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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~La&Q ~D/l sT
ADDRESS
SUBDIVISION / CSM#
LOT # .3
SECTION-_T,2 ~N-R l9 W, Town of
DJ?J
ST. CROIX COUNTY, WISCONSIN
PL )LVIEW ~Ee-T SHOW EVERYTHING WI HIN 100 OF SY TEM
I~
S~
t
ZIP
n
0
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 0A 7`164 /SOD /l~'S 44,16 jap,D
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Cd1EE1zX Liquid Capacity: /.2ow
Setback from: Well 41je _ House Other
Pump: Manufacturer- Model# ` --a ze
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: , Z Length e P Number of trenches
Distance & Direction to nearest prop. line: fp i LC'~
Setback from: well: IVPU= House y0 , Other
ELEVATIONS M.141
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold f'~' y~ Bottom of system 9y S$
tH r3.3
Existing Grade ~7.rJ Final grade f7a
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: j _14 f
INSPECTOR:
3/93:jt
W-;concnDepartment ofIndustry, PRIVATE SEWAGE SYSTEM County:
Labor and Human`Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PlaglIX".59
OLUND CONSTRUCTION X
CST BM Elev.: Insp. BM Elev.: BM DescriptParcel Tax No.:
TANK INFORMATION ELEVATION DATA A9500353
TYPE MANUFACTURER STATION BS HI FS ELEV.
Septic Benchmark loo,
Dosing f 2- (J'u
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St / Ht Outlet
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
rl
Septic 01 Jv y ~ NA Dt Bottom
Dosing NA Header / Man. y
Aeration NA Dist. Pipe
Holding Bot. System 7 ' q y, 6
'
PUMP/ SIPHON INFORMATION Final Grade Q-2,0
Manufacturer Demand
Model Number GPM
TDH Lift Lricti System TDH Ft
Fi
Forcemain I I Len Dia. Dist. To Well L
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /a' 6'0 - / DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Moe Number:
OR UNIT
System: -A2.191 JD fOJ'b ' ~I
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 /Trench Center Bed / Trench Edges cy h' .'J Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Hudson.27 29.19W, NE, NE, Lot 43, Badlands Road
II~
V♦
Plan revision required? E] Yes El-No
Use other side for additional information. S d. 4j /Tt.,~' (o 1 o~ k
SBD-6710(R 05/91) Date Ins sp6ctor'sSignature Cert No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
Safety and Buildings Division
~~■~rG■"Z SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E_ Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O: Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application StateSaanita~ry Permit Number
The information you provide may be used by other government agency programs ❑ Chl~clt if ieviSion to Ious application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
PropertOwner Name Property Location
1/4, S T , N, R 41 E (o
Property Ow er's Mailing Address Lot Number Block Number
11A & g r~
City, ate Zip Code Phone Number Subdivision Name or-C41 M1uTnbe-
yv cux- (3A6) - 1_Q4r
II. TYPE F BUILDING: (check one) E] State Owned El !t~ Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 2 O Town OF C1 f
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/Condo 40i20 - / t93-- D
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 online A. Check box on line B, if applicable)
A) 1. L4 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
110 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
Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
Feet 7.0 Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site - Fiber- Plastic Exper.
New Exist in Gallons Tanks Concrete Con steel glass App.
strutted
Tanks Tanks
Septic Tank or Holding Tank
El 11:1 1:1 1:1 1 El
Lift Pump Tank /Siphon Chamber
'El El El
❑ El VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of onsite sewage system shown on the attached plans.
4,V r's Name: (Print) Plumb 's Signatur ~ St ps) 44 UMPRSW No.: Business Phone Number:
7Yf'4`Y,4
is Address (Street, C , State
, Code):
d
IX. COUNT / DEPARTMENT USE ONLY
❑ Disapproved Sari ry Permit Fee (includes Groundwater Date Issue Issui g Agent Si we (No Stamp
A roved Surcharge fee)
pp Owner Given Initial ~ a~
Adverse Determination U
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber.
