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JUN 41996 1-3 FILED SUVEEYOWS RECD
C E I 1996
ORD JUN 1 3 V.
r . • KATHLEEN H.W~•~ 10
545233 Register of Deeds
SL C(DIX CO,Wl
CERTIFIED SURVEY MAP ti
Located in Part of the Northeast Quarter of the Northeast Quarter and part of the Southeast Quarter
of the Northeast Quarter all in Section 19, Township 31 North, Range 18 West, Town of Star Prairie,
St. Croix County, Wisconsin.
LEGEND • Set 1 1/4" x 24" Iron Pipe weighing
jit. County Section Corner Monument a minimum of 1.13 pounds per
• Set 1" x 24" Iron Pipe weighing linear foot.
a-minimum of 1.13 pounds per • Set 3/4" x 24" Iron Pipe weighing.
linear foot. „ a minimum of 1.13 pounds per
O Found Iron Pipe linear foot.
• • • . • • • • • Denotes 100' Building Setback Line -x- Denotes Fence ry
NORTH 1/4 CORNER SEC. 19 R = Recorded as jPROVEV
(ESTABLISHED FROM TIES) 210TH AVENUE
NE CORNER SEC. 19 rn
(BERNTSEN CAP)
S 8923'28" E 2675.21---- - JUN 11 3
w
NORTH LINE. Ofd THE NE 1/4 SEC i19 ti; loix COWTY
LOT 1 LOT _2 UNPLATTED LANDS Lw1,pceh*nsiv*P n*
C-. S. M_ VOL.1 8 PG. _2362 z~----F I ~ py s ~
cm.
i - - - - - I C;,)
R=S 9'32'17" E
S 89124'37" E I 1336.02---
-
O not rftwdod
Z x- x- x 906.18'--- a
z W**A lin 36,d*v of
= i 429.84' - ---870.63'-- -o 3555 IJ- Ipptdri$t>~f~
I cn .L rpsaV3i' # t~~l►
a'
LOT 1 S 89'24'37" E rn 10
0 9 N° 585 I; w W * 3 arAd
Cf)i N 548. SWELL 33r-'l I a ~q M04
.
9
LOT 2
Q Q~ I Z 1
- HOUSE O
a It
w 321.05 -
w Oj cO S 8924'37" E r= a Q SHED N 13 N
N r M ~I
H~ 1 N N to
F-I / - ORDINARY HIGH WATER LINE t` BARN Of WI
O QI GARAGE I I C Uj W 3
w ~I 3 7s' SETBACK 546. 2'
~I
z zi ?-z- 58 0 W
00 -
S 8924 37 E r 0 la) I N~Z°
F =1
L LOT 4 N' LO :o N N TX
I w
0 75' SETBACK-+- f 5 0 ~N I I QI V) Z N
!k I
o w M M
Z rk~i~ J 585.14': 3 f 0)1
ORDINARY HIGH WATER LINE S 89'21'20" E F 0_ 00
- Cq I Co 0 fn
S. LINE ( OF SE 1 /4 OF THE NE 1 /4 N ~
~ ~ o• (O r l I t7 Q
~
'1\'° 1288.34' : O t7 1 1- 68' I O m
1288.23' z 1 l i z o o
A-j
OF W/S~ 1330.63' I N 8'22'35" W 5 ? W 0 °
LOT 1 R=S 89'32'17" E w
o •AO rr U
DOUGLAS J. ice LOT-2 I (01 I LOT 3 r W X V) L N
ZAHLER =1 I 00 I - i a U- a
' S-2145 C.S.M. VOL. 16 PG. 1526 / 0 °
HUDSON, I i t o ~ z~
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Prepared for and at the request of Ji f""
Parcel 038-1079-40-200 04/14/2005 12:47 PM
PAGE 1 OF 1
Alt. Parcel 19.31.18.325F 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): * = Current Owner
" JACOBS, STEVEN A & BEVERLY A
STEVEN A & BEVERLY A JACOBS
2082 90TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2082 90TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 19 T31 N R1 8W PT NE NE BEING LOT 3 Block/Condo Bldg:
CSM 11!3114 3 AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/15/1998 580942 1331/398 WD
07/23/1997 1188/183 WD
2004 SUMMARY Bill M Fair Market Value: Assessed with:
30203 189,800
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 37,000 161,200 198,200 NO
Totals for 2004:
General Property 3.000 37,000 161,200 198,200
Woodland 0.000 0 0
Totals for 2003:
General Property 3.000 19,500 116,900 136,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 122
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
< s
STC - 10 4
AS BUILT SANITARY SYSTEM REPORT
OWNER %
i 4 RCi.; a T
ADDRESS
SUBDIVISION / CSM rLOS, 9
SECTION TLN-R~ W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/fi
9? 9
X
G~w
/ItS
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:Q
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 1
Setback from-
Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle--.
