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HomeMy WebLinkAbout020-1064-90-200 ~ 0 3 °c o O 6F3, d -0 0 0 y ~ h O N ti C ~ I z o~ h N N O o z C 0 c U. .o N a Cl) (D Z y W E Z 00 Z 04 a m N F- Z C p i C c~ U 0 2 d Z 2 0 T Z E -o 'O N M N a N N O t 00 C O Y U O d C w Z co D o Z O_ N d c v N a E E V! T a d _ Y 3 0) y m a~ c o 0 0 0 (L a c0 m 0 co Y c) = U EL 0 o 0000 z ~CL IL CL IL = z 0 'a LO U') W U o rn rn 0 D N T° t 0 Y -p N O ~ ~ ao a in e: O 10/J Y7 O 00 0 E N C 0 o~ 3 _ 0 8 a rn rn o G P N O. C O) Q) N lv, O co c U_ co Q O C 5 rn Z 7 I V"~ O U L w y M LO LO T W Li ~ w O C N CD 00 • N q. 7 O N O c E O U O y„ O N= 2 N 0 Z m 4) a ~t a M a m m a + E m C r-: o V~ A 0 a 2 0 in 0 Parcel 020-1064-90-200 01/12/2005 05:02 PM PAGE 1 OF 1 r Alt. Parcel M 24.29.19.247D 020 - TOWN OF HUDSON 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 HARTWICK, WILLIAM S & TRACY L WILLIAM S & TRACY L HARTWICK 878 KINGSWAY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 878 KINGSWAY RD SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 2.720 Plat: N/A-NOT AVAILABLE SEC 24 T29N R19W PT NW NE BEING LOT 3 OF Block/Condo Bldg: CSM 9/2629 2.72 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/28/2000 625496 1522/237 QC 07/23/1997 1092/361 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 48150 265,900 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.720 55,800 149,900 205,700 NO Totals for 2004: General Property 2.720 55,800 149,900 205,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.720 55,800 149,900 205,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 209 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE IN x a r x r x■- ....s ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 30, 1995 Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 ATTN: Becky RE: Septic Inspection for Property Located at 878 Kingsway Road, Hudson, Wisconsin Dear Becky: An inspection of the septic system for the above address was conducted on May 19, 1995. This property is located in the NW; of the NE, of Section 4, T29N-R19W, Lot 3, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please do not hesitate in contacting our office. I ince ely, . / ch ames K. Thom psdn Assistant Zoning Administrator St. Croix County, Wisconsin mz STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER - ADDRESS 7 7 z SUBDIVISION / CSM# SZL429 LOT SECTIONT N_RWTown of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ea, ~`yl INDICATE NORTH ARROW I 1 Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: / 6 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: 14 Setback from: Well ls_~ House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: IQ Length Sv Number of trenches Distance & Direction to nearest prop. line: r• Setback from: well: s House Other ELEVATIONS Building Sewer ST Inlet. ST outlet Jp217 PC inlet PC bottom Pump Off Header/Manifold /a2,_-)/ Bottom of system Existing Grade Final grade 0` DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ~Lz,~-a INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sa n ita ry Perm it No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village p Town of: State Plaggq# HARTWICK, WILLIAM S. X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /?Iel 10 14:2d I TANK INFORMATION ELEVATION DATA ;:E!L TY PE MANUFACTURER CAPACITY STATION BS HI FS EV. Septic Benchmark 9/, Dosing / Aeration Bldg. Sewer ~7 Holdin St/ Inlet TANK SETBACK INFORMATION St/Outlet /dd, 67" Vent TANKTO P/L WELL BLDG. A irl to ntakeROAD Dt Inlet Septic ro (D/ l / NA Dt Bottom Dosing NA Headerl& . i 161d"-w Aeration NA Dist. Pipe 9 ~fC~ Holdi Bot. System 3o' PUMP/ SIPHON INFORMATION Final Grade a i MamAaL urer Demand p S. T ' d m. Model Number -'GPM TDH Lift Fr n System TDH Ft 1 55 Forcemain ength Dia. Fi Dist. To Well SOIL-ABSORPTION SYSTEM BED/TRENCH Width Length No. Of j enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 57` DIMEN I SYSTEM TO P / L BLDG' I WELL LAKE / STREAM LEA► Manu act SETBACK INFORMATION TypeO pt,-& / CHAMBER o e Number: System: Yu/: OR U DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Sp Vent To AiTlntake Length L~ Dia Length Sad Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra yste my Depth Over Depth Over xx Depth of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges _ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.24.2;9.19W, NW N Lot 3 Plan revision required? ❑ Yes to Use other side for additional information. 5 9 SBD-6710(R 05/91) Date Inspector's Signature Cert. No. r , ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~I L SANITARY PERMIT APPLICATION ~.