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STC 104
AS BUILT SANITARY SYSTEM REPORT
OWNER. .-'$zr! 16
ADDRESS'
SUBDIVISION / CSM# LOT ma"
SECTION T ~C N-R S
't ! gjnTW, Town of_ ~ JOSf%
ST. CROIX COUNTY, WISCONSIN..:
PLAN VIEW
SHOWEVERYTHING WITHIN 100 FEET OF SYSTEM
6AIL
~eL,~
ty(
b ~
CI4
Gr
INDICATE NO TH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
•a
BENCHMARK' r SS{
t
ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: AJZ,'s,Cvl' Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer A/ A Model# Size
Float seperation Gallons/cycle:
Alarm Location
I
:SOIL ABSORPTION SYSTEM
Width:_.. Length ~ Number of trenches
i
Distance & Direction to nearest prop. line: E!
Setback from: well:
House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold_.,~,'Bottom of system__ 7z 97
Existing Grade Final grade
-134
DATE OF INSTALLATION: _ T 9
PLUMBER ON JOB: I C~~zrP
LICENSE NUMBER: S- 7C
INSPECTOR:
3/93:jt
' Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
RADIDLO. XLV1N & DINE R
CST BM Elev.: j Insp. BM El BM Descriptio { Parcel Tax No.:
TANK INFORMATION ELEVATION DATA 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ZS '/J Benchmark (o, Ssr la),Gd
Dosing LL /6 (0, 7 6 r
Aeration Bldg. Sewer
Holding St / Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 04 70
Ventto
TANK TO P/ L WELL BLDG. Air intake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Header / Man. /
(a, 7-3 9Y-2~
Aeration NA Dist. Pipe
Ho ng Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 6,- d 3,SS~ Od,G~~
Model Number 3 3,43 ' 03, ~(,2'
TDH Lift Frict* TDH ead
Forcemain ength Dia. Dist. To Well
SOIL BSORPTION SYSTEM
BED/TRENCH Width , Length I No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION 83 D
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACF Manu
SETBACK
INFORMATION Type O /I, CHAD Moe Num er.
System: dvu~ 14 OR NIT
DISTRIBUTION SYSTEM
Header / 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 Syste
Depth Over Depth Over xx Depth Of j,.! !x- /Sodded xx Mulched
Bed /Trench Center ' Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH. 3.29.1SSW . SW. SE OLD MIS RD ~ ~ ~"tt Sc~e
D J ~f ~l
C~0 ~i~ t~ t „'~l v? r" P our Cv
(1;}
`=J Ptah reJisro equired? Yes 0-go
Use other si a for additional information.
SBD-6710(R 05/91) Date Inspector's Signa ure Cert. No.
ADDITIONAL COMMENTS AND SKETCH `
SANITARY PERMIT NUMBER: _
Safety and Buildings Division
~•G~i,:r"i 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 1/2 x 11 inches in size. S T. Gi
• 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 I?TrJvis`ttl~tdZiD app~ti n
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
/CeL.•h D%Cye- !cam 'd to .5101/4 S7 E 1/4,S _I T N,R !sE(or)b
Property Owner's Mailing Address Lot Number / Block Number Opp Cit , State Zip Code Phone Number Subdivision Name or CSM Number y? y
Lle 64111*d eMl► ss-~~7 (G~~ > gay. 5'~~a- csky vac /A~5 -
I. YPE F BUILDING: (check one) ❑ State Owned City Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ~e Lown of SJ. Ss11~ X*,GL I?d•
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo ,2 ;D;O - /,p l Z - 7U
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. szLNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System ___System_____________TankOnly- Existing System Existtng-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 1jj4.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) Elevation
Feet. 6 Feet
Goa Ss'l 5-6 Y
VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank f i G 1 l 1 E] ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Witary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps).,
`X Surcharge fee)
A Approved ❑ Owner Given Initial 5(J
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 0584) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. 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.
