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HomeMy WebLinkAbout020-1295-50-000 Q a) °o o 3 ° c o: ^c o I o Q 0 0 2 © CJ y I (n r i O c co ti Y c ~a o S o a z Nt Li o m o °o 0 Q in I 3 v ~ m I rn z E z o rn `m d N F N - ~ d m 0 o z d ! c lz o cN - ar z o z c o E -o N CL w `wJ E N N C c c O U Q z z E z N E N ~ > N _ la m I a (0 "D GO N d m O r O 0 a a 7 ~ N j _o = N N N a U) z o •i O O O FL N fn J U ) rn rn } ) C) o E O _ E m IL O O O N C 'r:+ o C E Ln 0) O © Lon 30 N a) a C a- O O i n N E c v N l p of o o 0 a r N N Y co O C ~ N • y'~,~' O N 2 N O N U) CCZ [O .fir a+ v~ 3 ~ a s • CL c, E y y V ~rYl 4 rr ' STC - 104 AS BUILT SANITARY SYSTEM REPORT - OWNER A0 ~jPt^7`Cc,~` ADDRESS F SUBDIVISION / CSM# LOT 'Y ;Z - SECTIONTN-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK. _5zt,04 -'r- a,-3 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Y-~ Liquid Capacity: Z~~",fd Setback from: Well dl?rj7 fwuse l-S Other Pump: Manufacturer Model # Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM G6 Width: 55_ Length /pd Number of trenches 3 Distance & Direction to nearest prop. line:4 Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wi~conyin Department of Industry, PRIVATE SEWAGE SYSTEM County: ' abor and Human Relations ST. CROIX safety an&Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268631 Permit Holder's Name: p City ❑ Village Town of: State Plan ID No.: ROBERT MAKI HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r i D D ~ TANK INFORMATION LEVATION DATA A9600330 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 'd-j- Benchmark Dosing Aeration Bldg. Sewer 7. 3y 95, 6 g~ Holding St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet q,~~ ~ly$~ TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet rl Septic NA Dt Bottom ~t•a34~.0, ,,.aa', 9~•6'' Dosing NA Header/ Man. Aeration NA Dist. Pipe ra ;4`'3, 9a 3 zc Holding Bot. System ~v:5-7, .o PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft I Loss Head Forcemain Length Dia. Dist. To Well I F SOIL ABSORPTION SYSTEM BED/TRENCH Width Leng h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S Go go /dU 3 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER ~ Model Number: System: 44,114A.) 10 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 1 i i Depth Over t xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 3j o, Bed /Trench Edge _ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.24.29.19W, SE, NW,-NMCDIARMID RD Plan revision required? ❑ Yes [EI'No Use other side for additional information. p (2 1/ 2 SBD-6710 (R 05/91) Date I pector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: + ' Safety and Buildings Division v.~LR 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 8 112 x 11 inches in size. :5L - Cro • 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 xt 4140 T, N,R Ip E(or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number r/ ,r ( / -Y Q;71 ' I_ II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road ❑ Village yyt~ t rte, e Public 1 or 2 Family Dwelling - No. of bedrooms ~ Town of GL III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo d26 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 