I
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 al/ 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 wi!.h appropri ar(? 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 iniches must b.e sui_ ii ted cc, my The plans must
A) plot plan, drawn to scal-e ur with complete locau-_=~ Jlnq rank(s), septic
.;;t,cr trea! rnent funks; building sewers; well,,, water main/v at cc; str+ 1 1 kpU!Tip or siphon
r ut!on t ones; soil absorption systems; replacement system area if .i the to the building served-
J~ '.1I v( C'!cal e!'val~on reference polnts; L} Co 111ilE. te for Itil,lf` . c)nt_t'c+ S; do se VolUine;
_'Eva'i01) rces; fricti_~n loss; pump performance curve; pUmp M0, P! ~ T p rT- t,!,, rer, D) crc,ss section
.nFormat~on_
~,.f e) l sizincg
the, >v: f;tio.z systern, if required by the county, so test data on a ~ cr~m, a j
GROUNDWATER SURCHARGE
1983 Wisconsin. Act 410 included the creation of surcharges (fees) for a number of regulated practices.vuhich can
effect groundwater.
The monies collected through these surcharges are used for ,-monitoring groundwater contamination investigations
and establishment of standards.
e)e,7-F4 C'
A
DAVE EOGERTY PLUMONG
Licensed Pe* Tester & Plumber
#3233 #3269
Fopg~eerty Heights Rood
ROBERTS, WISCONSIN
Phone ?49.3656
~~U~/ ~vNs yl• ~T ~ s ~ ~r ~3, ,
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101-M~,?Y 7497-
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d ~ = 72~P o"r rw-z. re wz:x evo,o
d 2 = surD LoT Gzti~ C" fiST, su~ev,E~o,~ s
f ~Etrrot~S' ,~Yt,,~'e'~ ~S
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SaRvEy 's ~rPc ~ i3~ ,a~ ~'yY~
0 = ~oi~~s r~o.h ~i~~~ 7'~T _ fJTTi4chFF 1'
DAVE FOMTY PLUMBING
Licensed Perk Tester & Plumber
03233 #32e9
Foa~r~yyHeiggh Road
ROBERTS.-WISCONSIN
Phone 749-3656
C7~sT ~rxsv~ R.rpoN~ 0,e0t~/4 70 4 vorl) ew:r
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abo and Deparpent of
Labor r and Human Relations SOIL AND SITE EVALUATION REPORT Page/. of
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 Tf s A z . must include, but
not limited to vertical and horizontal reference point (~M ction an e, scale or IPARCELI.D.#
dimensioned, north arrow, and location and distan, earest road
APPLICANT INFORMATION-PLEASE PRIN" L IN00AM*f cot REVIEWED BY DATE
r:✓
PROPERTY OWNER: ' - PRdPW LOCATION
,t'q ~y k L GO T 1/4 1I4,S~7 T z p A,R E (
PROPERTY OWNER':S MAILING ADDRESS BLOCK # D. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER (]VILLAGE OWN NEAREST ROAD
New Construction Use [~J Residential / Number of bedrooms [ J Addition to existing building
j J Replacement [ ) Public or commercial describe
Code derived daily flow &P gpd Recommended design loading rate ed, gpd/ft2 , Ltrench, gpd/ft2
Absorption area required _4562.. bed, ft2 73-0 trench, ft2 Maxxiimum/ design loading rate , bed, gpd/ft2 Z trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations I-AP
Parent material - Flood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem LOS ❑ U ❑ S O U OS ❑ U ❑ S m U ❑ S U ❑ S Oil
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bota>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
.Z)11 G .S
Ground
elev. _
ft. Z 0 --,Zo - VA/
L
Depth to
limiting
factor 3 _ - S S~
Remarks:
Boring #
o z t
L SCL 5
Ground
elev.
p'= ft.
Uepth to - S D S L S , 7
limiting
factor
Remarks:
CST Name: Please Print 6:Phone:
r~2T
Address:
/ 0~-3 !D 31- 33
Signature: r ~?r . ate: CST Number:
PROPEMYOWhEA 61A( ciO 6;A04- SOIL DESCRIPTION REPORT Page Hof
.I
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
elev.
ft. Z - p , fy! M f~S . 6
Depth to
limiting
factor 3 /Q- 7. s - s S01
L
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
4:5
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground OGERTY PLUMBIN
elev. PERK TESTING, I
ft. P.O. Box 130
Depth to ROBERTS, WI 5402
limiting
factor
Remarks:
SBD-8330(8.05/92)
~a
z7/ '
N n 3
~.s
x
~ 3 9y~
ass
41
Q = AVM jb? OF 7-5'I /'Fltv&X , /9sXriwwe- rend ►
> 100
~s
/Y ;K
SaRuFy 's ~rP,c- ~ i3n, ~ 3- PyY~ .
