Loading...
HomeMy WebLinkAbout020-1321-40-000 c p 04 m I ,y a ~ I ~ I 0 N I o I "y I I Q' I ' I o", I Cr I z C 3 LL c C O d I I M I III a~ rn z c v T o 'o I z z a ) ° o O z d c d II, o - o d z O M 'a 0) CD M N a _ CD m I I c ~ c o d cLi C O U z z N i z I > E N N a' co C:, w > a' ca 0) O c C O G E a N U) U) U) CL C F- F- F- ca C Z ° a _ -o I ~y g rr r- ►i o V1 O b i Vl J U a O rn z _0ai (.0 ~ o 0 0 L m Q l r_ en CD o ~ o z m O °`o l U N c Co otS c O m 7° o CO C~ N OU C -0 E C) o cn o a d o o l _ -j V) a) E n N C, 00 O r U.) C o; 0 16 L W N 7 N m "O F- -0 N C &n O E U • yam„' o_ Y N o z cn c~1 I ~ = E m I • c~ a m .2 a`r a c t A c°~a~i'',Omti Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E RO R T Page / of TL hr and Hmman Relations Di ,spion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but X PARCEL I.D. # COUNTY WED B DATE not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIE G APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION Q M M I LL& GOVT. LOT /VW 1/4 N LJ 1/4,S ( 'S T N,R ~ I E (or) W PROPERTY OWNER':S MAILING ADDRESS LO BLOCK # SUED. NA~ OR CSM # 1 aP,J~N~~ tA LL&I CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILI,AU E~~\0)WN NEAR; ROADA New Construction Use Residential I Number of bedrooms uN~ [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft20 trench, gpolft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0 -7 bed, gpd/ft2 O g trench, gpd/ft2 Recommended infiltration surface elevation(s) ft as referre to site plan benchmark) Additional design / site considerations i.L Ey UA''6 S0 E: vo A ' PPRO vA t Parent material Flood plain elevation, if applicable ft S = Suitable for system ~0 VENTIONAL ngQUND IN-GROUND PRESSURE gT~GRADEsTEM IN FILL HOLDING T6NK U= Unsuitable fors stem W S El U ®S ❑ U I S ❑ U ~l S❑ U CSI S❑ F ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& l Q 1 /b~3 r in1 g I1-36 16v2 ,9 S,L I S gZ 34 Sg 7SY 4 Ground elev. yyf TS 915 ft. g3 I_I 16YR414 Depth to limiting factor Remarks: Boring # ,,y s Lk 4r 416 S,L I rhsbK c5 0.Z v.3 v<,...: > _6 ~q Q- S r n-7 76 Ground S l O.-7 'C) elev. -14 iA ft. Depth to limiting f for y ~,5a 7_1 Remarks: CST Name: Please Print Phone: Address: 0, a G~ Signature: Date: CST Number: 2~ g PROPERTY OWNER SAry! ~'/►L t et SOIL DESCRIPTION REPORT Page Z of • PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ranch Bed 0-l3 ~aye3 I t-i-sb< nv cL0 I o.4 ©•S n, Y-11 V 03 Ground 7.SYoe 4 S Mir P, r w elev. 4 O .tS Depth to limiting factor '7 )U,33 Remarks: Boring # .:.....k $ ! 3 Y~2 Sid v~ sb /,/IV r Cw I b;Za.3 Ground lev. ft. Depth to limiting factor ~4 Remarks: Boring # k k .k p-IO /Oy+23 / L I SbK mY~r CL,) ) o q.~ . z~ y►e 4 5. L i s b m r ct i r~ o Z .3 4-I~ cave 4 Ground 6.7 Q g ft. Depth to limiting 9 ~'`7L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) No~u 1-40' V~ 6 3~7~ ~~pr SIC, n M_ 1 ' 1 ~ I ~ i B~r.1C1~YhAiCK - Z ;QWIJ AT t! o~ CpQNf~ C2ati+C.L i~dAfl (VOY R~~1LT~ - s STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 20"7--C C.I/Io4jy"' ~~i+/AUFF ADDRESS 12u. r1,_1 ~ ZT, 1 ~ SUBDIVISION / CSM# ~7/7.o„/GF ~LL6 LOT SECTION _T_~N-R_,/?W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVE YTHING WIT IN 100 FEET OF SYSTEM PROPOSED y'IPVC SCHEL 40 BL 0G. SEWER RES2DENCE 1000 CoAL• SEPTIC TANK PRaF~WSELC aO L1 " PV C SDA 35 EFFLUENT "N E. \55\ o ~ 150' TO NORTH 15 PROPERTY LINE N (03' Ida' ~y SCALE fir' 501 B5 ~ 1 1 L 0 T NOTE: 1 hSS0R9TS0N TRENCH 1 1 NREA TO GL CUT l APPROX. a.50, TO B3 MEET MkY- IC>E.PT" ~5 5'.rr RE.QULREMENTS PROPOSED DRZVEwAY ALT. 5ITE5 aal.