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HomeMy WebLinkAbout161-1092-80-000 v O o~ 3 po I N O to M e pC~ c a a' 0 O C N ~ n III d~ o g _rn 1 a > y d a~ `o o° 1 ~ c o y E y O Z N C LL p a N o 3 x n I v a3i ~ I Z (I! CN co r o V rn V N W a m ~F-Z I O z ) z 4, ~ E II N U) C N C C O a) 0 0 C) • (n L_ {~q tC N d O L. L C> N o 4) Z o O Z m z Z O N 4 ►i U LO CL U 1 !v x _ a d v U ~ O ~ d E 3 ~ ~rnNrn E o U) co ) OI Q. 3 O O O 0 T- CL CL CL a I' r o U Z rn rn o N J U y rn Z oo c p C co O co O O 7 N y f0 a l0 m y 'O U) N CO m .6 d Q } (n f6 U) 04 N ' m ~l Ca 7 N ~Y O O = N Y! C O O C O m 7 p co E a N p L y C y U d p p 0. C -0 C C-4 r \ p r Z ~ ` C E R N ~y a0 v C N Y ~p c L C! GO b rn rn c°~ ayi !5 Z~ S L co 1••1 r, N f6 O C N f6 E U • ' ~ fn co O Z y Pd U) O ~ L v ~ ~ m •A , ~ a 3 •2li L;a ~1 A ci0. 0 v V STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNERJ_ w ADDRESS oZ ` " SUBDIVISION / CSM# LOT # SECTION 3 T o? . N-R~W, °f ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .sr sc ~1 INDICATE NOR A I^1 -S~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ 9 ~ ~o ~ g~q,9 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PE RM IT) Sanitary Permit No.: GENERAL INFORMATION 284306 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SALONEK, THOMAS H. N. HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 'a 161-1092-80-000 TANK INFORMATION ELEVATION DATA Flo ~%5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark d . Dosing J2 9,~2, Aeration Bldg. Sewer Holding St/ V 12, Inlet A2% TANK SETBACK INFORMATION St/ 0 Outlet 2.0?, $9, ' vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header d!LZ , 33 /3 O C Aeration NA Dist. Pipe o 1~ ' Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Numer: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: N. HUDSON.13.29.20,NE,SW STATION LANE LOT 8 r y 7 l y v ~2. ~""_~'}'Y~lC ~t "1 _ 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: r Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems ` 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 Count than 81/2 x 11 inches in size."" C~ • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency Y Y programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Ow er Name Property Location S . SOAone-411 (V E 1/4S W 1/4, S 13 T a9 , N, R O#or) W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number E N i d ( > -t . C.co ; Zko t,o II. 17PE F BUILDING: (check one) ❑ State Owned !t( Nearest Road II 01Ak Public 1 or 2 Famil Dwelling - No. of bedrooms To wn OF LAS 0~'1 s'Y`~fio+~ zaW III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. RNew 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System ---------Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11'nSeepage 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 foDO 1 "-s Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 7 Tr, 7 Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- plastic Exper. Gallons Tanks Concrete Con- Steel lass ANew Existing- strutted g pp Tanks Tanks Septic Tank or Holding Tank ~eZ54 ` W Q ^ 19 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ F] _l--/-+ I I 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 Sig at e: (No Stamps) MP/MPRSW No.: Business Phone Number: its 715 51 Plumber's Address (Street, City, State, Zip Code): Iqj,cj IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) A roved rJ[/ Surcharge Fee) pp ❑ Owner Given Initial rY~~1S