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Parcel 030-2038-50-400 04i07i2006 11:41
PAGE 1 OF 1
F 1
Alt. Parcel 25.30.20.481 B-20 030 - TOWN OF SAINT JOSEPH
Current ,_X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - PETERS, RUSSELL M & SANDRA L
RUSSELL M & SANDRA L PETERS
1394 25TH ST
HOULTON WI 54082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1394 25TH ST
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 7.500 Plat: 4422-CSM 16/4422
SEC 25 T30N R20W NE NW FORMERLY LOT 7 Block/Condo Bldg: LOT 9
CSM 12/3279 NKA LOT 9 CSM 16/4422
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-30N-20W NE NW
Notes: Parcel History:
Date Doc # Vol/Page Type
03/21/2003 714073 2179/116 WD
07/23/1997 871/331 QC
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/31/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.500 145,900 285,200 431,100 NO
Totals for 2006:
General Property 7.500 145,900 285,200 431,100
Woodland 0.000 0 0
Totals for 2005:
General Property 7.500 145,900 285,200 431,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 130
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisgonsin Department of Industry, SOIL AND SITE EVALUATION
Labor Vd Human Relations Page of .3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than (fit° Llriche~slofsiYe, RJan must County
include, but not limited to: vertical and horizon fence nt (BM);- irvktibn and 9, f
percent slope, scale or dimensions, north arr am Ioc tance(8 de> rest road. Parcel I.D. #
r" _ O- 38S` -/400
APPLICANT INFORMATION - Ple n i fv n. r eviewed b Date
Personal information you provide may be used for or dary p~rp"osef 1kLaw, s. 1 04 O (m)).
Property Owner 005- 0 _'P perty Location
4`~ 1 ► q 70,vt. Lot IV L4' 1/4 1/A11/4,%2r T30 N,R o70 jr(or) W
e ra
Property Owner's Maili Address ` ; Lot # Block# Subd. Name or CSM#
13,9 5i-ree AA I CS
City State Zip Code Phone Number Nearer Road
lOh ❑ Ciry ❑ Village TL. A f~i T
New Construction Use: ® Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 00 gpd Recommended design loading rate a S_ bed, gpde .45~_trench, gpd/ft2
Absorption area required /0700 bed, ft2 /4000 trench, ft2 Maximum design loading rate ~S bed, gpd/ft2_._~ trench, gpd/ft2
q r
Recommended infiltration surface elevabon(s)h'iaA..1 cA r8/- ft (as referred to site plan benchmark)
Additional design/site considerations /
Parent material a si 7 6.J,2 s' A Flood plain elevation, if applicable 11114 ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system Ns ❑ U Ns ❑ U CRS ❑ U ®S ❑ U ❑ S ® U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. S~z. Cont. Color Gr. Sz. Sh. r Bed , Trench
/ / / v f~/►~ S r Tl~ C~ e ~ e (nc
CJ
AR-2.2 pr 01-i r:.wl
F-2
Ground
rV~ S D / LJ Na
elev. 3 ® /t/o
Depth to
limiting
fact
Remarks:
Boring #
- y r y ONC 4- 154 GJ P .S'"
3 _PS NA /Viq 0/Ground
elev.
Depth to
limiting
r f c or
in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
s` l/ t1l e-J ha; 50,, Pis c✓`' ~s`s~a~ s~' A Z 2 o V610
PROPERTYOWNER Re/'G 404 0?1 SOIL DESCRIPTION REPORT Page if
PARCEL I.D.# 0.3LqJ S/0
Borin # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots G~ptft
- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
oZ -ya
Ground
elev.
Depth to
limiting
factor
Remarks:
Boring #
cs-
Z/ .2 /V04 ~Z
3 0- A '
Ground
elev.
/0~ 0 ft.
Depth to
limiting
factor
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 # 0 r3 /!l0/~E- o?m r /n t/
f,J r9 . ,d
3 9 9r ~ MOMW D IY19 /1,4
Ground
elev.