~5 ' To EAST PROPER" Y LINE (PPAMbE R0. R.O.W. ic~ BI INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. w , BENCHMARK: ac6S /297a, ,12-A9 1iy&z or /DO OD ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ,A/ESF~ (_0A1C_" FTZ Liquid Capacity: Setback from: Well Q House -?pFT Other /yiq , Pump: Manufacturer Model# Size N~q Float seperation /y,,-v, Gallons/cycle: /y, /1 . Alarm Location /7! /a, SOIL ABSORPTION SYSTEM width : J Length r7 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House ~T Other ELEVATIONS Building Sewer 9y, 9y ST Inlet: 9y , j-? ST outlet: PC inlet ,e/,,4, PC bottom Pump Off Header/Manifold 9`7, y Bottom of system.9,9,,S"D Existing Grade 99 yp Final grade 9 , OD ~jQN/SOLE ;Velz 99.-96 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: fy0poU `?,300 INSPECTOR: 3/93:jt . 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 284288 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: KNAUFF, LOUIS AND CAROLYN HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No.: 020-1321-40-000 TANK INFORMATION ELEVATION DATA 7//S/9Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~,-~r ~'ry,C a Benchmark Dosi~,.n. 13. r^ 3, a (oS~ Aeration Bldg. Sewer /3,SS S or-,~ Holding St / IXInlet 3.95' 9 / TANK SETBACK INFORMATION St/,* Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Headed. 9a' 3, W Aeration NA Dist. Pipe HoIdi Bot. System 9"~? , (o,' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~p o-4, T ei 7,71 odel Number GPM TDH Li Friction S stem TDH t Fofcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width 7 1Length No. OfZrenches PIT No. Of Pits Insid Liquid Depth DIMENSIONS DIMEN =MBE Manu actur~r: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO R Mode Number: System: L1,e,-4< 74 'OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) i , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. L Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade e I 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.1,9.29,1~,,0NW NW GRANGE ROAD -LOT 4 p a°►rtWl~" k ~t n JIMc t 2..A Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION V 0ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY er) / ...,.,..,,_.,e. x, STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ ~¢¢~~ll 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION zodAc= C /4,yA,,, t/4, S T a,9, N, R E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER . TYPE OF BUILDING: Check one CITY NEAREST ROAD 11 ( ) ❑ State Owned ❑ VILLAGE ❑ Public ®1 or 2 Fam. Dwelling- of bedrooms FICEL AX NUM III. BUILDING USE: (If building type is public, check all that apply) - 9 1 ❑ Apt/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. TY1PPEI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. I01 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - 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 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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./inch) p ELEVATION Zoo -P . 7S SO Feet pp. D Feet CAPACITY VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Doo _/,00 0 Lift Pump Tank/Si hon 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 Si I= (No Stamps) *P/MPRSW No.: Business Phone Number: ,~3o O rS ~?ap6 ' ~d'SO /J/'/~A ; 1 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Is uing Agent Signature (No Stamps) Approved ❑ Owner Given Initial 1$ Surcharge Fee) Adverse D t rmin i n -q-W7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) 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 the 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 (SB`;) 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 & Buildings Division, 608-266-3815. 