HomeMy WebLinkAbout020-1006-20-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS /p yy~.r
SUBDIVISION /,/'csM# LOT
SECTION
T_,Lq_N-R- 4~ W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~M
S
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IRK 1~' l JV d /sec j
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INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this f0r-7-
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK: T //o~ rya Lses.~` i/,n
r
ALTERNATE BM'
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:Zfjla Liquid Capacity: ~~vo
Setback from: Well g~ House a Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 5 Length 5o Number of trenches 3
Distance & Direction to nearest prop. line:
Setback from well House $ 2' 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: 8- /fl _ f"!~
PLUMBER ON JOB:
t2-Y fi,w•-
LICENSE NUMBER:
4
INSPECTOR:
3/93:jt
Wiscgnsin Department of Industry,
Laborand Human Relations PRIVATE SEWAGE SYSTEM Countv
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State Pla
IHN, PAUL X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
C4 , Gd G) I 0086
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic p' ~cyr C Gv Benchmark
CY
Dosing
Aeration Bldg. Sewer
Holding - - St/ Inlet
TANKS ACK INFORMATION St/ tkf Outlet C, ~Q% 9 , SO
Vent
ir Ito ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Air ntake ~ 5
Septic >SCj' / NA Dt Bottom "
Dosing ` A Header / Man. ~cy
C.G 4
Aeration A Dist. Pipe ~a
Holdin Bot. System~i
PUMP/ SIPHON INFORMATION Final Grade
Manuf turer Demand ST'` 53/a~ ~6,Oa'
Model Number GTDH Lriction Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length. No. Of Trenches No. Of Pits Inside D 0 ,,Depth
DIMENSION 5<~ IMEN
PQ T
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM L Manufacturer.
INFORMATION Type Of 7,, ccm, rWAMBER i , Moe Number:
system: -6-c"'e .,t 64 4) OR UNIT
DISTRIBUTION SYSTEM
Header / 7Id Distribution Pipe(s)r x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length J' Dia. Spacing 1_;!i_ -
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s Only
Depth Over ' , r Depth Over xxDepth Of zx❑Seeded / Sodded xx Mulched
Bed /Trench Center 5~- 3 Bed /Trench Edges Topsoil Yes No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: UDSON.8.29.19W, SW, NW, DEE RUN ROAD
Z2
Plan revision required? ❑ Yes No q
Use other side for additional information. ld
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
J
/ 1 9
ADDITIONAL COMMENTS AND SKETCH '
p j / J
SANITARY PERMIT NUMBER:
b
133,~ V) /~z
tF ! /%r7 v %/~c~ /
-
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f:
III
(S) SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code Co T~
I .
STATE SANITARY PE IT #
-Attach complete plans (to the county copy only) for the system, on paper not less than a a 931a-
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY WNER r~ PROPERTY LOCATION
L Sal IVV-1 , S e? T 2.!?, N, R /If (or)(0
LOT # BLOCK #
PROPERTY OWNER'S MAILING ADD S
CITY, STA E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
2664//7
II. TYPE OF BUILDING: Check One CITY NEARE T ROAD
( ) ❑ State Owned L~ VILLAGE :~QWN OF:
❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms ! PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) ~ o
1 ❑ Apt/Condo C9
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
13 El Other: Specify
5 ❑ Hotel/Motel 9 El Office/Factory
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1~ New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Min./inch) _r) e/Z ELEVATION
two 75o. -7 4 , 8 - ?2 -7 Feet 43 fa Feet r3 P CAPACITY
VII. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App
Tanks Tanks Gr
Septic Tank or Holdin Tank 4z r -NT- 0 1
