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HomeMy WebLinkAbout020-1161-90-025 (14) J Q o a-°i ° r--> er~j c o o o :2 N °Oa ~j O N N C Cn fp O m t ~ N U d. ~ C A I CU ~ y m U) 0 CL 9 Z O O C C . C N O LL c 0 a O n O 3 I Q Z N (D U Cl) CD Z I/! O Cl) 4i 0 Z a m N F- C%j fq i O O Z a c v ~ r I ~ 16 N H O Z c 0 (D Ch C C 13 N N CD Cy C O C C Y O c W_- O Z F- Z) O p Z Q y c > j G G a a y co x U) U) U) E T) L IN U i 0 if R oaaa cN to co y W J U rn rn O } N N 0 o :3 3: :3 co .0 E w Z) (D c a. N a m Q Z in m C Y N CL N y y M N Lo O Co y d O O O rr O 04 E C V a 0 0 U Fn CR O g Y N N 0 OA `p C C CO _ C N 7 CF C-4 N LO COO C N n O .O O N 2 a) 00 0 m N O Z C rd Cl) eC I Cc E y O # Q L; CL CL 2 C C NO 7 ~l E r I'I0UiUO r A v a t Parcel 020-1161-90-025 12/09/2004 PAGE E 02:18 PM 1 1 OF 1 F 1 Alt. Parcel M 23.29.19.926A 020 - TOWN OF HUDSON Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * IVERSON, JAMES B JAMES B IVERSON 832 KIT LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 832 KIT LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.590 Plat: 1723-CSM 17-4542 020-03 SEC 23 T29N R19W PT NW SE & SW SE Block/Condo Bldg: LOT 01 (3.59AC) CSM 17-4542 LOT 1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 868/29 2004 SUMMARY Bill M Fair Market Value: Assessed with: 2195 305,700 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.590 44,700 191,800 236,500 NO Totals for 2004: General Property 3.590 44,700 191,800 236,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 136 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 I...E APR - 1 2004 -7 z s e L-----~ VOL 1 7 PAGE 4542 ST. CROIY, C(}1; ,'TY KAT9= H. WACSH SURVEY01WS R[;;CRD REGISTER OF DEEDS ST. CROIX CO. MI lid z RECEIVED FOR kECORD v► Z II I 906 06/13/2003 01:15PH I~ vZi BEARINGS ARE REFERENCED TO THE I I~JI ccn N CERTIFIED SURVEY ![AP REC FEE: 13.00 NORTH-SOUTH QUARTER LINE OF SECTION I IP I 4 _t c 23, ASSUMED TO BEAR S00°08'31"E I° co m m COPY FEE: 3.00 m lM ~ PAGES: 2 S00°06'31' Ie/ \5258.08' ~ ~ S00°06'31"E 454.80 o _ SQ4°06'31"E 1024.88' N00006'31"W 284.65' 41„w 259.89; ~ I N09 5 p 00 ` m (1 NORTH-SOUTH P i'~~ I 09°54~9 26 m p p c / 177.19' Qo I QUARTER LINE i Co I OF SEC. 23 82.70 iG~ Z~~i I~I w i' 111 A D A 1 ~0 lO Z Z I I~ O gjCP loo -1 z 1,6 A IP I ~ti'A r / Imp m Ilob I %@ C O r O ' 1 p I 3191 0 0 "E 273.57' N -4 S08 41 CZ3 I 02~ _ _ co G~ I 1 v so / ,KIT; % LN ° • X 9p,L L m ^ Z) I ~ 1 yD i (n -1 W D C10, ` v~5 g e I~-irooIt>m 4, J,z v t r,3 I I o > W ~y IP ! DD a xx n pnS O c0 <v cn vscp~ P' / I A \ ?Z~raol~g W O m ~i m tJ+ ~~A Al 0 I F°a u u W mm IV -I 0 r%) c -1 a co co 00 CA) CA M 3) x ~mmm 9Zy ~OGj X01 / ` II ~1 -.7 A Wy co -1n A r%) N COCA) 1 91 -P- -4 Cb I 0~ I / II x x 11 II 10 I~ x x II II r c I~ ~ IP ovvI r oo ~4 g < ~ I ~ y v 1@ rri 1@ 1 1@ I > _ & P, ,c=o C T I D .r O C) A Z Q P I 0 > c I~ cP cfl m z I mm ~o T 'n r~ cn T M)23 m r^ 0 O O Q Q ZOm O r O c c ~n cn z; c 0 c m ~ T N I Op z Z Z Z Z C7 ~I o v CJ pT m or 'TI f= 1~~ m m F 8mv o~ Cp Y M U) m 5 zZ m e m ~ D m 0 v m °2N n 70 z 55- m ~i 