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HomeMy WebLinkAbout020-1462-06-000 -0 0 c p f» O G Q a 4 0 cam, p O O rn c O O j N Co CL N t-- co O N X N g in 6 N C ' 06 O - O I U M F co c M O l0 41 -p E (n m O L O U) U fc4 U O C f0 y U O .C .i L O 2 - C d Z M w N i C C (6 7 LL N • U LL 0 c ~ -0 CL ? N N N > ~ i \O N B N O m Q a o U o> 3 _ I m Z a U-j U) o v £ L z 04 a co N F- U) C O c C9 p ~ O z c M N 0 CD 0) 1 N N O c C O ~ O ° Q Z I- z o N z 12 V £ C N y ~ N d = CL v N d N c 0 0 00 O O IL E .C N O N Z° u' 0 0 0 d z Z O "J a N N 7 O V~ O (O 00 0) 0) N J U 'Np O MrV _ r O cl O - E N f p O c n m m 'IV • ~ y ~ Q } ~ I 45 cl O O p N C O M c 00 O ? _ co p) C N O O ® ~O 0' 3 2 ° ° p N H ' O) 'p N N (n c N O S c c N p~ C- w yr+ pj N Y p y u j c0 co co N 7 N D cis N O U O y w U ~ ik w cl E d at ° a w • Q Z U y rr~ E i G C w 3 col A uIL 0 U)0 Parcel 020-1462-06-000 09/28/2007 09:02 AM PAGE 1 OF 1 Alt. Parcel 24.29.19.2953 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/16/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner CYRUS & KAY BJERKE O - BJERKE, CYRUS & KAY 807 SUMAC TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 807 SUMAC TRL SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 11.287 Plat: 10-087-BAD RED SUMAC ASSESSOR'S PLAT LOT. SEC 24 T29N R19W PTS SW SE & SE SE LOT 1 Block/Condo Bldg: LOT 006 CSM 1/233 1 NKA BAD RED SUMAC ASSESSOR'S PLAT ('05) LOT 6 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 24-29N-19W SW SE 24-29N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 11/16/2005 812177 10/087 PLAT 07/23/1997 645/391 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 60,000 199,600 259,600 NO PRODUCTIVE FORST LANDS G6 10.287 72,000 0 72,000 NO Totals for 2007: General Property 11.287 132,000 199,600 331,600 Woodland 0.000 0 0 Totals for 2006: General Property 11.287 132,000 199,600 331,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1439-57-001 09/28/2007 09:00 AM PAGE 1OF1 Alt. Parcel 24.29.19.2784 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 O - BJERKE, CYRUS & KAY CYRUS & KAY BJERKE 807 SUMAC TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.064 Plat: 2128-INDIGO PONDS LOTS 1/57 020/03 SEC 24 T29N R19W PT SE SE INDIGO PONDS Block/Condo Bldg: LOT OL 1 OUTLOT 1 (1.064AC) (TO BE DEEDED TO NEIGHBOR) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 01/19/2004 752128 2494/394 WD 09/09/2003 739306 2404/068 WD 07/10/2003 729699 9/71 PLAT 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason OTHER X4 1.064 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT A~ AS BUILT SANITARY REPORT Owner Address 3S Vs- COL C 5 i CRC! r City/State N S~ 3' Y/ to ZONINGOFFiLE. e~y`= Legal Description: Lot Block ~ ~VASubdivision/CSM qyd E,. Sec. Ay, T_LQN-R_eTown of Al PIN # ©~O X 06 S ~L1 SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer U.~EEksCONBAize ST/PC avo/ Setback from: House ~~k Well P/L Pump manufacturer Model /4- Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Ven fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: ~_g0 Type of system: idth S- ` Levig_7-ir Number of Trenches Setback from: Ho a ~/S" Well „z-76 P/L Vent to fresh air intake f l S'D ELEVATIONS: Ica Description of benchmark Ck/ / "'OU C l Elevation Description of alternate benchm k ~o n ,~-F ~e+~•~~--G~tti &2~ Elevation ,y to e Building Sewer Mt. 3 Z ST/HT Inlet ?-3,6-/ST Outlet/ ,3- ..3~-~-C /Inlet PC Bottom Header/Manifort I. / Top of ST/PC Manhole Cover to . Distribution Lines (~f / % • 0 ~7Y 2 9 Bottom of System p 3 ) Final Grade 9~ S3' -S.3r Date of installation Permit number State plan number Plumber's signature _ 7~AL-AA4~ License number D 3 ;AS$ Date 61919 if Inspector 6Z~ '~h ('omplete plot plan or NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. 