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HomeMy WebLinkAbout020-1099-70-000 STC - 104 a AS BUILT SANITARY SYSTEM REPORT 19 OWNER Tcr~ e_s ADDRESS Y SUBDIVISION / CSM# LO SECTION T;eg_N-R_ W, Town of 4h~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM .0 k ~ ~ V I hi~- ~1 h s, `7~ t2 - 9x`10/ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 1 Liquid Capacity: Setback from: Well S-~- House Z,,El Other Pump: Manufacturer Model#Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: s Length Number of trenches 2 Distance & Direction to nearest prop. line: Setback from: well:1 fi House--7,r Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 3O p~-12 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM! County: Safety Labor and and Uildild nings Relations Division INSPECTION REPORT * CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ village aTown of: State Pla WO HOLM, JAMES i CST BM Elev.: Insp. BM Elev.: BM Description: a Parcel Tax No.: t /mod.' ( S TANK INFORMATION ELEVATION DATA 1S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic See G{.;S ltr. Benchmark Dosi ng- Aeration Bldg. Sewer Holding St/ Ht Inlet i TANK SETBACK INFORMATION St/ Ht Outlet - Vent TANK TO P/ L WELL BLDG. AirirIto ntake ROAD Dt Inlet - ILA- Septic ~Sv ~SSI NA Dt Bottom Dosing _ NA Header 3J Aeration NA Dist. Pipe - - 9, sv 9.~ , _tv Holding Bot. System " / PUMP / SIPHON INFORMATION Final Grade Ma facturer nd G M ZZ Friction Ft ead Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S N SYSTEM TO P/ L BLDG WELL LAKE / STREAM Man urer: SETBACK INFORMATION TypeO CHAMBE Model System: ~a, r/ E?S OR U DISTRIBUTION SYSTEM Header /M n#e4cl ii Distribution Pipe(s)/ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. T Length 52 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over t> Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter 2~'qv Bed/ Trench Edges 3 a A) Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION : Huds,o/n. 3 4 2 9 ._19,LW , NE, NA, Lot 1, Baker Road Plan revision required? ❑ Yes QIWO--' 2 Use other side for additional information. l 1A Al M SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~10hz e Q9!31 residence located at: h , ; , Section , T_~7 N, R_/ 9 W, Town of J0"CtdSd~ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /G?.z -P--T~ Construction: Prefab Concrete- Steel Other Manufacturer: (If known) : of Age of Tank (If known) : ~ lJ. ` ll ' a K, Ste- d, u l1,oi- (Signature) (Name) Please print (Titl ) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name f~~1~,•a,~ h Signature ~~~1__ MPRS C37 9 m"rp.uwTiro ~ • ~ Safety and Buildings Division r.~■■,.r■ 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. 15L . r_/ 01;K • See reverse side for instructions for completing this application State Sanitary Permit Num er 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 Name Property Location oYr+GS ,rJ 14, 114,5 Tat ,N,R/,o E(or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ED] ❑qtllyage Nearest Road Vi © Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Od~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) Q 02.0- l®! 9r7d 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. W 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 (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) ? !rte Elevation 4 TIQ . 