13E] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _-_Vgystem 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 11E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [R Seepage Trench 22 ❑ In-Ground Pressure 42E] Pit Privy 13E] Seepage Pit _ 43 ❑ Vault Privy 14E] 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 qa. d Elevation a Q 162 CS lad S- ,~fJa Feet Feet TANK Capacity VII• in Total # of Prefab. Site Fiber- gallons Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New Existin Exper. strutted Tanks Tanks Septic Tank or Holding Tank laed e- aote- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I --L4 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 Stamps) MPRSW No.: Business Phone Number: 7/ : Plumber's Address (Street, City, State, Zip Code): l e -d4l_ (Ji IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Induces Groundwater Date Issue Issuing ent Signature (No S ) .4/Approved surcharge Fee) ❑ Owner Given initial Adverse Determination ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy'To: Safety & Buildings Diw:ion, 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E)-soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a-number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i Z9 G~/rfG~ <2 Sa vlQdo~.Y~~.~ G~ lip f ~ ~ y4 sca~G ti Ca'~ s' 1 ~ r ~r ~ X00 ~VOy L i 1 Wisconsin Department of Industry, SOIL AID, VALUATION 2 Labor and Human Relations Page / of Division of Safety and Buildings in acc a an 4 y 3.09, Wis. -11 County Attach complete site plan on paper not less than 8 1/2 x 11 04in size PI 6i mustK ST C pad X include, but not limited to: vertical and horizontal referencq point (BM), i)ifectior►and percent slope, scale or dimensions, north arrow, and location and distancA'tearest toad. j s Parcel I. D. # APPLICANT INFORMATION - Please print alAinforri as Reviewed by Date Personal information you provide may be used for secondary purpose (Privacy Law ';..15.04 (1) (m)).' Property Owner Pr tion 14 P vt°jA JrE 1/4/f/&/1/4,S 21 T ZT N,R E (or o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 800 ~,04p,~&y 4/2 s~ti,Pl1~G~ City State Zip Code Phone Number d / Nearest Road ~}U~-sDAJ GU/, .5l101lp (~~7 ) 3~~P-7/✓~J~ ❑ City ❑ Village L7 Town RC Di/fk~'1/%7 0K), New Construction Use: esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: CC rwe 4 E* (3 13 s 3 Code derived daily flow gpd L Recommended design loading rate bed, gpd/f12 • 7 trench, gpd/fl2 Absorption area required bed, ft2 y~ trench, ft 2 Maximum design loading rate bed, gpd/ft2 _ 7 trench, gpd/ft2 Recommended infiltration surface elevation(s) $4-t 3 ft (as referred to site plan benchmark) SSE NdT S /D W Z/SE D-v t~ ~i EifJ Get S . Additional design/site considerations Parent material 5;C5 Y S~77.r6' Flood plain elevation, if applicable Z414 ft S = Suitable for system Conv tional ,M,ou In-Groun Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S El U L_:J s ❑ U [as El U El s 2u" El s 0,15" 1 ❑ S 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 0-/3 16 ye 3/z - s,/ Z-F54e Sti s 3f z 3- 10X 3/3 s`/, Zf sdK ds s ,S Ground 3 Ll~ f/~ 3~ J/~ ~rr~i~ .5 ~o elev. C 2- lio v ie L/ , S IZI Depth to limiting factor 1P L y65 Remarks: a~ ~i SUir~j3~E ow 1:F9it° *,Pa-6/P S/STE--s Boring # /o 511. 