0 PLAN VIEW -sly f ' -3 6 01 x~° r L-M q` Ta MP I ~ vwt h. INDICATE NORTH ARROW o abor anHamame dustry, PRIVATE SEWAGE SYSTEM Count LabordHun Relations County: Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262362 Permit Holder's Name: ❑ City ❑ Village UTown o : State Plan ID No.: BJERKE CY HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: v 11 I. A9600171 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic '1' Moo Benchm r 7 -1 S /D'/,/ I ©•p Dosing ~ M5, 1 0191*1 Bldg. Sewer Holdin St/40 Inlet TANK SETBACK INFORMATION - St/Outlet 1 3-7 4-1 3 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic ) + NA Dt Bottom ~Dosing NA Header/Man 4-au T `I" 4L i '-7- /s 1 / a 2 Aeration is, v Ga d` NA Dist. Pipe L7.., 1L /1_0-11 Olt r7(, Holding Bot. System f59s 9 l a r-7 lt.,657 0 PUMP/ SIPHON INFORMATION Final Grade ;4-I S 'CerveA Manufacturer and D.2~ `'I G FS Model umber GPM TDH Lift Friction am TDH Ft Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED If T N Width Length"T'/ 80 No. Of Trenches PIT No. Of Pits pth Liquid De DIMENSIONS 7 DIMENSIONS SETBACK SYSTEM TO P / L BL G WELL LAKE / STREAM LEA IN Man - INFORMATION TypeO ' 11 CHAM Mod System vt OR UNIT .i DISTRIBUTIONS STEM FftTdd2r /Manifold Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake -7 -7 Length Dia. LengthTT~ , Dia. ~ Spacing M:, s- Z°I 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" es No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.24.29.19W, SW, SEA SUMAC TRAIL NU - W 0 GZWIP.-4~op✓ iI'+AK Plan revision required? ❑ Yes No q Q~ Use other side for additional information. SBD-6710 (R 05/91) Date Inspect s Siqnature ert No r DILHR SANITARY PERMIT APPLICATION S7 s accord with ILHR 83.05, Wis. Adm. Code COUNTY eg (e 0196 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PERMIT # 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTOWNER PROPERTY LOCATION Ic 'u, it./ Y4 _SR Y4, S T N, R E (Or PROPERTY OWNER'S MAKING ADDRESS LOT # LOCK # 3i34115- 7-0 GL S CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NU ER S g~.Z c~3i3 _ 3 0 VI LAGE NEAREST ROAD II. PE OF BUILD71'orC2 heck one) ❑ State owned I OF: ❑ Public Fam. Dwelling-#~ of bedrooms _L PARE AX NU BER( 111. BUILDING USE: (If building type is, public, check all that apply) -;,o w - Les 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 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 in line A. Check line B if applicable) A) 1. P~ New 2.0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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) ELEVATION ®Q _;1 5'0 p r 3 '91" ©Feet `~s l Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structeA Septic Tank or Holdin Tank me S Lift Pump Tank/Si hon Chamber )a~ ____4_~_ VIII. RESPONSIBILITY STATEMENT 1, 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 MP/MPRSW No.: Business Phone Number: [Plumber's Address (Street Pty, State, Zip Code): ~v S 7~ IX. COUNTY/DEPARTMENT USE ONLY A I ❑ Disapproved is itary Permit Fea (includes Groundwater Date issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination r X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCOMONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of _ene~ -,d 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 (S8D 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 iy.,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 adrninistrator or the State of Wisconsin, Safety &.Bdildings Division, 603-266-3815. 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 in line A. Complete Iine 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 informatiion requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Corr plete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropnate 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% x 11 inches must be submitted to tl a 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 Mai, a'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; frict on 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) t top of 1" pvc pipe 0 el. 100, Al.t. ~f]Bm = nail in tree 0 el., 105.00' a ~ ► W ~1/1 tely 3!7 y E, T e g ~ ~ 44 9, d r I ~ • r~ 1 ~ ~ !J lid ` +J, 1 4 Wisdorsin Department of Industry, 