3-6 4;6d Feet 96el- ' Feet VII. TANK Capacity in gallons. Total # of Prefab. Site Fiber- Ex er- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic p New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank QDQ r' ~QS,"-& Lift Pump Tank /Siphon Chamber ❑ ~ El ❑ El ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature- (N t mps) P PRSW No.: Business Phone Number: - t 9;Z Plumber's Address (Street, City, State, Zip Co 1.6 57 Z) - 6' C Ll IX. C UNTY /DEPARTMENT USE ONLY ❑ Disapproved Sa I ary Permit Fee (Includes Groundwater ate Issued Issuing A nt Si ature ( Stam a4" /gr App roved Surcharge Fee) A 51 pp E] Owner Given Initial r/rj/f Adverse Determination / O C/ X. CONDITIONS OF APPROVAL / REA N OR ISAPPROVAL: ~ SBD-6398 (R. 05/94) - DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber - i INSTRUCTIONS Y 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 experiment.,! ,::roduct 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. Cornp!ete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the= ~o:,nty. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions !ocatior: wlding tank(s), septic tank(s) or other treatment tanks; building severs; wells; water mains/water ser.oce; stre, i-1, nil' lakes, pump or siphon tanks; distribution boxes; soil adsorption systems; replacement system area,,, a:.•. the lo~a~i,>r -,f the building served; B) horizontal and vertical elevation reference points, Q complete sped ficati a• or pur rps d ontrols; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manu f<.(t,,!rer, D) cross section of the soil absorption system if required by the county; f_) soil test data on a 1 15 form; and i ) )II sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practi :es which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contaminatio n investigations and establishment of standards. lpf tJ~ TO ~f/-a7er to r U'll 5,Fe-m'N er OF e e rh~yT G6 Ka,►w ar Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 La+hor Human Relations Divisioand n or Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1~14r{c,e j Plan must include, but St. Croix PARCEL I.D. # not limited to vertical and horizontal reference ppif YtiAj~, direction slope, scale or dimensioned, north arrow, and location and di tafl9o''to nears .'road. 020-1099-70 APPLICANT INFORMATION-PLEASE IT A4 INFO TIO REVIEWED BY DATE James & Sherry Holm v LOT NE 1/4 NE V4,S 34 T 29 N,R 19 f(or) W PROPERTY OWNER: J1OCHludson, ERTY LOCATION PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM # 6984 Baker Rd. na csm 6/1673 C H dsAon, WI. 54~O1D6 Y ❑VILLAGE ~JfOWN NEAREST ROAD BAker Rd. (j New Construction Use [x Residential I Number of bedrooms 3 [ j Addition to existing building :M Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 6 bed, gpd/ft2 .7 trench, gpd/ft2 Absorption area required 750 bed, ft^ 643 trench, ft2 Maximum design loading rate • _7 bed, gpd/ft~ • 8 trench, gpolft2 Recommended infiltration surface elevation(s) 92.65 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I 0~ ❑ U ® S C3 U as ❑ U laS ❑ U ❑ S au ❑ S 12U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 1 -13 10yr3/2 none L 2msbk mfr cs 2f .5 .6 .l 2 3-36 10yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 6-88 7.5yr4/6 none is Osg mvfr na na .7 .8 elev. 96.85 ft. Depth to limiting factor +88" Remarks: Boring # 1 -10 10yr3/2 none L 2msbk mfr 9W 2f .5 .6 2 2 0-20 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 0-30 7.5yr4/6 none sl lmsbk mvfr 9w na .4 .5 Ground elev. 4 0-80 7.5yr5/4 none lS Osg mvfr na na .7 .8 95.65 ft. Depth to limiting factor +80" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200 h. Ave., Neffl Richmond, W1. 54017 Signature: Date: CST Number: L_ t 2" or, 6-12-95 cstm 02298 PROPERTY OWNER James Holm SOIL DESCRIPTION REPORT Pages of 3 PARCEL I.D. u 020-1099-70- Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed iTrendi 1 0-10 10 r3/2 none L 2msbk mfr gw 2f .5 .6 2 10-36 10yr4/4 none sil 2msbk mfr gw if .5 .6 Ground 3 36-80 7.5yr4/6 none is Osg mvfr na na .7 .8 9 1 65 ft. Depth to limiting factor +80" Remarks: - Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. ~ Depth to limiting factor i Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel James Holm 1554 200th Ave. CSTM2298 NE4NE4 S34-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #1-csm 6/1973 N 1"=40' BM.