6gu °~2N1 S g 0 o n lO m z N O Z m ~0 g6oE /i~' i~ ag ~o O O nvSl~ !C4 m r 0 O Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: for and Hyman Relations Safety INSPECTION REPORT ST. CROIX arad Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268682 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: IVERSON, JIM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /00.100 06.00' ec, -4, ' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic yak /I /2-7J .f44 Benchmark A f! 7-A a, 9 /U U, 00 7 7 Dosing 614 If) , / r Fs9 . ~{4 /vU. o v Aeration Bldg. Sewer qG, 91/' Holding St/Ht Inlet roe 9$„9?, TANK SETBACK INFORMATION St/Ht Outlet 3',&4" ¢j ~6 TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic NA Dt Bottom Dosing NA Header / Man. 10 ~ V G qv, y Aeration NA Dist. Pipe /6,s v9; 1 ' 9a. a` Holding Bot. System S$ 9.31 9-59' 93 3J " PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demands _7(0 qq ry' Model Number GPM TDH Lift L Iction System TDH Ft mead 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 CHAMBER INFORMATION Type O Mode Number: System: s z u rv~ 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: HUDSON.23.29.19W, SW, SE, KIT LANE 4;64 sat- 84'~ 94 h Plan revision required? ❑ Ye Use other side for additional inf ation. q51 !X-/ r'~ ' 'F~'~-~~ SBD-6710 (R 05/91) ~ ~ Date Ins &6r's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: E E r SANITARY PERMIT APPLICATION Busafetyreau o oand ff BuilBuildiinWater Systems gWater 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. 57 hot~ • See reverse side for instructions for completing this application State sani ary PermiyNumber 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 Propert Name Property Location 1Icaner vci•soh/ c 114 SE 1/4,S a Taf N,R j9 A(or) W Property Owner's Mailing Address Lot Number Block Number 032- KZ-t bu 97 City Sta e Zip Code Phone Number Subdivision Name or CSM Numpie I s©ri W 54016 T ) Ox c.tt II. TYPE OF BUILDING: (check one) ❑ State Owned City Nearest Road ❑ Village 9 ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF W S o~ L L ~~v ► III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo o 2G i 1.54 - 02 O a 0 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. 1KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5- ❑ Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 (Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) d( qj.S Elevation so 1-5?1:3 ► g lpj 7-01, 4 ee e e t Ca acit VII. TANK In gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel N2W Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank /000 - © 1 Y~C s ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (Po Stamps) r P PRS o.: Business Phone Number: gele P -75 S-217S Plumber's Address (Street, City, State, Zip Code)- 1042- -3. MCL~l SIL. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater ate Issue Issuin Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge fee) J' Adverse Determination V X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SuD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety s Buildings Divt,.ion, Owner, Plumber 4 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. