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HomeMy WebLinkAbout020-1124-50-000 s N o Q c I 3 0 ~ r,. p (fl N II Gi L N o r` 3M on o C,j o -Cx o p E i N L d O.-0 U p 0)4) c O (n c C c Q 0 0 ra N O O N U) -O ~e J U C Z m m c N N 3 0 N L O O N _ O N CO - O C Z N ~ N O 7 ft5 O O o LL O_ w N N 0 III ~ J N Q B CL U M Q Q carom I M ? ~ Z H w E rV (n r pp ,y E i z d d a m r FN- z 0 m c C7 o z d c w .U~~ o N o z m z d rn a) a N H E N Q 7 N N N U) O O •AJ a L U c 0 U 00 Q O Z H Z p N z O E Y N N w o, O d y d O O. m r c Cl) d' O V T, g O o \I N 0 LO El C) U " t4t W M> F F' F U O 3 3 EL 2 o 0 Z C5 .~y N a a a n a g N J V c rn rn }~yy } M 0) `l J o rn Iry y ~ ~ ~a ~ ml d o W d N N ;3? m ) G o p E H c O CO c ° 0 C: O " O o 0 O (O O O O c- '0 N N L Uf F-- N N E N .S 75 c -5 w N c N d' Z r• Or _ O (O `yam' r1 O N Q vii E U ) N r` p U co N O 111VVV O O N O - Cl) O ~ ~ E m I 41 t6 a 3 C. is a • C~ C. d •V N w C N p m C 3 R 0 y c c 7 Parcel 020-1124-50-000 10/01/2007 11:14 AM PAGE 1 OF 1 Alt. Parcel 07.29,19.561B 020 - TOWN OF HUDSON 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 RONALD D & MARY H JOHNSON O - JOHNSON, RONALD D & MARY H 418 KRATTLEY LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 418 KRATTLEY LA SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.107 Plat: 1052-CSM 04-1052 SEC 07 T29N R19W EAGLE RIDGE LOT 2 OF Block/Condo Bldg: LOT 2 LOT 32 OF EAGLE RIDGE, C.S.M. V 4/1052 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/11/2006 834183 EZ-U 07/23/1997 1228/108 WD 07/23/1997 1206/169 WD 07/23/1997 814/119 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.107 69,700 238,800 308,500 NO 05 Totals for 2007: General Property 2.107 69,700 238,800 308,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.107 69,700 210,300 280,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 215 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~'I CL /Y'f l~L L ADDRESS SO/ 0 SUBDIVISION / CSM#~6 L~ /e / ,zj G LOT Z SECTION -2_T ?-7 N-R /y~io s W, Town of ff v &S O A1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7f- ~q S O r //-y-9 6 WF-zz /V07 f/07r cv F G C- -r-'K.5 r' 14 L c. 4E D S coL pads F t~~ x rd 7 h -7 6 Tfe it/NI w, e F k ~0~ E 1, i oo . oo, IND CATE NORTH ARROW Provide setback and elevation information on re rse of this form. Provide 2 dimensions to center of septic tank manhole cover. - ~ I BENCHMARK: To P m F -?/q, etA~42 ©/y ;E #JT- 1O7' 1,/11,6 E/.: O.js~ /arm dv ALTERNATE BM:_ / O P ©C 16e 14 W r S t loeNe! a ~ ~/v✓; R'_ ~ ~ . A 94, S TIC TANRUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: loo® ace_4-, Setback from: Well 7 0 House Other-;? Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length 7 S` Number of trenches Z Distance & Direction to nearest prop. line: ! z~ TO L i4 S 7- Setback from: well: S House yZ Other ~i To 7- ELEVATIONS Building Sewer ST Inlet: ~olS ST outlet: 7.50 PC inlet --PC bottom -Pump Off Header/Manifold Bottom of system_ `2 ~ Z, c- Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 11pw 5 d PSQ~ INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LabBr and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENE L INFORMATION 284164 Per older's Name: ❑ City ❑ Village Town o : State Plan ID No.: M LLISTER, JEROME/SAM MILLER HUDSON CS BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /od , ca /&zi , (cam 6 4~^~ ~I AZI - i a TANK INFORMATION ELEVATION DATA AQAnQA1A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G~a ~qop Benchmark 1 , 35 / la , Dosing ~r J3 ry~ 9S , S/v Aeration Bldg. Sewer 10,3, 63 HoIdirrg 71 St /1wt inlet 7, / 63. TANK SETBACK INFORMATION St /,of Outlet 971 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >25p / NA Dt Bottom Dosing NA Headert.