2,w di 41 CS f , S .L4 / 0-5 - Y4 2. s-/ /o ,e 3/i S 2 f s!e s/ f s;. G 3 a-2- /o ~ 3Xl s/ zf s/le ~F s / 7c , s G Ground 16 to Ai -ftA.i elev. 16,R y s Depth to limiting factor 9_~__in. Remarks: CST Name (Please Print) Signature Telephone No. 7rs-306- PIPE Address Date CST Number Ulbrlcht & Associates a _ _ . I- _ _ - ~ SOIL DESCRIPTION REPORT PROPERTY OWNER Page of 3 SU.v iPiO1~E" sV/31~ ' ' PARCEL I.D.# GOT Borin # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots Q~DM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench .3 o -7 %o & siA i ~~k ~s~ w 3 f , s , Ground e) V, elev. 53 . eft. S/' c o -/6 K& 4F XAI -7 * 7- S o Depth to limiting factor Remarks: Boring # -%(e /0 31.)- 51-1, ~,hi ShK G S4 w 3 f S'. G Z Z 0-3141 /o - sue/ s6 fie 4U f ' • S Ground Ffln-AUA c~D.vT'/%N S 5/ s~✓ /11t Ile 7 , elev. %P/¢NDD.if s'`f oca rs ot~ OS cP-e a •-7 - Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Boring # -10 16 3f , Z/' ' S S a - /0 Lf f,P cs , S ; , -3 X •3 /0 S~ 2 /w r cw / , S ; • L C 2 2 Y; Ground _G ygo elev. ,F&,o ( ft. f lj factor 3 din. Remarks: 1~1f* S r SUi'% "'-Y' ~iC A?l 1,vv SI S'T , Boring # CGJ S /h, c l • S G -34, Je VZP S, Ground G 2 !Wf T / ` , 'S elev. S 7 A s/ 1^s . ,~~ft. 7 , Depth to limiting fact r 5 in. Remarks: ~~Ffi ~4 sU~Tfi~~~ OAozt( 7o~te ~DU•vy S ST SBDW-8330 (R. 08/95) d mtj\ 0 l Q m rn Ul s W m c kal I ~ ~ it _ ~ _ ~9 dr bd' _ 1. _ --Its - - o ` o ! / O Nt jig / 70 -S~ _ \ / I rn I i -f I zj, ~t \ / I r N 03 h ~ C p I _ 11 1 -4 \ ~ \ U d ~d N I ~O / cD~ fJ Ln -Mc w ° 0 / \ \ of 2548 • 02 ~ \ ~ ~~.o N 15 ti ro ti °w \ \ ° o w V /I (Al L71 ~ ` w W n~ N / f7 10 \ \ \ \ \ U! ( -1 rri • O &V _ •o N g2 0 oDOSjN N (n A° \ psi W (n °'A \ D (A W ~ , 002 \ c7 o O -2 0 0 \-n CIO ps 0 O o c VA0 M I o Z O,ps 4g\jN N Z Z \ \V\ O• >"-y\ w \ Q \ Z \ b2 \ 1 Poo \2 11 N -p W o G~' \ 00 OD ° D (n _ \ K " C7 D \ i 701 \ i ti2 \ N \ Ste' ~ pp . N m N-o - O J, 00 - m ( cD Ul \ 0 - 00 \ D O O 0 ERENCED TO THE 00 rya ) \ EST 1/4 SECTION o BEARING ASSUMED cJ~T0 w ~o j ~k~0 006, O .41 0 o- i %::c :unsln Department of Industry, SOIL AND SITE EVALUATION Page / of Labor and I-lumnn Relations Divlsfon of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Allnch complete site plan on paper not less Ilion 0 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and ST' G,P~~ x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. N 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)). I Properly Owner 3 Property Location ST,EUF , SEEP11/1Nir ltlEe Govt. Lot 5E 114IWIM,S T 2-f N,R If E (or( Property Owner's Mailing Address Lot N Blocklf Subd. Name or CSMN 8& 0 13RIWE1 Ze • ~1/ z 13VA11<11*,D6iF- city Stale Zip Code Phone Number Ne rest Road HUPSn,U GUA Sys/tv t ) 3e6l- Y/Jr El city ❑ village 01-Town 71 V4 yoSoej ff-Nlw Construction Use: [t esidentlal / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: rr / ' Fd/C 4,lf-I 1 + 3 Carle derived daily now gpd L Recommended design loading rate .e--bed. gpd/If2 • `S trench, gpd/11? Absorption area required / -bed, It2~? _ _trench. 