Adverse Determination 74 7 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Div, 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; Q 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; Q 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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Harsh f}ay Of $re1M}te Cev..l... over PP lps I Yln• 2• AOOreg'ole OIi1r10~lion Pipe e o o - Toe i B• Aggregate Beneoth Pipe a Perloraled Pipe 0e1" ° Cap,nl Terminating At Bollom Of Syitem • a ~ V,) J son .SOIL FILL DISTRIBUTIOFJ PIPE APPROVED S~WPETIC COVE 2" A~GRf:GAT~ -fir c~ ' • , -•~._MAT~RIJ~t- OR 9" OF STRAW OR tjARSU HAy. p E ELEV. OF ~DIFMT_e„'s`bp at/tAGGKCGAT 3 { DI•S-rRIgIJTIOM PIPE TO INC AT LEAST lU'CHES BELOW ORIGINAL GRADE AUU AT LCASTtO INCHES •BUT~1.10 MORE THAN 42 INCHES BELOW FINAL GRADE MX'MUM DSPN OF ExCAVAT100 Rom .ORI&NA-. 69AD> WILL BAC-2 INCHES r11KIMUM BEPTl{ 4'F EXCAVATION fROf11, t tf,IWAL CjRgDF- WILL BE INCHES SIGWCO: LIC-OUSE NUMBER: A DATE: _ l ` ac~.v6~-S£lifE72 ~tiv~K G,4,PSo,v DEPARTRXNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INpUSTRY, DIVISION LABOR AND HUMAN RELATIONS 19 1 PERCOLATION TESTS (115) P.O. BOX 7969 (ILHR 83.09(1) & Chapter 145) MADISON, WI 53707 LOCATION: SECTION: 'TOW NSHIP/MatoerHAUTY: OT NO.:BLK. NO.: SUBDIVISION NAME: sw 4 13 /T4 N/R10E (or) W f/vDSo sr ~/Po/x siyrr.o t~ COUNTY:' eOVER S MAILING ADDRESS: S~ D of K SE,vv ,'/l°06 /P 6/St~ti e/o 7 o G / f ST USE Z S DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESRIPTION: ? y+ A IResidence 40 KNew ❑Replace 2Q_ /Sill ay L~_ W J !7 ,r,,if R ~ - / 9 I / RATING: S= Site suitable for system U- Site unsuitable for system 36 CONVENTIONAL: L I MOUND: JINZROOND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) ®S ❑U 29S ❑U ©S ❑U ❑ S EU ❑ S K7U ~oNVs✓v?~w~~- 7,~E~c~f w/ a o ~sr ~ v .o.~ If Percolation Tests are NOT required DESIGN RATE: * If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: G f% S S Floodplain, indicate Floodplain elevation: 6vO4,Z vLD.az/~ti1J - ov e PROFILE DESCRIPTIONS SC$ S~ BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3v- 3 0-#- 131'e, yR s/i 5- 04" s , ~ e ~ w • 5'-i8' r3... ~o '0 7 8-/ 72 Pu00cEI~ ~w~ /~-3 /O ~i? 3/4 '/S~o'».s Y2 r,&f' S y4 S/ /Ufsb►++f c5 ~ flf hofs o /0 pe J/q S~ onw s m, l c S S a - 7 z S- "4/G s~•/ B- 3 n~ S 6 k nv~ v C w i !7- tin 2 A o1Q -G y. I.1 o t S D > w-5 B- Z /0 r7 /08 /fs~/,y28"S Fs Sib Y~ %/4 'Cs- Sg ym,t3~ .3 - 716 yd A-, qD, Sy h~ > 9G Z~-vTi'c~L To ~d.~f L - SEA ~o~E it A Cg,/ p937. !y' ~ G .?Df-e~Tic~c To oR.t S~ oaF B- / ! / • 0-11 /D y/t 3/3 S/ 0'm /P n., cw/ 1/"- li ` /DPf am 6.P C Y w / %"_r6' /o y'( f%Cr pw'. B- 9Lt `l, b? lr y ~f ~h /°Y/' 313 If o^ j r~'iA ~ /o'Yf ¢ , M„~, cw - /rlo /o R 400G f57 O f S 0.11E w 61 PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DPOP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -pERIOE) t PERIOD PER INCH P- / Z 2% 2 i P_ C, P- ,~3 P- P. LP- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and pei.ant of land slope. Lb GvE 7-IVE,u eA~ = 0 ti ' SYSTEM ELEVATION. /T _ -..7 .q_.. ..J . ^ T o - 'e >L '0 it v, I-V 10 s I i w _ I rv~/~~SI~ a'd~ud I ddb x~ al Q' i CIA FIZ -4 w klA W ~ X N N ~ N a Ju J b Wirt ~ ~ ~h lu o _ n ~J P " 1 /4 0 F 7 SW OF SECTION- 12 ACID IK*4 OF SECTION 13, T 29 N , R 20W' !.~4. VILLAGE UNPLATTEJ IAA;. 57 14 18931 PLAT OF NOPTbi ENO -I 16 9. 