~3or~~s i IoM T~7" _ ~TTAch~F t~
DAVE FOWTY PLum wa y^,E
Licensed Perk Tester & Plumber
63233 gg#~h3299
ROSE S, WISSG`ONSIN
Phone 749.3656
CTEsT ~r ivy p=FpOM' 'zw oRO 461exD Gzr~ ~71RTJto/j
_x
s i .
Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Pagel of 3
Labor and Human Relations r
Division of Safety & Buildings in accord with ILHR 133.05, Wis. Adm. Code
_NTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plpn mast include, but
CEL I.D. #
not limited to vertical and horizontal reference point (BM), direction and % of 41oo,'"alo, ary.., < `a
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION
PROPERTY OWNER: fU,y~/,PQ /fi/s LAti~ O /d jPROOPERTY LOCATION
L j o Al GtiA/.P.H y T. LOT N 114 ,(/~1l4,S 2 7 2 9 N,R /J~' E (a) W
PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM #
334 8F-STS ST i-►UMBi elf H 1,11-S (?AASE- 2-
CITY, STATE ZIP CODE PHONE NUMBER EICITY [VILLAGE POWN NEAREST ROAD
/~gvL ~1N S5/o/ lGrz) zz2-5SS5 1iUv-S0,J d~~ LE L~✓
New Construction Use ( k"esidential I Number of bedrooms ` °'P 3 Addition to existing bulking
I 1 Replacement Public or commercial describe
Code derived dally flow &oo gpd Recommended design loading rate 7 bed.9 1 dlfttr ench, gpdM1
Absorption area required bed, 112 756 trench, 1`12 Maximum design loading rate bed, gpd/ t2 trench, gpdM2
Recommended infiltration surface elevation(s) s-~ P 9 • 3 K (as referred to site plan benchmark)
Additional design / site considerations ZIY,~E_ 1-0-J,0 y~°AO W 7,eAz-WG6-05
Parent material Sc S ~o ,S TTi~ Flood plain elevation, 9 appli6able 414' it FILL HOLO S = Suitable for system CONYBITION& 1 °'o U r 9-5 W R -
O U E~uAE AT-GRAM
-T- [I U SYST O U 0 SIrJG TAW
U= Unsuitable for s stem 0S o u 01 SOIL DESCRIPTION REPORT
oots GPD/ft
Depth Dominant Color Mottles Texture Structure Consistence JR
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
o-/ ~oY,c' 2- / f s6,~ ,rte fie f l /y 3S /6 Y
A 3/ .S~ le z f , S ally
Ground S /o YR y 4 - f
elev.
io y. -7o ft.
Depth to his tia ALP goo 11111.12
limiting
factor for cptic sys em.
Remarks: E S
Boring # / _ 1Qa y/Z v~~ ~f S~~ i►,~f~ C S ~f
[3 v- 1 /0 yx 5/f/ 4,
~a~~r a, s ~ i s ;
Ground
elev.
Depth to
limiting
Remarks: /
T Name:-Please Print f? C~ Q E P_T L(112f C- k 7- Phone: 715--3 P6 - e/es
ddresa: CQ~J S 0' Nt I L UPSO~ W . J` /(p G~ST~11 y~Z
Date: CST Number:
Signature:
N 64
8,7 /3 S 4. /
Ae'r4- °/r- 13 3 ' y' S ,per U,;1!o t - Lo~D,.;4, 44 7it-~ 0/
Pt Nye 5
r s. >
SOIL DESCRIPTION REPORT z
of
P~ _
PROPERTY OWNER 3
PARCEL I.D. # /Q7 - Y3 / /
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boun tary Roots GPD/ft
In. Munsell Qu. Sz. Cor!t Color Gr. Sz. Sh. Bed tench
Ground .1-2-2p d, S d-
elev.
Depth to i
6miffng i
7-7
Remarks:
Boring # d-6 to lQ 2~2 S/
Ground
y~ tt. ~
Depth to
limiting
factor
Remarks:
Boring # o_/D /O Y/ 2/2- S/ /-f' fk 11 / 1
/10 0 rs 4;
Ground
elev. %D y ~P • S . 01
aQ - 7 ,m Ao~ /5-', L ft.
