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HomeMy WebLinkAbout020-1324-10-000 l! STC - 10 4 Mill 1.998 w AS BUILT SANITARY SYSTEM REPORT ST CROV COUNTY ZONING OFFICE OWNER*- 04- ADDRESS 49~ 4 eo/, SUBDIVISION:-/ _.CSMI LOT ~ SECTION T 47 1~ N_R 'Town of ST. CROIX COUNTY, WISCONSIN ,Y PLAN VIEW ..__SHOW EVERYTHING WITHIN 100 FEET _OF .SYSTEM F ~ y -mac Al 01 ` 130 INDICATE NORTH ARL Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 6 13ENCHMARK~ ALTERNATE BM •rb SEPTIC TANK POMP CHAMBER pLDINGANK;-S,pgTION ..w Manufacturer Liquid Capaciq- (Z ta. ,2.Y..: Setback- from, Well: House .A V- OtheiZ. Pump_ -Manufac turbo Model - Size Float seperation Gallons-/cycle:.- Alarm Location SOIL ABSORPTION SYSTEM Width: S Length Sc7 Number of trenches Distance & Direction to nearest prop, line: I ZLC3 to Setback from: well: 5 ;Z House 3 O Other ELEVATIONS Building Sewer ST Inlet: 3,y57' ST Outlet: L ,1 11 0 PC inlet PC bottom Pump Off Header/Manifold I:C, YS' Bottom Of system t Existing Grade f 1, 1 Final grade DATE OF INSTALLATION: ' SI PLUMBER ON JOB: { , la 7 LICENSE NUMBER- INSPECTOR : -711::-7 3/93:jt isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice maybe used for secondary purposes [Privacy La s.15.04 (1)(m)]. 299199 P1gVt&,'s ❑_CYD90iNllage Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: HHU Parcel Tax No.: 100 lug Ib o~«o~ s1A$VLj0r•5 Mllk<,, 020-1324-10-000 TANK INFORMATION ELEVATION DATA A9700516 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar -Itig I l la Lf lob Dosing PA 2qZ 101.'7 Z Aeration B dg. Sewer 12,4 'r-r. /7 Holding t Inlet (x .05 q 7.5 TANK SETBACK INFORMATION C.>^ Wt Outlet 55- <35-0 94 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septi l 5~U( ~v~ 2a 2 NA Dt Bottom Dosing NA Header/ Man. I5.0°/%,S7 Aeration NA Dist. Pipe -L-7 el .3 7 Holding Bot. System 1(0 X <'15. 3 PUMP/ SIPHON INFORMATION Final Grade 11-7 q q, 7f Manufacturer Depand'-~. ~Jlav>~I~[cCo ' q.&~ q! . Model Numbe GPM TDH Lift Loss S ste TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BENCH Width Length S No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth e DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of p ~D OR UNIT Model Number: System 011 JBv~ DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Length U Dia. `1 Spacing l0 A 5-1 KA V4 2--7 7-1 55~ L4 I J'~_ 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ,1 K }.~~f , Depth Over Bed /Trench Center l ` V Bed /Trench Edges Topsoil El Yes El No ❑ Yes F] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12.29.19,SW,rNW 829 MOON BEAM WEST-TANNEY RIDGE LOT 44 Plan revs Ion r qul ed? E] Yes No S t~ lot~ ~r Use other side for additional information. ~614~Atoi!I,- I SBD-6710 (R.3/97) Date Insp is Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Wisconsin P O Box 7302 In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7302 Department of Commerce • 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. - Cm I Y, • See reverse side for instructions for completing this application State Sanitary Permit Number al 4? i9q .16 Personal information you provide may be used for se dary purposes y~ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 2iacl /moon 0ea ' e W State Plan I.D. Number 1. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location In/ t L.G .14' S w1/4 1/4,S /Z. TZ el N, 0 E(O Property Owner's Mailing Address Lot Number Block Number Ago /s/ City, State Zip Code Phone Number Subdivision Name or CSM Number u~ ®hl ctl) 06 ( ) lye 4~-- t 40 II. P F B IL IN : (check one) ❑ State Owned 0 't~ Nearest Road p Vil age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF & 4N ti?I~ III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1a -9 l ` 19. Q78 tY s 1 ❑ Apartment/ Condo /,5. T V- /0 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 Tank System ________System ______ly______________ Existing System Existina ----S-stem 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 17❑ Seepage Trench 22 ❑ In-Ground Pressure ~y ` 42 ❑ Pit Privy 13 ❑ Seepage Pit P b )(So 43 ❑ Vault Privy 14 ❑ System-In-Fil VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syste v. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch), Elevation O © gS Z- Feet 9 Qi I Feet ©C7 S.S VII. TANK Capad In ns Total' # of Prefab. Site Fiber- plastic Exper. INFORMATION gall Gallons Tanks manufacturer's Name Concrete con- steel glass App- New Existin strutted Tanks- Tanks [t r° El El e ticTa`n j2~Q 11~ El ❑ El Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No amps) MP/P//MPRS/W No.: Business Phone Number: ~j IE' O r7 Iw. ~/t S -b jSo a ~`fr w 1fO 7 Plumber's Address (Street, City, State, Zip Code): , o 4UV Xt1.