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HomeMy WebLinkAbout038-1174-40-000 o 60 c ts cu 0o a 0 I ~o c p H E m` o a I L I (0 I W N I 'tl w m (D [r U I f6 a~ ~ I o CD 9 z wpp N LL C a O C o 4 w U c`c I v d~ I Z y _p ~ II' .r O Z ~ an d I ,n a m o O Z c O d z m c z r V1 F- _ E -p M ` N N 7 01 • a O 0 (D ca z 0 Q z N z c y I c O N ~ N C v O a y w E L O C LO LO d o O T o. G C a E M ' N N - F I- v o Q ~ U) F- N 4 4 -oc z o • m E a O a O Oa n m 0 ~i a 7 p CO (D cD N U U rn rn a> Z ~7 !Z ^~l N LO '0 N rn Q C O Q E M > Q co C a p L y d) N 'p Q } fn co O w 04 p 3 N N c O ~ p N C6 p N C c O CL O) O ►r 00 N p € jy C -O N p ao ! D c O M p a a~ w m v 7 fD 00 CD 16 c C • , M N CO O N O N N U O M J N O z z TL (n l a a 4-, CL .2 v r c m c t A 0 at ':0)u Parcel 038-1174-40-000 02/07/2006 08:02 AM PAGE 1 OF 1 Alt. Parcel 15.31.18.858 038 - TOWN OF STAR PRAIRIE 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 DONALD C LINDNER O - LINDNER, DONALD C 1131 212TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1131 212TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.760 Plat: 0047-APPLE RIVER BEND SEC 15 T31 N RI 8W PT SE SW LOT 14 APPLE Block/Condo Bldg: LOT 14 RIVER BEND 1.76 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 02/28/2003 711679 2158/364 QC 1203/569 WD 1191/310 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 120098 345,400 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.760 55,300 284,200 339,500 NO Totals for 2005: General Property 1.760 55,300 284,200 339,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.760 55,300 284,200 339,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 215 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 S Labl, end Hum n Relations Usk' SOIL AND SITE EVALUATION REPORT Page of -3 Division of Safety & Buildings in accord with ILHR 8' Code i~ COUNTY T c R o t' K Attach complete site plan on paper not less than 8 1/2 x 11 inche 1 i . Plan nst inclu not limited to vertical and horizontal reference point (BM), direct' %0 0c a or PARCEL I.D. # dimensioned, north arrow, and location and distance to neares r ,V _ APPLICANT INFORMATION-PLEASE PRINT ALL INF ATIdUL REVIEWED BY DATE PROPERTY OWNER: LOCAT Vi'c h A PD 5 TO V T Nwm OT S S~✓ 1/4,S h6r T Y/ N,R 11V E (o Wo PROPERTY OWNER':S MAILING ADDRESS OT # SUBD. M# / 353 14 w,4 Tv,e,E, T.P. AE k CITY, STATE ZIP CODE PHONE NUMBER GE W OA rfi~ So.J ~~s. SgoI(o (~is)s~fq- PR~4l.rw ~Ywy cc o731 Ip'gew Construction Use ] 4--fiesidential / Number of b6drooms 3 +0 4 Addition to existing building ] j Replacement ] I Public or commercial describe Code derived dairy flow Y°cy God Recommended design loading rate .7 bed, gpdm2 trench, gpd/(t2 Absorption area required bed, ft2 7~O trench, ft2 Maximum design loading rate 7 bed, gpd$ -~trench, gpdgt2 Recommended infiltration surface elevation(s) SEA }'fig .3 ft (as referred to site plan benchmark) Additional design / site cons rations Parent material SCS I I S W2 r k q R DT- Flood plain elevation, if applicable ft 7Unsuitabloerfor itable system CONVEKIO AL MOUND- IN-GROUND PRESSURE AT-GRADE SYYSTWAN FILL HOLDING TANK system 2S El U td'S O U 9.5' 11 U 05" 11 U BI 11 U ❑ S Nom' ,PE~o~+/~~NaEJ.7 SOIL DESCRIPTION REPORT '111R= Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mrch / o-I3 /o ye 3/j__ S 144, 9/P s S 2of 7 4 1~j 2 3 - 20 /o Y/e y 0 Av s~ lP .7 of Itm d S S (c, f Ground 3 - 36 /o Yl 316 yR vim/ S . O S ~ %Q CS -2 - ~ elev. / of. 2 fK ft. 20 /-0 Depth to limiting factor Remarks: Boring # / 10~5 /o YR 31,;t15 lo, 1~iP S S /Gf 7~ YX .3 Ground elev. /07 -_J~( ft. Depth to limiting factor Remarks: CST Name:-Please Print R d Q t R T 2AL Q R I'C (n T Phone. E31 6 5 Address: -/6, - CsrA 1 Signature: , _ , Ulbricht s Date: CST Number: t w ~■r A PROPERTYOWNER RI?