1 3 Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page - of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8, St. Croix in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference n-)Z01*16ar ti and % of slope, scale or dimensioned, north arrow, and location and 'hce' o nearest rdad:. `020-1068-90 APPLICANT INFORMATION-PLEAS -PRINT XLL fNFORMA1I00 REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Cy Bj erke OVT. LOT 3Y1 1i4 SE 1/4,S24 T 29 N,R 19 for) W PROPERTY OWNER':S MAII-ING ADDRESS LOT # BLOCK # SUBD. NAME 0 CSM # 3845 Joppa Ave. S. 1 na csm vol 1-pg.233 CITY, STATE ZIP CODE J 02NE: R ❑CITYVsonGE (MOWN NEAREST ROAD Mpls, MN. 55416 Hud Sumac Ln. 4 New Construction Use [x] Residential / Number of bedrooms 4 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate -7 bed, gpd/ft2 - 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 91.90' ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash 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 INS ❑U ®S ❑U EIS ❑U ®S ❑U [3S E]U ❑S :E] 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 Tr I t~ 1 0-12 10yr3/3 none 1 27sbk mfr gw m 7 .6 1 2 12-24 10yr5/6 none sil lfgr mfr gw 2g .2 .3 Ground 3 24-82 7.4yr 4/6 none S Osg ml na na .7 .8 9g1e ft. Depth to limiting +~~c, Remarks: Boring # 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 >x2 2 10-21 10yr4/4 none sl 2mgr mfr gw if .5 :..6 3 21-84 7.5yr5/4 none S Osg ml na na .7 .8 Ground elev. 94.9 ft. Depth to limiting +8T, Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., New Richmond, WI. 54017 10-16-95 cstm 02298 Signature: Date: CST Number: PROPERTY OWNER Cy Bjerke SOIL DESCRIPTION REPORT Page af?r PARCEL I.D. # 020-1068-90 Boring # Horizon Depth Dominant Color Mottles (Texture Structure Consistence Boundary I Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed (french 1M .5 .6 1 0-11 10yr3/3 none 1 2msbk mfr 9w 3 2 11-31 10yr4/4 none sil lfsbk mfr gw if .2 .3 Ground 3 31-84 7.5yr5/4 none S Osg ml na na .7 .8 elev. 95.7ft. Depth to limiting factor +84" Remarks: Boring # 1 0-13 10yr3/3 none 1 2msbk mfr gw 2m .5 .6 4:2 13-31 10yr4/3 none sil lfsbk mfr gw if .2 .3 '•:;.^•.?};::iii::::: 3 131-82 7.5ry5/4 none S Osg ml na na .7 .8 Ground elev. 95.28ft. Depth to limiting factor +82" Remarks: Boring # ::h eca~•~:>,::, 1 10-16 10yr2/2 none 1 2msbk mfr gw lm .5 .6 5 2 16-27 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 27-40 7.5yr4/6 none sl 2mgr mvfr gw na .5 .6 Ground elev. 4 40-85 7.5yr5/4 none S Osg ml na na .7 .8 95 . l Oft, Depth to limiting factor +85" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-6330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Cy Bj erke 1554 200th Ave. MPRSW 3254 Sw4SE4 S24-T29N-R19w New Richmond, WI 54017 town of Hudson (715) 246-6200 lot #1-Csm voll-pg233 N 111=401 BM.= top of 1" pvc pipe C el. 100' Alt. Bm.= nail in tree C el. 105.00' vj 3 i 13 2U~58' „5~ i 'C ~ 23 '01 -17 10 3" Ilk' A14, M a a Gary L. Steel 10-16-95 STEEL'S SOIL SERVICE Gary L. Steel Gary L. S Cy Bjerke 1554 200th Ave. CSTM2298 3254 SWISEk S24-T29N-R19W New Richmond, WI 54017 town of Hudson (715) 246-6200 lot #!-tsm volt-pg233 H 1"=40' EM.= top of 111 pvc pipe 0 el. 1001 Alt. Bm.= nail in tree 0 el. 105.00, ~ 3 I ~'S? v 9, -C ZUvv ~ .S~ f g~ \ Ilk a- Q'''om. ~Z ~ Z ago ? Gary L* Steel 10-16-95 A l r- r 1 ~ r•r A5 . p:J;.. ' CERTIFIED SURVEY MAP NELSON POLEN Part of the Sd 1/4 of the SE 1/44 and the SE 1/4 of the S' 1/4 of Ser~tjq-~4 J T 29 N, R 19 W, Town of Hudson, St. Croix County, Wis :)I r COMPREHENSNE PAPKS PIANNIN~ AND ZONING COMMITIEE 1 yl APR 2 8 1916 41AY 6 1 {v wo- \ xi'inr,l of wN•~~~~ Scale: 1" = 200' 4 iiB RrwbPn qe 0,,,19 Note: Bearings based on south line of parcel " y described in Vol. 500 on 000 Page 546, St. Croix County Records. 