- J?- kook-b !4v o IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee tlncludesGroundwater ate ss Is u ent Si ature (No Stamps) q Approved ❑Owner Given Initial Surcharge Fee) - - I~ 68 5 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 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 iissuing 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- k. 6. If you have questions concerning your onsite sewage system, contact yourlocal 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: 1. 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 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 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. SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater Systems gWater 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 8 112 x 11 inches in size. S/ • (;Vd/~ • See reverse side for instructions for completing this application State Sanitary Permit Number 2q'1g4. The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na Property Location E(o W SAM - 5014 T z~ N,R Ifo Property OwoerIs Mailing Address Lot Number Block Number 0 2- 1? IV I City, State Zip Code Phone Number Subdivision Name or CSM Number { 4r /r. (3 >i i / II. TYPE F BUILDING: (check one) ❑ State Owned o City Nearest Road ❑ Public or 2 Family Dwelling- No. of bedrooms Vll own of 11410SIOW III. BUILD[ USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~t 1n Apartment/ Condo Z II i 3 Z T -/a 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. b[ New , 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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 12KSeepage 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 Apo Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 94` EN ~tion lairs-- ~o p Feet f ny• a Feet VII. TANK Ca in gaanllotns Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks eptic Tan ,44 i nag iatah. 2_s0 I ( ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 3reo I, the undersigned, assume responsibility for installation of the onsite sagsystem shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.:AM~- T~Ifiz Phone Number: 2 Z Sb p3 -RC2 Z._,. 46- 1 ID Plumber's Address (Street, City, State, Zip Code): /Q701 144,07FAf- A_'_ /AO S of TIC IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) A roved ~r Surcharge fee) ® pp ❑ Owner Given Initial 0U YM100 11,. •~J'f .0 f Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) 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, 608-266-3815. 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 13 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 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 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. N 0 .9 1 T 14 ✓j IS 3 I r a ,N, 4-0 "'r x4j ' Y 0 0 (4N Jam- U1 r f a 1^ ~ O ~Y LIJ p I "t 4A z I I (1. _ ! w I `y EL U LIJ w N 1 i i R. IVY o I 1 I W Wisconsin Department of Industry, 1~0I L AND SITE EVALUATION -REPORT Page 1 of 3 Cabor and'fAuman Relations Division of safety 8 buildings - in accord with ILHR 83.05, Wis. Adm.°06de - COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P IRCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ASVEaE BY DATE lr lZ1/6 PROPERTY OWNER: PROPERTY LOCATION Sam Miller GOVT. LOT'jW 1/14 t4W 1/4,S 12 T Z 9 N,R 19 E (w) W PROPERTY OWNER':S MAILING ADDRESS 0 # BLOCK# SUED. NAME OR CSM # Trout Brook Rd. Znd Addn to Tanne Rid e CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®fOWN NEAREST ROAD Hudson Wi. 54016 ( ) Hudson Tanne Lane JpQ New Construction Use jX] Residential / Number of bedrooms ] J Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow Goo gpd Recommended design loading rate 0,7 bed, gpd/ft2 0 trench, gpd/ft2 Absorption area required 85'7 bed, ft2 75y trench, ft2 Maximum design loading rate 0.7 bed, gpd/ft2Q % trench, gpd/ft2 Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark) Additional design/ site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable ft S = Suitable for system C NVENTIONAL eND I ROUND PRESSURE AT GRADE SY TEfd IN FILL HOLDING K U = Unsuitable fors stem S ❑ U ~J S ❑ U "S El U &5S ❑ U INS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.u~ Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxit AIS~K -V 0.10 :S~ ll-1-7 JbVe4 SLK M- C" ~Z o3 Ground J-7-0 ILay a A, r 0 7 elev. 1b3.4o ft. Depth to limiting factor y lD.~ Remarks: Boring # Q 4,7 ib ~3 L I it, sbK Air Ct-v SIC 41 . 