Lift Pump Tank/Si hon 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' Signature: (No S ps) MP P/ E SW No.: Business Phone Number:
(715 ) 7-7 z- 3.7 14
Plumber's dress (Street, City, State, Zip Code):
300~
a, k l~L4e L~ L~
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved . Sanitary Permit Fee (Includes Groundwater Date Issue id ss ing Agent Signature (No Stamps)
Approved El Owner Given Initial Surcharge Fee)
Adverse Determination I U9
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) 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 the 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 & 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.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. 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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
JOB WAY
TIMM EXCAVATING SHEET NO. / OF 2
J~z
Route 1 Box 192 y) t/
WILSON, WISCONSIN 54027 CALCULATED BY DATE T -
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1 Inc., Groton, Mass. 01471, To Order PHONE TOLL FREE 1-800-225-6180
JOB ~Gl IL I TIMM EXCAVATING SHEET NO. OF X-2-
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE L
(715) 772-3214 (715) 386.5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1 Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE I-BDD-225-5380
L
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
K Divin of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distanc 020-1006-20
APPLICANT INFORMATION-PLEASE P N REVIEWED BY DATE
PROPERTY OWNER: c PROPERTY LOCATION
Paul Ihn OVT. LOT NW 1/4 NW 1/4,S 8 T 29 N,R 19 XR(or) W
PROPERTY OWNERS MAILING ADDRESS r T # BLOCK # SUED. NAME OR CSM #
I
411 Cedar Ln. 4 na csm 4/1022
CITY, STATE ZIP CO PHONE CITY ❑VILLAGE MOWN NEAREST ROAD
1 ( )
Hudson WI. 54016 715 3>~- Hudson Deer Run
[xj New Construction Use [x[ Residential~ri~luNtte 4 [ ] Addition to existing building
% j [ Replacement [ j Public or commertesafbe
Code derived dal flow 600 9Pd Recommended design loading 9 rate . 7 bed polft2 . 8 trench, 9pdlft2
IY
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) 97.20 ft (as referred to site plan benchmark)
Additionai design / site C=ideratiars na
Parent material outwash Flood plain elevation, if applicablena ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem laS C3 U S 0 U S❑ U a S ❑ U ❑ S Eau ❑ S Im U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 r 1 0-12 10yr3/3 none 1 2msbk mfr 9w 2m .5 .6
2 12-31 7.5yr4/6 none sil lfsbk mfr gw if .2 .3
Ground 3 31-41 7.5yr4/4 none sl 2msbk mfr gw if .5 .6
elev. 4 41-90 7.5yr3/4 none co s Osg ml na na .7 .8
100.7 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-7 10yr3/3 none 1 2msbk mfr yw 2m 5 1.6
2 2 7-14 10yr4/3 none sil lfsbk mfr gw if .2 .3
{ 3 14-29 7.5yr4/6 none sil lfgr mfr gw If .2 ::.3
Ground
elev. 4 29-84 7.5yr3/4 none is Osg mvfr na na .7 .8
98.2 ft.
Depth to
limiting
factor
+8411
1-7-
Remarks:
CST Name:-Please Print Gary L. Steel Phone' 715-246-6200
li
Address: 1554 20 th. Ave., New Richmond, WI. 54017
Signature:
Y Date: CST Number:
4-5-95 c
PROPERTY OWNER Paul Ihn SOIL DESCRIPTION REPORT Page 2 of 3
PARCE41.D.8 020-1006-20
Boring # Horizon Depth Dominant Color Mottles (Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ffiench
3
1 0-9 10 r3/3 none 1 2msbk mvfr gw 2f .5 1.6
2 9-15 10yr4/3 none sil lfsbk mfr 9w if 1.2 11 .3
Ground 3 15-3 7.5yr4/6 none sil lfsbk mfr 9w if .2 .3
elev.
100.6t. 4 39-9 7.5yr3/4 none Co S Osg ml na na .7 ~.8
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-5 10yr3/3 none 1 2msbk mvfr gw 2m .5 .6
d 2 5-16 10yr4/4 none sil lfsbk mfr gw if .2 .3
3 16-3 7.5yr4/6 none sil lfsbk mfr gw if .2 .3
Ground
elev. 4 31-90 7.5yr4/6 none Co S Osg ml na na .7 .8
100.6 ft.