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LAWNS o PNRIM HelaVOM
DMMaa of eafo* a Build rge in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St •
not limited to vertical and horizontal reference point (SM), direction and % of slope, scale or PARCEL I.D. s
dimensioned, north arrow, and location and distance to nearest road. Pending
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Kevin & Diane Kadidlo GOVT. LOT SE 1/4 SE 1/0 3 T 29 ,N,R 19 fir} w
PROPERTY OWNERS MAILING ADDRESS LOT 0 BLOCK # SURD. NAME OR CSM i
135 E. Flaking Dr. #111 na na csm vol. 1169- 434
CITY, STATE ZIP CODE PHONE NUMBER []VILLAGE EVOiNN NEAREST ROAD
Little Canada; M. 55117 (612 484-4112 St. Joseph Old Mill Rd.
Ic ] New Construction Use [3d Residential i Number of bedrooms 3-4 Addition to exis*V bullft
I I Repkoerwt ( 1 Public at commemW describe
Code derived daily fbw 600 9Ad Recommended design lotlding We .7 bed, gpdrft~_ _ R _~ertctr, ypd<ft~
Absorption area required 858 bed, ft2 750 trench; 112 Mal num design ioalting rate •_7 -:bed, . trs , 90*
Recommended infiltration surface elevation(s) 94ya1tX 98.68 ft (as referred to site plan beflCfYnadQ
Additlwtel desip / site =vl fei'alions na -
Parent material stream ter ram Flood plain elevation, it applicable na n
S = fa CONV9JTIONAL MOLIND iN•GRDUNDPRIMIRE ATGMDE L SYSTtftA N Fill. HWNG TfWC
U- Unsu'lable f~ aw S❑ U a S 0 U a SOU EIS o u fl S o U o s E U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Sh#Mre Consistence Boadartr Roots GPD/
in. Munsell Cu. Sz. Cant. Color Gr. Sz. Sh. Bed lettdi
1 -10 1 r3/2 none 1 2msbk mfr Cly 2f .5
1 2 0-26 7.5ry4/4 none sci 2msbk mfr 9V 1f .4 .5
Ground 3 6-37 7.5ry4/6 none S Osg Mvfr 9V na .7 .8
OW. 4 ~17-42 7.5ry4/4 none s1 lmsbk mfr 9w na .4 1.5
102.9 5 2-86 7.5ry4/6 none co. S Osg Ml na na .7 .8
Depth lo
limiting
+86"
Remarks:
Boring #
1 -8 10yr3/3 none 1 2msbk mfr 9W 2f .5 ' .6
2 2 ~1-28 10yr4/4 none scl lfsbk mfr 9W if .2 €.3
f8-42 7.5yr4/4 none sl 2msbk mfr gw na .5 1.6
Ground
elev. 4 2-86 7.5yr4/6 none cos Osg Ml na na .7 1.8
103.1
uDOO~ E~EDF
tacb►86"
Remarks:
T Name- Please Print Gary L. Steel Phom: 715-246-6200
roes: 1554 OO
-p- r cbmond. la 54012 Signature:
242 Z ZZ D 4-12-96 cstM 022 8
PMPERWYO1lNER sw~ ut%SUHIP tun HI:VU tI Nape-2-01_.3___
P1 IMW
Depth Dominant Color Mollies Texture Structure Consislanoe Boun*y Roots GPDJtlz
Boring #t Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 7*0
maim
1 0-11 10yr3/2 none 1 2msbk mfr 2 .5 .6
312
2 11-31 10yr4/4 Wane sci lrasbk mfr g If .2 1.3
Gait 3 31-46 7.5ry4/4 none si 2msbk mvfr gw na .5 1.6
4 6-88 7.5ry4/6 none co s Oeg mi na na .7 1.8
[ tL
1103
i
Boor ~
}88"
Remarks:
Boring 1 10 10yr3/2 none 1 2msbk mfr gw 2f .5 1.6
5 2 0-43 7.5yr4/4 none sici imsbk mfr 9w if .2 .3
3 3-84 7.5yr4/6 node is 089 mvfr na na .7 1.8
GmW E
Slow.
ft
M. 5
tat~or
+84" 3
Remarks:
Boring P 1 -8 10yr3/2 none 1 2msbk mfr 9w 2f .5 .6
5 2 -21 10yr4/4 none sicl lfsbk mfr 9w if .2 .3
3 1-37 7.5yr4/4 none sl 2msbk mfr 9w na .5 .6
Ground
4 7-89 7.5ry4/6 none co 8 Osg m1 na na .7 .8
ft
102.6
06010
l n&V t
tam i
+89" 1
Remarks:
Boring
f
s
U
i
Ground
elan.
ft
b
bang
Remarks:
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Laboeand Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code r'
COUNTY..