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 in 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 in #1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, 'ocation of r;olding tank(->); septic tank(s) or other treatment tanks; building sewers; well,; water rnaimt/water service; streams and akes; pump or siphon tanks; distribution boxes; soil absorption systems; repla!!.ement system areas; and th,~ location of the building served; B) horizontal and vertical elevation referenc.~ points; C) complete specifications for pumps and controls; dose volume; elevation differences; frir,-,i -,n loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil abso ption system if required by the county; E) soil test data on 4 ,115.form; and F) all sizing information. - - - - - - - GROUNDWATEIR SURCHARGE 1983 Wisconsin Ai:t 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. Tr,,o, monies collected through these surcharges are uses; for monitoring oroundw,zter, ground- water cent ruination investigations and establishment of standai-ds. SBD-6398 (R.11/88) .t3/~1 = USGJ' DAT!/i'+~ J929 ~Nw LoT L'oRvf/1 ~ ELEI/. =/ooad , ' ~ 'S'pYC ..CDR 3S'~'FFlls•EM' LINE .40410 Ovvt. J'~~~zG TAN/L scvrL 5'G .OLd6 Jrwtit PLB 57• 'PLOT & CROSS SECTION PLANS PitvNorea ZAPPA BROS. EXCAVAT1Niii INC nE.rzoENC.~' ~So' WI~ING UNIT /O /loA~orsO P PROJECT ST 'S O 63' L 6T / ' '1 ~s60I /YoTE- AQ1'O/tT2ON T/lENt~v AREA ?O QB CcCT ,oowO A SO Ff Yo /7EET ~ ~ /'7.vx . L?EOTN /tE~ uS/tC/+IEnTT1 0 j ~/loPaSEa •Q'tivEw/~Y ~ ~5 ~ \Tb N ALT, .CST- ' o2?26S" To Ga,oNS~ ~1r ~/ZOPE/cTY ' f: ( Q LLvE .~SOS SCALE FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 4Z' ABOVE PIPE TO FINAL GRADE SIGNED: MARSH MAY OR SYNTHETIC COVERING LICENSE: ,id/1?p(~ MII~MMUM 2' AGGREGATE DATE: o y/osC/97 OVER PIPE DISTRIBUTION PIPE I_+ TEE 801E TE8TINq BY: ELEVATION BED d' AGGREGATE BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST 18 COUPLING TERMINATING AT BOTTOM OF SYSTEM Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labbr and Hultman Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ~X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW PROPERTY LOCATION L rS E GOVT. LOT N~ 1/4 1/4,S /s T 29 N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOTS BLOCK # SUED. NAME R CSM f s}. L y CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VI GE OWN NEAREST RpQ y ( ) d ON CT 4 ,~j New Construction Use [~'J Residential / Number of bedrooms (J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate ( . 2 bed, gpd/ft2 0j trench, gpd1ft2 Absorption area required bed, ft2 trench,42 Maximum design loading rate 0. bed, gpd/ft2trench, gpd/ft2 Recommended infiltration surface elevation(s) &---,JCCN 1,3 A & K .S ft (as referred to site plan benchmark) Additional design / site considerations &-TI4 diRt A:S Parent material Flood plain elevation, if applicable ft rU = Suitable for system CONVENTIONAL MO ND IN ROUND PRESSURE AT-GRADE Y TIM IN FILL HOLDING T K =Unsuitable fors stem S❑ U S❑ U S❑ U I~jl S❑ U WS El U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmr& 'w- fir:. kti3Y5~i\~ f 4ti x 8 - 23 4 , L ~r C S O Z 45 $ y? 14 - 5 r= rrs 5 O3 0 Ground 3- -77 elev. c91ft. S-I /b S r M~ 4.7 Q, Depth to limiting factor Remarks: Boring # J9 -1 '6 'v - I b~ cs l~ 0.4 os Ground _ Y P, 4- /4 ft. Depth to limiting factor >-6 Remarks: CST Name:-Please Print Phone: gb Address: r 1 ~C Signat re: Date: / CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed r & 0- 11 LnTR~E - I Ask r- CS 0.4 O.S B 11-21S IAAA/h - S , L ~K i'►, CS - O.Z O . Ground -77 -7, S y - v ' .7 CAe ft. g3 77 -13 > Y .5 6.7 0 Depth to limiting factor Remarks: Boring # S -S /byk L. n, br. (hTr CS O.4 0 o S L. sIo>; n,r CS rS,Z o 3 L'AIJ - 0 9-2126`SO