Depth to
limiting
factor
X-Lin. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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L5 t 'r KAl iiLEEN H. MALSH
REGISTER OF DEEDS
` FEB -3 ST. CROIX CO., 11I
RECEIVED FOR RECORD
SST. CROIX COUNTY 12/09/2002 02:40PK
APPROVED EXElPT #
ST. CIROIX COUNTY
Planninn 7nnin:+ anti Darkc CnmrtittP.2 REC FEE: 13.00
BEARINGS ARE REFERENCED TO THE TRANS FEE:
:
3.00
0 DEC 0 9 2002 NORTH LINE OF THE NWI/4 OF SECTION COPY FEE: E
CERT COPY FEES
25, ASSUMED TO BEAR N88'49'50"E PAGES: 2
If not recomeo wtu I'll 6V oayb or
m approval Cate approval shall be
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M JUN 1 1 1997 ► 4
KgHLEEN K WAM
560897 F~ co° wi s sum R's ECORo
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STC
- 104 AS BUILT SANITARY
SYSTEM REPORT y~ OWNER
ADDRESS_/3c~
s'r cRIx '9
S COUNT'
ZONING OFFICE
cel SUBDIVISION / CSM# OLD
SECTION LOT #
__g 5 TN_R Q W
, Town of
ST. CROIX COUNTY, WISCONSIN
SHOW EVERYTH NG WIITHINIE00
/5 fao~r ~ 1 Drr• ~~<<o~.o
1 ,
r a 8e' 0 i '
W p eD J~
INDICATE NORTH ARROW
Provide setback and elevation information on
reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 6,a, T d0 J" QUG LIID4g' ^Ar W Z& /dO ~6
ALTERNATE BM: . fob ' 46c EL . 42(A B
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: /,Zpp
Setback from: Well 6 y` House IS' Other
ufacture Model# Size
Float seperation Gallons/cycle:
Alarm Location- XA
SOIL ABSORPTION SYSTEM
Width: Length _Qp Number of trenches
Distance & Direction to nearest prop. line: Mk-r&
Setback from: well: f ~D House 1301 Other
ELEVATIONS
Building Sewer ST Inlet: Q ST outlet: fQ/, 2?
PC inlet PC bottom Pump Off A14
q/• g/ go.76
Header/Manifold--?pe 2_,3_ Bottom of system
Existing Grade ?2. Final grade q~.
DATE OF INSTALLATION: - 2
PLUMBER ON JOB:
LICENSE NUMBER: 32Q $
INSPECTOR:
3/93:jt
Wisconsin Department Commerce PRIVATE SEWAGE SYSTE.tM
• Safety arad Buildings Division Count tT. CROIX
INSPECTION REPOR
GENERAL INFORMATION (ATTACH TO PERMIT Sanita291"i$~.:
Personal information you provice may be used for secondary purposes (Privacy L , s.15.04 (1)(m)].
FERG696%',NaRVID ~,fity 136 gvPA3 Town o : State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel "tlo-:2038-50-100
TANK INFORMATION ELEVATION DATA A9700201 ~7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ZL-1- e ,2CZ Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TAN SETBACK INFORMATION St/ Ht Outlet
Vent
TANKTO P/L WELL BLDG. A
irIto ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade
Manufact r Demand
Model Number GPM
TDH Lift Fric System TDH Ft
Forcemain ength Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside id Depth
DIMENSIONS DIM I
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI
INFORMATION Type O /7 CHAM Model Number:
System: L -•?~l OR IT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) [;:z ize x Hole Spacing Vent To Air Intake
Length Dia. Length Dia: Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ms Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodde
Bed /Trench Center Bed /Trench Edges Topsoil _ E] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH 25.30.20,NE,NW 1394 25TH STREET LOT 7
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R.3/97) Date Inspector's Signature Cert . No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
,r
Iticonsin SANITARY PERMIT APPLICATION 20 E w shnlgtonAve sion
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 vz x 11 inches in size. , +
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 E] Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)).
