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HomeMy WebLinkAbout020-1312-20-000 s Q w o M o N ~ O 0. c C N U p.. C O p 76 C S p X O O ~ N T N N w o m I w O N M O C c O N Z LL O C LL c occ O (n ,6 7 II 0 N Q N O O III M w Z E Z O a £ o d d N N a M C O C U O Z d c v M w N N H N Z c ~ -o I ~ N O I C Q1 Q ~ N CK N (D C: (f) 0 _0 L a o O N Q U (9 _ Z co Z N z In _ Y N lot L N CL LO N O N d O C o 0 c p O O C L O N b J'~ N p~ Lo fn fn U) j O U M F F F v _ O •N 3aaa a ° o N= rn rn N to J U 2 rn rn } "V aNi v c~ o E C) O N O : N N co N 4.. c M N N O O d O Q C6 00 O N C oo n O O, c - ° c E O) o N 0 E N N C 0 0 o C~ ~ m c E c v N l U) o am 7 CO a.s 7~ Z' L W W X ~ p N "O 2 O^ N E co ~O O 2 N O N=3 (n CCZ I i L d a (DC E c a c r~ r A tia~ l0 U)0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A I1'J ADDRESS 2 Z _y'~DSaAl u// yp~ SUBDIVISION / CSM 7-o+9hlAe V R/106,t- LOT _ SECTION T 'z,'~_N_R Zy Town of ST. CROIX COUNTY, WISCONSIN ~GO,y PLAN VIE o..oa SHOW EVERYTHING WITHIN 00 FEE OF S 6 ~ WEI,~ r)R(ujr-- /f v5 F-, i ~XS~ (~~oA211FE 7 W ~ m TO P of f/ _ /do.oo INDICATE f RTH ARROta Provide setback and elevation information -averse of this form- Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK: To f o~ / GoT / /f E~I~ SGtJ®9L ALTERNATE BM: 7 S/~B ~T ,BAc~ ~/~iClp,d0o = Z !0 2 - /Q 2 3 ' /~SEPT C -TANk / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /Q 0 Q C., L Setback from: Well 40 r House 2 3 To Other 76 Lo7-11NE Pump: Manufacturer Model# - Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: I $ Length '-/D Number of trenches Distance & Direction to nearest prop. line: 4z6 " To MIST- ,CoT G/pE Setback from: well: 72- House 3/ Other 10 ' T c, S 7- /(/I A Al l~ l-l2 / .c/ 6= 9, o S q S, g ELEVATIONS Building Sewer - yd _9Z•: Z/ ' ST Inlet. ST outlet PC inlet PC bottom Pump Off - FH I3,oS=91,87' Header/Manifold P-14:1,3,-22=470 Bottom of system Existing Grade 9 Final grade /0, e DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: &Pop s `O INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laborancl Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village R Town of: State PI o.. MILLER, SAM X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No-: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 41, ' Dosi ng d Aeration Bldg. Sewer Holding St/Ht Inlet aU ga~Sc ` TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic -70 io o , 43' , 2- 0 - NA Dt Bottom Dosing NA 'Header / Man. 7 Aeration NA Dist. Pipe a9, 9i. S 1 Holding Bot. System 90,-7 PUMP/ SIPHON INFORMATION Final Grade ~o,b y~ y 3 gb' Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss ead Forcemain Length H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '/O DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: 3 7 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 150 Bed / Trench Center ' Bed / Trench Edges o,)9-30` Topsoil ❑ Yes ❑ No ❑ Yes ❑ No I COMMENTS: (Include code discrepancies, persons present, etc.) L CATION* Hudson. 