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, butt. Croix
j
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA~ry . # "
"Im
dimensioned, north arrow, and location and distance to nearest road. + finding
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R € ED BYI AQTE -I
PROPERTY OWNER: PROPERTY LOCATION
Kevin & Diane Kadidlo GOVT. LOT SE 1/4 SE 1/4,S` .a~ I 2 A4,49
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR
135 E. Flaking Dr. #111 na na csm vol. '1,69° 4
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [TOWN NEAREST REM
Little Canada, MN. 55117 (612 484-4112 St. Joseph Old Mill Rd.
tr,] New Construction Use [A Residential / Number of bedrooms 3-4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate -7 ed, gpd/ft2___$_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) 94.40 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material stream terrace 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 IF21 S ❑ U IRS ❑ U ER S ❑ U E] S ❑ U FLI S ❑ U ❑ S g-411
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouinday Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 -10 10yr3/2 none 1 2msbk mfr cjW 2f .5 .6
,...1...... 2 10-26 7.5ry4/4 none scl 2msbk mfr gw if .4 .5
Ground r437-42 6-37 7.5ry4/6 none S Osg mvfr 9W na .7 .8
elev. 7.5ry4/4 none sl lmsbk mfr gW na .4 :.5
98.4 ft.
Depth to 2-86 7.5ry4/6 none co. s Osg ml na na .7 .8
limiting
factor
+86"
Remarks:
Boring # 1 -8 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
....2... 2 -28 10yr4/4 none scl lfsbk mfr gw if .2 .3
3 8-42 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
Ground
elev. 4 2-86 7.5yr4/6 none co s Osg ml na na .7 .8
98.6 ft.
Depth to
limiting
factor +8611
Remarks:
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 00t
Signature: Date: CST Number:
4-12-96 cstm 02298
PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
? 1 0-11 10yr3/2 none 1 2msbk mfr 2f .5 .6
2 11-31 10yr4/4 none scl lmsbk mfr gw if .2 .3
Ground 3 131-46 7.5ry4/4 none sl 2msbk mvfr gw na .5 .6
elev. 4 46-88 7.5ry4/6 none co s Osg ml na na .7 .8
98.5 ft.
Depth to
limiting
factor
+88"
Remarks:
Boring # 1 -10 10yr3/2 none 1 2msbk mfr gw 2f .5 .6
2 10-43 7.5yr4/4 none sicl lmsbk mfr gw if .2 .3
U
3 3
-84 7.5yr4/6 none is Osg mvfr na na .7 .8
Ground
elev.
98.2 g,
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 -8 10yr3/2 none 1 2msbk mfr gw 2f .5 .6
2 -21 10yr4/4 none sicl lfsbk mfr 9w if .2 .3
S
U
3 1-37 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
Ground
elev. 4 7-89 7.5ry4/6 none co s Osg ml na na .7 ~.8
98.1 ft.
Depth to
limiting
factor
+89"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
low
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Kevin Kadidlo New Richmond, WI 54017
MPRSW 3254 SE4SE4 S3-T29N-R19w (715) 246-6200
town of St. Joseph
N
111=401
Bn.= top of NW lot stake C el. 100'
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Gary L. Steel
4-12-96
FILED
N1AIR 1 8 1996 01
KATHLEEN H. WALSH
54093;,> Rer > Cf0i~iXC0., of Dads1M iD
SL
54a
ti/ II
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CEP T 1 F l ED SUP V E Y MA P
Located in the Southwest quarter of the Southeast quarter of Section 3, Town
29 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin.
Owned by: Donald & Judy Kadidbo
611 Old Mill Road
,,~~~tlNilll Hudson, Wi: 54016
% SO
HA VEY G.
• JOHNSON _ North line of the'SW1/4 of the SE1/4
• S-1899 ljnpja&tgd- L.ads owned by the NE corner of the SW
HUDSON to WIS 1_6 State of Wisconsin. 1/4 of the SE`1/4
~i O 187.06 112.10- L7 S 84.3' u
.0o <,q '~•,'....".!'F. ' 50.00 56 E 327.32 ' a
344 / 272 S`1E0 .0
LOT 1.