= top of cement walk SE corner @ el. 100' 1031 30` b Y 33 Zan ' Gary L. Steel 6-12-95 STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNERIBUYER 1 c. P. z / t. ( I t r MAILING ADDRESS PROPERTY ADDRESS )G► ~C/Z ~'Z a~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE yb s d r S YuIG PROPERTY LOCATION NL 1/4,_ 1/4, Section T a-/ N-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER . CERTIFIED SURVEY MAP VOLUME b, 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. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Certification stating that your septic has been maintained must be completed and returned to tile St. Croi,\ 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, Ai 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 Location of property 1/4 IV9 1/4,Section 3y T coq N-R W Township f ysd ev mailing address qo -44 eF2 fPo43 Address of site 0 1-3,4e& /Z X0/9U Subdivision name Lot no. / CSI &//I, Z-2, Other homes on property? Yes No Previous owner of property /-y, cj /,/v e- is Total size of property 0 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes _ No Volume 5~~ and Page Number y07 as recorded with the Register of Deeds. >-do -fo PwPi~~ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. i Signature of Applicant Co-Applicant Date of Signature Date of Signature r • FORM NO. 985-A M4WIINrCarpvry® ;Fl Stock No. 26273 D 41C~6 1986 t- "n W comma f Doody sk Cab mb CERTIFIED SURVEY MAP LOCATED IN THE NE1/4 OF THE NE1 /4 OF SECTION 34, T29N, 1119W, fi TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN NE CORNER SECTION 34 T29N, R19W 0 o; o SCALE IN FEET POINT OF M U _Z BEGINNING Q 01. 100' 200' < w m w H APPROVED OCT 0 51983 0 z6 ST. CROIX COUNTY i. `~'0Z 003 COMPIEHENSIVE PARKS PLANNING J j~0 AND ZONING COMMIITIiE i o Se I ~ r \ \ - LOT 1 3. 46 0, Acres± 5 \ 150, 765 S.F.± N 89058'W 577. 35' 1 1 351.25' 226.21' I ~I N 6 6 C~ ^ z l in Q I 00 I I o c -J I LOT 2 ° (n rn > Q o Q O 3. 02 Acres± N p ~I I N'~ 131,668 S.F.± w zo LL O w I- I I c ' ~ o °o Q1 I = Q N 89°58'W 571.00' Q I I ~ JI I M -Q,u JI p O I I Q M o- I w pl I O Z Z I w -j shed p I l I ~ w I I-► I I driveway LOT 3 I-I I w 3.58 Acres± QI I w Z. o~ 155,814 S.F.± JI I Y ° N N I I Q Z in n. I I co s M ZI I ~I I N 133' 33' N 87025'30"W 429.20' ~a O_21 1 0"W NORTHERLY RIGHT-OF-WAY LINE OF COUNTY 142.80' TRUNK HIGHWAY "N" This i'ns'trument drafted by James T. Swanson. 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CROIX CO., WIS. a Corporation duly organized and existing under and by virtue of the laws of the State of Rec d, for Record this lst Wixoatiq grultor, of...._...... _$1 .w.._Cmi.X....... County, Wisconsin, hereby quit-claims !Qr~....Ka....H.Q.1i!-..and...Sh-er y...A-. _ day of'.iy-. A.D. 19 _78 Ho•• m..__ husband nd wi f 8:30 _ a q l• ~ i9iiJ: ~illAt at NA. gtancee..S......, of....._S~.y.._~r4X _ County. Wisconsin, for the sum ofOne Dolla . ..r . ~$1 X00-~ and other 0 A ....4DA...Valuable ..-ca~sideralt~on Re9Mr of Diedil the following tract of land in......... at...--_c.rQl.:K..... County, v Sate of Wiscomia : N RETURN TO Part of NE 1/4 of NE 1/4 of Section 34-29-19, described as Lot 13 of Certified Survey Map filed 3-25-75 in vol. "1", page 94. Consideration is Less than $100.00 and is for corrective purposes. In WittIm Whereof, the said grantor has caused these presents to be signed _ Lee A. Kenall its President, and countersigned by.......... 1C and .L: Kenall...