2.29.19W, SW, NW, LQt'39, Moon Beam t/1/ r (2 S7 ~S_ ~'x s t. Gt (~`v Plan revision required? ❑ Yes ❑ No Use other side for additional information. !D y~i t. 6 a 6 SBD-6710 (R 05/91) Date sped 's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 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 Count n „O 1 than 81/2 x 11 inches in size. y t Cr • See reverse side for instructions for completing this application State Sanitary Permit Number a ;/a 7~3 The information you provide may be used by other government agency programs Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION • Property Owner N me Property Location 14 101/4, S / Z T Z~ , N, R/e E ( r) W Property Owner's Mailing Address Lot Number Block Number X 2-S Z_ City, State Zip Code Phone Number Subdivisio Name or SM Number rJ 5 e w ls-volta (_t> z7 ffiVNJF 0UD L TYPE F BUILDING: (check one) ❑ State Owned ° ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _ ° rowan OF 14 0D5 d w *0 III. BUILDIN USE: (If building type is public, check all that apply) arcel Tax Number(s) dZp-~3~ -~.o 1 ❑ Apartment/ Condo Z. 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 M 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 E] Mound 30 E] Specify Type 410 Holding Tank 120 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 01- Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ey 5 d V z d $ . fd 17S Feet 9.!i Zr Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank O 4V wE~ S 1 ❑ E I ❑ Lift Pump Tank /Siphon Chamber ❑ E 11 1 13 -1 El 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's Signature: (No mps) MP/MPRSW No.: Business Phone Number: F, j w f)ONEL_ [ 1_Ah1I f~2S 3 © 38~fe-roln- Ik Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY Groundwater ate Issued Issuing A nt Si nature ( St s) ❑ Disapproved Sani ary Permit Fee (Includes Surcharge fee) Approved El Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS i 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 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. 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 Count (n ( / than 8 1/2 x 11 inches in size. ~ • See reverse side for instructions for completing this application State Sanit ry Permit Number The The information you provide may be used by other government agency programs o C~it revision to vtous 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 I SA 99- 5c,JV4 &)v4,S/ T-49 .N,R19 E(o W Property Owner's Mailing Address Lot Number 16iock Number go #zy~ S City State Zip Code Phone Number Subdivision Name or CSM Number s o r o/ c s8~> i7 T~ K0'e1w. /Sr A.0p II. TYPE F BUILDING: (check one) ❑ State Owned El it~age 0,050 ff /ft/( Nearest Road saw M 3 Town OF hL Public 1 or 2 Family Dwelling - No. of bedrooms vil III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Z o 3/ Z LO 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________System_____________TankOnly Existing System ______T_ ExtstingSystem 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 ❑ 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 Z/ .5-0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) C? r Elevation 7 ~ y 3 7 e-0 _ 7 13,®© Feet (77,10 Feet VII. TANK Capacity Site INFORMATION in gallons Toltons Ta of Manufacturer's Name cone e e con- Steel Fib ss Plastic EAxppepr. New Existin strutted Tanks Tanks Septic Tank or Holding Tank ~Q ~C / S 15 ❑ Lift Pump Tank /Siphon Chamber ❑ El ❑ 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's Si~~gn~att~ufr ~(No St s) MP/MPRSW No.: Business Phone Number: M f K f, D o K>% c t /V~=-Y/o>.r D.