=L■7~ In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE S)h{V Iz/MIT -Attach complete plans (to the county copy only) for the system, on paper not less than ptoZCY~ 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. PRO ER OWNER PROPERTY LOCATION . /a ' - Y, S T , N, R i(or PR PERTY OWNER' MAILING ADDRESS LOT # BLOCK # CITY, TATE [ZIP CODE PHONE NUMBER St~B IVISION NAME OR CSM NUMBE G _ e II. TYPE OF BUILDING: (Check one) CITY NEARS ROAD ❑ State Owned ❑ VILLAGE ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) - 9C?vo 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 7 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) A Sanitary Permit was previously issued. Permit =2.:2e!.22 Date Issued 2-Z - ,2S__ 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 220 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 (sq. ft.) (Gals/day/sq. ft.) (Min./i ch) ELEVATION /,Zl/ If, 7 11 Feet Feet VII. TANK CAPACITY Site in allons Total - of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed _17 F1 I EF F1 Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installa ' n of the onsite sewage system shown on the attached plans. Plumber Name (Pr' t):, Plumb 's Si na re: N6 pal MP/MPRSW No.: Business Phone Number: ✓ /7 T P u er' Addre (Street, C ty, State, Zip Cod A O-A IX. COUN /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Inclu oundwater ate Issued I ing Agent Signature (No Stamps) . Ed I Approved I F-1 Owner Given initial arge Feel Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS 1. Asanitary 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 lumber 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. 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 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) ~/u~,~ ter s-SaiG a / o sew ~s X,~,c ~cr/• ~ P 41 (ID meo, k ~6 Wis6onsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of Labor and Human Relations Division of Safety & 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 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 PROP RTY WNER: PROPERTY LOCATION GOVT. LOT Ali, / 1/4 114 T N,R 9/(or& PR PER OWNE '.S MAILING ADD LOT~# LOCK # SUBP. NAME OR CSM # Cl TATE ZIP CODE PHONE NUMBER ❑CITY ❑VI GE LVOW NEAR ST ROAD 1 ( ) . ~ [k] New Construction Use ],~(1 Residential / Number of bedrooms [ J Addition to existing building [ ] Replacement [ J Public or commercial describe Code derived daily flow Q gpd Recommended design loading rate ed, gpd/ft2-, S trench, gpd/ft2 Absorption area required 3 bed, ft2 trench, ft2 Maximum design loading rate ~ 7 bed, gpd/ft2trench, gpd/ft2 Recommended infiltration surface elevation(s) q7, S ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem JE S❑ U MS ❑ U © S ❑ U MS ❑ U ❑ S (@ U ❑ S o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench ::4i::•iiii? ii:~ 4 tM1,•.. '2 7C-,4J S' I Ground elev. /a2_y ft. - - Depth to limiting factor ~yg Remarks: Boring # z6 Z9'6/Z__ as- Ground _ elev. 7 Y, as rZ 41, / ft. Depth to limiting factor Remarks: CST Name: Please Print Phone: 229/ Address: Signature: / Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page _of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench M Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor F-T Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 8// //77 r5 Gp _ 7 L,~-leak _ - ~ ~ p r'6U5E ®a~ack ~o ~1 SANITARY PERMIT APPLICATION COUNTY v~~IIIr■IR In accord with ILHR 83.05, Wis. Adm. Code STATE S/~(JIT~1aY PE^M # ~,1J 34 -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. 1:1 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. PROP RTY NER PROPERTY LOCATION '/4 N, R 4or~ PR RWN MAILING ADDRE n LOT # BLOCK # CITY STATE IP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER L' 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned ❑ VILLAGE Tow ❑ Public 21 1 or 2 Fam. Dwelling-# of bedrooms PARCELTAX Nu B R(s) ~7► III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 N 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 (sq. ft.) (Gals/day/sq. ft.) (Min. inch) ELEVATION r Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank P-/O& S' Lift Pump Tank✓Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install tion of the onsite sewage system shown on the attached plans. Plumber' ame rint : Plum er's gna e: ) MP/MPRSW No.: Business Phone Number: Plu ber's Address (Street, Ci State, Zip Cod © IX. C UNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing Ag t Sign No mps) Approved ❑ Owner Given initial y 1976 Surcharge Fee) / Adverse Determination 15~ 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. 