- 20 Aeration NA Dist. Pipe /v19~s 993 ao, / P Holding Bot. System /2- PUMP/ SIPHON INFORMATION Final Grade (o o~' pcf 3o Manufacturer Demand t°,.,o o T #!D~ Q~,SS Model Number GPM TDH Lift Friction System TDH Ft ; Loss mead Forcemain Length Di a. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Widt S Length S " No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS LE anu acturer: SETBACK SYSTEM TO P/Le BLDG WELL LAKE/STREAM INFORMATION Type -07c- eat Y-. ~ MBER Mo a Num er: System: ><rer7c&s OR UNIT DISTRIBUTION SYSTEM Header / ry Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. ~ Length -Z422_ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-G System 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.7.29.19W, SE, LOT 2, KRATTLEY LANE CC/ / ► ~ ~ Ai ~ 'T 1 e%t~ lam' "'G ~G: %~d2' Qllf~/ k4-1 Plan revision required? ❑ Yes [TNo Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 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 County than 8112 x 11 inches in size. • (2,1-01)( • 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 ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D_ Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ,S e_olnE / C/9L-L /.ST~/e ✓ ILL 1/4 g 1/4, 5 7 T Z , N, R/ E (or Pro erty Owner's Mailing Address Lot Number Block Number Coy At, 2- 1 City, State Zip Code Phone Number Subdivision Name or CSM Number goo u ~ a ul l 5- o c.. (3 $C) "z~ ~ 9' ~ ~ j2 r ~ G F C 5M 370 II. TYPE BUILDING: (check one) E] State Owned E] ity Nearest Road ❑ Village U S O N RA471- ZANF Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 It e- 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. `yNew 2. ❑ Replacement 3- ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------`-'-System System Tank Only______________ Existing System _________Exist)ng 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: !o z, 1- Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) qy, q Elevation y Q to 7 9 7, j Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /~~L7 S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam s) MP/MPRSW No.: Business Phone Number: 119/ /c E Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San tary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature tamps) Surcharge Fee) Approved ❑ Owner Given Initial 41~ Z Adverse Determination oCJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety 6 Buildings Division, Owner, Plumber - INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 8 112 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. e pkl1E /v1= ALG i S fAR 1,7,4 LF XAP4 DoT ~ ? Z SySTE~ ~'.419~1.9'i?; - 9~,3 SG. ►1y" `~o " Z-07 Z C s -'~37 nyyc> K ,e Ar rr c y z ffiva 1 n~ 4 ~V L o 7 3 z- ~ ~eT 31 /71 LoT 0 2, t (,yak -4 v led 'io ry v ~ v1 o i ys~ Nr y ~a ~3 3 ALTS M *Jlrt EA io I j I f ' 0 ~ 0 7 vl ~ C9 LXI T =wo g I ~ ~ z I ~ I I t'1 ~ N rtr ~ I a r ~ I I 1vJ ~ ~ ~ I 1 I F- `C 1 v LL. z z T _o Q to f ~~t F .J a U I w ~ ~ I r r ' I o „ v1 I i I• ~ I W a Wisconsin Department of Industry, SOIL AND SITE EVALUATION-REPORT Page i of -i Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05q* A' dm: CQce COUNTY ~ St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in si;e-N"'n must include, but not limited to vertical and horizontal