5 4' Fig l 53396'_ - - - - - - = ~e s I • - - -4 ~ ► 9.0 7 199.74' I52.5 ~'p~ 239 05 352.27' p1• 66% 739.26 `r.9• 199.7 7' rJro 11 , ~ ~ 7 fVR`5 p6+. 1.06 AC RE S6,' 10 _N r` ° j 152 ACS' S N76•~9E `,i / E 01 'x:70 0 l'i i~ °4 'l 4- l' CFHTEp y~ ~ 9 20• LIN o, / / ~41 1 \ _ 16.7.53'4 d' OPaIN E OF ?4 ~i r o1'Oiy, 4~E f43E40C ~ ,r " 117 ACRES c'' ~ . q 15: 6 6 - r :y 3s' aal: c• Z r b 1.18 ACrrESO o o° b 30 ` 10 1.56 ACRES f Il'iv I 7,k Q v t 2r5.2~' ~ ~ ~F~u m"Ji • rJ ~v ~N 5 5 6' 1 w• q; 29 0 31 1 ' 12 5°id'3;Y _ O V) CD y Z 1'~., 6 ACRES 1 \ '.n 1.34 ACRES CM .G I ti 32 , 1.03 ACRcs • 1 5 82.OJs °rr•C'"E ►!._4.~• 2Sz' SQ• 31.11' , 2 62. 220.00' . -00 Sl 28 C"i 1 1.01 A\RES\ o prol o _ o \ \ 27 o 0 26 N ~Iw'o Z 1.01 ACRES - N 1.01 ACRES o a 1 N n cli lb e` 19 5.0 0' 220.00' i° - e ST. CROIX COUNTY WISCONSIN - ZONING OFFICE M n p _ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 _ (715) 386-4680 April 26, 1995 First Federal Savings Bank 201 South Second St. Hudson, WI 54016 Attn: Darlene Sorenson RE: Jenny & Roger Olson soil evaluation Location: Lot 8 St. Croix Station, NEkSWk, Sec. 13, Town of Hudson, St. Croix County, Wisconsin Dear Ms. Sorenson: The above referenced soil report was completed by Bob Ulbricht on March 30, 1991. I have reviewed the original which is on file in our office. I feel that the information contained within the report is acceptable so long as the physical location of the soil pits can be recreated. This would require that the original horizontal and vertical reference points still be present at the site. If you have any questions or concerns which I can address for you, please contact me at the Zoning office between the hours of 8:00 through 5:00pm, Monday through Friday. Sincerely, mes K. Thompson Assistant Zoning Administrator cc: file 0.9I' r B• = 4CgES * TQ,~Y (W 01, 74. c r 100.00' 4 So+C ,QYrt"M l+e.lEQ 04 b g r s w _ - G O - $,S, 'o t Nf CD Op' p 4q'F +o tic SE 1.01 20 oor,", 4s _-4 0 (4 7 • iu u'~ mw ^ Wm ul m , .w 33'I qO 00, O • cu U ODA D [r T! • •y COO U N O V 0 N N V 101 h._E• ` W U II °.I J' CD .0 0. A) (A L. A A IOW N N - •Ip• in L' 0 v tr O, O J lY I I'yl y" M D to m 'J ' t. U V O /'1 p ti l nl m _ X I1 uN u.~ ,I " iI INS m 0 . r m ~ SAG6~~~/B~:V ~i' `:t1,2:`(u.m[•,~i•!;j'`~~''~ " ti,. DN N I° ;o'u ~Xj~.SS r~.. ;`I•• .4 I I p r • I v C A d` c--S `q `/C • ST FT of iWl ~Iv f?f-~T,. 1500., t }9 01 ~ ! rrA~r rr U u _ O~CZ [j - 1 T i N In \ V H / !'o! I S rr inr' N - ♦ ~C y~• r I:_° 0, r 0 _A 'JU N I. 2G'E NP:G• E '{a.1,ha•✓_/,•`" ,.e°~ W _ ni I I < 250.00' rooou' • r.+ ,~~~,-O; r y O _ Ci 71 I au• , In ~vJ i~ - I ' f•1 7 I O y w n is fir/ Y +I~ I I G) _j 0 f L / _ + A N I• 6'E / / , 1_• Jr _ fA CJ 200.00' 0 AD z '41 0 UJ -n ;D p SM I _ goy I + r c 2 I- N Iv I~ vI° 'm^ . Q ~.r y 1 r°r, d' p WoI • 0 A p{ I m I CD I 3) L~ I a cl • a N 1 1 //l - ♦ - y r j•JG:i I 0 O 1 N 1. 2G' E r, 1/ + ~Q rn I .n .y .r.,: 1 O v 1 200-00• •,.R. 1 ,~;t. }1 W N N_ O 11 ! j 0 Dw_.1 _y 14?' 1'30* I Y G N I M ••I{'( 1 fill 1- NI• I! [ 2•r •.~.QQ 29a ?I' n Ti Q - n ,~lu• w 1 is AJ.PQ °4II' f: u' n 1•a [ >'19.t1 • c. [ • 0 W W N U 11 l 4y' I ( r y ' i : + A ( y, I N D N NOW 1, Icf yI~L~ N I•' 6'C 2SS.P0 r. = CI~I Ilf" mIl 0 Z „ - e{•.sv ' +I;,,'~ N I r D m . ."r'e t I 1 I ° m i)I II I•' • N O Z JUU't-••-~ []J~M\ I N I. 2CE W '!l +i I V t O•;0 - 1 200.00' %i ! i~~ w I -I - J all. N 7 Z 1 .14 < N ^O ~ ♦ Y I / 3 E E 1 1 0 p N ° a°1 o w 'r / b I Z 0 0. 1 t 7t•C UY )PL• ' O0\'~.t. UI A n 1' 0 O Z O U •7U' 1 I pV Oa'• ti~ Al ' Q 1' 11 a 'y 9.1' v •U J y' x n m N' I -1 r 1 7: 1. 