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HomeMy WebLinkAbout032-1082-30-200 o O I 0 U!J, h ° m 4) op 4 o w ° ' I 0 o I N M1 I a I o~ ~ I v ( o~ A I d I I I 3 ~ o I o z I c LL c I 0 3 ~ I a I I a v 4) I C/) = 0 0 i~ m m co H ~ ! a m o E z c 4) Z ° Z N c 0 E N N ` M S N CL .1 1 m N U) c g •^l e ON O Q z H z o z N ~ c 'o c I o m ~ N c M I Lo 12 co m a o a 4) - c LO cn (D C, D O d > {y. N N Z sf S O O d Z O O cn 0 0 0 z • A Naas ~y CO co co 0 I ~i 4) 0) 0) o z 0) Lo > _ 0 rn oo N r _ o co y c a o o co m o N ' ~ ~ d Q fA c0 O 0 N H C 6 Lo O L -U O O d = p N O co Q M p) H U N Vl a C CL O O O V M_ -0 N N N C N N y d co 00 ° M E c 0) (A d c 4) o I • 7a N O N E E V Q it O co CO LL N O z_ fn r`Iri E c c r A 0IL2 o3U)ic°~ MAY 2 3 19% ST. CROIX COUNTY SURVEYOR'S RECORD 0 0 Bearings are referenced to the n COD south line of the SW$ assumed to Ll-~ I I bear N89°57'52"W. a I F - (D M. ire 0 0 a, ro. 2193 0 M (D r* I West line of the SEk of the SWk of Section 2 rat w W ---N00°16' 15"W 1332.63' p: 1292.91' ~ 39.72'- 0 w s a z 0 viw N C~1 nft w lw I s y 5. 03 •hd fi N N - 2 0 (D Co cc, ~rt CA 0 W N 7• ~ ~ y ~ '~'i O t0 W _ 0 -P M p~. ct o • ✓ 0 N M _ 398.60' 41.161- i I m °o N= a N00°16'15"W 439.76' I o n _ E rt N 0 yG 3 w r F w lA N .'"1 C:) L Cc ME 0 :j 0 W 0 l N N O '9 tD C OD ---I N O 'T7 tf w O _ O JC (n 00 N, Q CD 7 N ° R7 1 Z/I n W T C °iQ a 0-4 ct m a 398.60' 42.60' - I N I- Cx 0 0) - 00 IM d Q, N00 °16'15"W 441.20' in rn i j M C- CL Ln ODD O ODD I . 4'42UN'fTf' ~ < a a co ST I o' N CaVIOAec>sWe falaanit (D ? N m w ° and M Racks Committee -v Q, 0 a w a N = S00°18'57"E V 0 CA -1 -3 H o m ---j N ~N If not recorded 0 829,481 -0 o w ,30daysof" 7 Z * 0 , ° 10 >muoval data (*1 r X M 33' 13' -roval shag be w m o CD N a E -11 $r void °o 117 I C w w Oo 0 S00°18'57" 1287.43' 'N" 0 °w 0 o n 828. ' 1 398.61' N N 4' rt W _ _827.93' _ 444.27' ---S00°2 E-1332.92'-- v*~r u, STC - 104 AS BUILT SANITARY SYSTEM REPORT -47 OWNER ~/T U~EJ^S~`a /1/ >C S ADDRESS t SUBDIVISION / CSMJ oQ 7W-S LOT # SECTION- ~7-KT 31 N-R /5 Town of -hsLC 70L' , ST. CROIX COUNTY, WISCONSIN PLAN VIEW ~Dh+l SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o~ ; 5 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: >Aaa lD~ Liquid Capacity: pp Setback from: Well House -2,3 Other -S-0 Pump: Manufacturer. Model#kA Size Float seperation Jr Gallons/cycle: Alarm Location ":SOIL ABSORPTION SYSTEM Width: Length 17 t65t7;2 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House 5_f Other ELEVATIONS Building Sewer ST Inlet. , $ S ST outlet PC inlet PC bottom Pump Off Header/Manifold 1 q.3.~g c"QO~~ Bottom of system_ ~ 3 3 , s7 Existing Grade Final grade / g,y$ ~ 3,60 96 . x 9 7, DATE OF INSTALLATION: oy-11 9 ~ PLUMBER ON JOB: 2Z LICENSE NUMBER: p ] S g' INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268695 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: FRANCIS, MICHELLE SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION TypeO CHAMBER Model Number: System: 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 : SOMERSET. 2 8.31 .19 , SE, SW, LOT 4, 192ND STREET c a~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s Safety and Buildings Division ~f■■_r■r. 