' c 133,422•5quare Feetm
\ ~A 3 (-3.063'Acres) m
5
LO T 2... ~N W
368,589 Square Feet _
-'L (8.462 Acres) 2
m 1
/ i 01 0
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co -'I
tuBearings referenced to 0 a1 N iI i
the South line of the SE 1 /4, o aI U-
assumed N89054' 1811W . a.
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Lo
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i A 232 02 r O$
EP• Q.O' / N 89' 42' 074.W 503.62'
Vp \ POINT OF BEGINNINGW
0
\ ti
\9b 3\ NOTE: This map is a rearrangement of lot N
lines. No new lots have been created. b ~
Therefore. Town and Countv annrovals
ZLO£ aSed.11 •Ton
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M.,10 z oo:~N
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04/15/96 11'15 2 715 294 2188 VIEBROCK CONST. F.05
S ,
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER /C e v,'•, O. 'a„ _t 1 C< J j C MAILING ADDRESS r Dr //i L r ~'TL e Cs. A- a hi /U
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION S - 1/4, S C 114, Section 3 , T a9 N-R 15 W
TOWN OF -S7-. Tos f:;a ~ , ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP )4- , VOLUME//49, PAGE y~ Y , LOT NUMBERj
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 to operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
04/15/96 11:13 a 715 294 2188 VIEBROCK CONST. P.04
' 8TC- 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 P~ e vg,, ,L- 0,j,, R c J,~l ea
Location of property Sc-, 1/4 S G"' 1/4, Section T_=Z9 N-R_ !S W
Township 57; tense o < Mailing address
11;r 2
Address of site
Subdivision name Lot no. 1
other homes on property? Yes >4,--No
Previous owner of property 00 c a d ; d 4l~
Total size of property
Total size of parcel b6c-mss
Date parcel was created 3 / 4 G
Are all corners and lot lines identifiable? ~'4' Yes No
Is this property being developed for (spec house)? Yes _>4, No
Volume Z(9 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) an (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-y/-T'3/ , 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.
,S-Y/ S'
Signature of Applicant Co-Applicant
541531 STATE BAR OF WISCONSIN FORM 1 - 1982-
WARRANTY DEED
, , ,
REGISTERS
PAS: L . ST. CROIX C 1
DOCUMENT NO. 9
11 U
- W forFi3C;-d
APR 1 1996
This Deed, made between Donald G. Kadidlo
and Judith K. Kadidlo a/k/a Judith 12:45
Kadidlo, husband and wife, ,
Grantor, Register of Deeds
and Kevin D. Kadidlo and Diane M. Kadidlo,
husband and wife, as survivorship marital
property,
Grantee, /v
t' HIS SPACE RESERVED FOR RECORDING DATA
Wltnesseth, That the said Grantor, for a valuable consideration Q
one dollar and other valuable consideration NAME AND RETURN ADDRESS
conveys to Grantee the following described real estate in St CroiX14-a 1CQdj'dh
County, State of Wisconsin:
Lot 1 of Certified Survey Map filed
s
March 18, 1996 in Volume 11, page 3072.lo
Together with a non-exclusive easement - over and across the "EASEMENT" shown
on said Certified Survey Map, for
purposes of ingress and egress to Old (Parcel Identification Number)
Mill Road bo~~wct 1ocz-{e-d LN Sw q-A*.,TrrQ OF
H lZ~/x+'+E 19 wE~
A>6 iZ?
t{E SC f~t.tit-RT&K of StiCTlo/, 3 J TOWW AR
low o OF ST. T45CP;4 61 C kav Cou ktY w o sca r.t7 .
F
This /`s ND 1 homestead property. 'j
(is) (is not) I;
j
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Donald G. Kadidlo and Judith K. Kadidlo
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants, and restrictions of record, if any,
l
and will warrant and defend the same.
Dated this / day of / / t 19 9 6 .
it (SEAL) (SEAL)
I~
Donald G. Kadidlo
(SEAL) (SEAL)
Judith K. Kadidlo a/k/a
Judith Kadidlo
j ~
AUTHENTICATION ACKNOWLEDGMENT
~i
Signature(s) STATE OF WISCONSIN
SS.
ST. CRO I X County. „