r te Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
E) _ E 1/4 Nh/ 1/4, S T , N, R.D E (oro
Property Owner's Ma ling Address Lot Number Block Number _f4 7
City, State Zip Code Phone Number Subdivision Name or CSM Number
1401" I -vn 5 a 1(7/ S) 599 599
II. TYPE BUILDING: (check one) ❑ State Owned it~r earest Road Y
Public 1 or 2 Family Dwelling - No_ of bedrooms own of S f J ~
J
U k1
,T C 42
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 t30 -ZU 36 6- 01,00
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
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
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./inch) 9X, 74 EI ation
Loo ® Feet - TO Feet
VII. TANK Capacity gallons Total # Of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank /a b, o ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans.
Plumber's Name: (Print) Plum r' Signature: (No S m s) 17 M PRSW Business Phone Number:
~-J-V
s5chWl 7-7- xy&~-Z. OLE
Plumber's A( dress (Street, City, State, Zip Code):
1`710-,g? 1 46
IX. COUNTY 7 DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued issuing Agent Signature s)
roved Surcharge Fee)
pp roved Owner Given Initial
Adverse Determination
. CONDITIONS OF APPROVAL / REASONS OR DISAPPROVAL:
SBD-6398 (R.11/96) 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, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's namkpnd 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 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 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.
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
La'c.:ir and Human Relations Page of .3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and k
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
O- 385- - /OU
APPLICANT INFORMATION - Please print all information. Reviewed by Date
"Star111gI I/flrlfll/g1Ir111 V'11I Illrlvif+q may ha Ilcgli int wirr111rlgly r1111I n4an (r iivnev I qw, q Ir o4 ( I) (111)).
Proprtynrner Property Location
f Govt. Lot Lt' 1/4 //jA/1/4,SO?S- T30 N,R 070 f(or) W
e ~ Lot # Bloc S a or CSM#
Property LOwner's Mall g Address
Clty 7 j'Statee Zip Code Phone Number / A I PC 0791007
Neares Road
~Oh (7/.r) ~y - 9B,? El City El ❑ Village , Tewry Mfr I _j
CR New Construction Use: ® Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 00 gpd Recommended design loading rate o6_bed, gpd/ft2 . entrench, gpd/ff2
Absorption area required /0760 bed, ft2 OO trench, ft2 Maximum design loading rate ~S bed, gpd/ft2~trench, gpd/ff2
Recommended infiltration surface elevation(s) ~f.,A lre,,A 4u-.) 8/- ft (as referred to site plan benchmark)
Additional design/site/considerations
Parent material C/s~~ L4j,6 CA Flood plain elevation, if applicable ft
= Suitable for system Conventional mound in-Ground Pressure AT-Grade System in Fill Holding Tank
S
U = Unsuitable for system ® S ❑ U S❑ U ®S ❑ U ® S ❑ U ❑ S O U ❑ S Nil
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDAIt
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
milr_ ~ c . 6
Air Naive- S ' fqr
/ / o--~
o? - Q 3 p/Y~ f5 ~r cJ -r
Ground 3 a- AQ/Y~ S GJ A
y6 0 orrCC ~ l /'V,4 4 r
Bh. y
5--2 A
Depth to
limiting
fa
in.
Remarks:
Boring # C
- v 10 iii- IVON067-
A 0,, -t~ y ONC
3 y y divc= NA s-
Ground
also' Ell
Depth to
limiting
Win. Remarks:
CST Name (Please Print) Signature Telephone No.
Tho.Y,a 1,~ ' 71S'
Address Date CST Number
/a Ilie, J in i Some.-SOI_ 4-11' SyOdS_ ryed- A? ;t 0 VO/0
PROPERTY OWNER Qei Q( &YUSon SOIL DESCRIPTION REPORT
Page
PARCEL I.D.# 3d - d3 C7 3~~ '~OD
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
0-.29 9
Uloul
elev. a a fro 6 vaN~ S N NA
ev. Azifl
•
Depth to
limiting
factor
QQf in.
Remarks:
Boring #
Z& CY
14- o? i8- /Volre
3 0- p /I~DiYF fS RYA
e%c
Ground
elev.