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar 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 Propert per am Property Location ~ e- r/ 114 114, 5 T 3 , N, R g E (or) Property Owner's Mail' g Address Lot Number Block Number f City, St at Zip Code Phone Number Subdivision Name or CSM Number/ o ll~l 5' S~6 lS> Sy ,~08~ 3 cS 11. TYPE OF BPipor NG: (check one) ❑ State Owned ❑ C'ty Nearest Road ❑ Public 2 Family Dwelling - No. of bedrooms -t- ❑ Iowan OF Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) p 1 ❑ Apartment/ Condo 6-3.2 O D O _ O~ 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. TYPWOF ERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11E] S epage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42E] Pit Privy 13 ❑ Seepage Pit 43E] 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/da /sq. ft.) (Min./inch) Elevati0 /000 0 93,7 Feet Q ~ 7 Feet - VII. TANK Ca alloacctns Total # of Prefab Site INFORMATION in g Gallons Tanks Manufacturers Name PConcrete Con- Steel Fiberglass- Plastic Ex per. New Existing strutted Tanksl App- Tanks ;01 - Septic Tank or Holding Tank v ` DO 1:1 El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber 111110 ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signature: No Stamps) MP N Business Phone Number: c~n A; S_ -8~ 7~t"F ~33:-"2 Plumber's Address (Street, City, State, Zip Code): .avbl9f`~S W~ S`07-~ 9X- -7 IX. COUNTY / DEPA TMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing A a s) Approved ❑ Owner Given Initial ;F go SurchaSurgefee) ~ -/l - Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I SBD-6398 (R. 05/94) DISTRIBUTION: Original W County, One ropy To: Safety & Buildings Di-ion, Owner, Plumber INSTRUCTIONS r 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. IL 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. iA 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 8 112 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 EDINH REALTY HUDSON WISCONSIN OFFICE 09,03,1996 14:23 NO. 4 P. 4 r . ..ti. . ..emu V v -773 lod / 4~w A-2 i A;O : s' 'M 7 ~p,e 3y • I T N a ~Of / a .a n I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page /of S Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. A Pr` de / A. COLIN Y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan m~ Jude 13iOf not limited to vertical and horizontal reference point (BM), direction and % of slop , sc le or - PAgGEL I. t dimensioned, north arrow, and location and distance to nearest road. tr f9EVIEWED Y DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY WNER: PROPER T( GOVT. LOT :.1/4 S T N,R E (orb PRO 0 ER" S- MAILING ADDRESS LOT BLOC AtkME OR CSM # 1 NEAREST ROAD CITY STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE OWN ~ - ___j - New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ;9~L gpd Recommended design loading rate 7 bed, gpd/ft212 -trench, gpd/ft2 Absorption area required 3 bed, ft2 sC: trench, ft2 Maximum design loading rate _._bed, gpd/ft2 , ,Q trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations Parent material Flood plain elevation, if applicable -'411"" ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U 0 S ❑ U 0S ❑ U _RS ❑ U ❑ S 0 U ❑ S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxiay Roots GPD/ft in. Munsell Qu. Sz. C pt. Color Gr. Sz. Sh. Bed Tmr& Ground s~ elev. ~Y~' ft. Al '5J11 Depth to s - limiting factor Remarks: Boring # lm- A/ / r Ground elev. - ft. s ILI Depth to limiting facto, Remarks: CST Name:-Please Print Phone: ,d Address: Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page, Zof,~ PARCEL I.D. # s Boring # Horizon in. Depth MuDominantnsell Color Sz Szre Consistence Boundary Roots GPD/ft Qu. . Mottles Gr t. Color Texture StructuSh Bed . . . Trench Ground , U.1 g elev. 2a ft. Depth to limiting factor > 9" Remarks: Boring # 7 L9 Ground 3 ' elev. 2-12 ft. _ 7 Depth to limiting factor > Remarks: Boring # n}} S / - 14 11 Ground elev. _ _ ,27-L ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ~S7 ? c e1 6J Bid o i I ~ s~ ! 