I
i
t Depth to
limiting
factor
+90"
Remarks:
Boring #
M.N. 1 0-7 10yr3/3 none 1 2msbk mvfr 9w if .5 .6
2 7-20 10yr4/4 none sil lfsbk mfr 9w if .2 .3
3 20-31 7.5yr4/4 none 1 fs Osg mvfr 9w na .5 .6
Ground
elev. 4 31-65 7.5Yr4/4 none is Osg mvfr 9w na .7 .8
98i,3-- ft.
I' 5 65-72 7.5yr4/4 none sl 2msbk mvfr 9w na .5 .6
Depth to
limiting 6 72-81 7.5ry4/6 none is Osg mvfr na na .7 .8
factor -
Remarks:
Boring #
Ground
elev.
ft. i
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 1 Paul Ihn New Richmond WI 54017
MPRSW 3254 Nw4Nw4 S8-T29N-R19w (715) 246-6200
.town of Hudson
lot #4
N
1"=40'
BM.= top of mid lot survey stae C 100' el. Cn
I3r1 ~
9~
0Cr`2
Gary L. Steel
4-5-95
Wisconsin Department of Industry, SOIL AND SITE E V ,,LW~'CT I O N T Page 1 of 3
Labor and Human Relations 11 ~1/
Division of-Safety & Buildings in accord with ILHP `05, Wls Jacln. Cod
<; a COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1 /2 x 11 inchesliweize. Plan rnd-V include, but i; PARCEL LD. #
not limited to vertical and horizontal reference point (BM), direction ~apd, % of~slope, sc or
dimensioned, north arrow, and location and distance to nearest rodo, r'~ 020-1006-20
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORM~;iti, ' ,A
PROPERTY OWNER: N
Paul Ihn G 1/4 NW 1/4,S8 T29 N,R 19 )E (or) W
PROPERTY OWNER':S MA!i_ING ADDRESS k OT # LBLOCK # SUBD. NAME OR CSM #
411 Cedar Ln. 4 na csm 4/1022
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
Hudson, WI. 54016 (715 386-8290 Hudson Deer Run
[:4 New Construction Use [x] Residential I Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft2 . 8 trench, gpd/ft2
Absorption area required na bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/1`1:2 .8 trench, gpd/ t2
Rem-mmended infiltration s urfarp Plavationts) 92.00 ft (as referred to site plan benchmark)
Additional design / site considerations step down trench starting at 92 0' and following 3' below surface el.
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 for svstem 06 ❑ U I❑ S lJ I21S0 U ❑ S Riv ❑ S EEW ❑ S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed Trertdt
1 0-9 10yr3/3 none 1 2msbk mfr 2m .5 .6
6
m mm 2 9-24 7.5yr4/4 none sicl Ifsbk mfr 9w if .2 .3
3 24-90 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
95.10 ft.
Depth to
limiting
factor
X90"
n~~ ~ ~arlw:
Boring #
1 0-9 10yr3/3 none 1 2msbk mfr gta 2m .5 .6
7 2 9-32 10yr4/4 none sil 2msbk mfr gw lm .5 .6
3 32-80 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
95.5 ft.
Depth to
limiting
factor ,
+80"
Remarks:
CST Name:-Please Print Phone:
GAry L. Steel 715-246-6200
Address: 1554 200t 1y. Ave., New Richmond, WI. 54017
Signature: Date: CST Number j
4-18-95 f
PROPERTY OWNER Paul Ihn SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 020-1006-20
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 18ornc3y Roots GPD/ft
I I I
in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed iTrench
X"
1 0-10 10 r3 3 none 1 2msbk mfr w 2m .5 ~.6
,
8..: 2 110-25 10yr4/4 none sil lfsbk mfr gw 1m .5 1.6
i
Ground 3 25-78 7.5yr4/6 none Co S Osg ml na na .7 j .8
elev.
