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HomeMy WebLinkAbout020-1009-40-100 y o 3 C) o p e» r: y a ~ ~ I ~ I r~ o I 0 N 0 v 0 ti U Q C ~ I s v ° I ~ z 3 ~ LL C O d v ~ _ Z y rn W O I Z d d o04 am F- U) 0 c O o Q co F- P Z c E 'o .O 0 m Q) ca _~V N C O N U) C U • AJ CL O C c O U O o d Z H Z o z N N N C N C NI d N O N A N m O 'O W d R w O C co 00 T) m d O 0 O Y O o 0 0 d E U c ° ° H E mM> =333 ~ a O O O •rNV ~ o a a a *a a Ir 3 O N~ CD O V! I }}yy tlJ W U U) m rn v a) i-a } a rn o a U) CN ~ N E _ O C 7 m d m NP 4) O m o m d cJ.) a C U U) y N C O_ O 15 ` E ~.r O O C N > O N O O L" O n Q O N C C 0. 0 0 0 y Tyr ,t CJ U Y Y "O N N N O) Cl) C C C N In \ In O~Ll m C 00 N N m r O O `n N • N 3 O G N N co > N O CUn O d t0 a at d L a CL c E c c o r~ o w 3 o A u a 0 0 V 01 STC - 104 NO AS BUILT SANITARY SYSTEM REPORT j/' tD 4 `V OWNER ADDRESS /d S~ of ~f g J £ SUBDIVISION / CSM# LOT SECTION__/~2_T2j' N-R_Zf W, Town ofi cavil ST. CROIX COUNTY, WISCONSIN PLAN VIEW Q~ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ ~~~Ylt~f r o- µy4„ - - - - -C r f =s v 5 fL rn s' 5&' dP INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f Aq F . / . AV BENCHIrI~RK • /v!{J Z, rv~~v /av~ ALTERNATE M : SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~-je Ee C e Liquid Capacity: Setback from: Well House 1-71, Other Pump: Manufacturer 41,n Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S ` Length SB' Number of trenches 72'- s & Direction to nearest prop, line: Setback from: well: House Other ELEVATIONS Building Sewer /,Ld3 ST Inlet: / / lO''-~ ST outlet: /la>>, PC inlet N PC bottom 414 Pump Off Header/Manifold >2 5~, r Bottom of system 9ii Z9 Existing Grade /6Z. F3 Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER : A Ae f i -)-'7-4( INSPECTOR: yi, 3/93:jt ' Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sa n ita ry Perm it No.: GENERAL INFORMATION 268658 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: VIEREGGE, EVAN HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600364 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic /V Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet b0.65- TANK SETBACK INFORMATION St/Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/Man. a 17' Aeration NA Dist. Pipe x•60, x/'9.59 Holding Bot. System ~o y y• aS ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. I f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION Type O CHAMBER ~-let.J Model Number: System: j 3 02 rJ J A- OR UNIT DISTRIBUTION SYSTEM Header /Manifold Manifold Distribution Pipe(s) lx-- SOIL Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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: HUDSON.10.29.19W, SE, SE, LOT 3, BURKHARDT STATION, SCOTT RD ~IJrF.,f.'zJ q," l ,Cirz a rc ~t r~ F"' N l~ /lam 6-h.~.e 6-1 Plan revision required? ❑ Yes 2"'No Use other side for additional information. 9 SBD-6710(R 05/91) Date ns sSignature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: , i _ Safety and Buildings Division v^•~`°~}■'R SANITARY PERMIT APPLICATION Bureau of Building Water System, t~ 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 orbl than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number a&Q/0 s9 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 Name61L." Property Location £ 114S'4' 1/4, S /D T N, R (mot 'Qor I a:; Prope y Owner's Mai Ii Ad Lot Number Block Nu r City, eta e Zip C cle Phone Num r Subdivi on Name or CSM Number ( Lc do/Gy a