-..............'° I#udson its Secretary, at ......s........_....... _ Wisconsin, and its corporate seal to be hereunto affixed this _ day of-........ c A. D., 19-.7e. SIGNED AND SEALED IN PRESENCE OF ........Ke 17.....E E. t ]n.7..S-e~....Inc.9 Corporate Name Lee A. Kenall President COUNTERSIGN . d....'~_..... Jecrrtary STAGE PWISCONSIN, Richard- 4- Kenall-_ ss. Personally came before me, this /sf til day of................. A. D., 19. F Et, Iaee...A_...Kenall........................ Preside T,'_and RiCkl.ard...L....Kenall.................. Secretaq of the above named Corporation, to me known to be tl a j;;mv;s- gttfxecuted the foregoing instrument, and to me known to be such i President and Secretary of said Corporation, and 8cka°owleef jlr heyxecu: the egoing tntmr , uch ers as the deed of said Corporation, by its authority. f THIS INSTRUMENT WAS DRAFTED BY - Aw ta#'fo" RICHARDS & WALL by Robert F. Wa~r~L) Notary Public . ..................St.._....C.JQ.i~....__.. County, Wis- My commission (expires) . ......................2/4/79 (Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plaint/ printed or typewritten therein the names of the grantors, grantees, witnesses and notary. Section 59.51; similarly require. that the namt n( the r,m who, or govern- mental agency which, drafted such instrument, shall be rioted, pe P typewritten, stamped or written thereon in a legible manner.) Q CIT C1:.A1N OF FD- STATF OF WISCONSIN By Corporatle■ FORM No, 14 15rsw°~ k^.f.`e`1. (Job N No. Company DOCUMENT NO. WATtItnN`ry LE1:1) STATE OF WISCONSIN-FORM 10 THIS SPACE RESERVED FOR RECORDINr: DATA H8832 AGISTERS OFFICE THIS INDENTURE, Made by..._HUDWORTH1 INC. _ - _ - - . ST. CROIX CO.. WIS. a Corporation duly organized and existing under and by virtue of the laws of Recd for Record thiS__4t _ the State of Wisconsin, grantor, of......... t. Croix. ame Holm day of_~c#,oer___p,,D.197 County, Wisconsin, hereby conveys and warrants to..J.............s K. . ..and..Sharon._A._..Holm,....huSb.and...an.d...w fe._.aa_.j.aint....... at---11.,2 ...tenants M. grantees % of............ S.t....... Croix County, Wisconsin, for the eRlster of ore g sum of ..Crxe....(.$1.Q01.... Dnllar...and...stthex.-gnad...and ._valu- -able cons.ideration the followitig+ tract of land in St......CrOIX.................. County, RETURN TD State of Wisconsin: Parcel #14 - A parcel of land located in the Northeast Quarter of the Northeast Quarter (NE4 of NE4) of Section Thirty-four (34), Township Twenty-nine (29) North, Range Nineteen (19) West, Town of Hudson, described as follows: Commencing at the Northeast (NE) corner of said Section 34; thence S00081W (true bearing) 884.76 feet along the East line of said No theast Quarter (NE4) of Section 34 to the point of beginning; thence SO 08'W 403.12 feet along said East line; thence N84021110"W 142.80 feet along the North right-of-way line of the Present County Highway "N"; thence thence N87025130"W 429.20 feet along said North right-of-way line; thence NO0081E 369.75 feet; thence S89o581E 570.25 feet to the point of beginning. Also a roadway easement 66,feet in width located in the North one-half (N4) of the Northeast Quarter '_(NE4) of Section 34, Township 29 North, Range 19 West, being all lands lying 33 feet radially and at right angles each side of the following described centerline of roadway: Commencing at t;4 North Quarter (N4) corner of said Section 34; thence SUo08'W (true beari y 1290.81 feet along the West line of said Northeast Quarter (NE4) Section 34; thence S89049135"E 610.47 feet along the North right-of-way line of the present County Highway "N" to the point of beginning; thence N0008'E 