~sbo 3$ Sh 9z Plumber's Address (Street, City, State, Zip Code): 46( C i%E (r! I- 4~ k- q E JPZC) c-J I S a _N fi4 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Itary Permit Fee (includes Groundwater ate ssue Issuing Ag nt Signature (Nam pp roved Surcharge Fee)Owner Given Initial P~(G~~ Adverse Determination Ov X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) 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 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. Vl. 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. 3 ~~N cow c;~ ~`r-ST m rn J o 1P Illy C J~a ~ ti ~ m fi I x a ~ Q V ~d J o ~J 111 ~ ~ ~ v p Z bli \ O CY) -o 1 r~•.o 111 I r er r \ is ! on `yF m > al- I ' TI o ~ I ° 0 D 10 J l/~, ddd i W Cm . i l~6lS o .p -i I •I ~ < I I I ~ r~ z I s ~ I f I ~ j x'~ Z I j •A, j 1~ R~ • I ~ ~ to I I I n. , I o h I I ~ I ~`1 < I I I Fri rn j z I I j ~ i I I 1 m w I I rn 1 (A O t m I I 1 I r I I I b n I I I r~ N m j -D I I I ~ ' 46, m "0 n 0 'D I Z I I ~ z I 1 1 I -i rn Z ~ I ~ i nC v I I I I 1 1 I I Z7 W w° v I I I i 1 I 4h. I ~v M I M I z Cd ?s m # I z op 9 cil A~ x o o ~ r ! 56 r >I z m -u m v o To C m m -P Zz m In Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3 Labot h d Human Relations Ckvision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code . COUNTY 'JT Attach complete site plan on paper not less than in size. Plan must include, but `°e f X not limited to vertical and horizontal refer 'n t k i d % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a. a to neares ~P APPLICANT INFORMATION-PLE RIN ).Ql R REVIEWED BY DATE PROPERTY OWNER: PROPERTY I,QCATION S n i I l L -to, Y } 1.4 ;'9- GOVT. LOT _W 1/4 W 1/4,S JZ T 19 N,R E (or) W POP RTY OWlql&Q'SMMAAIILIIN DRES Z:_ ; LT BLOCK # SUB OR CSWI 4t C06N T Y ciTy, STATE ZIP C f~f61$1~1 ❑CITY [:)VILLAGE SOWN NEAREST ROAD 57 i ! L, ,[)Q New Construction Use [,)q Residential / Num rooms (.ANK [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 4 • bed, gpd/ft2 0.1 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0,7 bed, gpd/ft20 Z~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations E VAL.L)A"71 ow b6m-E govt, LA-r A-AIN A Z Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MO ND L-PROUND PRESSURE AT-GRADE SY TIM IN FILL HOLDING TANK U = Unsuitable fors stem d$1S ❑ U S US ❑ U El S U WS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnench 7S 1, m Cr n, CW 2 6, .S (3 gr (1% A VC -11-7 /Wk 44 Ground elev. 9D.s3 ft. Depth to limiting cto7r ~ 3 Remarks: Boring # 7 SL yh r I C 2 4,4 /sue r`j 4 :k> 2-71 !0`I►e4 4 S r rh 0. 0, Ground elev. 9Z-3-9ft. Depth to limiting t~ Remarks: CST Name: Please Print Ly JOuN~U1J Phone: _dQ Address: I iJ &S 4k) ] `ff Signature: Date: 7 •Z! q CST Number: 341? L_ :A2!=n _j PROPERTY OW ERrh ll'IKC$e SOIL DESCRIPTION REPORT Page Z .of •3 PARCEL I.D. r GPD/ft Depth Dominant Color Mottles GrStructure Boring # Horizon in. Munsell ()u. Sz. Cont. Color Texture Sz. Sh. Consistence Boundary Roots . Bed Twit A - /d 3 SL 1 m SbY- r Cw z 3 .4 _S /6YP, 41a Ground ~Z " a /e y►e s 3 7S-`Ye'J S'~ ) T S~ok !6~ r CtJ J~ >P fJ1P elev. 97.ot ft. 83 -l21 >OYP- $ Q r rh 0,7 0.