Alarm Location
,:SOIL ABSORPTION SYSTEM
Width: Lengthy ` Number of trenches
Distance & Direction to nearest prop, line: Ail- a '
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
910 _2 \
PLUMBER ON JOB: 1)
LICENSE NUMBER: 9
INSPECTOR:
3/93:jt
Wiscoinsirt 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 268519
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
CLOUTIER, JOE STAR PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description Parcel Tax No.:
I
TANK INFORMATION ELEVATION DATA A9600229
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
a) If 5, C eLd Benchmark l
Dosin
Aeratio Bldg. Sewer 8?~
Holding St Inlet .,5V 9 4,f
TANK SETBACK INFORMATION St/ ~t Outlet 7, e17
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Headed®S' /ll
r
Aeration NA Dist. Pipe 3 97,06
Ing Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 7- S fL' 67
S
Model Number GPM
TDH Friction System t
oss H
Forcemai n Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width r Length No. Of Tfenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC ufacturer:
SETBACK
INFORMATION Type O v i C BER Model Number:
System: /6 /p siS ® /j/4 R UNIT
DISTRIBUTION SYSTEM
Header Distribution Pipe(s~ Hole Size x Hole Spacing Vent To Air Intake
Length / Dia. Length~3 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At- e s Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mu c We-
Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRAIRIE.19.31.18W, NE, NE, 90TH ST
+Cxi ~~s"4_. Vii., ~~'~A.~f U%[,...--'' c_ f ( i
Q k i~ R-vr J Q ~n ~n r ut' ~~w~cw~ `i /1'c.
t /
Plan revision required? ❑ Yes
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
F
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency 6126 X519
y y y programs ❑ Check if revision to prevt us application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property ner Name Property Location
1/4 Alrr 1/4, S T , N, R E (or
Property 0 ner's Mailing Addr of Number Block Nut r
Cl Va 3'
10~. Zip Code (hone umber S~5 in N or 7M Number
'Aiiii
Nearest Road
BUILDING: (check one) ❑ State Owned ❑ ityage
Public 1 or 2 Family Dwelling - No. of bedrooms E] V l ll 3_ Town OF -
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo -2v
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- 1RNew 2- ❑ Replacement 3- ❑ Replacement of 4- ❑ Reconnection of 5- ❑ Repair of an
-----System System Tank Only Existing System Exlstlng 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
11 5d Seepage Bed 21 ❑ Mound 30E] Specify Type 41 ❑ Holding Tank
12E] Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy
13E] Seepage Pit 43 ❑ Vault Privy
14E] System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1- Gallons Per Day 2. Absorp. Area 3- Absorp- Area 4, Loading Rate 5. Perc- Rate 6. System Elev. 7- Final Grade
Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min-/i ch) Elevation
_4/,:_~7, ] " - Feet .h7_1, 1 Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, t undersigned, assume responsibility for i allation o the onsite sewage system shown on the attached plans.
r7 Plu b s Nam Plum er's na N a ps) MP/MPRSW No.: Business Phone Number:
Plu tier's A dress (Str et, Ci y, State, Zi Code):
~s~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved S tary Permit Fee (includes Groundwater ate Issued Issuing A ent Signature o S mps)
Approved E] ? Surcharge Fee)
Owner Given Initial
Adverse Determination 14e5 r
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) 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 b~: renewed before the expiration date, and at a time of renewal any rie,> criteria in the
Wisconsin Administrative Code wiI! be applicable.
1 All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit. Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815-
To be complete and accurate this sanitary. permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7-
V11. 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.
19 ~m/f,6(lig /j
.
9e, ~M
fold
s
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, WIS. A d
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan clude, to `J St. Croix
. #
,k hl)
not limited to vertical and horizontal reference point (BM), direction and % of sl p cafe d! 'e~] PA
dimensioned, north arrow, and location and distance to nearest road. 00 ending
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION AP 2 BEVIE BY DATE
PROPERTY OWNER: P TY LOC
CZoe Cloutier G ZCMOBG1&TFVE 1"T 31 ,N,R 18 s(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # SU CSM #
31$. Surk se Dr. 3 a' nding
CITY, STATE ZIP CODE PHONE NUMBER [:)CITY ❑V N NEAREST ROAD
Somerset, WI. 54025 (715 247-t-602 Star Prairie 9 utih: at.