I
89.45 ft.
Depth to
limiting
factor
+78"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
xxx.
Ground
elev. j
ft.
Depth to
limiting i
factor
Remarks:
SBD-8330(8.05/92)
.
r
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 1 Paul Ihn New Richmond, WI 54017
MPRSW 3254 NWINW'k S8-T29N-R19W (715) 246-6200
town of Hudson
lot #4
N
1"=40'
BM.= top of mid lot survey stae C 100' el. Co
BM
ri 46'
30
p
b
.
d
40
0C« - ¢4A
Gary L. Steel
4-5-95
• ? NC YM~O..~r.®
F~LE)Dle
~0a80R•ow.P a 36~34CERTIFIED SURVEY MAP ~ ~ CaLEGEND
UNPLATTED 45 W 5248.00'
0
SECTION CORNER _ 58 T-a)
0 1"x24" IRON PIPE No > NW CO
RNER WEIGHING 1.68#/LINEAL
SECTION 8 FOOT, SET.
T29N, R19W
1" PIPE SET FENCE ti
r
Ii SCALE IN FEET co
ivv-4 L.I 66' TRUE 100' 200' cv 4- CRESQ1
X I BEARING o r~~* • ~G' W
Irn IO I UNPLATTED LANDS c. " v a
Iv c
14 I 126.55' ✓ v,~ .x~~
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1 COMPREHENSIVE PARKS PUNNIN
MONERNTSEN UMENT Icy -a POINT OF ANO ZONNO COMMITTEE 'IVA
N
OUND IZ 0 BEGINNING 9
W1 /4 CORNE 0Cal '11 330.00' 10 SECTION 8 , 120.44' 91.44' 238.56' I Is A] 1 10 fi Z 9N , R 1
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LOT 26 ;
1 This instrument drafted by Wade Hartenstein. Volume 4 Page 1022
STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER N ii X k Tics mda S .S- liA W
MAILING ADDRESS ~ I C E D Z L l~ti i 1~W OSy rJ
PROPERTY ADDRESS 1 Q `4 y t) r E (Z ~R u tom; 7~, A , k~ 'j. C~S Q V.J
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE L') k sco'\i s' t
PROPERTY LOCATION SW 1/4, N W 1/4, Section (e~ T 2`t N-R W
TOWN OF r\ 1. oso iJ ST. CROIX COUNTY, WI
SUBDIVISION DC: 1' tz Z1V1-J LOT NUMBER
CERTIFIED SURVEY MAP -50bil7, VOLUME , PAGE QZZ , LOT NUMBER 9
• 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.
UWe, 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 co ipleted and returned to the St. Croix
County Zoning Officer within 30 days of the three year ex ration date
L
SIGNED:
DATL
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Iiudson, W1 54016 111:93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
• only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Ownerof property---NLk ~~nc rr4NS J- l~N Su e \l~ (fir; T~t~1
Location of property 5\,J 1/4 N;W 1/4, Section T Let N-R kcA W
Township NL\1~Sgi.7 Mailingaddress
L411 CENN2 URNC-
Addressofsite I -Aq ~v,r; ►2c~. N„k'Z> Sc,~v
Subdivision name C7EC 1Z R,vw-\ Lot no. LA
Other homes on property? Yes ✓ No
Previous owner of property j7erc- L. Sekz\.K v\ L-iAioA K, PyytKF_ 2Z
Total size of property Z . y (\C-[Z S
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? ✓ Yes No
• Is this property being developed for (spec house)? Yes L--~ No
Volume LA and Page Number i(>Z Z 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.