% Depth to limiting factor > /D.oLs Remarks: L~ ~►OVY' ~a~14+~ Boring # A 4-6 1611k 3 - Sz l sb n-► - cw p, 30 /0`/►~S 3 CIG1 75~/~! 5 C 1 ~SbK n, r Cw i 30 64 /oy~4 3 - S r m Gw 6.7 (3Ground q9 ~ft. $3 4- rz~ 10P, 4 4 0 r - 6.7 d Depth to limiting factor Remarks: ~rnbvc 14vmo, Boring # /Oya St, m Sb n.-G C O. A r- $ - 7 /0 ►2 S~3 G 2c17.SYR4 S) L S r C w N P Ground gel z3ft. 3 ~-12D 16YP- J' A S a r n'► O~ ' d. elev. Depth to limiting factor Remarks: ~1~1~a1/~ 1. 141~~2. Boring # Ground elev. ft. Depth to limiting factor Remarks: cRn_enanfp Ac'", IOC/ -ro ~ ~Tw r t gyp' qj w .1 ~ ~ { J i Z 1 j { k' T~ LoT 3 i ' _O ( . 39- _nr r I Y i s ' - - ; t ~ 1 'I I IR-7 ` 7.g -I i s~ ' q - i V Z 7.00 oK.••r 15 - 1(.i )wf O1 D)~,M7Y3j)v )r. tOwirY)t ~ ) 1 O O .W LLJ V j N ail an C'1 . ! H I tnt J 5 c W ) : r ^ V) OIA.i .j w i L1 r0~17)S '~/1MM 11. O •-t 7.1 !O W, 15117 Q ZI fSb M,60,90.OON O '00 W z Q6, p W ~ ~ 4 nl ~ O g r- W Q O W o O g0 d ~ a vl r tr£ 3,r ~ 49'I£ z N g n r ; Z 8Z•rrN ` 3.6S,Zb•£ON 0 3t O m , Y 4 6er9z'sr>tz acy-_ sc 3.6s.7t,.CON► Q 3.6S,ZS.tO' a a 01 0 b • A 7 - ~~~3 on N \ to cc) E ` ` CD 4 Z 506'25 or N H J N ° e O CO O Q ? sr. . C .s 05 Z 3- W 3: aoz_oo= r O QO a e M 1~+ N v~ cP Q r _i.► N O 031 bJr p NOON - Q I-_ a Q}~ 1 1 O N 01 Z O tY NO O O g St Q 3.OO,OZ.DON 0\~ DO Q 0 o z Ir S f`r V a 1~ \ / Lj C. F- N # O p~ CPS ~/9 Z NWT M J d / do O • ( RN loom N CO -w d W 2 O V N u. /f/ 1 I r -S O Z w~•//S 1 • h- O I \ i • ~S U ~n ' M Q % , r • 60 Qa' low p; p; r Q) O N -IJ y` ~t rl Ri rl In1 i L)1 ~ lJl (•71 ~i: NOO,36'06'w 40000' o_ 1 17072' 22928 ~I \42 ~ 24x93 C1 26" YJ I.1 0 r ~ a ~e4 \ \ ~j. M ly ( W a ~ O o 423 27 O \ a- M ¢oj a- J ^ m J N o O V c lZ' t~ O p W fV co W O O O # VN_ N b80t2 3.81,Iq.005 ~WV+ a \ M ~ LSIb L26Z2___ OJr 3' at~y \ Q_',~~ -.gBoLZ--3•B1.1q•00 / e ~ ~O n qti a ^e 9 / - a o p / to (Y) IA 0 op V) b. O $ (V a N= c~-- M W a 1 o p Q h 0 ~1. ''.11J \G \l 267 ` a r 0 oz a'•J \ 1 s R ' N tZ i~~ )m \p',f~ J N (A p Q OU ch \ ~Od'~ ~ J ~ ~ / " / J \I , nQOO O O p„ ` _ ~ as N i' v6 tJ ~Pa / f 8 O J N ioo. 90N Q \ ~y , l m R 9l Sb9 M.Zb.9S• cg:w 096"1 (D W a U Q n o .3 I # q OS~ OD Mcrv _ ePp. soya 1 1 .9 9SSOC 0 a p M CP -.41 \ ~tEO n _O I O ~O N m` r~ 264p, b o\Cp 2 p ,n p~~ G Q' v 1 w JNT a o~ / o~ a z W W / 1 a o ti PI cli Q 'f• 0 p~ E r \ _C _ f y' 1 aD LA Q "J OD h O W O N Z C\j .6 F 01 13 0 M.608 / Ob0& 1 IF w O CQ ~ • , 9 ~ ./o Fre r 10 r- ' oo~ ;n C; m N 90 3 N in p N Ny FNn ` N¢N a WO poor a$ } 0 = %n _j O f O Navl N fl NavO+ •V'~ N --dC f ~4 Ng Jn~ iN o f b e N •O CAM 0 2 F f O~~ w W r MO~o g n O n to 0% M In R n I+ 0 F bg O OOO} N IFS OZ.901, oooot tY•Ygi 00.011 to eqZ ,98~1£I 3'froPsQ05 a rou»..,,.