Plumb am e. I Plumber' S' atu t p MP /MPRSW No.: Business Phone Number: Plum er's Ac1dres feet, City ate, Zip Co �^ IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fe (includes Groundwater ate I ssued Issuing entSignature (No Stamps) Surcharge Fee) Approved ❑ Owner Given initial f � S Adverse Deter mination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber tAVINUI I DI Odltaty dFIU DUIIUIIIyb �-- , Bureau of Integrated Services in accordant w�, p tkiil i 83.09, Adm. Code A in a F Attach complete site plan on paper not less than 8 1/2 x 11 inc x ize. F unty include, but not limited to: vertical and horizontal reference poi ) dire tlo p ercent slope, scale or dimensions, north arrow, and location a stance to negreSt rl 9 APPLICANT INFORMATION - Please print all information. 1 ��ic.� ev' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. V) (m)). 7 Prope ner Property Loca' n h �_ /.p, j Govt. -Lot` 1/4 - 1 /4,S T N,R E (o Property Ow is Mai Ing Address Lot # Block# Subd. Name or CSM# .- City Stat Zip Code Phone Number ❑ City ❑ lllage own Nearest Road ( > W New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow - 0 gpd Recommended design loading rate = Z bed, gpd/ft trench, gpd/f1 Absorption area required _�Lbed, ft �_ trench, ft Maximum design loading rate 7 bed, gpd /ft S trench, gpd /ft Recommended infiltration surface elevation(s) 9. Y 7Z ft (as referred to site plan benchmark) Additional design /site considerations 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 [0 S ❑ U I ® S ❑ U R S ❑ U ,® S❑ U ❑ S ,®U ❑ S 911 SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 Ground _ P elev. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (P ase in Signature Telephone No. f Address _ Date CST Number ` � — 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. 111. 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 isto 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, 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 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. SOIL DESCRIPTION REPORT PROPERTY OWNER — Page of PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GepIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................... Ground elev. ft. Depth to limiting factor in. ' 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 # i3 Ground elev. ft. Depth to limiting factor in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) I ! y Y o r• R• A l ' 1 . 1.. 5 d v I � f � ' f� 8 � _r CO 7 1 t G i s — M Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count tT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar1Nr16 Vp.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. N ELSON �er'sl�la fZ t�ta..Tl�Lillage ❑Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TP2bL;1339-10-000 `3 � •3� I 2." v i 12 e _ � pt TANK INFORMATION ELEVATION DATA A9800579 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r "i ePtic CO / op Benc a 3• 3 Dosing A (4. 97-05- Aeration Bldg. Sewer (, .a - 75, 7.? Holding dD* Inlet 9S. S 7 TANK SETBACK INFORMATION (!j)*Outlet 6.73 '75 2- TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic as �y NA Dt Bottom Dosing — NA Header / Man. T Z qS< 7 Herat' n NA Dist. Pipe 7. ��/ 7 Y Holding Bot. System 5. PUMP/ SIPHON INFORMATION Final Grade 3.a 0 19 - . /v Manufacturer ;7� Model tuber (2 TD Lift Friction S ste TDH Ft oss Forcem Le Dia. I Dist. To well SOIL ABSORPTION SYSTEM TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid epth DIMENSIONS L DIMENSION M n facturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE : ING INFORMATION Type O /w . / L MBR um er: Syste ��5 C(/� / �C> �� OR UNI DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) H x Hole Size x Hole Spacing Vent To Air Intake Length (,' Dia. Length �� Dia. U Spacing (o ��T�+/l _ -L 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 33.29.19,SW,SE 602 SUMMERFIELD CIRCLE - LOT 5 (7A14.6m - Top 4 dobv5;l1(W1A /koV� 'jam (4 PVJ 'j64-1 -fA w111 NYC lOSD ' ktu: k{a. 1 '► /p Q i0c�s G). c oJGt 3 �ewi t) [frfiA - �p k — "4 d (o o f r5 — w u7 /�'e rt w4 5 ' y9 a., ��`�!' 5� Plan revision requ9red? / s ❑ No Use other side for additional information. 