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dvveiling. 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 i. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, numi -_r of tan'<s and manufacturer's name, indicate prefab or site constructed and tank material. Co,i?plete fo - al! :,(~!>tie, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experin- ent. ;:product approval from DILHR. VIII. Responsibility statement Installing plumber is to fill in name, license number wi'n appropriai )refix (e.g_ MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Cc let_ N 3 r "'e-ificatior7s notsrr,a 'roan 8 1/2 x 11 rnc!,..: mtisf be sL,Lt i-ed t;, inty. Trepans must plot trlan, dravr,,. kale or with compic:::: r nsiu,r 'oct1 i,.:. dinc~ tank(s), septic tr,nk~, bu ~.vel1,- water rn >C'', _ ~I,e . Li s pump oi- siphon r I. orp, u,: r e1 acerrer the wilding served, v.; rn C;L,; 017 volume; Ir 5; 0_-7-1 ,n<. U'. C!-oss section .xo pt _ ~t r qui 'd J r_, testva?:. _ ~'rnr sit.tr3 information. GROUNDWATER SURCHARGE '1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of rec3 latec pra :tir which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamwi ti<;n investiq_ ations and establishment of standards Fresh Alr Inlets And Observallon Pipe - - r Approved Vent Cap 100 r Allnimum 12" Above pC Final Grade_~Y_R..2OAI " _JK 20- 42" Above Plpe. 4" Cost Iron ~~jjHfilJ Vent Plpe To Flnol Grade Synthetic Covering. uln. 2" Aggregate Over Pipe Olstributlo.. Pipe 0 0 0 0 0 Tee 6" Aggregate o # ~ 91.5 M K Beneath Pipe k57e ~'Je~OW Yho 1Yic~ tb,z. o C-L. 2 48" b"OLi rf ,~,hy ~raj~ La>v~ o weLL N°~e ;I'~1 ill IH ►vcw i coo G-a ( Sepfic Taw d WOOACj STecp Sir, ~ J D p N 4d as opt", s m41( b►«5'b ~ QQ rL'k ~rua~ t33 Q _ ~ ~ IgS!~?O. - _ tt 2 iQ 0 q$Qti33 50 Prue. i L, -e y w I ~U` j[JH Gr~ u s s ~ N t _ } c°- SEP-04-1996 07:17 ANDERSEN WINDOWCARE SERV 612 438',5827 P.01/01 LOT 3 ~v 4)4 2 R4! 0- 2 N w ~ w 922 as i LOT 28 J n a? 4Z2 75' ( } m 927 i LOT 24 P 1 92 3 150.00' . 43 126.1 t ' LOT 2 7 r~ P S ~ 0 926 A - LA 0 r 459.35' v LOT 921 r Y~ , x 393 ` ,t .h 462,08' Ov7-I-OT No f 85O ~r LOT 6 92 4j 30 SW 114 ~ SE 114 ago 00 244A . ro Li _513. ou 497. °T' N 239.87' f 3 ~e Ja ~4 Y LOT a LOT zs 831 i r fi 4 r.. O. 2448 a(~ 94 LOT ' - 830 ( LOT 3 p a~ 244C xr _ ~ t r 1) S RV _ M,4P VOLUME T - - 492.88 ; ~ i it LOT 4 v, LOT 244 D _ 829 700.04' 863,55 " t9ADLANDS ROAC S 1/4 COR. a SEC. 25 Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page _ of Division 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 CJ . 