New Construction Use [ Id Residential / Number of bedrooms 3 [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate ' 7 bed, gpd/ft2 ' 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark)
Additional design / site considerations alt site=95.959
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 &S ❑ U KI S ❑ U KI S ❑ U ® S ❑ U ®S ❑ U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 -6 10 r4/3 none sl 2m r mvfr cfw 2f .5 .6
1
2 -22 7.5yr4/4 none sl 2m r mvfr if .5 .6
Ground 3 2-82 7.5 r4 4 none Cos osa mvfr na na .7 .8
elev.
99.8 ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
1 31-10 10 r3/3 none sl 2m r mvfr 2f .5 .6
2
2 0-82 7.5 r4 4 none is os
U
Ground
elev.
100.00 ft.
Depth to
limiting
factor
+82"
Remarks:
CST Name: Please PrinGary Phone:
L. Stepi 715-246-6200
Address: 155 200th Ave. /New Richmond, WI. 54017
Signature:
Z ZLLJ2 Dat4-23-96 cstm C Number:
ST02298
PROPERTY OWNER Chuck Borst SOIL DESCRIPTION REPORT Page 2of 3
PARCEL I.D. # pending Lot #3
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots C~PD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
~1 3 1 0-12 10 r3/3 none sl 2f .5 .6
- = 2 12-27 7.5 r4/6 none s1 2
Ground 3 27-84 7.5yr4/6 none is os
elev.
100.1 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 10-13 10 r3 3 none .5 .6
2 113-84 7.5yr4/4 none is os .7 .8
Ground
elev.
98.3j
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 10-6 10yr3/3 none 1 2msbk mfr gw 2f .5 .6
5 2 6-26 7.5yr4/4 none sl 2mgr mfr gw if .5 .6
3 26-82 7.5yr4/6 none is Osg mvfr na na .7 .8
Ground
elev.
98.0 ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Joe Cloutier 1554 200th Ave.
CSTM2298 NE4NE4 S19-T31N-R18w New Richmond, WI 54017
MPRSW 3254 town of Star Prarie (715) 246-6200
lot #3-csm
S etc
'
111=40
Bm.= top of steel stake @,el. 100'
%1;7- D I +
Od 2(0
5'
~ .
2
,
2-6 0 f
/o
GAr L. St el
4-23-96
FILED
JUN 1 3 1996 HLEEN
H. W 545233 KATReegister 01 peedsSH 10
'C'L
c Co. l
CERTIFIED SURVEY MAP ti
Located in Part of the Northeast Quarter of the Northeast Quarter and part of the Southeast Quarter
of the Northeast Quarter all in Section 19, Township 31 North, Range 18 West, Town of Star Prairie,
St. Croix County, Wisconsin.
LEGEND 0 Set 1 1/4" x 24" Iron Pipe weighing
County Section Corner Monument a minimum of 1.13 pounds per
0 Set 1" x 24" Iron Pipe weighing linear foot.
a-minimum of 1.13 pounds per • Set 3/4" x 24" Iron Pipe weighing
linear foot. a minimum of 1.13 pounds per
O Found Iron Pipe linear foot.
• Denotes 100' Building Setback Line _x- Denotes Fence
NORTH 1/4 CORNER SEC. 19 R = Recorded as raPROVED
(ESTABLISHED FROM TIES) 210TH AVENUE NE CORNER SEC. 19 rn
(BERNTSEN CAP)
S 89'23'28" E 2675.21'---- - JUN 113 W
w
NORTH LINE Oli THE NE 1/4 SEC 119 /
j ;;Flax COUNTY
1 LOT _1 _LOT_2_ UNPLATTED LANDS ceh•nsilr: Piatx>lir
z
L I Zoning -XW
C_S.M__VOL.I 8 PG. _ 2362 - - j = p,rkCoittr•
of R=S 139 321 E
S 89124'37" E 1336.02 - ~I I ° not rocwd d
w x- x- x - 906.18'-
z a 1 z -NiMin 3049" of
w / 429.84' ---870.63'--- -c 3555 aDpR4vYlFd#U
c~i1 i s aroV3i' lhsM be
3 r LOT 1 S 89'24'37" E rn I a'
- 585 ~ ; W s ~ tlrsid
`'o I 9 M N W
■
p ' N
~ Zj I O LOT 2 9WELL33' 74 M.