I&P 3 5 I CS Ground elev. F-6-4-- r r CS ft. Depth to I Z y S bm~r nil -8.7 ®;S limiting factor Remarks: Boring # a - /bye, - L I Y% SeK rm cs a ,s' sit- sbr ~r Cs 6.2 0. El 13-31 16vQ4 L4 Ground W-4 1A-,,4 (A S Y 1,9r- n, Cs 02057 18 e ft -12 &y 3 6.7 0.3 Depth to limiting factor } /L1.SF4 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) Ad "I &-oxi-maky, ALUNWIYM CAT a A-Y S>rcrio" Ca2NwQ - S u f' i L.rc I I f I 1 i ~ ~ t 2°l0 ~ $Z'..3b'- ~ 1 i t 14 `t it ii ti i f Z~~12oN nA~ ZT `f; 1~~0' " -W of the NW1/4 or the nWl/4; z' 183.42. feet to the southez z J Northwestern Railroad; thence a N a 1539.01 feet to the south W I 889054144"W, along said south m NWl/4; thence N00612149"W, alc of beginning. Above describe( Ft.). WILLOW RIVER S I A NW CORNER OF ENCHMARK EL z 923.68' SECTION 15 USGS DATUM 1929 J- N99°5 182.00' 3 2.00' HWL --904.7 I L 0 1 co 92 o 8 W ©I I~ 2., 87 ~o (ED 00 V) LOT 4 LOT 3 p J W O W X 2.47 ACRES ~0 2.59 ACRES p W v a 107,690 SO. FT. 112,886 SO. FT 14 Z 0 M ~ a 2.37 AC. EXC. ESMT. 2.25 ACRES EXC. ESMT O a 103,324 SO. FT. 97,995 SO. FT. I 7- o WO f U. _ e 5 / r W \ - 83.00' m 00 CmD - L- - - 5~- % . GRANGE 'II"E 138.74'-v ~V I _98.0 = 6.5,-, ---109.00'--- o S86°05'56"W 20r tC)I I _ _ _ --14 7-1 89047'11"W--138.74'- -1 - C71 I-1 ~1 C1 / 0 ~(,71f Z 01 > N LOT 7 M 3.29 ACRES f - i- 143,347 SO. FT. LOT 5 2.73 ACRES 3.21 AC. EXC. ESMT. 139,949 SO. FT. d 119,002 SO. FT. W N_ o I 2.68 AC. EXC. ESMT. N fi 116, 703 SU FT. 0 STC - 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 Lo'-kiS 14-MO CAA-c 4,J Location of property !I Ke 114 ,,vw 1/4, Section W Township Mailingaddress 601- Cry JCZ le-C, t jL)'Lsc_ 574016 Address of site S~~t A-. -A,6cJ Subdivision nameok"yc'. tJ,q-t.~ Lot no. Other homes on property? Yes_>No Previous owner of property SSA rr. Total size of property 2. 47 A Xr_s Total size of parcel Date parcel was created Are all corners and lot lines identifiable? ~C. Yes No Is this property being developed for (spec house)? _,_,_,,,Yes =_No volume My and Page Number 52-2- 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. ~157-1t3 , 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. Signature of Ap ant ZCo-Aap--pLli ant 3"Zl~'97 -3-?.S--97 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~'1n R- ` vK ►~-5 c.i~ s lC- ti ~u c' T~ MAILING ADDRESS D &,A-e4cle: Ztil kA t se,^ UV +-rc- S-40 l (6 PROPERTY ADDRESS S AF ,,s to A ao J_cc (location of septic system) Please obtain from the Planning Dept. CITY/STATE -S 4C) (t, PROPERTY LOCATION AIW 1/4, AI tom/ 1/4, Section 16- T Zgi N-R_Lq_W TOWN OF "u,DSc>,J ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 4 CERTIFIED SURVEY MAP 9 VOLUME 9 PAGE , LOT NUMBER 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: 3 - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 Stat_ r of Wisconsin Foam 2 = 1982 52.1.1 WARRANTY DEED DOCUMENT NO. VOL .2OV PACE' FiGUtJltf'1~CJti14~. ST. CRCIX Co., vil Sam E. Miller , P,a:'dfXFAVI NOV 1 3 al 11:30 A. conve s and warrants to Louis J. Knauff, Jr. and Caroly~_~! Inauff, husband and wife, as joint tenants F,r_ cfLe?'1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS First National Bank 307 Second Street the following described real estate in St Croix County, State of Wisconsin: Hudson, WT 54016 (Parcel Identification Number) Lot 4, Grange Valley in Town of Hudson T AN FE $ o° This is not homestead property. !K!jj (is not) Exception to warranties: Existing highways, easements and rights of way of record. I ~ t d~'v Dated this day of November , 19_96_ j (SEAL) (SEAL) ii ■ * Sam F Miller I! (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) ss. St. Croix County. J