II. TYPE F BUILDING: (check one) ❑ State Owned Lo !ty Nearest Road illage E] Public 1 or 2 Family Dwelling - No. of bedrooms 3 wn of 50.17 S III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) r7 - p - lDd 1 E] Apartment/ Condo a 24E - /D0 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. pNew 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 1 1Seepage 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 o (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (MinAnch) Elevation .411.1 b $ ov, 3 Feet /4Z,93 Feet TANK Ca acit VII. in Total # of Prefab. Site Fiber- Exper INFORMATION gallons Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank or Holding Tank >6 &/449A r el ❑ ❑ ❑ ❑ ❑ 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' Name: (Print Plumber' Signature: (No St ps) MP/MPRSW No.: Business Phone Number: 13 Plumber' Address (Street, City, tate, Zip Code): , IX. COUNTY / DEPARTMENT USE ONLY gnature (No Stamps) i ❑ Disapproved Sa nary Permit Fee (Includes Groundwater MIL P<Approved F1 Owner Given Initial surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: original to county, one copy To: Safety & Ruildings 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 lice ised pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage systern, 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 num _er(s) of where the system is to be installed- 11 - Type of building being served. Check only one and complete # of bedrooms if 1 er 2 Family Dv,elling. 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: rE-iconnection, 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 VII. Tank information. Fill in the capacity of every new/or existing tank, list the tota' (gallons, n( m,)- - of tanks and manufacturer's name, indicate prefab or side constructel and tank material- Complete fo'-.1// )tic, p(..mp/siphon and holding tanks for this systern- Check experimental approval only if tanks re(- , 14 experiment roduct approval from DILHR. VIII. P,esponsibiIity statement- Installing plumber is to fill in name, license nUrnher w:i 1 z!pproprlat , arefix (e. g. MP, etc address and uhone number. PI urnber must Ccn application form. X County / Depar, rrient Use Only. X_ ~cunty i Departmer, Use Only. a ht y 'e pla -is must septic v e. p art,p 0r si{51ior; ross section jj! rm"3tlOr1 GROUNDWAT.a? SURCHARGE -110 mc_luded lh--eal,,cm ^isurcharge-,(le"') fora numbe c%t ated p'aC Ic. S whlc l can e ~I `I:_s_ r,rges are used ro ,rc,c t~;, ,,ves, rla -ions o` stan;lar ?s ' Joe TIMM EXCAVATING SHEET NO. OF Z Route 1 Box 192 ~ WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 i' MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE _ g.(.... Y r _ T2 c~`~ • . . 0dl efa..d C( Al well sly' f4 6~ O TZ yX, 2~ f' . . PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-8380 JOB -r V C/ l TIMM EXCAVATING OF 2. SHEET NO. Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 f DATE MPRS #3224 WI MPCA #696 MN CHECKED BY SCALE . ` - 4 < t . Ic - PRODUCT 205-1 ~ Inc.,Groton,Mass, 01471. To Order PHONE TOLL FREE I-800-225-OD DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ' INDUSTRY, DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 (ILHR 83.0911) & Chapter 145) LOCATION: TOWNSHIP/ OT NO.:BLK NO.1SUBDIVISR5N NAM : /PE 1/4 /v jT2y N/R~9E(or)W N~uSV -J 6."t) S-+ -ZosEPlf 3 rau kho1RDT' ST~1r/o.J IrE COUNTY: . MLING ADDRESS: Sf-CPO I( 10A lie W de'AffRp f 6.jj G- 1171S PAVI' IA- Ave •V'E- Sto P)ES, IL(i.vA7 5(;7 USE DATES OBSERVATIONS MADE NO. Sr- MS : AL RI TION: [Residence 3 oR f- I I(/, /f . New ❑Replace /~PRi L 14'15 5/ 1APPI-1 1(_ I ffo RATING: Sa Site suitable for system U- Site unsuitable for system 6(f 5 C I 11 o T S I `v/ C S S U Q STIQA 7.f ONVENTI AL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) DS ❑U El S DU ES DU DS u ❑S ©U Co..