112 Maxlrnurn design loading rate _ bed, gpd/fl2 • 7 Irench, gpd/112 Recommended Infiltration surface elevation(s) S-c-e 3 It (as referred to site plan benchmark) Addilionnl design/sale considerations. SF NG~t /D tJ ' SSE ~y 7~LriV G~e.I S Parent material s Jr1r -Si11F77;6E SE1.Y%~ 1'7.5 °pe;f Flood plain elevation, if applicable /_kA it S = Sulinble for system Canv nlional 7SIj In-Group Pressure AT-Grade System In FIII Holding enk U = Unsuitable for system v S ❑ U U ❑ U a s La "U" ❑ S 0,6~ [IS SOIL DESCRIPTION REPORT Boring N Horizon Depth Dominnnl Color Mollies Structure GPD/112 9 Texture Consistence Boundary Roots - , In. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l 0--/3 _ id ye •3/j- _ s,/. Zfs6,e s! s 3f S .G T z 2-f 2 /0,x / sh.~~ ds s .S . , Ground 3 14145 16 YX JlLe Si/ 1 S~~l i1~t ~i~ -Yv / • s ; • G elev. Depth to - limiling factor 3 5.._._In. 4 tc y65 Remarks: A,Pf9 0` f.3/ /fldaklP 7-1V P' Sly _725---r Boring fl .Lt l o-S /Off 2,/w dJLi df 3 f , 5" I- 5-IL- /0 3/-.- ,S/. 2-f si ,w-yC s ; .4, 3 /.z-2 lo Y4 3/ee' s/ a-f s!& s / , s • G 14 Ground ~i -49 /d rlny s 4 m . elev. PAVPV,e4 Depth to limiting factor In. Remarks: CST Name (Please Print) Signature / Telephone No. 11 71s-3P,, - ~8s Address Dale CST Number Ulbricht & Associates Private Sawa a Consultants Csr'y Z s . 101'EIl1Y UWI,!F-11 - nyrr - nCFL i.D.N ; tin N Horizon Depth Dornb,ant Color Mottles Structure 2 q Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trencl► 3 / - 0-7 AO W 31:t- - - ~i/. 14., 5~k cQS~ 3 ~ , S -31 /0 All round 3 .S/ sci / / r S ev. S~~ f o Tai v S -S U VAJA /~o epll, to - - - S'~N~ miling - clot in. Remarks: oring H /0 YX 31-1- 4H W s 5', G _ r elev. G qq L,/- CAD t~Tgjv S 5 s`f Il elev. -/-~/a ~~~~.-~u- - ~ _L~ . .SG it. - , ~e C~~T s a~ n sq Depth to - ' Ibnliing lactor • In Remarks: Horizon Depll, Dominant Color Mottles Structure D/1 Texture Consistence Boundary Roots In. Munsell Qu. Sz. Coral. Color Gr. Sz. Sh. Bed , Trenci, Boring it 3f ' 5(: - s J- -4 /0 W,331 Sik _3 is _ S// r Ground -G7 1 O'~.V...It. - ' Orpli, In Ibnlling ' factor 5. ...In. A& W F-Ox IOAP vy .s' X T ' Boring H / -0-/p 10 3 - S,//. /-f J14r ,w,f~ Cw F . ; . S ~ io _ S 1~ 0 1 .S, .G 1/0 RS Ground G 2.~/~ elev. S Y P s/ • j le It. [)('Pill to , Ilmlling last r 3! In. Remarks: erlf ~4 ` SU~7il~3~~" o v CI( Svc' /~!d Uti SyST 555 SBDW-8330 (R. 08195) h 0% \ o O o co N Cfl ~ v, I I ~ - \ Ze) r- I a . A Or , Y EASE v n ~ cl I Pf VV vv vv 142.65 w 6. 0 1 ~S O t .9cJ,, / 1 s z 1 34 i / 2 87-1665 SQ. FT. p' f 1057.3 1? NNS 2.013 AC. / / 1po '00 o .pp' T 0 1057.86 o / o vp. %P 41 / app • 10Gj, • 0 W ' 0 1 " / 69 00 0 , 4051 1057. 0 40 59-~ c~ 0 E a. .00° 97,253 SQ. FT. PGA 2233 AC. G% )`P~M~o 215 ~ ~ ~ ° ,,~~P~ `o O 00 /0 po i N 4 23 ~ DO 88,002 SQ. FT. 41 o \ D00• / 2.020 AC. o ' 0 0~ / O 0 N \ 2 42 \~ooj• o~~~a~~ ~po~ sS N 919345 SQ. FT. P~~~ / ti , O 2.097 ACC yc°Z 4 ga N 87° 29 17~ ~ E O 259.02 t~ .doe 43 164.97 N~ O 94.05 ~AS3>, v, •1 30 D AINAGE - O EASEMENT 92,851-SQ.