Wr L
e of Applicant cgz:-Applicant
^
Date of S7anatl]rP na+~ ~f c;n„~+,,,
State Bar of tt ;onsin Form 2 - 1"2
'=753G WARRANTY DEED
DOCUMENT NO. it V is- r~ REG STER'S OFFICE
ST. CROIXCJ., WI
Wd for Record
-jam L_ 4pnvn and .inrA K- Parker, - APR T 1995
_as- joint tenants,
11:15 A-M
x utt'..` . oij,
conveys and warrants to Paul Ibn and Jody Ihn, Reglater of Deerta
husband and wife,
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND R& URN ADDRESS
Paul & Jody Ihn
1044 Deer Run
the following described real estate is St. Croix Hudson, WI 54016
County. State of Wisconsin:
(Parcel Identification Number)
Part of W1/2 of SWi/4 of NWi/4 of Section 8-29-19 described as follows:
Lot 4 of Certified Survey Map filed December 18, 1980, in Vol. "4", Page 1022.
TIANSt E',
,3.10(0 6.0
FEE
This is not homestead Property.
= (is not)
Exception to warranties Easements, restrictions and rights-of-way of record, if any.
Dated this k5w day of Auril . 19_ .
(SEAL) (SEAL)
Jer L. Serum _
(SEAL) (SEAL) let-
Lirda K. Parker
AUTHENTICATION ACKNOWLEDGMENT
Sigt.ature(s) Jerry L. Serum, STATE OF WISCONSIN
Linda K. Parker SL
County.
authenticated this 65~day of &Ki-,19--9-1 Personally came before me this day of
19_ the above named
Kraus a Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by $706.06, Wis. Stats.) to me known to he the person _ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland
Attorney at Law Notary Public County, Wis. I
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: i~
necessary.)
} 'Names of per.ons .i,nin, in any capacity sMwld be typed or printed below their signalurat-- - - - - -
I I WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. I - "aI Milwaukee. r.,s
r mar -rs -.r aeorc a., rc- r. y' r S'_ _ r+' :•:;._7-'3_ - 'A:^ ~,-S , .-1
ii
ij State Bat of Wisconsin Form 2 - 1982
WARRANTY DEED
DOCUMENT NO.
i _ _ .Jerry L-Serum and. Linda K. Parker,
tenants,-.__-_
conveys and warrants to Paul. Ihn and Jody,__Ihn,
I; husband and wife
ii THIS SPACE RESERVED FOR RECORDING DATA
~i - NAME AND RETURN ADDRESS
II
j the following described real estate in
I County, State of Wisconsin: ~i
~i
t
(Parcel Identification Number)
r.
Part of-W1/2 of SW1/4 of NW1/4 of Section 8-29-19 described as follows:
Lot 4 of Certified Survey Map filed December 18, 1980, in Vol. "4", Page 1022.
it
i
it
~i
i
I~
`I
,I
(I
This- is not homestead property.
(is not)
Exception to warranties: Easements, restrictions and rights-of-way of record, if any. i
i
VII Aril • .
~i Dated this day of 19 95.. P 'I
N l
(SEAL) -r- - - (SEAL) II
Jerr L. Serum
- (SEAL) (SEAL)
Linda K. Parker G~ 1-------- 1
AUTHENTICATION ACKNOWLEDGMENT
II
Signature(s) Jerry -L.---Serum,- STATE OF WISCONSIN
-
Linda K. Parker
- - - County.
authenticated this day of 19 95 Personally came before me this day of
19, the above named
Kris ina Ogland
I
TITLE: MEMBER STATE BAR OF WISCONSIN
;i (If not,
ii authorized by §706.06 Wis. Slats.) to me known to he the person who executed the
foregoing instrument and acknowledge the same.
'i THIS INSTRUMENT WAS DRAFTED BY
j' Kris tina Ogland
Attorney at Law - Notary Public County. Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.) 19.___ ) ~
*Nan"" of penan. %iKning in am capacitc chuuld he lyla•d or primed belon their signature..
WARRANT I" DEED S'1•AIT HAR rf WISCONSIN Wtscunsin Legal thank Co . Inc
1.01INI No. 2 - 082 Milwaukee. Wis