~uE•JrfC.JA L - T~2E..IClt~ts If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is In the under s. ILHR 83.09115) (b), indicate: C LA- S S S- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, EXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) s o . B. 7 S$ . /od. 7,y, , / o' s, A Y ' T ~ St/ i, o - -0/e - RED -CS 1 ~ , S T,fiN vEA 5 ? 6-k . p /,0, 31r. Si'I~ ).0' BN- Silo I.o 74'.j j i/3 /.O' IPC-o S y S ' 7:,f ve-A y cs i /0' 1344' 0 8,V 5'// A S ' r1 fAd S'i -/0, B_3 / , 5' If ~ 3 y// e > P. S )eev eS / o ' T~ ti V Fx y cs B. 2. • V 3 > ~ , S ' • ? 5 ' A RS ~~Cail) . ~ 5 • ate . s%/, . S" o e s z , o , f. S T~?ti vE~i+2 ms's B- S" S ' /02 . z8' > . s I - o - r31► s o' , s~ Z v E72 00* , vER e -f B- PERCOLATION TESTS U6 a Y C S STk'nT~t S TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RA MINUTES NUMBER INCHES' AFTERSWELLING INTERVAL-MIN, PERIOD 1 p I PER INCH P- / 3,7' I P. z 71 P. .i P_ P- P 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 percent of land slope. , SYSTEM ELEVATION. ~ D r 9p IVDgTN Lot^ Li.~.` t _ c ~ ~ I t0 0~ / t PT •R ~ ,W B s J~ oa Td Ad of N ~ c h 1 S -x svRvevo~ l t p s Pi f3 ~ G O T /IpON . 4S ~ r 2 ~ ~ i h 4S r /t cif 7704 TN 231/ S x = P~ I~ c SITL-s / may/ ' '4: S v FILLED MAR Z 91991 b- 0 JAMES O'CONNELL 7700 r} ~ pogislar of Docds'::••., / t, SL Croix Co.; WI....' I CERTIFIED SURVEY MAP Located in part of the SE} of the NE{ and part of the SW), of Lite NEI and part of the NWk of the NE-k, all in Section 10, T29N, R19W, Towns of Hudson and St. Joseph, St. Croix County, Wisconsin. LEGEND OWNER 19 Section Corner Monument - Aluminum cap in concrete. Dale Wucbef-rp iria3 1710 Ravilla Ave.. NE • found 3/4t'iron pipe set in concrete. Staples, Mn. `56479 o Set 111 x 24" iron pipe weighing 1.60 LOS/linear foot. nI ->F A- existing fencclinc IV ~Y4p `_j ~ `vrr~ O " ro Water Retention Area ^ . this instrument was drafted by Douglas Zahler r~ i~>' .N!-f 'N31'::;ItY:NAWSPLAIy WO, job no. 90-02 /rN1.1r"_,ft11Y;i fvvrr 0 1 C7 SCALE IN FEET m NE corner Ur ,b 7 Section 10-29-19 ' O s ^ 1 m 300 200 100 0 300 I;e , ~~I rn .r ..r •r1• J tip' V. r O ~..Y Ip N ro -ry j O unplatted lands owned by others un,latted lands owned by others fence' fcntclin 9.5' north I n'+ I 2' cast of Fcncclinc S89°40'0611W north line of the S14, of the NE-4 .1~ ~c 433.01' S090451 1311W 1319.14' sit dine of- tI, NW . •o F, the NE{ v, c 1254J.651 / o o ° v' N N r o 1O ° r ° r -Scott Roa has a 66' right-of-way width C is ° v 1 0° rn 1(n DEDICATED 0 TIIE PUBLIC cn 1ro1 ~ r O, ~ 1 O_I V v r_ io 1 1 N - I-. .1 ci N09°40' 06"E I C, 425.701 l nla r ID ~ i 1 ro 1 r-• r r0 N IV ` V 1 p. U, t0 O m N 1 N _ N O. _ - r o Q fcnceline 12' west C2 424.74' 457.75' f ~~.1~• `\S/L b N09047116"E ° LINE DATA TABLE I G _ ro S09°451 3"W LINE BEARING DISTANCE 55'.45' l e•r N••;• ~b~El corner a - b R89°40'06"C 6.371 ` ;rn a , Section 10-29-19 a - e S0904010611W 426.641 Cl- I~r o/r• j \ a'~ ♦ z, b - c S00°03' 29"E 9.69' i o u~ Marv 'o c - d N0904511311E 59.49' A f - g N89047116"E 33.01! ;r - . 