41 r ew Ground elev. /61.6) ft Depth to limiting factor .7 lD,~7 Remarks: CST Name:-Plea a'rve G. Johnson Phone: 386-4080 Address: p . O . ox 91 Signa Date: Oct. 96 CST Number: 3484 PROPERTY OWNER SOIL DESCRIPTION REPORT r Page 7- of PARCELI.D.# Z6r 44 . Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxary Roots GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed tench -7 /b 3 - L / A SbK r~f $ 1/4 j,e ¢ - S, C 1 r►, s K ter Cwt - p ;Z 3 Ground J 14-130 1 ,2 4" S V M _ 6:7 1c) g elev. 2.6I ft. Depth to limiting factor ~ 10.83 Remarks: Boring # A o-I 4 /oypn z - L C.w 14 33 >o Q4 L 63 1-1 1 4~ :n.:... $ 33-IzC I ,2 412 S 0? Ground elev. C/9. C b ft. Depth to limiting factor 1p,sd Remarks: Boring # A Q-I Cw 2Sr 04 'LIZ 5 1 b n►-~~- ew p.Z s 8 /4-46 msykA &MM _ d-f3 16Y r rh Ground . elev. /d3 .osn. Depth to limiting factor 16.97 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: nor) OQOn/D nrl"N i c ~ 1ti i 4~~/`J I I / I 1 Iz lob p a i f I I W je ~I ~ i o~ lb (4 10 C r ` 7rJ ~ ,d~l~ ~ 1 I n d ~ ~I m 1 n r , r $EKX-amAkt- I~~lod" APE LoTLQ. APE E L.E/ , 188.66 i 1 ~ 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. owner of property S/~ A /-,V//L L JC4 Location of property.S k/ 1/4 N LO 1/4, Section Z- ,T Z`1 N-R Township L) V Za Mailing address to X I S 1 H~Qn40" Wt SVo/4 _ Address of site ??-I M-CoN d Ftl 1vj k/0.5? Subdivision name TAN #01 /L 10 air. Lot no. Other homes on property? Yes X No Previous owner of property RANDAG(, :S' t"XM N Total size of property z," C Total size of parcel a - S8 A G Date parcel was created _ / 3 - 9 7 Are all corners and lot lines identifiable? ,X Yes No Is this property being developed for (spec house) ?.)C Yes No Volume 10 1 and Page Number 'KrZn as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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. S'0 Sl J?S'S' , 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. S' ature of Applicant Co-Applicant _ (9 - - l Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 'S t+Yl1 PA I L L F,, MAILING ADDRESSa X lY I PROPERTY ADDRESS 2 5 6) O©N $ q IVN W (location of septic system) Please obtain from the Planning Dept. CITY/STATE P L) LSO N LL) 1 S Vo f (o PROPERTY LOCATION 5 1/4, u u) 1/4, Section Z T Z~ N-R TOWN OF HL) t) _-z Q ST. CROIX COUNTY, WI SUBDIVISION T" 4N V Y R t NoE LOT NUMBER CERTIFIED SURVEY MAP 5S /G 3 S, VOLUME L , PAGE 7 S , LOT NUMBER q 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 expiration date. SIGNED: DATE: Z ' Z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. ~ STATE BA "F WISCONSI ORM 1--1962 r"I• ,✓ACK ■[SrevW FOR eeCO"oi"o'1Ar• ' ARRANTY 0 D 504835 VOL 10 31PAGE 456 CISTER'S OF` C This Deed, made between y Randall W. Synan and Patricia E. Synan, 'ecO,brRe~d - _ . husband and vile _ ~ Grantor, ' SEP 1' 1993 and Sam...E.~...hli... ~e.......a.........-.1e...Person 01 t0:45 - A.-'M _ •4 oew~, _ Grantee, l_._ + witnesseth, that the said Grantor, fqr a valuable consideration...... Randall W...... Syna❑ and PatrlCia E. Synan_ . "stun" ro conveys to Grantee the following described real ntata in St Cro y County, State of Wisconsin: Tan; Parcel No: The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 < of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. F~ JAL, ~ AND A part of the NE1/4 of SE1/4 of Secti n A parcel of land located in 11, Tovnship 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follovs: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point ~q of -eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence S00 28103"E, 500.00 feet; thence N8q 30100"E, along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This i. n42 homestead property. r (in) (is not) Together with all and singular the hereditsments and appurtenances thereunto belonging; And..... Ra.?tda•11-- W..___Sy.na-n_ and._.Patr,ic.i_a.._E_.._.Synan..................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except cept easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this ........1......... day of A,ug.uSt......... 19...9.3.. G~f~Ytd'?-'Y...Gc,~• SEAL) ~7aLl~u 4 !(ls✓ ..........................(SEAL) Randall W. Synan Patricia Synan X, .......(SEAL) ........(SEAL) e. AUTHHNTICATION ACENOWLZDOMENT Signature(s) STATE OF WISCONSIN 7 a& St. Croix Counq. P authenticated this ........day of 19 Pwwnally came before me ........day of August 19. . the above named . ~ i Randall w:---SYnan,...Patrfc l....E'......_... TITLE: MEMBER STATE BAR OF WISCONSIN Synan y J I (If not, authorized b . by 4 708.06, Wis. Stata.) to me known to be the person .-,9._.....N6iFz e I _ - 1\ - w.... _..l J1LIlMa A