= w_ J S= iK A STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Z A I L L MAILING ADDRESS d3 ©x Z~ PROPERTY ADDRESS g 1 -7 /l'~ on (location of septic system) Please obtain from the Planning Dept. CITY/STATE v S O W s yo PROPERTY LOCATION S (-AJ 1/4,_ 1/4, Section Z T z '7 N-R W TOWN OF ~0 D-5 ST. CROIX COUNTY, WI SUBDIVISION T k K 0~ ~ ~ 10 (.,E (IT ADD LOT NUMBER 37 CERTIFIED SURVEY MAP S3 / 9U Z, VOLUME 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: S - 7 ` S St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 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 S4-41 Location of property , G V 1/4 9UJ 1/4, Section /Z , T Z 9 N-R / l W Township g ~D S o Y Mailing address a?2 - {4uDSp w( SAOlJG Address of site '9/-? I\gob N 3 ~ M wt s 7 subdivision name 7-4V#5 r' 600 25 /St AOD Lot no. Other homes on property? Yes No Previous owner of property U D F- LL Sf N N Total size of property -2, -7 3 A C Total size of parcel 2. 73 A L Date parcel was created S Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? X Yes No Volume/031 and Page Number 951- 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. S0V9 S~ , 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~ ss co Si ture f Applicant Co-Applicant ~-r41 r<7, Date of Signature Date of Signature • DOCUMENT NO. STATE BA F CONS I ORM 1-- 1983 THIS SIACS R[SMvC0 ,on eaC ltaiNO *ATA ARRANTY D D 504855 103111GE 456 - VOL CISTE4'S OF ICE i _ : S• l~•\ 110.• This Deed, made between Randall W. Synan and Patricia E. Synan, .;ec'filrReoo,d - -..-husband-..and .wife --•.-----'t c=.ntor. SI=P 1' 1993 ......i.....-----.---... and _..Sam_.E.~.. Mil ler, a sin9.le...Person . at 10:4 .-'M e'-'LA _ R- .~ossa. Grantee, f Wit~lesseth, That the said Grantor, f e a valuable consideration...... Randall W. Synan and Patricia E. Synan eTU11N To R conveys to Grantee the following described real estate in St • Croix County, State of Wisconsin: d f ' Ta: Parcel Yo: to The SE1/4 of NE1/4 of Section 11; the SWl/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, Town of Hudson, St. Croix County, Wisconsin. F~~+Is AND ' 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 N89 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 V AQt_... homestead property. (is) (is not) I Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... R410A L W_L... Y.nan.. and• Patricia...E-. -Synan warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. a~/l and will warrant and defend the same. .~5n Dated this day of At61gUSt....................................... 18..9.1. (SEAL) r'e~sti.tc..4~ ✓ ..........................(SEAL) Randall W. Synan Patricia Synan .........(SEAL) ...........................................................(SEAL) • AUTHRNTICATION ACENOWLEDOMBNT Signature (s) _ STATE OF WISCONSIN a& St Croix `z County. 3_. .....day of authenticated this day of 19 P Wally came before me Augus 119 the above named riciE ndall W. Synan, Pat TITLE: MEMBER STATE BAR OF WISCONSIN Synan L.OMO~'s (If not- authorized by ¢ 706.06. Wis. State.) x he . 09. I~ to me known to be the person ..,9....... H~~i~~ r in inatru nt and a n wle~ THIS INSTRUMENT WAS DRAFTED eY ' r ; Kristina Ogland Atcornep' at 1:aW Alice Joy o ors Notary Public •-................CountY. Wis. l~ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. f not, state exp. atti]]on are not necessary.) date: ) 1Q t') y •Names of persona signior io am taPacitT should be taped or printed below their signature. 'Y WARRANTT DEED STATE BAs: OF WISCONSIN 'Niseon.in Leral Blaak Co. Inc 7 FORM Ne, I - issi Milwaukee. Wis.