reference point (BM), direction and % of sloe, scale or iARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. s 020-1124-50 VIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATfON ' A PROPERTY OWNER: `PROPERTY L47CATI /a T N,R 19 f(or) W Sam Miller Construction Inc. 16F~11T.17,,S 7 29 PROPERTY OWNERS MAILING ADDRESS e0 S D. NAME OR CSM # box 282 .32 e2 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE SOWN -NEAREST ROAD [x] New Construction Use [x] Residential/ Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate . 5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate ____.5 bed, gpd/ft2_,,f2__trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.4/99.9/99.4/97.3 / ft (as referred to site plan benchmark) Additional design / site considerations trench system Parent material pitted Glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ® S ❑ U MS ❑ U ® S ❑ U ❑ S E U ❑ S CR U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 1. < 1 0-14 10 r3 3 none sil 2 2 14-28 10yr4/4 none sici 2msbk mfr gw 1f .4 .5 Ground 3 28-80 7.5yr4/6 none lfs osg mvfr na na .5 .6 99e1~v. ft. Depth to limiting factor +80" Remarks: Boring # 1 0-9 10 r3 3 none sill -2c-pl mfr QW 2f np i.2 2 9-30 10 r4 4 none sici 2msbk mfr UK if .4 i.5 1:>......-. Ground 3 30-80 7.5 r4 6 none lfs os mvfr n .6 elev. 100.3 ft. Depth to limiting factor +80" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 54017 Address: 1554 200 ve. New ch n W1 84l3 Signature: L~~'r K A- Date: 9-27-96 CST Number. m02298 PROPERTYOWNER Sam Miller nnct JVCyUrL Ur-bUKIN i ivn ricrvn rayc? u 3 PARCEL I.D.# 020-1124-50 Lot #32 Boring # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-10 10 r3/3 none sil 2c 1 mfr 2f n .2 ::fi 3 rK>=`vw none sicl 2msbk mfr crw if .4 .5 2 10-32 10 r4 4 Ground 3 3258 7.5 r4 6 none Ifs os mvfr na .5 .6 elev. U2.-It. 4 58-90 7.5 r4/6 none ms os mvfr na na .7 .8 Depth to limiting factor +90" Remarks: Boring # <:>::<>: 1 0-11 10 r3 3 none m n .2 M 2 11-31 10 r4/4 none sici 2msbk mfr if .4 ':..5 >4 3 31-80 7.5 r4 6 none ifs os mvfr na na .5-::.6 Ground elev. 104.9 ft. Depth to limiting factor +80" Remarks: Boring # 1 0-13 10 r3 3 none sil 2c 1 mfr 2f n .2 "2 13-35 10 r4 4 none sici lcsbk mfr if .2 .3 3 35-80 7.5 r4 6 none lfs os mvfr na na .5 1-6 Ground elev. 105.E Depth to limiting factor _ +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Sam Miller Const. Inc. 1554 200th Ave. CSTM2298 NW4SE4 S7-&29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 T lot #32-Eagle Ridge N 1"=40' BM.= top of 3/4" rebar side lot stake C el. 100' ZS'~ 5 k' 20 9v71 r 70 . 1561 Gary L. Steel 9-27-96 ST. CROIX COUNTY CERTIFIED SURVEY MAP CONSISTING of LOT 32 OF EAGLE RIDGE SUBDIVISION LOCATED IN THE SE-1/4 OF SECTION 7, T. 29 N., R. 19 W., TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN ~~,d+ ! TRQUT _fflRQOA -Mal- SUQD/V/S/O/V EAST-WEST QUARTER LINE OF N. 890 26' 00" E. 290.40' (290.00') SECTION 7 - 29-19 loll F3. , \`L ss., N to . z 0 ~w LOT 33 Z O° to w I~ Z4GC€ `Lp°- CI~ LOT 2 - N P ° I~ 2.107 ACRES 3UB~J/V/S/ON -N - p W h =!,n 0 m 0 Ui _4 00 co w - Q O 0 Q 9 0, c°°o LQ I\ D. y I D. "A N tD. c- IA APR 22191 ~r "a oolloac raw 114 Crok GwAhr;: ~6 so . wbgmo o 00 02, 8:...... 92 120.00' 170.18' s~ W N. 870 49 48" W. w (N. 870 49' 30" W. 290j4') 018' R/W L/NE w w KRATTLEY LANE R/W L/NE APPROVED RESTRICTION: LOT I IS RESTRICTED TO SALE TO THE ADJOINING OWNER. MAR 2 5 1981 ST. CROIX G'), COMPREHENSIVE PARKS FLAs,.AINO LEGEND AND ZONING COMMUTTEE 0 I"X 24" IRON PIPE SET WEIGHING 1.68 LBS./LIN. FT. 0 1" IRON PIPE FOUND ~Si f ) DATA OF RECORD _~~°4'.