Depth to
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Structure
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed , Trench
Boring # Q rd~~ ~F m r M v{v~ W n9 . b/
Ina-312- 1V01W- -PS 6 <0 141/
3 9- r No/~%- Q NA *4 b
Ground
elev.
Depth to
limiting
factor
,Z-*in. Remarks:
Boring #
E3
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08195)
a
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Paftd 'Id, 0 3 0- 0V385 = /00
/V
(;M, : 7P o-f -7" PI/G Pipe koca fed on 104.4A Proptf ly line ~L. /00'
P/t. 8M= 70P OF -7" pyc APP El, 1a0-87'
Ft. loo,
.300+1 goo Alc,4 k Property
tine-
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Orig.
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SU ~s~eor f!'P.n~~ Ele,o f~ohs 6feo' 1 83 1
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FILED
01 JUN 1 1 1997 10
Regloff of0
5610897 E, C-2 * bcCo. V"A
rn
This instrument drafted by.Michael Erickson o No. 97-51
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L
` "-SdkVSYOR' S CERTIFICATE a
I' Y)ougla ~b Zahler Registered Widconsin._ Laaid;Surveyar, hey
" ert fqthat by , the dincctibn dt ;Reid Vbrguson,,~ 1 stave s r
t r urV~, dedt Ahd ..mapper a° t;`oi `;;the °NS1 ofk the 4 b SeC~i
bl 30 x h., Range 20 WdA n` Tbwn~ Of ,5t o'se sh,'
Lnt 2 bf Ce, ' .f3:e
p Wis ~i b 3~gm pat o 4",
r r ii' .s ^y i k Rb.
'ia xa87< te office of,, ~t~r Couny,
"tern ofI3~tdesCZed as fo av~s - ,ra{
'AL` ' ro 'yl` Y Y 7z {:+r+~'L~'
ty }r' Y-1 i .,q?E $,,f+L ~y y ~q'~` ~ J N F v "4'v Y
*8.~A/~'i 4~orner-of 1~,d Section 25; t41 e~n r S
t of c el/4 '.of aa$`t~
H* ' d1 w
rod CeAlfied Survey l p o Or$ t Yom.
to', e' NF3 :`.cbrne Lot_,,2 F
age ' 487 "at the St a C:ro` County, r istex' of: tD ds ° off e
g the r~ ± `t" ea `n~?3nc; thence continuinq, S o(9 t g"W, :atl, 'a 1-
at ue ofd the l~si/4 zof :the, 4 ek~iuc, the 'Qat C $1 t~ s d dot
k 3 eeC, tt `tliel SX,,,,corner . of fsaid Lot' 2 ;
> ;fie j south 1, linL- ~'o~°j`said I.ot Z' .x94.31 : feet to the`, S'~3 co ae~c f
'tli6 e4~Nb0o1.7112~'8, . a ong, thee` '('St liae:,o$sne d Lot
W;feet, to, the_:' NW 'cotider ,of ea3ii= lot 2.; thence.
ityrth;l~inwof 'eaid°LO1293 `'~3' feet try the ;n~i~~►•rtr:
4 beecribed parcel Contains 15.20 acres (653,402 square`.feeeY., Sub~ct
all, 6a~semeitw,
Tooon Road -(25th,, Street) Right-of-gray and
restrictions and covenantsof record.
al:`so certify that this Certified Survey Map. 3.s ~e'r'corr % ect
s
repi*9bntatidn to ~ scale of the- exterior, bouaa ' -.sutve e'a11d
~ ul N 6, }
th' t
bh he prov3.sioas#' ae ~o,
t "±~~i ►ed; tfu~tt I -ave wi
of;tle cons° 5ttut,.Subd
d v3sim C4
f'' 4
~~"bounty Hof St Croix ;`an I ids' :b sur g%
y
'J 77A
t? ttg J;.. Xahl.er
Surveying
s2alxnxt St.
~ ` tdsn~ Wx 54016 j ttC?