-44,PD 554007- SOIL DESCRIPTION REPORT Page Zo, PARCEL 1.134 LO j- A hr iE /Var- 8g!--'WD Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD/ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mach jig-/o /o re 3/12- _ - s /~f -7 p z /O - /o YR 3/lQ 9iPA ~S / c S Ground 3 2Z-yo /o yx y/ S. Q - • 7 0 elev. /off , ?l (T it. j Depth to limiting factor Remarks: Boring # ; J5 /14 .7 .0 YX 14 .7 1.06 3 .2_ 3G lG yR `//CP yi'°~4 E/ry s s 7 g Ground elev. - /0 %I R Y16 S . U ,Q ~ ~ • ~ 103 i Depth to i limiting I factor 1 Remarks: Boring # 0-/0 /o YA 31a- ~5 /.tom S S Xaf 7 Z 14-.10 31s~ very cl cs } • Ground 3 /r4-- 32- le M CS elev. - /o An 5X, S (j GQ Q . /07,/Oft. Depth to limiting 1-7 ~factor i , Remarks: Boring # Ground elev. ft. Depth to limiting factor GN kA m m ~ y o o p~ o L" -77 a o m ~ ~ ' s tp N O N N ~ I lei. U'l iJ Q W CIQ, Ilk n • \ul ~ ~ N ~ ~ op r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS rT' SUBDIVISION f CSM / # LOT # SECTION / W, Town of% ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEMS-- r ~ J Pil ~INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ! c~'.zC a~ - / -t ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~j Liquid Capacity: Setback from: Well House / Other /D Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length_ Number of trenches bistance & Direction to nearest prop. line: ZC Setback from: well: ? House- vZ_5 Other y ELEVATIONS ` Building Sewer 6` J ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold / Bottom of system Existing Grade T,-,-Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County- Labor Labor and Human Relations INSPECTION REPORT + 01 CROTX Safety anr~ Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284171 Permit Holder's Name: ❑ City ❑ Village jI Town o : State Plan ID No.: LINDNER, DONALD C. STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /Op O /00 J- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S Benchmark Q X00 - Dosing Aeration Bldg. Sewer , 3 Holding St/Ht Inlet y' 9T,8 TANK SETBACK INFORMATION St/ Ht Outlet Vent to TANKTO P/L WELL BLDG. Airlntake ROAD Dt Inlet Septic 3 NA Dt Bottom Dosing NA Header / Man. S q' Aeration NA Dist. Pipe Sq Holding Bot. System 1 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length _ I I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S` DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO) CHAMBER Mode Number: System: X T Q e25 3 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: STAR PRAIRIE.15.31.18W, SE, SW, LOT 14, 212TH AVENUE r Fs h Ito Lusaa ea Anse: ~ a, ~ .r w.rX Plan revision required? ❑ Yes JINo Use other side for additional information. L SBD-6710 (R 05/91) Date In `e is +gnature Cert. No. c r ADDITIONAL COMMENTS AND SKETCH f SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION BureaSafetyu anofd Bildi uildiinnggWaterlSystem! 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 f than 8112 x 11 inches in size. Grog • See reverse side for instructions for completing this application State Sanitary Permit Number g~// 7/ The.information you provide may be used by other government agency programs ❑ Check if 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 / Property Location ©4 1/4 1~1-1 1/4, S --T , N, R/ (or Property Owner's Mailing ~ Z/77 Lot Num er~ Block Number -141 City, tate t Zip Code Phone Number Subdivision ame or 9M Nue( . TYPE F BUILDING: (check one) ❑ State Owned El It r Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ToWa9 pF 7u^f /'urh, ~C 1.,2 ;41= k Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _______ystem---_----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 1 1,1~f.