7 l SBD -6710 (R.3197) Date Inspector's Signklure ert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT UMBER: G� �(a 14 L Safety and Buildings Division sconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with tLHR 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 1/2 x 11 inches in size. !�� , �e , • See reverse side for instructions for completing this application State Sanitary Permit Number 32�6�1 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLI ATION INFORMATI N - PLEASE PRINT ALL INFORMATION Prop Owner Nam Property Location ., 1/4 X114, S T , N, R E (or)s Prop rty O ner's Mailing A res Lot Number Block Number City, St a Zip Coe Phone Number Subdivision Name or CSM Numb r ( ) s II. TYPE OF BUILDING: (check one) E] State Owned E] Cit Nearest Road El Public 1 or 2 Family Dwelling - No. of bedrooms '_ ° Town of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Q� 1 ❑ Apartment/ Condo 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. a 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 [3 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: 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. nch) ,tom Elevation ? `Feet Feet VII TANK Cap aclt in gall g Total # Of Prefab. Site Fiber- Exper, INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic app New Exist in strutted Tank Tanks Tan Septic Tank or Holding Tank gym'' " ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, t eAindersigned, assume responsibility for instaWation of the onsite sewage system shown on the attached plans. Plum Nam nt Plumber's i 9 mps) MP /MPRSW No.: Business Phone Number: Plumber's Address (,Street, CAy, State, Zip ode): L _ S ce, ' M)t IX. COUNTY / DEPARTME T USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Sign4ture (No Stamps) Approved E] Owner Given Initial �} Surcharge Fee) Adverse Determination U ` i -` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 9g" �S /Ooo d sit 5 3 X G � y �5- ,TD vvisconsii,.Jepartment of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page 1 of 3 Division of Safety and Buildings i �c, rdanc O s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less th 2 x 1 in4a size. Ian ust County include, but not limited to: vertical and horiz eferen�I), dire i' nd St. Cr oix percent slope, scale or dimensions, north ar o nd location and distance to st road. Parcel I.D. # I ► ► 1997 N ��q - - d APPLICANT INFORMATION - Pie rint al tion. Reviewed by Date Personal information you provide may be used for s purpos I's (1) (m)). Property Owner Property Location + Govt. Lot SW 1 /4Se 1/4,S 33 T 29 ,N,R1 9 E (or)IIQi' Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 1353 Awatukee Trail 5 LS 1/0/ •2 4 3 -2300 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson I Wi 154016 (715 )549-67311 Hudson ❑ New Construction Use: W Residential / Number of bedrooms - 3 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: 450 Code derived daily flow 6 ._ gpd Recommended design loading rate _ bed, gpd /11 gpd /ft Absorption area required 258 _ bed, ft2 T5 0 trench, ft 2 Maximum design loading rate _ bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) B 1 H2 g3 9 4 - R 5 ft (as referred to site plan benchmark) Additional design /site considerations & 1 4I ate 93.05 Parent material G 1 ar. i a l Banns i t 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 g 5 ❑ U [R S❑ U U S El ❑ S ®U ❑ S K] U SOIL DESCRIPT R EPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 -12 10 r3/2 none sil 2mabk mfr C Im 2 12-32 10 r4/4 none sil 2mbk mfr Cs Ground 3 2 -9 7.5 r5/6 none ms osq ml -- -- elev. 9 a . aD t. Depth to limiting SG factor 9 6 in. Remarks: Boring # 1 -12 10 r3/2 none 2 2 12-32 10yr4/4 none sil 2mbk mfr Cs if .5 3 32-92 7.5yr5/6 none ms osq ml -- -- Ground elev. Depth to 1 0 limiting factor 9 in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number i PROP94Y OWNER g - Shout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 -14 10 r3/2 none sil 2mabk mfr Cs 1m .5.6 2 114-39 10yr4/4 none sil 2mbk mfr Cs if .5'.6 Ground 3 h 9-9B 7.5yr5/6 none ms osg ml -- -- .7..8 elev. 9 8-3-5t- Depth to limiting �� factor 9 in. oio .v Remarks: Boring # 1 -16 10 r3/2 none sil 2mabk mfr Cs 1m .5 ..6 4 2 6 -4 10 r4 4 none sil 2mbk mfr 3 8 -1 0 7.5yr5/6 none ms osg ml -- -- .7 '.8 Ground elev. 9 7 _ 7 5 ft. Depth to limiting factor 1 in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring# 1 -16 10yr3/2 none sil 2mabk mfr Cs 1m .5 '.6 5 2 6 -5 10yr4/4 none sil 2mbk fflir Cs If .5 .. 