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HomeMy WebLinkAbout020-1311-40-000 Q o o ~n p N ~ vi ~ O `+r I I O O N N CD I chi x I v in I N o Y c Z cq z I Z °o c - N 7 C ~ U. O (D Q V ill Z a) E o i j' rn (L m N 04 Z O II O Z d c d Z d C O fA 1- O) N z C E '2 p M N O < N O N In c 'p C C Q U Q O Q w m z F Z o N Z CD Q) U , `i o N ~w W d i O C O Co co o N N n u FL 2 `o O O O Z • ►ri R a n. M m 7 O V1 O 0) w 0) 0) J V D7 } _ 0O CV O N 0 ~ C 0 00 C, E N J p p = 3 m m _ CL I o ~ y an co C R C,4 0. Ali O C) O m N Q o ~ c o oo w o° o m a c rn o s. 1- E N a 7- E c rn N 0) I 0 C (n O N 5 N a0 ~I N 'Up ~ ^O w 7 ~ ~ U .OC N Ci 3 p to N U • O = g N O N '7 Cn ~ I #t c. L a w • cm a m d y c _1 A 0 a 2 0 0 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER-S/),/)/ /AIL (Z-12 ADDRESS z e z f~U L) O SUBDIVISION / CSM#_T-gIVA(Fy-l RIp6~ LOT #_j>1_ SECTION /7- T Z7 N-R , Town of J-r L'! 0 N ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /0 e-7/F /->G 27 6A eh (.1 % /I1 1~ ~ 1 J 1g1C5br 3Z aI \N LL I dS g o } j D'S5 ~Z IVSTA«E D. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: T o P o F z P AT N L o T ~o.e.VE2 qov' ALTERNATE BM: Tom c~ Ldp 00 73to<-1-- Fou ivi),f o N sce S Z SE III' PTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: r Liquid Capacity: z S- a Setback from: Well hS _ House .Z (o ' Other-32- rn Pump: Manufacturer Model#Size Float seperation - Gallons/cycle:- Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length 7 S'- Number of trenches 7?- Distance & Direction to nearest prop. line: S cl Setback from: well: House a -7 Other 3 ~ 7-6 S`T ELEVATIONS Building Sewer - ST Inlet, ~ ST outlet ( , PC inlet PC bottom fM 1o ~9 Pump Off Header/Manifold4RIf Z ~ Bottom of system Existing Grade FS~S 3 Final grade x,53 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laborand lumanRelations INSPECTION REPORT ST. CROIX 4ety and Buildings Division (ATTACH TO PERMIT) Sanitary Perm itNo.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o.. MILLER, SAM i{ Hudsen CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /O0 ~ O J ~ • ate. <._r. , TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / J 9 Benchmark ~6Q /oo , Dosing /oo 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 > 00 c26 NA Dt Bottom Dosing NA Header/Man. o'? g3.9a io.yz 93. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade' 95. ~7 Manufacturer Demand S Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH width LengthNo. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 5 75-/ DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER nv Mode Number: System: aT~ 59 a ? 1rJr 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson~12.29.19W, NW, SW, Lot 31, Tanney Lane C> /o/y~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. o~ i a oZ SBD-6710 (R 05/91) Date inspector's Signature Cert No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t.- V~iLnA SANITARY PERMIT APPLICATION Bsafety an ' Bu uildiinWater System! ngWater ureau o off Buil201 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. 