1J 9 '~6..E' MAR z s 1991 JAMES O'CONNELL 467700 FTogislor of Docds•: / i'1. SL Crolx Co.; WI , , CERTIFIED SURVEY MAP J Located in part of the S11 of the NEI and part of the SWI of the NE1 and part of the NWI of the NEI.,* all in Section 10, T29N, R19W, Towns of Hudson and St. Joseph, St. Croix County, Wisconsin. i LEGEND OWNER Q Section Corner Monument - Aluminum cap in concrete. Dale WucbeorrFe++iria~ , 1710 Ravilla Ave.. NE „ Found 3/qiron pipe set in concrete. Staples, Mn. `56479 o Set 1" x 24" iron pipe weighing 1.60 LOS/linear foot. yy -x-x- existing fencelinc N Ci'Pr~lt,!,1i Wat r Re o N J U L J a 1990 a lention Area N this instrument was drafted by Douglas Zahler • GC~•Vfd~7tx~~atid('ldi,!yF%ANtJ;ly1,-, job no. 90-01 o !,n'1r~:.~tlrrr:t„!.r/rv*rTf n• Cy C' I rr o ro i c7 r; NE corner SCALE IN FEET Section 10-29-19 -y, 300 200 100 0 300 rr 1 i n• " cb' I:s L •n r1 41 .r it 0 nr. • k?P N n ' q j/` ro - -1) unplattcd lands owned by others unplattcd lands owned by others I fcncelin 9.5' north OG W north line of the SCI of the NEI m 2' cast of fenccline S89040 111 if hl+ '~c 493.01' i~'b 509045113"W 1319.14' south "line 0F-th. NW . of the Nu{ u, c - - 1770765 / o f N N ' n. 2` to o o r Scott Roa has a 661 right-of-way width f, is no 1.1 It Co 1 0~ 71 c o 1(n 1 ° 1 r. l r m OEDTCATED 0 THE PUOLIC / rn L 1 alv v r_ off. to ~ . i cri n. o N090401 0611E i-' / • / \ / z 1`<1 rt ..V ~l 1 1 rr I:cr ~O N . i°+ia 425.70' r Ib . 1 7.1 N r7 N IC:1 Cj / • O I rs l r v. r l0 9 1 'I l nr r v m ) v 1 N 1 to V f7 / V,f~ " M U 1 ty In 10 O m N Q N O. .fenceline 12' west o~ 424,741 9 y ; / Q• ,n 457. 75' m N89047116111 • re j' LINE DATA TABLE 1 509°45' 3'W , 6 LINE DEARING DISTANCE 55 .1151 no • [1 corner 6.37 N z/ a - e S09°40'06"W 416.64' i ° I' .•7 Section 10-29-19 • 4~Su u~ ~a`,''' b - c S00003'2911[ 9.691 b c - d N0994511311E 59.49' e'' 1 w / f - 9 N0904711611[ 33.01! ;r - 1 " I 1 Q I_nT I Ins_r,nn cn_ ('P_ f9.69 arrncl g HH94~D90'~E8 P Sandra S. Wucher of Hudson, Wisconsin. Wucher and and Zephyr Lane, Known own Gas Scott Road Known T page. 3 OUTSTANDING STATE & FEDEALIENS IN THE JUDGMENTS OR CONSTRUCTION ABOVE COUNTY AGAINST THE CURRENT OWNER(S) NONE RECORDED EASEMENTSt streets as evidenced by easement(s) over, 10 feet adjoining 469138 in Volume SO1, page 4~3' Utility Document No(s)• shown on the and temporary Cul-de-sac easement(s) as 2. Utility recorded plat of Burkhardt Station- easement(s) as shown wer Company . Certified Survey MaP 3. 100 foot wide Nor^t ~~rof States Burkhpoardt Station and on the recerd~~g~l `348. in Volume 8, +h by Surveyor's was decreased to 76•`~ feet in wid (Said easement wa page 67) Affidavit in Volume 1"101, Water retention area over part of Lit 3 of the Certified Survey page `342. Map filed in Volume 8, 86400 in Utility easement (s) av~umentf No(s).13 t Right of way and as evidenced by D Railroad right-of-way 669, page 322. 5 and 6) (As to the Southeasterly 100 feet of Lots 3., over a 35 foot and transmission lthe former easement(s) right-Of-way in . Right of way and parallel to "e Document No. 6 ad in strip North of as ct^e favor of Northern States power Gompanl 36,7724 in 61 + page 09. 135 feet of (As to the Northwesterly 35 feet of the Southeasterly nt(s) over the Lots 3, 5 and 6) North .,09 Township E9, 7. Right of way and transmission line eaSe;ee Range 19 rods of the SE 114 of NE 1!4 of Section .,09 ORT Fain OLD REPUBI CRT Fora HS; elQ►28 F' ale G. Wucher and Sandra S. Wucher Known as Scott Road and Zephyr Lane, Town of Hudson, Wisconsin. Page: 4 in favor of Wisconsin Telephone Company as created in-Document No. in Volume 238, Page 14. 