~~~"` Z50T 90ed r~ aumTOA nR pj 0*5 'NOSM14 L017 VS 9TO 75 uTsuoosmm •uospnH .?uTAan,znS pupa m v s L Ot7T 'ON JOA9AjnS pupa ' ua.9puAN • 0 uaTTV ~pau2TS • UT SUOO sTM ' uospnH q p ' T86T ~'1"frovv O App-'-A-t b-STIJ; P8TJT;JG[) awpS 2UTddpw PUB 2UTAOA,ZnS uT XTOJO •;S jo A;unoO au; jo aOUEUTPJO UOTSTnTpgnS pupa auk. pup 'sa;n;poS paSTAOU UTSUOOSTM 17C•9CZ .zao,dpu0 jo suOTStnoid ;u9jano auq. q;TM paTTdu oo ATTnj anpi( j I-pLt~ s pegT.zosep pure pa~an.zns AaEpunoq joTaeq xa au; JO UOT;P;Uasejda.z ;o9jjoo P ST dpW A9AjnS paT, T;ja0 STq opus •uTSUOOSTM 'A;uno0 xTojo •;S 'uospnH JO uMOy 'M6TH 'N6Zs 'L UOT;oaS JO -7/T SS au; UT pa;poOT 'UOTSTnTpgnS 9OpT8 9T2pq JO ZC ;O'I s SMOTTOi SP Daa T.T7San PT nnti&Ritt 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. 01 Owner of property Sj ,e / f~GLI S7 P I SY01 ~1/t G c~ Location of property 1/4 5E- 1/4, Section T_17 N-R L W Township _ Jp © Mailing address &OX z~ /-~j D -S0 / Sao iy Address of site q t Z ~C e !q 'r` I Y L14 AI E Subdivision name P-: 4 /L E / D <0 4!~ Lot no. i _ Other homes on property? Yes No Previous owner of property Sp N )y To o Total size of property (o ~f A Total size of parcel ? , (I A Date parcel was created 6 / 7 8S) Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? X Yes No Volume V'f and Page Number /l 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. ~f3 8Si L 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. Sigr ure of Applicant op~p l icant A0 ZI Date of Signal-ure Late of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J-,-- © MIF- 5 T~ S N Yn 07 j L try MAILING ADDRESS /38X` z ~ Z- PROPERTY ADDRESS L+ (5 tC 9,4 TC L14 I (location of septic system) Please obtain from the Planning Dept. CITY/STATE J CJ 5 O N U-) ( 5- 4/0 PROPERTY LOCATION 1/4, r 1/4, Section:, T ~ ~N-R TOWN OF V S rCl , ST. CROIX COUNTY, WI SUBDIVISION A 9 L.. ! Go + LOT NUMBER Z CERTIFIED SURVEY MAP3 ~ I714 VOLUME_'~, PAGE on , LOT NUMBER .Z 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: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . AI u qG 7 i 5f This r la_- JQ3in Sc~do - - ✓ sr Mr..AI~.~ st eJ.' JIM 3 7 E%-me- W.-.McAIM ,ter h'a~ laxci..alad..~tiz_e .as---survIvorz-hIp...rcar;t_tal i 03 10.3 !I! AM rorfer vy a . - a~~, ''s^•=3.~C Wit Ct±' 1ha` th, g.l~. GY ,>rg~, fc,i d vH?ll _!e Lonst4e-r mt.o`l Ilk ,st ~S~ Jok1n...T , ..S t.Qd of a a tcl__.Tirirc i ~t_..C ...St.ad ola 11:°7-JR-v TO ' 4 - t Sr Cr-o-.x. I i cor,v is to Gri stz ti -,.e :a7'?c iYt3 1 . arib.i r: al eAts.e ;n , y County, Stare of Wdaroa3r4. ~I Lots 32 and 33, Fagle Ridge in the Town of T%-Pa-:. No Hudson, St. Croix County, Wisconsin. ~I t , ~ Y c M rv>.t ji Thls __.__.._i-5-------------- honlc3°'" A property. (Is) (is Pot) witl, a'l and at* y the he.~';ta,nfnty and app t.ter;ance.= th , a t'.o belonging, AnJ --._.,7ohr.~ C. Stodola . and free and clear of eneumbrances excYpt ~I warr~,n", Lh~; the titles Is gae.a In~?e,*.asib.,,l e in fee simple ara easerr?nts, restrictions and rights--of-way of record, if any. I~ atad will wbraa.,t a-A de'~rad tP Y a7 ii Dated~Yhi- - - of - .Jur>e- ;I ` ----J^-,> -,...Stcu, 2.-- ' ---Nucci-a C..-Stodola I . --(5F ,1. ,j - - - F.A D ~C OF Y s5- r0 x c i q J.t me. . . - • 19',? 9.... th5^ s! ^ :rte r;,.a ' JOhX?..~ ---Sto.dola- -a. Or Yla. ica--C,. . (If not, . - 8i3. ti•t' l79 ~ I?c ~?v, 1<*u. 5Lo n,v ! .~,x-n to ha tnv ru .<,+.S._-_ Rti!O Ytt{l