6 3 4 -1 0 7.5yr5/6 none ms osg ml __ __ ,7 •,8 Ground elev. 9 7 . eft. Depth to limiting factor I 1 —in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) 7/� Q V (n � 0 L 1 -'-v e. , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer Mailing Address ��o� R' /�O �� ,�(/ L 1?O 73�J?7 37 Lr/yZ S Y D a -3 R !� Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number Oa0 - /D 9 SO - Ooo LEGAL DESCRIPTION Property Location ' /., ,�! ' /a, Sec. -=, T 2 9 N- R49 W, Town of u Subdivision S© tjq vti _.P R e l r,, Lot # S Certified Survey Map # ,Y��f , Volume - , Page # a Warranty Deed # , Volume , Page # Spec house g yes ❑ no Lot lines identifiable 429 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. 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 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. SIGA 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 vittue of a warranty deed recorded in Register of Deeds Office. / /T '?e SIGN. 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 pp p D eeds office h' g a copy of the certified survey map if reference is made in the warranty deed VOL 1379PRE0.44 STATE BAR OF WISCONSIN FORM 2 — 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIVED FOR RECORD . . . ........ . ...... ....... ... ...... . . . . ........ ... ......... ...... . . ... . . ............ . ...... . . ........... RICHARD O. STOUT 5 11-19-1998 10:00 An WARRANTY DEED conveys and warrants to GARY NFT-90N and JIT.T.U.NNE T RECORDING FEE: 10.00 PAGES: I NF.T,.';0N, hiic;hanc3 and wift- - ,nryiyc)rqhjp m arital property, THIS SPACE RESERVED FOR RECORDING DATA . ........... NAME AND RETURN ADDRESS the following described real estate in - S t . r r o i x County, tF- State of Wisconsin: Iq L/ C Lot 5, Plat of Summerfield, Town of Hudson, St. Croix County, Wisconsin. ... .. .. .............. n2n-101q-q0 -0n0 PARCEL IDENTIFICATION NUMBER TRAN O �FER FE This i s not homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights-of-way and covenants of record, if any. Dated this 1 9th day of November A.D., 19 98 _. Richard 0. Stout (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County authenticated this day of 19 Personally came before me this 1 9th day of November 19 2 the above named Rirharcl 0- Rtniit- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stars.) C to me kn to be the persqr(2— who executed the foregoing e Kn it to to 0� instrume and a cknowled g e e same. Sa te THIS INSTRUMENT WAS DRAFTED BY it Janet P. Stout --7 1353 Awattakee Tr. Hudson, Wi. 54016 N4� Public, L " 4 1' County, Wis. (Signatures may be authenticated or acknowledged.. Both are not M commission is permanent. (if n iration date. necessary.) r . . ........ . - ............ ............... . . . . . . .. ............ Names f persons signing in any capacity should by typed or printed below their Signatures. WARRANTY DEED BAR AR OF WISCONSIN Wisconsin Legal Blank Co., 11 Form No.2 —1982 Milwaukee, aL nci 10 4.7 io O to. JL R28 S 08'36'51" W 20.62' ).98' R29 S 82'30'12" W 14.44' 3.62' R30 S 13'41'37" W 72.23' 9.05' R31 S 09'19'16" E 34.19' ` 2.86' R32 S 74'31'22" E 50.17' I ).59' R33 N 23'17'57" E 43.72' I 5.52' R34 N 15'23 E 56.00' R35 N 44'10'53" E 15.38' I LOT C.S.M. VOL. 2, PG. 448 28" W 1280.89' (S89 "W 1280.91 FENC 320.68' Ri X320.68' LOT A CRES w H.W.L. = 908.0 107,868 SQ. FT �•R4 0) F4 N R1 J o Z LOT 6 'pH•WL• = 923.0 w 2.511 ACRES - 1 109,382 SQ. FT co og 0 z 00 LOT 4 °' (Do 41 to 36st3. 5���9 to o 7 .. /' Np 0 N ° o • NTH • ' X70 O o° d. to to • ,� �� 07 •r'� O v "t �O,p C2 \ O I) Z 04 RAD 80' I N -a LOT 5 a �� n R O 2.047 ACRES . 14 �, ° U 89,164 SQ. FT ~ LOT 8 N / \ 2.098 ACRES cV _ w w 91,366 SQ. FT BENCHMARK { 1;: 1.80 + \- NET BUILDABLE ACRES USGS DATUM 1929 • • • • • • . . . . ° w . . ^� d•. . . . . . . . . . . . . . . . . . . . ELEV. a 924.28 • o • . llR`2 Ni. o� 33' 3' Ip o f U° — U ' ) of THE SE1 /4 —• - -•— —•— • -- • - -• -- — •r- • - -• - -• VARIABLE R/W N 89'5 19" E 646.49' — — — — VARIABLE R/W to — HHIGH RIDGE DRIVE — LOT 2 LOT 9 I