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 G®~ Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel Plastic p New Existing structed glass App. Tanks Tanks Septic Tank or Holding Tank L~GI ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1-4 -o ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu 's Name: (Print) Plum s gnature: (No Stamps) MP/MPRSW No.: Business Phone Number: PI er's Address (Street, City, State, Zip C de): WApproved UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag t Sign ure (No St ps Surcharge Fee) 96 E] Owner Given Initial J`121~ ~a Adverse Determination C/ X. CONDI IONS OF APPROVAL/ REASO S FOR PPROVAL: fir D-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber < e INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years- 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority- 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family 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. PROJECT ADDRESS o./ O~r► ~r~~~ ~-0~5 'ell 1l4 f~J 1/4/S/S'/T~ N/R W TOWNS h COUNTY MPRS . Byron Bird Jr. 3318 DATE a c{ - BEDROOCLASS PERC CONVENTIONA N-GROU PRESSURE CONVENTIONAL LIFT MOUND HOLDING TANK SEPTIC TANK SIZE IFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE=BED SIZE 1_2 . k Benchmark V.R.P. 'Assume Elevation 100' Location of Benchmark , ' o * H. R. P. 0 Borehole Q Well Scale _ Feet 0 Perc Hole System Elevation Uent 12" TYPAR COVERING M 12" 3' 4 6' 4O 3' I 6 , sewer Rock ) gi4l G~~ 5 I GNf J 19 I ~vr Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code E ~y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. * < c 4 APPLICANT INFORMATION - Please print all information. Reviewed `Date i Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location n ek le-1 ~ r Govt. Lot t' 1 `L,114 T / N,R ` E (qr) w Property Owner's Mailing Address / Lot # Block# Subd. Name or CSM*- Ci State Zip Code Phone Number ❑ City ❑ village Town Nearest Road New Construction Use: Residential / Number of bedrooms _ l Addition to existing building LJ Replacement ❑ Public or commercial - Describe: i Code derived daily flow &~7 gpd Recommended design loading rate ._bed, gpd/ft2_ trench, gpd/ft2 Absorption area required _~K bed, ft2~trench, ft2 Maximum design loading rate 7 bed, gpd/f12y trench, gpd/ft2 Recommended infiltration surface elevation(s) /07 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system 7;-ventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S ❑ U j-S El U _SS El U .J-' ❑ U ❑ S )NU ❑ S 29"U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseil Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0- Ground elev. Depth to limiting factor ,~;,Z in. 41 5 Remarks: Boring # Ground ft. Depth to limiting factor Remarks: CST Name (Pleas rint) Si re Telephone No. Address Date ST Number PROPERTY OWNER 4l?SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots t Bed Trench ©t 4a 1 r J j- r !mot ~ ~ Ground , e'QV- Depth to limiting fact r J~ ot Remarks: Ling # Z-t 7 r Ground elev. 