54 • Cav 1 • See reverse side for instructions for completing this application State Sanitary Permit Number a~~7~ The information you provide may be used by other government agency programs eck 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 Name Property Location lLL)~50p__ #14) 11ZSW 1/4,S/Z_ TZ N,R E r)W Property Owner's Mailing Address Lot Number Block Number .Z 8 7 City, State Zip Code Phone Number Subdivision Name or CSM Number Hr>~5©,y sKo1(a 3$4)Z 7 e. A/ E/D 5 644 L AII: TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town of 1`1 0 LID S a 1 111. BUILDIN 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 ____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 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 ❑ Seepage Pit 43 E] Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 6,C) -26-0 -7 'Wo Feet '757-? r,~Feet VII. TANK Capacit n lions Total # of Prefab. Site I Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name concrete con- steel glass Plastic App New Existin structed Tanks Tanks A{ Septic Tank or Holding Tank ~ZS~ W sic?, 29 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): -1G/ ,e£ n4f 11 E Naps a N w S IX. COUNTY / DEPARTMENT USE ONLY 1:1 Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A nt S nature (No am Surcharge Fee) Approved E] Owner Given Initial Adverse Determination =tv 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 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. 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. 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. Vlll. 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. i M v 1-4 w, ~a w N ~ n I~j A) lea ~ 't U 07 ~r 9►~ M VI) ti J ~ J I 4 ~1 O N W N o ~ d ~ % SroPE \ c- Cl IL. 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 y, than 8 112 x 11 inches in size- • See reverse side for instructions for completing this application State Sanitary Permit Numbe ,wl yd73t9 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 LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 47 SA/n jO f LoA 1A,S ZTZ, ,N, R/ E(or Property Owner's Mailing Address Lot Number Block Number ,13o X Z Z_ - City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned C/ ❑ Ity Nearest Road A Public 1 or 2 Family Dwelling - No. of bedrooms - Town of 111. BUILDING USE: (If building type is public, check all that apply) ParcelTa((x,,Number(s) 1 F1 Apartment/ Condo Uo- 13/1-4- 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/ Mote[ 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. t] New 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] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 NSeepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13(❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) e~ Elevation 6,00 7 SO ,5-0 Feet 9 5", 2-1 Feet VII. TANK Capacity 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 lz~ / C1JE1 ,FA- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans- ss Phone Number: Plumber's Name: (Print) Plumber's Signature: o m s) MP/MPRSW No.: T M 1 K~ o 14 5 c ~ S~0 Sad '~-8G9 Plumber's Address (Street, Cit , State, Zip Code): ,err LL- Z -A p-szN w r -.5-5461A, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing A nt Si nature (N t s) Surcharge Fee) AApproved ❑ Owner Given Initial '`/p Adverse Determination O b CONDITIONS OF APPROVAL/ REASONS ZFODl PPR VAL: 1 >F BD-6398 (R. OS/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Di-,ion, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be'renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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 aU septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks receives 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. Cc Xnc'' if] cations not smaller than 8 1/2 x 11 inches must be sul,- it •~d t ! > _c my The plans must n<iude th~_ioi ovrl~ :1: k) piot oian, drawn to scale or with complete clliner.s .)i.„ Of r.c Jinci ian~,(s), septic :,rkis)o: o'-I ~a!r~tenttanks; building sewers; wells; water main5'. -E, ~=r,•;, lakes pL.rrip or siphon r.ks; •al , 0 I i;oxe, soil absorpllion systems; replacement Syster, a` -:the b~.,iil(Jirlg served; .tt`Ci /t?rt~(al C"tv<;iJOf _ re points; Co,-,, p! 2te c dtlGl", 'c - Gnt"GIs, c, St voIUtTle; ~evation difference;; faction loss; pump performance curve; pump mryr!a;.i :rnl, r:: rer, D) (rosssecticn of .Oil absorpticn system If rzq i';:;1, b ,C; t C unty" Sol! test data u't...~ i I .Ring Information- - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practi(e,, which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater -ontami -)ation investigations and establishment of standards. r S ~'I m i~ Eft 7-170'--y ~lD 6E Lo 1'~' 3 / FIR, /DyZ- 7- IYeY !A4/E 5- S rTM E r. 1 ,64116, Illy 7yI s 3 S-O0 i -4 q `5 i 4t ~ ~ ~a7 3 ~ 07 3 ~ a, O M N i / sIO~.E' ~ ~ ~n A 15 i~ I { ~5 j j V 0.c T.4I~X l0 3z qq iV e F ' u,' .N r G Ii _T~ LANE I ' 1 m 2 O LA I ' W I , cil o ~ I I I O I d I I ~ I ~ 0 a w } -n t , v -o I m 1 I U) I I Z - - 1110 c r. O O rn LA o n Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of Labor arni Human Relations t~Iyision oNafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but '57 Gea ) not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PR ERTY 0 AjLQQ ER: PROPERTY LOCATION AJ GOVT. LOT tqIN 1/4 SW 1/4,S 1Z. T Z7 N,R L'9 E (or) W PRO2ERTY OWN S MAILING EPQRESS T # F CK # SUU-NAME OR CSM # D¢007 - 1 AN q l_ ~~G~ CIry, T TE A , ZIP CODE PHONE NUMBER ❑CITY ❑VIL GE OWN NEAREST ROAD L 1 ~ t~/U~ W D ( ) ~i~S~U j &V IAA,( XNew Construction Use [ Residential /Number of bedrooms U [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate C3. bed, gpd/ft2 (3 1 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0-'7 bed, gpd/ft2 (7 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations EV.4LLU TIO-IJ hOD,A TbR L)4^j- A iP1Q'AoVAL Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL R" UND IN- ROUND PRESSURE A RADE TEM IN FILL HOLDING K U= Unsuitable fors stem S0 U U S❑ U S0 U SYS❑ U E3 S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& Ground r n7 ` ©J 01 elev. Rz 3% ft. Depth to limiting ~f~to~r 33 Remarks: Boring # n O- `va m b C W 2 Zb D 4 S L Dti.sb k m c 1 , -Z 76- /A /bYteA- s r l D o g Ground elev., 4?je' ft. Depth to limiting f for Remarks: CST Name:-Please Print hleay 40)4146,n)') Phone: -3% A ,c Address: 0 ,Dtlx 1 v&SOlti ) Signature: 1~ / Date: , 9~ CST Number:NE4 1 --A4&ft~' 7/~~ PROPERTYOWNER S~?4 h MILLIE'k SOIL DESCRIPTION REPORT Page Z ofJ PARCELI.D.