-T. 4 ~sr~ i \2.132 AC. \ \>2ss2; 02. n o I?0 A A LEGEND •o 00. SECTION CORNER MONUMENT-ALL oo ~~2 2g 0 2° ROUND IRON PIPE FOUND • 1° ROUND IRON PIPE FOUND ° ~9 p5 2'X 30° ROUND IRON PIPE WEIGF \00 O ALL OTHER LOT CORNERS MON, ROUND IRON PIPE WEIGHING 1.68 n. 11' UTILITY a DRAINAGE EASEME .2p co J?i ~ X -X -X EXISTING FENCE 1057.00 ELEVATION ON LOT IRONS ON 7/2 0 ' It1 Z W 1' I ~ 0 ~ 0 1 SCALE IN cn no-p ST C - 105 SEPTIC TANK MAINI'h;NANCG, A(:IZG11,"N1I?NT St. Croix County OWNERfBUYF,R "Wo 6eA 7 ate{ J c ni/~ k i - MAILING ADDRESS 73 o -!o r •y PROPERTY ADDRESS 87-1 Inn ~rw~•~►u! tJ►-- ~vc[do.~r, C~i S`/opt (location of septic system) Please obtain from the Planning Dept. CITY/STATE 14 v ot3 -yn W I S PROPERTY LOCATION S E 1/4, /U ty 1/4, Section 2 , T~Pcj_N-R / TOWN OF vcbr'-n ST. CROIX COUNTY, WI SUBDIVISION EuY, R,d-Lje_ 'fr LOT NUMBER U 2 CERTIFIED SURVEY MAP , VOLUNIE , 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/«'e, 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. SIGNI~D:,X , ► L - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson. WI 54016 11/93 S T C - 100 r ,r 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 Abe-,-f • 4,4 Z.Knda k_ /YIa1r; Location of property SF 1/4 Nt✓ 1/4, Section QY ,T ~9 N-R /5 W Township Mailingaddress 73o s", ~ St Ptj CQ%0 W1 LJ 1 5L014 Address of site $'7-7 Dr Subdivision name SLJn 64a, IT Lot no. 42 Other homes on property? Yes y No Previous owner of property '','1•,x Xa -a Total size of property a. I a-C'e, Total size of parcel f Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house) ? Yes ,_No Volume ZZff and Page Number ©S'O as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S-Llrg,?J , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature o Applicant Co- pplicant 8I~° ~pb s a.o-~~ Date of Signature Date of Signature /a Vvjk-6`- VOL 119$PacE~50 10 WARRANTY DEED 54$931 REGISTER'S OFFICE Document Number: ST. CROIX CO., WI Reed for Record AUG 3 0 1996 Return Address: Robert and Lynda Maki, 730 Summer Street, Hudson, WI 54016 at 11.15 A. M , Register of Deeds Parcel I.D. Number: THIS DEED, made between Greenwood Enterprises, Inc, a Wisconsin corporation, Grantor and Robert J. Maki and Lynda K. Maki, husband and wife with right of survivorship, Grantee. WgI'NESSETH, that the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 42, of the Plat of SunRidge II, filed in the Office of the Register of Deeds for St. Croix County, Wisconsin, on August 1, 1994 in Volume 6 of Plats, at Page 17, as Document Number 519728. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Greenwood Enterprises, Inc. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record and will warrant and defend the same. T ~~NS~ER Dated this y7-rn day of August, 1996. GREENWOOD ENTERP SES, INC. GREENWOOD ENTERPRIS. C. FEE By. By: mes E. Rusch, its president ary , its r tary AUTHENTICATION ACKNOWLEDGEMENT Signature James E. Rusch, its president STATE OF WISCONSIN ) authe4ticated,this ~ ugust, 1996 ) ss. ST. CROIX COUNTY te- `Lois A. Murray Personally came before me this TITLE: MEMBER STATE BAR OF WISCONSIN day of Au t, 1996 the above in Mary R. Rusch, its secretary to me kn be the person w executed the foregoing instrument and acknowl ge the `same. THIS INSTRUMENT WAS DRAFTED BY: Lois A. Murray Brenda Poulin Zilz, Estreen & Ogland N blic, State of Wisco i~j 304 Locust Street My commission expires olr Notary Public State of Wisconsin P.O. Box 359 Hudson, WI 54016