8. Right of way and transmission line easement(s) over the Northwesterly 76.5 feet of the Southeasterly 135 feet of Lots 3, 5 and 6 of the premises in question in favor of Northern States Power Company as created in Document No. 357466 in Volume 595, Page 223 and Document No. 52^2998 in Volume 1101, Page 67. RECORDED DECLARATIONS AND/OR RESTRICTIONS: Restrictions, covenants and conditions as contained in Document No(s). 469138 in Volume 901, Page 493. A violation of the above covenants, conditions or restrictions will not result in a reversion of title. NOTE: INFORMATION REGARDING PENDING SPECIAL ASSESSMENTS, APPURTENANT EASEMENTS AND TITLE DEFECTS, IF ANY, WILL BE DISCLOSED ON A TITLE INSURANCE COMMITMENT, IF ORDERED. PLEASE REFER TO THE ABOVE FILE NUMBER WHEN ORDERING TITLE INSURANCE. } OLD REPUBLIC Nobwol rft Ins~.* war Off Form 3131 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT e St. Croix County A^ h de- v OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location) of septic system) Please obtain from the Planning Dept. CITY/STATE (//~j 6'/ h l'/~ PROPERTY LOCATION 1/4, 5Z 1/4, Section /v T~N-R__Zj_W TOWN OF ~~ev! ST. CROIX COUNTY, WI SUBDIVISION lc r G!?~ if/6!ti LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: - ' DATE:' l St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. I Owner of property 1 Location of property S ~ 1/4 Se- Section. Id T 2r'N-R-W Township n,/ Mailing address Address of site ~'q sz f j yL " Subdivision name =9~" Lot no. _ Other homes on property? Yes X No Previous owner of property &14 L(/cc~~ei Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? X Yes No Volume and Page Number f1;75 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 th office of the County Register of Deeds as Document No. S~ Za , 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. t , ignatur ppli Co-Applicant Date of Signature Date of Signature l~ STATE BAR OF WISCONSIN FOR _ t- 1982 WARRANTY DE.. vot 1196Po4?5 DOCUMENT NO. 11 REGISTER'S OFFICE - ST. CROIX CO., WI Dale G. Wucher and PaddliorRead This Deed, made between 1996 Sandra S. Wucher, husb4nd and wife AUG 2 2 Grantor, at 2:40 .1 P.M and Vieregge Construction Inc. , a Wisconsin Corporation Register of Deeds Grantee, THIS SPACE RESERVED FOR RECORDING DATA Wltnesseth, That the said Grantor, for a valuable consideration _ NAME AND RETURN,~DDRESS l conveys to Grantee the following described real estate in S • Croix 1 County, State of Wisconsin: HEYWO & C , S.C. Attorneys l; 204 L0 t. P.0. Box 125 ~ H son, 154016 020-1009-40-100 Part of the SE tZ of NE k of Section 10, (Parcel Identification Number) Township 29 North, Range 19 West, St. Croix j County, Wisconsin Described as follows: Lot 3 of the Certified Survey Map filed March 29, 1991 in Volume 8 of Certified Survey Maps, Page 2342 as I~ Document No. 467700. I i, I' i i~ Ili i TRANSFER III O FEE i This - is not homestead property. 6tA (is not) i' Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances except ~I easements, convenants and restriction of record, if any. ii and will warrant and defend the same. 96 August 19 Dated this 22nd day of I I (SEAL)/G~~ (SEAL) Dale G. Wucher i, (SEAL) folo' z C;;7 /LK I?A L4 - (SEAL) Sandra S. Wucher AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day of , 19 Personally came before me this 22nd day of August , 19. 96 the above named