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HomeMy WebLinkAbout038-1090-30-100 'T o o NO p a g o 0 o N N 4=. goy' ~ c 0 c tl b N o~ > ~ U N c Z N C N C z 7 c6 5 LL O 7 I 3 ~ y 0 (1) ¢w 3 Cl) Z w E ao o z ~ Cl) a m N F- z c 0 o z v 9 c v o N N Z o z U) F- N c E -o N N C f0 N N a y • d CO p m 0 4) Q Z co z Z N ° ~l N c O) y - N C Q 4 G N T 0 O l4n G G d a CO C. 0 co N N Z o w o m Z o •N ~ ~aaa a N N 3 O N :j E O h 0) y v N w U V rn rn } v o o 'V o N o CD po j _T co c c C N N m O Q } (n Q O O 3 O N C co O N M N N t0U 0 :3 CL O r O- N 'O N_ M C O V 42 O C N 00 0 N In H co M R d .NN. N F- C L M m v~ ~ O E v • O N fA O N O Z- CA v~ d € a ~xt a L: aW- • el a m .2 N rr`wIv E c c S cc _1 A 0IL2 ov)0 Parcel 038-1090-30-100 04/20/2005 09:21 1 PAGE 1 OF 1 F Alt. Parcel 21.31.18.370B 038 - TOWN OF STAR PRAIRIE Current ilk ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner THOMMES, JAMES P & TARA L JAMES P & TARA L THOMMES 2055 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2055 CTY RD C SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2.570 Plat: N/A-NOT AVAILABLE SEC 21 T31 N RI 8W PT SW NE & PT NW SE Block/Condo Bldg: BEING LOT 1 CSM 11/3227 2.57 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 04/11/2002 676120 1871/412 WD 09/02/1997 1261/380 QC 2004 SUMMARY Bill Fair Market Value: Assessed with: 30334 165,500 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.570 48,800 124,000 172,800 NO Totals for 2004: General Property 2.570 48,800 124,000 172,800 Woodland 0.000 0 0 Totals for 2003: General Property 2.570 35,300 91,400 126,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER r ~OG7 Y ~oy ~i d /S~ Gj ADDRESS SUBDIVISION / CSM# GS~y~~~~/ o~.aZ~ LOT #-L SECTION~T N-R_/',;J~W, Town of ,Q SIT. CROIX COUNTY, WISCONSIN 31.1$ • ''~'1 XI PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTE .'o r r G~ A INDICATE NORTH ARROW Provi e setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: TO d ~LS/ V,1` ALTERNATE BM• SEPTIC TANK /PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Q Liquid Capacity: y~ Setback from: Well use 4/-~ Other Pump: Manufacturer Model# Size Float seperation _ Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM r Width: 1,2 Length_~~ / Number of trenches/) Distance & Direction to ne crest prop. line: !1G Setback from: well: Ve/?House Other ELEVATIONS Building Sewer ~T Inlet ST outlet PC inlet PC bottom Pump Off Header/Manifold ~9.g 5 Bottom of system Existing Grade -53- Final grade S 5 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wiscoh'sin'Department of Industry, PRIVATE SEWAGE SYSTEM County: _ Labor and Human Relations INSPECTION REPORT ST. CROIX Safety t-id Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284308 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: OLSON, ROGER L. STAR PRAIRIE CST B Elev.: Tlnsp.BMEIev.: BM Description: Parcel Tax No.: 038-1090-30-100 TANK INFORMATION ELEVATION DATA S d ~r TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing-_ l 2-` Aeration Bldg. Sewer 97 Holding St /Fjf(Inlet G,Y' ( TANK SETBACK INFORMATION St/ FW outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >5~ NA Dt Bottom Dosing NA Headed - Aeration NA Dist. Pipe 7, GU 95 yQ Holding Bot. System 5-e PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~d .a~;~,~ 3•>Or ~9•~~ Mode ber GPM TDH Lift"" Loss S stem Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length/ ' I No. Of Trenches PI No. Of Pits ia. iquid Depth DIMENSIONS o2 DIMEN s SYSTEM TO P / L BLDG WELL LAKE / STREAM LE Manufacturer: SETBACK AMBER INFORMATION Type Of y/e~~ r Mo elNum er: System:r~tec~dta• /G OR UNIT DISTRIBUTION SYSTEM Header / 9 Distribution Pipe(s) „ x Hole Size a pacing To Air Intake Length Dia. Length L Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound r At-Grade Sy s Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded u ched Bed /Trench Center 3 3 ' y~ Bed /Trench Edges 33 -"f~ Topsoil ❑ Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRn/IE.21.31.18 NW,SE CTY RD C LOT 1 0 Plan revision required? ❑ Yes B-4ci rr Use other side for additional information. S 0$ d SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 V~~7R Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems In accord with ILHR 83.05, Wis. Adm. Code 201 E. Washington Ave. P.O. Box 7969 Madison, Wl 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. • See reverse side for instructions for completing this application State Sanitary Permit Number eNI The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)]. ❑ Check if revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Namg operty Location 4 1/4,S,Zl T N,R/,13'-E( W Property Owner's a I I i Address Lot Number , Block Number City, State Zip Code Phone Number _ Subdivision Name or CSM Number 32a 7 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City ea rest Road Public 1 or ,2 Family Dwelling- No. of bedrooms ❑ village t5/u~ J'~✓,'Lerr"t Town OF CCi ~L/ III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 03T- 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 S ❑ 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 S Repair of an ----System System Tank Only- Existing System E3 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 1 1 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43E] Vault Privy 14E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Sysihpm Eley,$ 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 5 Elevation GLF 14" VII. TANK Capacity eet V Feet INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per. New Existing Gallons Tanks Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank X Z411 j 2 -e ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) 0;~ 's Signature:: (Nmps) MP/MPRSW No.: Business Phone Number: 107 Aly; &e2c 1~71 , Plu er's Address (Street, City, State, Zip Code): rs~t. P f''t fy IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fe (IndudesGroundwater ate Issue Issuing Age Signature Approved E] Owner Given Initial /1CJC1 ~r`nar9e`ee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divr_ion, 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: 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. -4EII - ~6/ I/ tl 5 1r j fe e I 1,31 L J~ 3~~ 1~ ~ ~ ~L r 3 cv c r~4 .a v o r w~ I' Q=om l~ Wisconilh Department of Industry, SOIL AND SITE EVALUATION ' Labor and Human Relations Page -L of bivision of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 5-t r o t Parcel I.D. # j pf-"~ " Y~ APPLICANT INFORMATION - Please print all information. Reviewed d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location e.'