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 # _ r G r Ground elev yr-~ft. Depth to F-T limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) <`~jn yeti l Soil Test Plot Plan Project Name o/rte Byron ird Jr. Address C' 'P,-, s<a s 3479 Loth/ Subdivfslon. ~ rye-,,, pate ~ 1/4~iA S 1 N/R/iW Township 0 Boring 0 Well PL Property Line County L BM or VRP Assume Elevation 100 ft. System Elevation o' *HRP l r M , Scale 1/4 .10 Ft. When dimensions aren't stated yn ~M WM w H ii w, o $ - ~ bb EgO ..get rR= a>o AM rMl am ~ a A G h nM Mo " w m ~s a rt xx ~ a ~ o. 33HG 33G ^ R $ n n Ira rL VA ir & O _ sign M.GY •9Y•OIN t 1~ '9 Y w° p iNry+ _ V p f' \ m pv O 1 y a s rt oJ•" N " •Q; 1 1 ~s g ~s 9'0 ~n 001• $ " d Np~• n IIY ~ •Lt 1 i l", ~r1 ~ r o s~ KF'10P l}Y~ C S S T~ 01 0 1 a a (1 1 v. 2 m ~ CT1 f' ^ ~ . ~c N ~v 1 3g~ ~T `LG ~ t Tv , . s g2t to JO` 1S rn~ \ a 2\ ` ~ ~ bo _ N l y ~ b^ • ` ' N A pY V r`► n ` 01 Ll N t O J C 4~ ~ . 4 O T O b O ~ N 1~' O 'V1. A N N Nx O_ ~ J, $ N ~ ~ N ^ ~ N wft Y T co \ E 218.98. ~]s.FZ' kIYE •rr9f N06. 8'17'E 192.6~~V~4 1m $p `t Nl4•S/ 2 I w. F ~ \~43 ~•f 3 oA r et *i :a APPLE Z p C y r. O - TNkf40 _-pF l Sills, O S Y N o m O ; ,t o. H. W. M 862 s S R STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Droat Lel, r. e MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE 101-5 C t7k16 ; o, PROPERTY LOCATION f~ 1/4, .5&l 1/4, Section T ,3J N-R_22 _W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION Se" j LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , 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/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: 71 / w- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 106 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 017dl~ Location of property , 1/4~~L 1/4, Section TAN-R W Township Mailing address-~~ Address of site' 21_2 Subdivision name Lot no. ~i/{~ ~vPG' {U Pv7G Other homes on property? Yes_,Z-' No Previous owner of property Total size of property Total size of parcel 1,71-' a~~-mss Date parcel was created A,,-"I Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes __,V No Volume /,,2,m 3 and Page Number 5' 7 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. 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 of AppTli-cant Co-Applicant Date of Sig ature Date of Signature , . 5508'71 VOL 3203PACE569 STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. r MUSTERS Richard 0. Stout 81 CROIX CO., W! This Deed, made between Rec'dtorRecord 11 1 'OCT, 15 1996 Grantor, and Donald C. Lindner and Marcy A. Lindner, at 11:00 A.m „ husband and wife, `Kapt'L -h low,„ f; R+r of Deeds f Grantee, Witnesseth, That the said Grantor, for a valuable consideration Richard 0. Stout conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS Lot 14, Plat of Apple River Bend, Town kqW~ Be* Hucbw of Star Prairie, St. Croix County, aw'cw Ot1d sulo Wisconsin. pp.Box ~ PARCEL IDENTIFICATION NUMBER i. TRANSFER i I i This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Richard O. Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights-of-way and covenants of record, if any. i and will warrant and defend the same. I Dated this 13th day of September ,19 9 6 C.lJl~ ~-~1 uC 6- (SEAL) (SEAL) ! Richard 0. Stout l (SEAL) (SEAL) * * I AUTHENTICATION ACKNOWLEDGMENT I Signature(s) li }-,t a-W'--/f State of Wisconsin, O • ~-tlti'~` ~ ss. St. Croix County. authenticated this, day ofCaG7(.~' 1~ Personally came before me this 13th day of 8 0 VON v + = 1~~0 O f71 W Z X a--w- N J _ O /y~ i S O N ll P (O y/ ti <2~S 2~ Z cl: `S,SF~ a v CL Z brN \ U Q r yFU • O. ,3 + WN o 3 V Lli r \ F.. A ~ rp: ~ W G O U O M ~ r N V LL. Ltd O (nW W 3 m ~ti ^N N o N ^ J 2 Np W lYJ F LU V~ Z r y N I to a lyJ Q e m = s O p N / ^ 01 t~n r inN a` w C) Lu L C) N ftaft LL to ;N 6 W 1 •A~ LLJ LU Z W V Q ~1 81 N~9 (O W F- X 1 N0 IOL N Lw C) Li O o~Cc 445-94 cr- U) cc a ~ ~ E, H SINE ? z MpTC , W O O O _ SEE S#ET KI „ Qv~z ~ o a ; n~ ; A ` W J 8 u Yu J~ 1 1 3