$ach~ parcel shown on this e map : ( $ subs Pct to State, County and
MLU~
mini
~ownshi ; 'la~PS , rules and xegtYl aeons (i . e . , ~oetlands YOt
A- laws
ti-
g., to pS ~rcel, etc : Before pnrchasiu F or dbv& 3nJ Y
; ~ 'd el ooCi tct the 'St. Croix County Zoning Office and appropriate Z'en`
Baart- far,adiiice
TOWN OF St. JOSEPH CERTIFICATE
4#
IL~hereby certify that this Certified Survey Map is approved by the St,.
Jbseph' Towii Board
Date 7
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
Location of propertyLjSl/441j~j 1/4, Section',- T_30 N-R2r
Township (j Z rgje n Mailing address Z 3t~ 4
Address of site j 3 9q~ th S~
Subdivision name Lot no.
other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for (spec house) ? Yes __V No
Volume and Page Number ~-l-~ as recorded with the Register
of Deeds.
INCLUDE WITH THIa 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.
Si nature o Ap~! ~1 Pr plic tepo ican t
Z?u /3 Date of Signature Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER `
MAILING ADDRESS Y //OR 2~
PROPERTY ADDRESS S-W921
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION IVC-_ 1/4, -1/4, Section, T 30 N-R _Za W
TOWN OF V~ ST. CROIX COUNTY, WI
SUBDIVISION r f+ f 2 LOT NUMBER-7
CERTIFIED SURVEY MAP SF, , VOLUME I, PAGE , LOT NUMBER
LL
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:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
1
i4o
THIS {IACt RR{R,IVRe /OR R9GORD4#WQ4r*1 z_ WARRANTY Opp
STATE BAR OF WISCONSIN'FORN 2--1M
-1-JOUN 28 5Q0 REGISTER'S 0G ,
> j ST. CROIX co., W1
.,a mth-19....EiiU. a4. V1CW....L,,..ii~,U A . a... wife Reed for Record ,
#,r~di..d1,~,xc1ctl. i.rt. theix' snare xiptlt
JUN 3 1993 ,
.at 8 : 30 A M
convey[ and warrants to flF~f1\ .~~w )r(~t ugctn anCl INR1..I"., ~w
'
z~ua -i•. husb=4..and..wife,.'. as . joint.. tenants..
R of Dge"
,
Wertheimer, r
Second St. P. O. Box 108
430
f Hudson Wi 54016
I the folbwtn~ described real estate in St% .CWIX. .County, ,-s
State of Wisconsin:
Tax Parcel No; 030-2038 50-100
i -4
lot 2 ,of a Certified. Survey Man recorded .'Rine 1, 1992 in Wlume 9 of certified
I Survey Ips at Pages 2487, as Document No. 484073 in the office of the Register
of Deeds for St..C=ix Ootmty, Wisconsin.
I ~
i
Z RAM
j
1
i j xe
f
i
.T.hia . ~..not homestead property.
(W, . (L Trot)
~s
7CRep OA,'LO~V *rr ti ==Hm WT1H AND ma=r To any other easements,. Covowts
exva may. of >reaord, if any, but :this shall not bet crered to extend
such otter' xeoord0d'1tlpCli=21IIG~9 bBxOt$ the tsrm`.established by law L}1f r@fOT. y~ -
Dated";this 28 day-of ..1!......... IY..93..
. SEAL .............(SEAL)
K's;*th `R. Hilly
I U .(SEAL) (SEAL)
AUT,RXNTICATION - ACKNOWLEDGMENT
3i~uatuse(s) #1 $n..~.~.. STATE OF WISCONSIN
ViL w.
County, 44
- au tad -do .i .I:' Personally came before we this day of
G. r 18 the above nsmod d
T Cain , ...............W?.
.y
TI TL; i"A~$E`.. STA.&, OF WISCONSIN
1 -
"(It not.
authorized .by If I06.g6. WIe. Sata )
to me known to be the person who'executed the
n foramina Instrument and acknowledge the same.