1'0 1 h percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 0 '-?o - l -aoda0 APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location VVI J- j7 Cr Govt. Lot .S u1 1/4 S F 1/4,Sa 3 T N,R I (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 9 2 -2 1 fi b -j - - c,;- I v-AW City State Zip Code Phone Number ❑ City illage Lo Town Nearest Road O nr S lOZ~ ( 7/S ) Js' 01%1 t~ Z ko New Construction Use: ® Residential / Number of bedrooms Addition to existing building A ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow `f SD gpd Recommended design loading rate bed, gpd/ft2a , a trench, gpd/ft2 Absorption area required bed, ft ft 2-- -9&_3 _trench, ft2 Maximum design loading rate - bed, gpd/ft2 0, 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) Yh[cS7~t ha lac.) YNot/l'/,(~o„zw t (as referred to site plan benchmark) Additional design/site considerations I nj7,* 5 -tcr t S G2T~e..~~r S term Gt(~e~r~.~c S ~~l-, w 1) Leg cL Parent material Flood plain elevation, if applicable N i4 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~0 S ❑ U R] S ❑ U 0s ❑ U ❑ S K U ❑ S ,K] U ❑ S O u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground Zl-3jp j 3 -s L3 ✓h'5 C W 1 V vsf~ L~ 4 3 rod S I M 5' k c VV r~ Depth to J 91g 7°S~'~ ~°~3 4 / 55 , cllimiting factor t a > 94 Remarks: Boring # ► 0-R '75 Y2 3/ S '2 of b z 19.2 ~S t.R s; a~ s U S 3 -L-3 S iv a is e~ >4 1; 2 oZ I rns pp W 1 d~ G. S Ground 5 S Cb h UT' C t,J T ifiW ~ . ft 5 4L84.5 Y GZ &/j - S'+ A C w 017 0. Depth to limiting QQ factor ~Hee marks: CST Name (Please Print) Signature Telephone No. Lad -)IS - 4;2s Address Date CST Number )04z- S S <<S Li I. S 4r? ,L- )0-2- - 4 C,&7&0 3 r' SOIL DESCRIPTION REPORT PROPERTY OWNER VA V CvS C Page-2--of PARCEL I.D.# 020 1 ° i Si 'gym' Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Y23 S l a~sb rnur s 0,~ o.~ o <5 j0'2 i16 _ s ; l h,s S I u-P o. ~ Q. S .1 D Ground 342,3-44 9.5 V10~' -r G w I j elev. Depth to 5 L S 1 1~7 r 47S ? :a limiting fac r It ' in. Remarks: Boring # " t -16 75 YU/231 Ground 'lv a, s 2`4lL' c~. 7 ~Q d C b f1~ Yt V / Qv. , d, . Depth to limiting factor 'jZin. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color j Gr. Sz. Sh. Bed Trench Boring # M 0-)Z Yt? Ar ~ 2J G,S s iu+ o, L _yk %j Ground -4 2-5 ii ~l S ct7 1'AU Depth to limiting factor in. Remarks: Boring # o 7, 5- -2J 4/0 Z ~z-a .S YR~~ l m 1VT 3 ~s ~3 n. sci z m sph S f S D, Ground 8- d cs YOZ Ge 41 ~b Vh vT r ! ~ elev. Depth to limiting fctr in. Remarks: SBDW-8330 (R. 08/95) Fnx 00A ex "d ~onAC'~tfuv- STrrPer Sty ` 8~ ~ fps 0 N Cee~oY` / Bm 2 app.., - 5rhk" ~1",ti FL. 99.9 ~ r~ YPc so.4-tM q1~~..+y 1:,,~s o-F L.r1 27 g5q.33/ (~,~.-rlQ't ou.~~e:~ ~Y $ern2 pwhcv V WS d SOIL DESCRIPTION REPORT PROPERTY OWNER Y9 Page ~ of PARCEL I.D.N 02-01 1$1 -2-0000 Boring # Horizon Depth Dominant Color Mottles Structure QPQ/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 0-10 ,5 Y23 aw51~ My;v s 0,s 0.G 2 )0' IVA M 44 S t v-P o. s ; D. ~O Ground 51 v C. w l✓ f 0,5- : 0,G el v. Rift. 0- d c w - 0 yp_ ' Depth to $ L ' q . V, S d 0.7 :0. $ limiting a r It in. . Remarks: Boring # G 7 S 2 ms~i~ I v f O S:0' 3 a - 2 m, b~ c 1 f o,,c : a, Ground l Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench Boring # 0-) 2 Y2 - j 2 m r c Z~ G. S ' -5 16ZS-:0,6 i D S :G, 3 "&-s s - /S 1t i10 a Ground -4 2.5: fL'1 2 [i S G4 1~u r i Depth to , limiting fSa Tr in. Remarks: Boring # 1 0-1 