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 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 tanks 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 i 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) , Ja.OSo,J U) T 5-:j104 lv t/u4sOs,/ A Awe 4,, ids a jrsoe ,-4~e&O D S G czw,--),w ,b~,o .Sze /o.-2 lrsy 6w-2 tuzEt~S mop-l S5 /,e n~ q. _ n a p3 r 1,e~rzo 41oc X Y mot ~ ~ PAGE OF CrC)sS Jec~lun o~ lien SyS r Frech Air InI11s And Obcervallon Pipe ~^J--- Approved Vent Cap Minimum 12- Above Final Grade 20- 42' Above Pipe _ 4' Cast Iron To Final Grad• Vent Pipe Marsh Hoy Or Synthetic Covering yin. 2' Aggregate Over Pipe Olatrlbutlon Pipe 0 0 0 0 0 - Tee 6' Aggregate Pipe Pipe Beneath Perforated Pipe Below Coupling Terminating At Bottom Of System n 0'3 C I~ T• 1 n a I ('c. C'1 { D P~uP g. / ~Icv•. ton /~~/~j\ SOIL FILL DISTRIBUTIOM PIPE APPROVED S4grAETIC COVER ° MATERI~i- OR 9 OF STRAW Z" OF A6GR EGATE OR MARSU NAy ° (eOF 12 -Zt/2 AGGREGATE ALE V. oFk ~ FE~T_-► DIbTRIgt,TIOU PIPE TO BE AT LEAST a_ WCHES BELOW ORIGIMAL GRADE AIJU AT LEASTLO INCHES BUT 1.10 MORE THAN Li2 IAlCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXC-AVAT10" FROM OKI&hIAL f KADR WILL BE INCHES MINIMUM Wnt OF EXCAVATION FROM. 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I "M, I A a,ao,►yoe I W '0 (r ell rn c oS~ Pa N a' 1A w d r / o v► E-q 0 n o I 2 0 P4 (A J y l hr c P N .1 J 4 G 0 . 19 / J N ~ y Jy !v in V ~o ID N li F~ `o j d I 2 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER .922xT 1-k MAILING AD DRESS 6l . oa 461-4 PROPER S'^ TY ADDRESS "7 $ 0 (location of septic system) Please obtain from tfie Planning Dept. CITY/STATE 1-1y0/!:~c94J Gv i S`440t ;;0' PROPERTY LOCATION 1/4, AF 1/4, Section "a_1, T_ ~ N-R_,Zf_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER Y CERTIFIEDSURVEY MAP 9 VOLUME PAGE 2 LOT NUMBER - ~oc . c71/z Improper use and maintenance of your septic system could result in its failure to h premature andle 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 thre ar expiration date. 01 SIGNED ( L2 DATE: 'Z - `1 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r Y3'' 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 40 eLz-' 14 wl `4~ ~ " C Location of property N-V 1/4"t 1/4, Section -R Township Mailing address ,~~s~ Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel 7 Date parcel was created Ali C Z f - 7 Are all corners and lot lines identifiable? X_Yes No Is this property being developed for (spec house)? Yes X_No Volume 1097- and Page Number X61 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. 5a o Sip 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. !5-"W 54 2 (r'Y'l'yK 'gnature of Applicant Co-Applicant ~-Z-qi- Date of Signature Date of Signature Y66CUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 r voL 7S1. _k'Z`0 OFFICE Burt Kn CROIX CO., WI Wd d for R-ecord . 1l. am.,S. , Hrtw~,ck::....:::::::::...:::::::::::: .AUG2 0 1994 W 1 conveys and warrants to ...y.Q! ~..1'...f?~. : P'q M 1 . I~ ReSISWOf Daft RETURN TO the following described real estate in .............Stl .C O X............... County, - State of Wisconsin; Tax Parcel No: Part of NWARAII.Sec. 24-T29N-R19W described as follows: Lot 3 of Certified Survey Map recorded in Vol. 9 of Certified Survey Maps, page 2629, as Doc. No. 501128. This property is subject to the Well Variance attached hereto and dated July 22, 1994. F~ . This ..........i5 RQ9...... homestead property. 3= (is not) Exception to warranties: Easements, restrictions and rights-Of-way of record,. if any. . Dated this 0. .............1...... day of U3t........................................ 19......... (SEAL) ~'`-✓1... (SEAL) .(SEAL) ....................................................................(SEAL) • ' AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. t. Croix County . authenticated this ........day of 19...... Personally came before me this .day of ......Allgaist 19.94.. the above named Burt..R...K.itg,................................................. e . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorised by 708.08. Wis. Stab.) to -me known to be the person who executed the f r ng lust ant an cknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ~61ll~WTS ............Kristina _Ogland otary •Pi~ilic......... Alice Jo , Co. ors..SW.0f.WiSC0nSifr..... Attorney.Bt::LSW Notary Public S.t...CrO~7.1C County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is pe anent. f not, state expiration are not necessary.) date: . I.- to ONSum of Pawn stsalm In any capacity ehouid be typed or printed below their strustura. WAh, 11'r STA, 'R WISCOx Wisconsin Legal Blank Co.. Inc. OJT M