# L6r ✓ / ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench -563 16 Cw 7-37-374 07 B~ -zz ib\lk4 4 - sc 5~k 1 C a.4 q Ground JZ ~Z`~ Ib 4 S 1dt v b~7 elev. 9'1 SI ft. Depth to limiting yfit0 3 Remarks: Boring # ; >d O- b 60 3~ 5 L. l m s b r to O-4 S C /47 4 4 Ground elev. 9~L0'l ft. Depth to limiting factor , > 4,9Z Remarks: Boring # 4 SAC s LK r c w 1 2 0.3 10k Ground 14 elev 96.Sq ft. Depth to limiting te factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: can_ao~nrR nSoo, NS Y~~ - q ~ ~ cp r "6i J s W ~ M N1 `L M 1 ~-~y ADf D l ~ J i ~v LOT 12 :.S3 Ac LOT 41 Iro.z~s so.n °s. LOT 42 'm. 2,44 ACRES LOT 40 IU^C./ 2.25 ACRES F 106,124 SO. FT a 5.76 ACRES / o 97,851 SO. FT m s 251,006 SO, FT. ti't d ~ i2 N83• 0500 Of. C 1 LOT 43 _ u` r1Fb ~l 2 12 ACRES LOT 13 92.59_ SO FT N83.05•,O,w \ J 4.24 A, 874.613 S4. FT. LOT 39 O v . - 0' ro 2.73 ACRES \ 00 118,880 SO. FT/ 6 g re y j~ ~M 1 >.y c~ 0 f ~)pd~ vlt' S>3. / f /C 3 a/ LOT 38 'w 2.00 ACRES LOT 14 a 2 87,165 SO. FT $ / 2.07 AC. \ I 6h 123,937 SO.fT, f~ \ ~O V 9gsv.~~, I N~ 1 b. LOT 37 .45' a M 'p U 2.25 ACRES L N c~ 98,009 SOFT Z ~f LOT a mac. ~0 2.18 ACRES ES \3~ ^ 94.892 50. FT pS\ ~3 \ 7 \ v X6\52 W o y~~ ~ ® °0~ P LOT 35 0 s~. S5~' \ 9 0 2.00 ACRES 67.163 S0. FT. Z 676.03'40°W 51490 LOT 36 N 2.26 ACRES 98,601 S0. FT 1 LOT 19 \ x`610 3.26 ACRES. ! \ \ "SApA m 142,171 SO. FT I O / 559 .0, LOT 34 '40N656.84 2.661 ACES \ O N S76- 03 ® \ jj ~S• / \ / / 113,830 SO. FT. N O-~ 3 LOT 20 h CJ 4.02 A N9 5503505 y50. ORES T QL I O.. .'('y/ 175,310 S0. FT. ~ (f ` lyJ~ 4-. pia \ LOT 33 pg040 J6G.OG '~N \ \ 2.11 ACRES ,76.0340 w 92,036 SOFT. U' Z _ 43C ac LOT 21 h !n. 5\A 2,27 ACRES /V 4/ m \ yam' 1 P a`3 N c0s 99.081 SO. FT. I 1 -535 05~ LOT 22 _ s4 N~• 3.10 4CRES 134,960 SQ. FT. N '\Q LOT 32 co 65° 54.5H,...`., \ 2.62 ACRES \ I - 50.00' `~D, 114.062 S0. FT. 'A 1 N>3,4/ S3 W • ' , v\,. yCy n • N O 1....~ ~O S6,5 43 /1 W F(..1 C.! a / S85'54'52"E J' LOT 23 3 ! I J'. LOT 3 1/" 3.76 ACRES q i / rV r, 2 ES ? 163,942 SO, FT 0 h s/s, / ` ' 00 ACRES LOT 27 0 87,162 SO. FT. o a 0 2.08 ACRES 1 0 0 \ ~-i~ ® /2 LOT 26 0 90,599 SO.fT O J Y~ .y915' N 2.08 ACRES 1 583A s I 90,642 50, FT ID ~ _ II ~ 563• 0 O N89•3C 39"E 420.28' vi ~ LOT 30 1 eo S82'30'33 'w 305.38' I \ 2.00 ACRES 1 87,161 SO FT 565• N Q~ r LOT 24 0 Q n O 2.85 ACRES 123,972 SO. F7 O co I wer1F3'4~°~ 380135 Z LOT 28 W ' I LOT 25 9 2.08 ACRES N 33 33 C ' i o 90,683 S0, FT h 2.08 ACRES LOT /m N w 29 90,642 SOFT - N'o _ 2.00 ACRES o o rvo 87,166 51, FT A 352.00' 2 r^ n O 7 z2.oo - ° D R 30~,~) LINE or THE Nwr,t or THE s-A, SECTION 495.42' \ 1 , N89°18'42R 274.58' E 1568.00' ///A~~~~ 6 380. W' T~' C `-E-ORARV CUL DE - SAC 7ED D , , 1 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT /J~~ St. Croix County OWNER/BUYER A 01 Z e Z f MAILING ADDRESS TR jDx _2t~ Z ff Z PROPERTY ADDRESS /0 9 Z, N N OF 1 ~~-NE (location of septic system) Please obtain from the Planning Dept. CITY/STATE &L2 b S D K L~ i Vo PROPERTY LOCATION 1(14cJ 1/4,.5 16,," 1/4, Section / -L-, T oZ N-R TOWN OF ICI ST. CROIX COUNTY, WI SUBDIVISION ~A N / R. 1,D 6 C LOT NUMBER CERTIFIEDSURVEY MAP 3 YeZVOLUME , PAGE 3 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: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. Owner of property ~-g:S A- W /1%/L Location of property iY Lk/1/4 S GcJ 1/4, Section , T~N-R~ Township 11-U D S O N Mailing address ac g z$ ALL., 5 a ~.I W i Address of site /o 9 Z -r,4#, x- 1-4m r- ZLV kSoo tA)/ f%#1 Subdivision name 6!e Q/0 (-.t. Lot no. Other homes on property? Yeses No Previous owner of property Rli l b y(L L LA J. 5y 1110 Total size of property -Z . o 0 A- C- Total size of parcel _ 2 . D O Date parcel was created Are all corners and lot lines identifiable? .Yes No Is this property being developed for (spec house) ? Yes No Volume_ and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) 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. S 1~/ y ~1Z-- , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. S 3 /7 / Z-- szx~- Signature of Applicant Co-Applicant 'E' J" Date of Signature Date of Signature • 1 -1962 THIS 60"9 eaaaRVaD FOR RtCOROINO DATA : DOCUMENT NO. STATE BA F WISCONSI eOR. ARRANTY 0 504855 _ YOL 103inGE 4% ' CJSTc-R'S OF,-.ICE ti This Deed, made between . f ~~•'~0 .........Randall. W.•Synan_.and_Patricia- ESxnan,•. sbnd ad i,ecfor Rowed • Grantor, 1 S E T 1993 and ..-Sam E. Miler, a single -person _ i oU 145 A. M Grantee, L a- ~s~se oaaa i' t Witpessettl, 'that the said Grantor, fQr a valuable consideration.___. ty Randall W. Sy{,nan and Patricia E. S nan ...............i......_........ S__..t . ..i 04TU11N TO conveys to Grantee the following described real estate in C.o x County, State of Wisconsin: a ~ ' Ta: Parcel Na: The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Torn of Hudson, St. Croix County, Wisconsin. FF,F; _ wj „a AND "A A parcel of land located in part of the NE1/4 of SE1/4 of Section " 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of :.eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N84 30100"E, along the North line of Certified Survey Map filed in Vol. "3", " Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This 1IR..AQ_t... homestead property. (in) (is not) Together with all and singular the hereditaments and appurtenances titereunto belonging; And---..R4-Aa4_j.j w-'--..*ynan.,and.•Patricia -._E.....Sy-nan..... warrants that the title is good, indefeasible in fee aim ple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this day of ..August 19_.4.3.. (SEAL) ~GlOfrt~.t~eC~.GC.A~ i✓ .............(SEAL) .W...-.S yna.n a Patricia Synan • Rand...all • • ..................................••--....._-•-.----(SEAL) • AIITSBNTICATION ACENOWLBDOMBNT Signature (a) STATE OF WISCONSIN St. Croix County. 1 authenticated this day of........................... 19 p Dally came before me 1..._.,_.day of Auqus07..D 19 the above named Randall. W.•..... -Synan, ..Patricia E. 1511 . • • TITLE: MEMBER STATE BAR OF WISCONSIN Synan L•OMO~s lice- 0 (If not, .A authorized by 706.06, Win. State.) to me known to be the person $ -.......fix e tIS(a0> gulag tnstru nt ;and n Wleftfte* w] THIS IN STRUMENT WAS GRAFTED BY ~ r Krishna Ogland 6 - --------At-corTley--a-t--taw------...••--... a Alice Joy o ors Notary Public County, Wis. T (Signatures may be authenticated or acknowledged. Both My Commission is permanent. f not, state ezp- amt' TI are not necessary.) date: 14_3-) Jr ~•Nams of persons sienine in any capacity should be thped or printed below their sisnaturs. Y WARRANTY DIKED STATE BAR Or WISCONSIN Wisconsin Ears[ Blank Co. Inc 77 FORM Ne. 1 - 1282 Nilesaukee. Wis.