7`1 In U W ° r yl; •B A A 1~ rl Z A • X O X u IM Q O • ~l, ' J. ~ n V )fI 0 600 • ~ N J, ♦ I I V) y J I Z . N ~y OI [ ° JS l } J'~' JOB ' I u A N JJ I I V_) 19. V" I 25000• 343.43' 693.57' I LIMITS 1 1 S 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 Mi4SLO Nc /e Location of ropert NF 1/4 L u 1/4, Section f ~ ,TQaN-R ~t~W OWILstri-p 1 0S 0 N Mailing address 2~ (o LA---yu"L-7P A/ A-vc . S/V 4ff-a ca4 N &j 5st Z _ Address of s11t/4 M-xgx S Q o t-Amc- AI OSv~c1 .L Subdivision name C,12ZIX 0/-j Lot no. Other homes on property? Yes No Previous owner of property O(.i G" c"7. N Total size of property 1,1 2, AL Total size of parcel l• / c., Date parcel was created ~ / 199J~ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes X No Volume NO and Page Number 7A 7 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 i the of ice of the County Register of Deeds as Document No.jZ~3~1 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. 522 33~/ S gnature of Applicant Co-Applicant Ll-(S--i -7 Date of Sianat>>ra S 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. ownerofproperty Ml~S / S41-ONEg Location of ropert V IC 1/4 Section 1.3 T .;tcl N-R o W -JFmnTsh rIt7ff Mailingaddress 289~o LcK~~c~Ta~/ of sit >y 5 Address 0 N 1-4NC A 4 ~{If 1744 OSox1 ~ -L Subdivision named 1C _5 a ~l Lot no. fs Other homes on property? Yes No Previous owner of property ---ko(.s GZ Y- OL-&O N 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 X No Volume 00 and Page Number 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 fora, by virtue of a warranty deed recorded i the of`~jice of the County Register of Deeds as Document No. ~2,t 3 3 7 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. SZ-33~ ~=lh~crd S gnature of Applicant Co-Applicant Date of Sianaturs- na*~ nf c --•~}•r~ ii d, .11.•97 11:07 '3`7.15 783 9281 1st. I'k:U-1.a.1:111 j11 IQ;UUL II 51~,,dar of Wisconsin turm 2 - j 19,92 WARRANTr' DEED 11 Ili 19P DOCUMENT Nn. 11 1 Ari~'2t7 1 I! /IS ~r ~~j~( I Het~ ~ [ar' ter...., ~J tiger D_ Olson and Jennifer A. Olson, I MAY 199 a - y' - _ - - - at 5 l' conveys and warrants to Lind -Th°~rt- gs H. ~nek.. gad -I`-5alonek hup anu and wife- +i - - T}•,ia yp/SCE ru9GRVCP. Fpp FECC7rIL_'r.hA7n _ ll - - NAME AtiD 9ETURN AW)RESt Y - ~I l ~ - - - I /ell the following describcd rrai estate in CrolX ~I ~I County, state Of Wisconsin., fl I II i (Parcel Identification Number) - ~I I' I~ Lot b, St. Croix Station in the Village of. North Ijudson, St. Croix Count l Wisconsin. yy ,~,`aF I? I lIl 'I I This iS not homestead property, II (is nut) 'j Exception to wurranti f! ~s, Easements, restrictions and rights-of--jay of record, if any, i1 i I Dated this I~ li - 19 4$ fi i - - (SEAL; (SEAL * ~I it D. OI - - ) - Son it - (SEAL) _ il - - eIIf zt6~ - - (SEAL) l I I r A. Olson i I AUTHENTICATION l ACXNOw1.,EDC I~ - M1LNT Signature(s) - STAFF OF WISCONSIN 04/14/97 16:55 FAX 608 785 1685 FIRST FEDERAL 2002/002 VILLAGE OF NORTH HUDSON BOBALANCE DUE W/ LO f 55-i 51 113 1996 .9126 .021862804 T I iner4 Joseph A. Kaluzny Loan Servicing Supanrls&-Ee=w and Vault FiRSr ~EDEWAL 605 State Straot. Le Groan. WI Mm-IM (60) 7644 = (1300 057-4M Ext S43 765.7 665 161_ 098-80 2611 836/24 8 s13/T29/R20 L 45000T 1085.16 13.89.20.732 ST CROIX STATION LOT S VIL T 45000N 983.93 s 101.33 THOMAS H 6 LINDA J NH SALONEK E 49300 2895 LEXINGTON AVE S EAGAN MN 55121 ~-C ;r 13\v*~` e