I _ 1
W JI N d 1 z 321.05' HousE < °o
w S 8924'37" E co r, I SHED c i ~i 13 N
F~-~ ORDINARY HIGH WATER LINE Mj~ I BARN M IM I°^ Wj W
° 3 / 75' SETBACK N 546.7 iit-k I I yo~q _ F
'I
z f5I LL
Zi 58 3' .co-~ 4 1 I ° V) Li
DI M M
S 89'24 37 E r~ Irn 1 c~vN
i Z z
It
o LOT 4 N LOT 3 N IN I ~X I a W
O 75' SETBACK-►•,` , -ZN 544.76' I OI Q Z N
585.14' I & w
ORDINARY HIGH WATER LINE S J S 89'21'20" E :3 F 00
C C,4
-4 co 0 vX) V)
0 F-
S. LINE OF THE SE 1/4 OF THE NE 1/4 max: rMI~- N
o' oM M 1 O O_
~ a
R=1288.34' • L V F- m
1288.23' e' z 1 'I ss' w rn o
W/ 1330.63' N B P-22-35- W____ 0 0
SCD.f, LOT_ 1 R=S 89'32'17" E 5 W 1- w
a DOUGLAS J. N LOT _2 ~I LOT 3 Ww 1w n
y ZAHLER g l 1 col I _ 1 a U_ a
r c~
* HUDSON 145 * C.S.M. VOL. I 6 PG__1526 M /I z ° N
WIS. Q I 0i 1 0 % a U
9~Ip SLgv (ol I a m z
Prepared for and at the request of
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER- J OS ea A - J G / C- C/o U Yee r-
NAILING ADDRESS O o M -e(Je 1. _rt/o,1, f"
PROPERTY ADDRESS _ Q`ciFJ'o7 9D
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE f 0 m -e-rie-1 w7--
PROPERTY LOCATION1~ 1/4, 1/4, Section
'SOWN OF SO M -Cr.Ser ST. CROIX COUNTY, WI
SUBDIVISION
LOT NUMBER
CERTIFIEDSURVEY MAP64 3-f6o , VOLUME I , PAGE I l , LOT NUMBER 3
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.
Tlie 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, hercin, 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:
10011,
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
AS 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 - d) U D e- C /00111 cr
Location of property_ 1/4 /VE 1/4, Section T_2LN-R~W
Township ST P(W rf c, Mailing address
Address of site ~QFfo? 9a--- .
Subdivision name Lot no. -3
Other homes on property? Yes ✓ No
Previous owner of property Ue r•U0~/ C G l'Qy!j f/ Qors7-
Total size of property S G /as
Total size of parcel 3 4C ft, S'
Date parcel was created J (,.,C- 13 / 99l0
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume and Page Number 11 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 he 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'.
gnat re of Applicant -Applicant
Date of Signature Date of Signature
WARRANTY DEED
546357 Document Number VOL PAPE18
. REGISTER'S OFFICE
ST. CROIX CTY., WI
Redd for PAwd
Return Address J U L' 3 1996
f
at 11:35 A M
Kat&. -q J.4j,
~oee~
Parcel I.D. Number: 038-1079-30; 038-1079-40
Vernon F. Borst and Carolyn R. Borst, husband and wife, cones and warrants to Joseph A. Cloutier
and Julie A. Cloutier, husband and wife, the following described real estate in St. Croix County, State of
Wisconsin:
Part of NEIA of NE1/4 and part of SE1/4 of NE1/4 of Section 19, Township 31 North, Range 18 West, St.
Croix County, Wisconsin, described as follows: Lots 3 and 4 of Certified Survey Map filed June 13, 1996,
in Vol. "11", page 3114, Doc. No. 545233.
This is not homestead property. IR S WR
$-.1-3
to warranties: Easements, restrictions and rights-of-way of reco f any.
Dated this Zday of June, 1996.
(SEAL) ~"j - 12( (SEAL)
Vernon F. Borst Carolyn R. Worst
AUTHENTICATION
Signature(s) Vernon F. Borst and Carolyn R. Borst,
husband and wife, authenticated this day of
June, 1996.
Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
THIS INSTRUMENT WAS DRAFTED BY:
Attorney Kristina Ogland
Hudson, WI 54016