3/ 4~ 1 David Bracht Certified Residential Specialist Graduate REALTOR• Institute 192 NQ North line of the SEt of Sxk of Section 26 . - - - - INUE~ - - S89o58'33'E 1355.82'-- - 328.29' 328.29' 699.7' l ♦ - r- - 1 328.30' I ~-3D I 656.43' - .n S89.43'30"E _ 1313.03• ~ o f O_ W _ b N 1 ~ N N Lot #2 $27,900 " N LOT 4 LOT 3 w 0.25 Acres y x a 7.11 Acres Inc. R/st _ ;o I r a o 'y °a N .i N 309,732 Sq. Ft. o It M N 6.01 Aces Exe. VW - i • Wooded u 3 a; c o 261,707 Sq. Ft. ^ I ,'S .2 F- _ z S89.43'30"E 1028.29' Rolling 378,30- 656.74' 699.99 43.25'- " °c 656.60' 328.44' o' 371.69• N u W c> 0 Lot #3 $26,900 LEGEND ! n ry H 1 LOT 2 „ b 6.01 Acres 49 Alum nteo County Section Monua•n[ Found „ I IJ1 Wooded • 1" Iron Pipe Found o 1^x24" Iron Pipe set, neighing 1.68 lbs $ °D l+ per linear foot MATCH UNE Rolling - 100' Roa<May Setback line - ° 7.06 Acres Inc.: 308,306 Sq. Ft. x o Lot ^ #4 6.25 Acres Exc.. R/M $17,500 272,193 Sq. Ft.: ` H 3.00 Acres ' M _ I 1 Rolling s LOT 5 W ( H e) o - W m I u a, 30.57 Acmes Inc. RJIi' .n W 3 r 1,328,921 Sq. Ft. 14 N O n 30.14 Acres Exc. R/M o ~ IRECIIONS TO 1.342,757 Sq. Ft. $ r. • 589'57'52E ° W ROPERTY... 372.40' 43.97 , 328.43' 60.72• rom Somerset 3 482.65' ounty Road I North N o - W° N89'57' 52"W ne mile to 192nd. ! « o N .o M C.S.M IN Z O ~ I 412-76' 4$9.20 -J Davi Bracht N89.57 ' 52"W 871.96' Office: 715-247-5900 Q WM Kteaml realty Home: 800-73 3-9915- 103 Main St., Box 68 ® ~iaso Somerset, Wisconsin 54025 Office: (715) 247-5900, Fax: 247-3622 Residence: (800) 733-9915 Each Office Independently Owned and Operated z ~ cD ~.J 1 . MAY13 9H1996 9 543452 0 ti 00 Bearings are referenced to the :4 0 O south line of the SW% assumed to m I Ll-~ I I bear N89°57'52"W. 0 O M , I a s. M. N o V.87 rJ-Q.2193 N fD rt I West line of the SEk of the SWk of Sect on 2~ rrt to w ---N0001611511W 1332.63' 0 1292.91' 39.721- o a a 0 rrtt O Z W I . t-h O w w~ I ~ ~ nfi' I '-1 O N w Co r N O I N --I • . I O C~ v; O aa•• ct Ln (7 _ 398.60' 41 .16' - ( m r N00°16'15"W 439.76' o 0 C r , 3 t I Z ONO Uii0 o > _ > c C7 t.0 0 c. a ro 3 w r N N w O 7 O N O W N~ co E N (A 1< O -0 O 7 Co ---I CO jr- En 00 - cn O -n rt w O r 0 1< CA M CA no w c0 I~ sv m h 0 'ROVED ' 42 .60' - I 'v C* c~ a L9 398.601 ~ Co IM w N00°16'15"W 441.20' I d `t Ct t 10 ° I ®~1 r7iVl o O a _ 0 w I, o cn _ 0' ON 'r1 In I Ln i~t~,,,~ a oo 0 OD w ~ ST 4 l Tiff v a w w I NJ C t4vAd1Iwa iatnit N -G M > N , °4 -4 n Nn O : ii n S00°18'57"E m o (n 0 'm --q M ;o I(D If not recorded h-h pr 2 829,481 vOD Lm am F N IN p IV _ W W wt:fitrl 30 days Of O r t0 ~'I X -n 7 1; Ct Z Ct 0 n wxovai data ~ o M I oroval shallbe Cr r w rT 0 ; 33 ' c C) N W f ID v.:l1 & void N Iz 0 ~ - I C ' 171 0 0 w M N I O . N CA a 0 a r fD S00°18'57"E 1287.43' 0 828.10' I 398.61' CA 0 CA a m .0 N (t Fl. _ -827.93' _ .444.27' _ I -n X -n W- s-_S00o21 I55"E -1332. 92•'~- 1 I * I d a It a W w M. SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land-,Surveyor, hereby certify that by the direction of David Bracht, I have surveyed, mapped and described the lend parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in the SE1/4 of the SW1/4 of Section 28, and .part of the NE1/4 of the NW1/4 of Section 33, all in T31N, R19W, Town of Somerset, St. Croix County, Wisconsin; further described as follows: Begin at N1/4 corner of said Section 33; thence S01031130"E, along the east line of the NE1/4 of the NW1/4 of said section 33, 5.28 feet; thence N89057152"W,, along the north line of the NW1/4 of said section and the north line of Lot 1 of Certified Survey Map recorded