0 v v N89°53E 3 76.22' 418.00' 547.23' 90. EAST 965.23 ~ h W r a, o I z 25 A~r2 s CO `r= co ~ 4a-) ,n N 3 9p. w 376.22 6404 965.23' o>. o r-- 859.03 N89053IE S89°5 W P. 0•B• N co o Indicates 1" x 24" iron pipe stake set weighing 1.13 #/ft. SI/4 Corner o " 1" iron pipe found. Sec. 24-29-19 Description: ,T certain parcel of land located in the SW 1/4 of the SE 1/4 and the SE 1/4 of4the SE 1/4 of Section 24, T 29 14, R 19 W, Town of Hudson, St. Croix county, Wisconsin, more fully described as follows; Commencing at the south 1/4 corner of said Section 24, thence go N 010 421 05" E a distance of 158.37 feet; thence N 890 53' E a distance of 859.03 feet to the Point of Beginning of the parcel to be herein described; thence due North 508.81.feet; thence due East 965,23 feet; thence due South 506.84 feet; thence S 890 53' W a distance of 965.23 feet i.. 4-1.. n-.;...+ „P ne..;,,., 4- +nnn+hn.. ..74+1, nn oacAmont fnr innress and eeress STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 9 MAILING ADDRESS 3 912 7, /LL-1- PROPERTY -s ~ PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE --s- S l PROPERTY LOCATION -5 Cd 1/4, s 1/4, Section , T~N-R 2 W TOWN OF /7 ~Cc a ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME J-, PAGE _;2-3 - .OTNUMBER 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 the St. Croix County Zoning Officer within 30 days of the three yea ex irati date. SIGNED: DATE: ~Ss (v 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. Owner of property Location of property s • l/4-Sf _~-1/4, Section -IV T N-R__I~LW TownshipT Lt{~ a,l4 , Mailing address?; S~( r Jag, Address of site 7 ~4~1, a a V&t' A Subdivision name Lot no. other homes on property? Yes z---No Previous owner of property Total size of property , 2, 6? e" e Total size of parcel Date parcel was created 913 Are all corners and lot lines identifiable? c.~es No Is this property being developed for (spec house)? Yesa Volume ld ~5~ and Page Number " as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 3 7 7 j P0 , 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. f Sign re of Appli ant Co-Apple nt ~2 S -S _ Date of Signatu e Date of Signature Cyrus Bjerke 3845 Joppa Ave. So. St. Louis Park, MN 55416 May 20, 1996 Henry and Walter Nechville 967 Highway 65 Roberts, WI 54023 Dear Henry and Walter: Since you weren't able to come by our place this past weekend we are sending you the documents the you requested. Please review them and we will talk to you next weekend. We will be out on Friday evenng and will not be leaving again until Monday evening. If this does not work for you, please let us know so we can make other arrangements. Otherwise, we do look forward to meeting with you next weekend. Thank you. Cyrus Bjerke . nc rel., ca.c+a DOCUMENT NO.'S / STATE BAR OF WISCONSIN - FORM 2 VOL 645 r~"' 1-1 WARRANTY DEED 77190 THIS SPACE RESERVED FOR RECORDING DATA i I ~'j7 I NELSON V. POLEN and FLORENCE K. POLEN, RcfilST&S OFFICE husband and wife, and each of them, Grantors ST. CRO!X CO., WIL I 1 { Rac'd. for Record ft 201:11 I conveys and warrants to CYRUS C. BJERKE and KAY M. BJFi12E, day of April A. D. 19 82 I husband and wife, as ioint tenants, as Grantees at 2:45 , M. j in consideration of the sum of $5,625.00 Register of Deeds I t RETURN TO ~ I the following described real estate in St. CroiX County, State of Wisconsin: i ? Tax Key No. f i Part of South Half of Southeast Quarter (Sh-SE;) of Section Twenty-four, Township Twenty-nine North, 1 Range Nineteen West (Sec. 24, T29N, R19), described as follows: Certified Survey Map filed May 6, 1976 in Volume "l", page 233, Document No. 332838 in the j Register of Deeds office for St. Croix County, together with an easement for ingress and egress to the Town road thereon, shown on said map. t FEB Thisis not homestead property. (Is) (is not) Exception to warranties: Dated this 16th day of April to 82 (SEAL) (SEAL) -T . Nelson V. Polc_n (SEAL) _ (SEAL) • Florence K. Polen ----~~ucuT r . • ' O o ~z LAO (A) r r r - d& M M aa~° O z~ LA~ ~I R x O0+ r o~ N Oa$ Z ¢a0 Q r Op d x U 9 L Q o JC ¢ 11 O Z LLJ YO wy d ~w p~ J 1 v9c W m mQ rr 0.' 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