Depth to }
limiting Ld
factor
Remarks:
Boring # '
Ground =
elev.
tt.
Depth to
limiting
factor
Remarks:
con eoon,o mein"
C4
Oar 13
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S89°26'42"W 161734'
hI5.00' 205.00' _
'A,
11 220.00' 332.34' ' g
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6p 00 Sg, ~~1~~\
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\?'9'LOT 40 2.82 ACRES
23i 2gs 122,949 SQ. FT. 36
O 4>, 9\ I
o
2.:46 ACRES
LOT 39
• - Fqs O i 3.68 ACRES
F•~E`,y~i 160, 279 S0. FT.
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LOT
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42,
2.17 ACRES
94,642 SQ. FT, d• ~ ~
,w : - Ste, f/~ 2SS ~9 sF PoN
EASEKY \
LOT 43, 0 2.34 ACRES 0) S (o
101,995 S
Q. FT.
10
QS hh _ t
I
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PONDING 9 2 SQ FT. ( I
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FF EASEMENT
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYERL~a/l~~,.~7 F,.~ ae y '+k,
MAILING ADDRESS //2'7 111(1(4AEC&S 6" S r, Iy- ~.140060? W r S 40(6
PROPERTY ADDRESS I` G n r n 7-71-1 (location of septic system) Please obtain from the Planning Dept.
CITY/STATE GAF" W,~ch.i , 4~,ed►.ac~„,a
PROPERTY LOCATION &AE 1/4, ~ 1/4, Section /7, TAN-R,1_ _W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER 4-
CERTIFIED SURVEY MAP , VOLUME , PAGE , 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:. ~W NtJ lod~.SYDATE:
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 QLuAll) Cop P.
Location of property,&L-r"_1/4 0- 1/4, Section .7-,7,T 7 N-R /TW
Township {~~,~~~aIJ Mailing address
Address of site 77'1
.~e`le~r G.v
Subdivision name Lot no. -13_
Other homes on property? Yes____X_No
Previous owner of property 4tg G-gj►L
Total size of property Z -3f ~rG= ;
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house) ? ___)L_Yes No
Volume 11W and Page Number S36 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. S3s`~ 83 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'~ 0 8 3
"&Ial 0p, dWL'-Q 6jisi, Qokp.
Sig a ure of Applicant Co-Applicant
10
~~~1gs
Date of Signature Date of Signature
"A Family Tradition Since 1988-"" D~.Team of Speer
Hudson Office
400 S. Second Street
I IudMon, WI 54016 F-lumbird Hills - 2nd
Ot)ice (715) 386-8236 Addition
merro ((,12) 416-7072
FAX (715) 386-1502
Voice Mail 715-386-0251 Lots 26 - 45
St. Croix County, WI
Lot Prices
November 8, 1994
Lot # Price
26 $27, 100
27 $31,900
28 $30,900
79 $28,900
30 $31,400
31 $33,400
32 $30,900
33 $31,400
34 $32,400
35 $32,400
36 $31,400
37 $31,400
38 $36,400
39 $31,400
40 $26,900
41 $25,900
42 $27,900
43 $27,900
44 $31,900
45 $28,900
77 • - •
3
-A Family Tradition Since 1933"`"
Hudson Office
400 S. Second Street of
Hudson, \V1 54016
Office (715) 386-8236
Metn> (612) 436-7072 TCO &
FAX (715) 386-1502 B4
Voice Mail 715-386-0251
Humbird Hills
Addition 3rd
Lots 46 - 62
St. Croix County, WI
Proposed Final Plat to be Filed 1/95
Lot Prices
November 8, 1994
Lot Price
46 $33,400
47 $32,400
48 $30,500
49 $29,500
50 $29,000
51 $24,720
52 $26,720
53 $26,220
54 $24,220
55 $24,220
56 $24,220
57 $23,220
58 $25,220
59 $28,220
60 $28,720
61 $27,720
62 $29,220
tea,.^-• - LOCATED IN PART OF THE NWI/A OF THE 140/4. NEW OF THE NEI/4k SEI/4 bP THE NEV4, I
AND THE NEI/4 OF THE SEI/4, ALL IN SECTION 27, T29N, MOW. TOWN OF HUDSON, /
' N ST. CROIX COUNTY, WISCONSIN. F DT
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LOT 41
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118YE7 MAP
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_MAL LOCATION.--
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SECTION 27
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HUMBIRD HILLS THIRD ADDITION
LOCATED IN PART OF THE NEI/4 OF THE SEI/4 AND IN PART OF THE SEIM OF THE SEIM, ALL IN SECTION 27,
T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN.