5- ~l✓~12 / i {l ZvhS~i)~. »iv`F~ 5 -2J -7, 1VT 0-S 3 s-~ 3 h 5 lip s Ground 8- d vc S Y41 OC 4~ ~b m v r 0 Depth to limiting W f ct r in. Remarks: SBDW-8330 (R. 08/95) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER - l~M 5 Tub RSEa~~ S F2 MAILING ADDRESS B3.1 K, } L m PROPERTY ADDRESS J63,Z K, L,-+rl a- ~v~s~N w S o/~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE, ~5~oAl PROPERTY LOCATIONS 1/4, c5~ 1/4, Section o?3 . T o2 ~ N-R W TOWN OF J~W.D501, ST. CROIX COUNTY, WI SUBDIVISION jq>A E St A'o LOT NUMBER . o? 7 CERTIFIED SURVEY MAP VOLUME /O , PAGEa935", 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 expirati date. SIGNE . DA a St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 B 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. --------------------------------------------------~ot ~7, ~ox if Ue~f Ownerof property -.~AVVJCC, Ps -yE P'So1\1 "Yk 54- g043 Ili Location of propertyZ!W 1/4,-S E 1/4, Section,)--3 T 9 N-R J 9 .W Township ub~ tj Mailing address _K;fi ,L,AnI~ lbSc .L-Ei ©/b Address of site- 63: 3 c) 'A""" w gsp/~, Subdivision name s7 Lot no. Other homes on property? Yes No Previous owner of property _~~►ARic"S 7':/4-'E1✓ 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 ✓ No Volume ~ and Page Number _ a 9 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. 15 '7r o 02 , 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. !tSZ SoA Signa ur of Ap 1' ant Co-Applicant 3 Date of Signature Date of Signature fi I' • a •ru s.ACe ltescltvrn volt ltiColto m< pwT11 ii ,CCK;Uf•tENT NO. ~ STj.TE. BAR OF 9 ISCON3IN FORM 1-1lgi` WARRAM DEED REGISTER'S MCC 45'75® i 'd C. ~pAcf 29 ST. CROIX CO WI ~ 1 i Ret d for Retold q'lug D~Bd i between Char11es '~~c~en and Geraldine M. 'Tilden, - ~7 I~~ M APR 'Q ` husband and wife as joint tenants 11:00 A, Grantor. ` l I~ and J$M.P B 4.. Iverson, . Jr-,.. •i - - . Gram for a valuable conaideration. t jr W'tnesseth hat tchhe aid Or Char es and-'~eraldne '~~den TVRM TO conveys to Grantee the following described real estate in • CT'OiX E County, State of Wisconsin: ?ax Parcel No: `1. Lot 27, Plat of 1st Addition to Fox Valley n in the Town of Hudson, St. Croix County, Wisconsin. ti At;; S Va f This I's not -;-_1 - homestead prope (is) (is not) 11 h rpgpt~ Togethe~harles nandgGeralhe n tarn end appurtenances tbereccnto belonging; And - . . warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this 16h-.... - ~Q.alc>~la April - - 90 day of - - - - - 19- - / (SEAL) (SEAL) - h-ar- .._...M..-..Tilden.. ..GeraldineN.- _Tilden . . . C - --.(SEAL) - - (SEAL) - • - AUTHENTICATION ACKNOWLEDGEHM Signature(s) .__Charle_s..M_.Ti3_den....... STATE OF WSIIIK,'KN SS COUNTY OF SHOE SH suthenPeated this 1-r._-.day of--April _ 19_Q.) PERSa~ OW BEFCEE ME THIS 29TH DAY OF MARCH, 1990 Kristina Ogland Lundeen THE ABOVE NMD GERALDINE M TILDEN, TO ME KNOWN TO BE TITLE: MEMBER STATE BAR OF WISCONSIN THE PERSON GE[1 FAD THE FoRECJOINO IIISIA[I1Z1Tf AND ACKNOWLEDGED TW SAME. ([f not, - , authorized by § 706.06, Wis. Stats.) Geraly'Lne M Tilden