(' I Govt. Lot ry w1/4 S C 1/4,S T31 N,R I E (or) W OA I Property Ow r s Mailing Address Lot # Block# Subd. Name or r SM# 2~o C,} City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road `JOrwer c W t 540 5 ( 1150 b- 5ta 4. C P 'l C. Y New Construction Use: Residential / Number of bedrooms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow q S0 gpd Recommended design loading rate bed, d/ft2 d o gp trench, gpd/ft2 Absorption area required to43 bed, ft2 s b ._5 trench, ft2 Maximum desi~loading rate . 7 bed, d/ft2 9p trench, gpd/ft2 Recommended infiltration surface elevation(s) + 1 t) ft (as referred to site plan benchmark) P';"" Y~ P1 Additional design/site considerations re 4 c " " Parent material 1 rr C , c., L. es Ayj g s Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound r1n-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 19 S ❑ U ®S ❑ U 121S ❑ U ❑ S ®U ❑ S ~9 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I I o- Io \fP, 3 13 - SL 1 F6r Mfr (i s aF .s a -a3 -5 Y/ 1.5 0-5 My Cc Vj F -7 , elevund 3 a 3 7, 5 Y R 941 S - S M L - - 9 .ya ft. Depth to limiting factor in. Remarks: o` J Boring # G- 0 0 -10 b `(IQ 31,1 5 L 1 F , r^ r q a F a --k-/0-2Y ,S Q Yly 1.5 0-5 rhvrr, frw 1P , S ~3/ -3 7,S fP, yJb CS 0- rr,l, C F 17 Ground 7 33--)7,5 Y 5 `j O_~5 t,.►~ elev. r 7.&O-ft. Depth to limiting factor 1r% in. Remarks: h ¢n, ' CST Name (Please Print) Si nature Telephone No. S. S+0'Y' 72 IS - -249-355 Address Date CST Number a•l ~Do*~ 5-~, Star e', e 9 7 y D SYa:1-b ~ a SOIL DESCRIPTION REPORT of J C" Page OWNER PROPERTY PARCEL LD.# Horizon Depth Dominant Color Mottles Structure 2 Boring # Texture Consistence Boundary Roots Gep/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench SL 1 F~ M Fr q s a . . s 3 o-4 ! 3/p, ,i 1-I 7.5(Pq )-5 0-5 c, M~ fr Gw Ground 3 I (o- 1, rJ RV( C S CV-) ~ U~ • 7, . 8 9 elev. ft. I W10 -7, S Y s~~n IM l- ~ ~ .7 ' .8 Depth to limiting f ctor Din. Remarks: a Boring # 5 0-4 5 L FGr rnF, 5 can • y 9-16 7.SKR Y/ 1.5 b-5 Mvfr CW F J 4-al R 1 c o- s m L c w 1 V F ,7 Ground 1-~D 5 'S L- O - 5 1^11.. ele ' `l8, of ft. Depth to limiting factor in. Remarks: r Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ! b t ye 3/ 5L- I F 6 F AS a F 5 q- -7.5 yf, - L-5 CA F r e w~ $ 3 .,a P,y C5 b- Sq M- G~ V 7 g Ground -90 7-5 Y 5/16 j 5 Yn I.. elev. Depth to limiting fa,gf_or min. Remarks: n Boring # Ground elev. tt. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) j i' II ill tj, i-T e lv~ lit ~ i I jTl ~I - - - - j - - - - - : I I I I o► pr x: q,-k ' I i ~ I ~ I ~ i I I I I I I I i ~ i i j 'I I ' I I I l i ~ ~ I I I I i i I I I I I I I I I I ! I i I - + E ' I iov) } fi - i I ` I I~ -~--r-; ,---';=fir ~ --t-t--. b - -_t 119 t y1_ I I I F►r ,It„ i -J----r-- L ` Ors : i ~~c ~ ~e.v~ta fo••-~ 7- ~ T ' I 1 I I j - - - 1 , e CERTIFIED SURVEY MAP of dated in part of the Southwest Quarter of the Northeast Quarter and part of the Northwest Quarter the Southeast Quarter of Section 21, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Prepared for and at the request of: NORTH OUARTER CORNER OWNER: SEC. 21-31-18 Roger L. and Nancy P. Olson (F)VD 1-114" RESAR) 2061 County Road C Somerset, WI 54025 / UNPLATTED LANDS OF OWNER Somerset, / ~etNOe+N / , WEST' LINE OF THE G 0 /VS °r°e l N ~NE 114 OF S£C. 21 124 3 C, _ RONALD F. I cr I G~~ JOHNSON s-1IBF AVERY' WIS. J' G , V) LINE TABLE B LINE DIRECTION DISTANCE 9y~~y ~0 A~ L1 S 43'00'03 E 45.00' Np SU R~~~ o~ G % / `S0 00 L2 S 43.00'03 E 30.00' °0°e6Qp~a~,~e'~e /6o D b~ L3 N 00'42'24' E 57.64' © ; F ATTED / I II 32 616,0 UNPL- - LANDS OF OWNER 1 / I o `I W SOUTH LINE OF THE NE 114 NORTH LINE OF THE SW NOTE: AN ALUMINUM I TOTAL AREA TO RIVE R; I 124,915 ESO. S FT. w w MONUMENT WAS FOUND 6 2.87 S01.40'09"W 4.78' FROM ACRES THE LEGAL CENTER OF SECTION. I W I I W AREA EXCLUDING R.O.W.