OWNED BY- LEGEND
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g LOT 47 44•I ' "E ADDITION
eb / 66.00'
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$ LOT 48
aa•'aa• ~tL.ieea l LOT 62
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Z LOT 49
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INTERSTATE "94" a bl.a s to b.
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• DOCUMENT NO. ~ .STATI, BAR OF WISCONSIN VORTA 1 - 193E y +~'a ar cE nc cnvr.., •c•n nECOn•.,.+.
J r WARRANTY DEED
a ~ I
I~
5 a3. I REGISTER'S OFFICE
This Decd, ,nt,dc between ....Humbird__J, n4... Cpx pc?ration-,.,_- ST. CROIAVo•tWl
A..Minnesota..(:uxPazati:4n Redd for Rewrd
Grantor, OCT 17 1995
and..... ALund-.Conatruc tion.-Corporation-,..a._W1sconaln....
..Corporation .
at 1:00 P. M
Grant:oo,
Wi.tl-)OSSath, That the said Granter, for a vniuable coaaideration._.... *fZ:711fsbayftg. C•
_ _ nr„o
n>_ Regwar bfDeeds
oonvny5 to Grant-no the following detieiibed reul estate in St Croix
County. State of Wisconsin: Q CFO
Lot 43, llurnbird Hills Second Addition, Town of Hudson,
Sc. Croix County, Wisconsin Tax Parcel No:
i;
•
is not:
This homestead property.
(is) (is not)
nrtrnnnren t.herHllntn hn)nneine: ~
Togothon with ull and ntrlgular the horoditatnwnts and uPP
And Humhlyd Land Corporation
\varrallts that the titlo Is good, ilitle.k.-Asthle In foe sinlplo rind frue and cluat• of cucunli~rnncuJ oxau:pt
Ennentents, resrrict:ions, and Rights-of-way of record, if any
I;
and will warrant and defend the same. It
l;
1•
Dated title ......:,301 day of 1CJ;Qbnr...... . 19.9r~....
...................................(SEAL) a ...•.....r F.AI.) Ii
pH au,mliird aiicl Cbpo on
• _ jcy T..... Austin J. Bllon. to President I
(SEAL) (SEAL)
E.
i'
AUTIi81NTICATION A0ILN0WI,EI7CilKErJT '
Signaturo(s) STATE OF 79MM70*XKW Minneso a
ss. I
y Comity.
RAP)MR--
authenticated this day of 10...... rorsonally came before trio tills USA.... tiny of
OCt_4.b8.r the above named
aillon President of • Humbird
end..
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not °-•----•-----•--e~
authorized by § 706.06, Wis. State.) e
to me known to be the porsoIt- _-:,ti-..RCt, 'oAc>Myeto"
foregoing inetru eat and weknvWtieq!j~- MINNESOTA
TM1o INIrr"UNIENT WAS PnAPTEO UY GTp~y CQUNN
j _ ....Hump ird. _Land. _ Co r PQ x u.t ~ C'I) . Cornm. Expires Jan. 31.2000
_~:iiv 1. _A Ba 111on_. ; .~vv J~!vvievvlnnntwwawnvvavvt
Notnry 1'ablic War.....- On........_........County, Wiw. '
(Signatures cony bH nuthenticated or acluleaYic(It;ed. Both My Ctnnmission in permanent. (if not, state expiration
are not neceseary.) date: January._31................................. 2009
•Nwmew of l.crr0n9 91~nlnt{ 1n way [wriwelty whould ho tylind - 1)"ntt l bA.,w thwlr CIA ant.. ru•. '
AD.nA NTY DS:aD aTATB DAR OF WASCONSIN Wi.ron•In I.oenl Itlwnk Co. I—.
W
FORM Nn. 1 - 1092 Mllwwa kcr, Wt..