in Volume 8, Page 2104 at the St. Croix County Register of Deeds Office, 482.65 feet; thence S0103113011E, along the west line of said Lot 1, 316.00 feet to the south _line of the north 10 acres of the NE1/4 of the NW1/4 of section 33; thence N89057152`"W, along said south line of the north 10 acres, 871.96 feet, to the 'west line of the NE1/4 of the NW1/4 of said section; thence N02007154"W, along said west line, 321.40 feet; thence N00016115"W, along the west line of the SE1/4 of the SW1/4 of section 28 and the east line of Lot 1 of.Certified Survey Map recorded in Volume 8, page 2193 at said office, 1332.63 feet, to the north line of the SE1/4 of the SW1/4 of said section 28; thence S8905813311E, along said north line, -135:82 feet, to the !east line of- the SE1/4 of the SWi/4 of said 'section;_thence S00021;155"E, along- said east line, 1332.92 feet to the mint of beginning. Described parcel contains 48.02 Acres (2,091,567 Sq.Ft.). Parcel is subject to right-of-way for Town Roads (192nd Avenue and 45th Street) and all easements of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map:! (plat) is-subject to State, County and Township laws, rules and regulations_(i.e., wetlands, minimum lot size, access to, parcel, etc:). Before purchasing or developing any parcel contact the St`. Croix County Zoning Of f ice and appropriate Town Board for advice. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Lga , MAILING ADDRESS PROPERTY ADDRESS Tai I' I9~ in✓~uc~M n ~o 51~~,$' CB-) (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 5;.z'5:7 1/4, S 60 1/4, Sectiou573, T_? / _N-R / p TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME L°~?PAGE ME 001 , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: )bA& 4 DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 b "1 C, - Iuu 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~ 1/4 SOU 1/4, Section ~B ,T_.3ZN-R / Township s Mailing address f~c► /,Gr - .-_yo& -2_ Address of site Subdivision name Lot no. Other homes on property? Yes A-~No Previous owner of property '&'A, ~ I Total size of property /p , Total size of parcel_ /a '44_A~L~ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes /-No Volume %2D%L and Page Number OOZ 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 A!Z e office of the County Register of Deeds as Document No. '"o , 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. o Signature of Applicant Co-Applicant 9 Date of Signature Date of Signature J { VOL 12D2 PACE007 /0 OC14 STATE BAR OF WISCONSIN FORM 2 - 1982 550430 WARRANTY DEED DOCUMEIfT NO. REGISTER'S OFFICE Hartman Homes, Inc., a Wisconsin Corporation, ST. CROIX CO., WI Re: d for Record -~c '0 CT 4 1996 conveys and warrants to Michelle T.. Frans c at 10:00 A. M V U THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS ~ the following described real estate in St. Croix County, -i_'~ State of Wisconsin: Sb r.u j 0 r1 ©3~ C PARCEL I JN=IFICATION NUM ER 11 l1 0 $-1- (od Lot 4, Certified Survey Map, Volume 11,'Page 3101, Document No. 543452, located in the SE1/4 of SW1/4 of Section 28 and North 10 acres of NE1/4 of NW1/4, Section 33, all in Township 31, Range 19, Town of Somerset, St.-Croix County, Wisconsin. TTA?$$FER I This is not homestead property. XKDM (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this Y~ day of October , A.D., 19 96 Hartmann Homes,, Inc. (SEAL) B G = (SEAL) Michael J. Hartman (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Michael J. Hartman State of Wisconsin, ss. 'y County. ,....L-_.:--._a .L:- i ~1 j--.-f October , , 9h 5 0 ~ r-- 1.01 / 13. e ~ ~.v3