• z C LO LO c cLL) I Z ,I I $ O 108,273 SQ. FT. to to o ,x I tWi rn I 2.49 ACRES z z c N ~j N 3 C AREA TO MEANDER LINE., of W I 'r? It 112,147 SQ. FT. ~ w w cly N 3 2.57 ACRES Z~ c o V) I U I li I `j ,a Q rn N o) O I O ~'y~~ KI ~ a<? N I $ ~ ~o 0.0 b P) a- 5 04 V 7 o ZI W LO o i I UNPLATTED - - LANDS - OF OWNER z z ~I , Ea° a 3 z V 'E U D "E a S89' 17'36" E y vi ,,m NO TH O N I I >131.58' N o c c 2 ♦ I I/ / 1e BENCHMARK.- V 0 0 a v Q, 3 ; g / I h^ kti ASSUMED ~ ° 5 .G 0 ~ ~ , ~ rn \ ~~~~yydS TOP I. P. 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Olson (f-ND 1-114" REBAR) 2061 County Road C / UNPLATTED LANDS OF OWNER 6 Somerset, WI 5544025 / in - - - - - - - - - - - - f ~ Gay . / M WEST LINE OF THE FILED N ~NE 114 OF SEC. 21 ` 8 MAR 2 6 1997 KATHLEEN H. WALSH 2 3 Register of Deeds 1 I O f d !a L F i N I OE SL Croix Co., Wl N LINE TABLE Cn WIS B LINE DIRECTION DISTANCE ~Q \ . js'-~ L1 S 43.00'03 E 45.00' ~~"►,.9 D r / Ll SO p0, L2 S 43.00'03" E 30.00' g, SUS GD O. O L3 N 00'42'24" E 57.64' F 9& S16- UNPLAT- LANDS OF OWNER 01- ;p SOUTH LINE OF THE NE 114 I NORTH LINE OF THE SW 114 TOTAL AREA TO RIVER: NOTE: AN ALUMINUM 124,915 SQ. FT. w w MONUMENT WAS FOUND 66 1 2.87 ACRES S01.40'09"W 4.78' FROM (n LO LO THE LEGAL CENTER OF AREA EXCLUDING R.O.W.: Zu-) Ln SECTION. I ~v I I co 3 0 o I Z I I o p 108,273 SQ. FT. LO av _ I I 00 2.49 ACRES m r I 3 AREA TO MEANDER LINE: z z ° v of Li I 04 LO 112,147 SQ. FT. W w w D o s gl wi w i 04 0 2.57 ACRES N UN OI e} eN I O LO O Q) Q) ~ I u7 N I N ° Ln 0 L) o a-I ~ ON b I UNPLATTED LANDS OF OWNER z z 3 o o E u° ~I o i - - E a) ° <r Z 3 z o~ S89' 17'36" E E a `C = p cv I , ,131.58' y~ Ln o o NO M C'j + m o BENCHAIARK.• v o to N N w 1 = g 1, I h^ ~R• ASSUMED a ° o o = ° 3 1 \ Cry TOP P. rQ w 3 a o0~ N o EL = 100.00 o w o WZ I LOT 1 o~U-)o -E Zo C) in 0 10- LI: Ln X: 3'0 c° ° °w z w 11gIZ! 0•/?O~ / J z Q L p O° a) 0 M U u N (n C cn u, U-0 o v I I C~v y` J O~P1 O~o~ a ° vo a r7 S ~90~y 0z U-) OO o~ ° ~z~ rw I w o O O a o a~ O ° C` I r ) .y~~ P5Q,6h q+tls5d =UW J CCo s V o~ awa w I i bj~/ ~ 1 m ° ; N < BENCHMG4RK. L o = n TOP 1. P. vci ~v PROVED 0 3- o wz= o EL = 83.30 \ Q ~d~(oo Z° a) N CO J 3 ° p, CO STc-l ao 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 %e Location of property 1/4 rye 1/4, Section ,T_';?~ N-R / W Township u v Mailing address ~2CQ /~/1c~C er5~ • S add- S Address of site DS J2~/ C Subdivision name CS VW- I/ 3O~ Lot no. Other homes on property? Yes , No Previous owner of property Total size of property S 7~ Total size of parcel O? ,S ~-c r r s Date parcel was created Are all corners and lot lines identifiable? Yes No Is this propert'ly being developed for (spec house) ? Yes _,No Volume , and Page Number lyQ 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 Jo 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. nature of Applicant Co-Applic t Date f Signatur<- Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER G^ -C`^ Z MAILING ADDRESS ze- PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION ,f 1/4, 1/4, Section,--/ T__2/ _N-R l W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION r LOT NUMBER CERTIFIEDSURVEYMAPSSP7o,VOLUME~LPAGE35U LOTNUMBER r 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 expi ion date. SIGNED: / DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 y _ "I L 1, (..::i".~. •J ~I DOCUMENT NO. WARRANTY DEED Y] %T1,car tctuON lIN--1(W\1 I 11M SPA(t Fit A RVI n FUR IM ORM.-iG DATA II ;a ' '.J it I i I , ~ IIS INDENTURE, Nhd this ~II 7 I lt 0 July ~I A. D_ 1,6(' I I ii a ✓c~,, ~ nr', Ru~h C)ison, husb and :d ~ i t> I r~~ I I-C, th, to 11i.ui .:nil RCF_ er L. 01con ,ind if ~11C;y~ P. (1I -oii, husband and wife as joint, t ,,,n:mt. - - - ( h II Part 1F'Sot thosecoml part' RETURN TO ~j W i t 11 c S 5 e t 11, '11,at the ,aid It-I i C,.; of tlu• it, 1 I:.u1, t:,r : Id in t wl'idh r.iii'm ' of the punt of Fifteen Thcusand- ,(A0.00) nollars - con ic„e,l.111'Iu-Lnowl,cL~c,I,h.,VE' L't%,n_,ruit~•cl,b'irt;nin,1'-I,I,r,iii:,I,nl.r-i~l,ali,n,il,~"u~.-c. do - give, } rant, ir.i ill, ,-t II, rrtni,t-, I,'I„-, ,.,lien, ,:nil :,a,t„ liI imt., Ihr -Id 1 ❑rt 1 G n . ,,n:,l I:,u Gilt~.i 3i~ i. .....1 n, Forever, the folloming (1, rib,,l real e,lalc ,itu,,Icd in th, C ,im(% i I %t. Croix n,l Si t ,t a: ,a The Southwe~ 3t (_luarter• of the lior•theast ~)uarter of the Northwest quarter of the Southeast quarter M'lti of SE'4~; the North Half of the Southeast quarter of the Northeast quarter (NP of SE4 of NE4) and the Vest Half of the South Half of the Southeast Quarter of Northeast Quarter (WL of Ste. of Ss4of;JF41) all in Section Twenty-one (21) Township Thirty_one (31) North ul-Ball,:," Eirrhteen (18) best, except--- r~ " 1 Uti 1C:I U.I f~AU) IAA d(1 II~.i.S U I:I(1 A NVNTIV AA c)n 1 [ [s e. _ ull,a saa)n[uY 'cYC )v¢~y aq) jo un- oq) w nl) I-111--do m 1 .)ill sd 61s p p1 aeeq 11-1papYOia~ aq of e)[taum ~)eu! Ills lmp ti pl+onl slot[ )ti s f 71 [asT t~ I) 30 CI) IS (9 col) S> I LIT7,uooomj `puouiuozg MaN Ol6T` n . 1 zzdXa 1Y f-miogq% ls~Ij JnH 'M tldasor ~t~ I,~llu.tp ~u~iun~l~n `nIJ, i ~ ~ "1tl3S I~ ~I - Anvix . - u"2 "'Pil ,Iji (lilt: III'min.17.11t 11:e<_t-ld.)III atl ill (t.Atowl Sul of I n uL LIO`~_ lr3/1:~ )•tutt:u l.\oc l'Ot l c33V.9 PU pUI'qSnq <LI05T0 t~~ ~fi P TO t I I 69 ATnr - pn .Crp T41 oult_l dpruos~~,l xzo.z~ •~S `NISNOJSIAk Ao '-I1.V.LS _ i n.l l uojailor auc-- uosTp ugn~i I I-''os'TO "I r- anzl?H r. AO ~IJti;'1~:321d NI Q"I'IV;9S (INV (I1M)IS ~r (o b l "t l A "Y ATn fit, .<t•l/ yl I, , pnu inn i`Z~Ct i l is olnn.ti`'y O~..ril In°tl l iil ,nil L. L~~iYi I n nil ui.nt1.11 ss~uaL11 ~lI (IV' I:I~IU tl\\' LN\ 21 `I\-A\ Ill%t ~~t{~ ~I"'''t'tyl jwd vu , -lo opip ~,qt ~uuuult A~~n;w l ~n ~r_nl in un~1.1I .<mna Iwr Ile )111111.1 n,a_.a inn' L~rr T411 t.n,l 1, 11, .'[I) s0 Intl I p." )ill lu nn!:.t~: nl .tpiran'.ul pit- t.nil1) .,(1 (1i ~,1 ~_1111.)1,[ pautt." w(l a.voyc .ttll tell) Ilue 04/14/97 08:28 $715 248 7185 S&S COATING 1j001 C 410)11 W' 4 In uit a pmpIY6 10 . O S ~ OJV Pf ' S i s~ apl~l cil kg Soon mei- l ~ a7SIG, Say/ -01 8 o w 64, N m ti 1 o Chi ~ p ~ I 1 it 1 I _ le ~h►s y . - <:3r~ mob` xot\ L aJ` S 0A bu'l vlj Is" m elk, < 10 clq C o \ 60 NIS Ci r A Oki t~ u . 7t ~ J L Az T-V rr~Ut ~l 04123/1997 15:48 1073217152462230 -rite t All W. a. ~J~•t°P~r~ Corner ~ ~ ~ ~1kGfQf1(~SfS 4 Ls 10 CRo~lo~1 Pl~~ Rog or - N&..ncy Dk6n lr,f`... ~6 G ~ ab 41 Cil YN~SSes Cr ae 5o w►~rsef W ; SUa, 0 4 1 A t rid.' aw'' r got all rrw- A" o ! J l Ml r~ ~-ZTY :;;eo r• ~~o loe