466.29, feet; thence Northeasterly along a 233 foot radius curve concave South- easterly whose chord bears N45 05'E 329.22 feet; thence S890581E 954.00 feet; thence Southeasterly along a 233 foot radius curve concave South- westerly whose chord bears S44055'E 329.80 feet; thence SOo08'W 432.52 feet more or less to the North right-of-way line of the present County Highway , ffN... i TRANSFER FEE (IF NECESSARY. CONTINUE DESCRIPTION ON REVERSE SIDE) In Witness Whereof, the sai ranetor has caused these presents to be signed by...James ...A_...Kenall--_----•-- , Its President, and countersigned by........ R1.Chard L. Kenai] r:.._......._..., its S tt at ..................................HudSOn____.............. Wisconsin, and its corporate seal to be hereu ,a this t I day of..Septe?r!ber...... A. D., 19.... 73 SIGNED AND 61:ALI:U IN PRESENCE OF HUDWORTH, INC.. - • ~orp 3tt Kahle ~ a , 0 1 . ~ t _ Vice: - - James tames A. Kenall Ff"°~w`~ COUNTERSIGNED: +afffaaa~~ $ectetary } Richard L. Kenall STATE OF WISCONSIN ......•••-••...-St . CrO .x County. I ss. Personally came before me, this............ -8th day of.......... Septembe-r................... A. D., 19---- 7.3 tla~ies... .Kena11.... -..ViC,ePresident, and ........................Richard..I,-Kenall..... Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President and Secretar p,f,said, Corporation, and acknowledged that they executed the foregoing instrument as such officers as the e~. GF~s iid .,xtrrds,zti , y its authority. P tJ 0 74 . } ' 9L THIS INSTRUMENT WAS DRAFTED cqueline Olson A r Q 1~lol Iry Public . St.................... Croix County, Wis. ROBERT F. WALL rt' + ~ILt Feb. -.--27,. 1977• I (1741. ^ -Attorney-at-.-LaW t* 'tfy commiseieg (e 'r s e ~ BOOK tv FAI,E6-1I (Section 59.51 (1) of the Wisronsin Statuteb vi a itatglt instruments to be recorded shall have plainly printed or typewritten thereon the mores of the grantors, grantees, witnesses an Vftiiy. Section 59.113 similarly requires that the name of the person who, or govern. mental agency which, drafted such instrument, shall be printed, typewritten, stamped or written thereon in a legible manner.) WARRANTY DEED-By Corporation STATE OF WISCONSIN Wisconsin Legal Blank Compnny FORM No. 10 Milwaukee, WL (Job 80458 ) C 0 CO) 0; c -0 n d m O A I c 3 r+ N III ~j !D V N M .t ~Oy ~ ° N ° 0) 4 O O "1 tol) G • p CD 3° N N 3 cn CO `.3 CL z CD OD - CO CO 0, CD 0 0) o- O 3 O O v N O W N 7 vim, N O O c W P: CD W. OM O O o ° 3 NI w O m (n D a (D cQ fD CL m I y co T (D 3 p rn c°~n Q rn cN`o J J C co co a o r co) w m co 0 3 M M M M N~ z O O O car, ~i o o 0 _g ~ ~ ~ v o o N d N W N z zco z 0 =n CD 0 v D a 9 -b CD N~ ~ v ° cn :3 c m N w m a a m vi Z ~ ° En O X CL zh: z C) o z w w M m A CD CD to z a 3 A $ z 3 m to N z W i =r G) 0 0) =r a N I C a Q m m m y -n m C CD a; m z a ac `D ~ a) N I ° c o a?a~ x w "2 ° 0 Q~ cn a co co e o~ CD A cn 90 w W Se d a d N N p O CD tA O A 1 0 ID o 0 e cz CD a FORM NO. 985-A KQWWC~ OL&E.- Stock No. 26273 413046 D 1"n o' CONN= CERTIFIED SURVEY MAP LOCATED IN THE NE1/4 OF THE NE1 /4 OF SECTION 34, T29N, R1 9W, ~ TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN NE CORNER SECTION 34 T29N, R19W D 0 can, 0 SCALE IN FEET POINT OF M CD U n z BEGINNING < 0' 100' 200' w M w p ~ S tiy%~ APPROVED OCT 0 51983 0006` ST. LINTY i. ? ' ~~rO Oo 0'~ NSIV KS FLANNING AND NG COM AUTTEE LM C14 3, \ ar.v eway f ~ LOT 1 \ 3.46 Acres± 150, 765 S. F. ± N 89058'W 577.35' 351.25' 226.21' Q7 q C4 N N Z 6 6' Ln 00 ¢ I o I LOT 2 i M} 0 N 0 3.02 Acres± N p l 131,668 S.F.± p I I LL 0000 w I 0 Uj -Z c' CD 0 H ¢I _ Q CD N 890581W 571.00' .r _ Q ...I ► I ch I p ~O J DI 10 N Z 4. i I I W Q Z I wl ( w -j shed p I t-I I I driveway LOT 3 F-i I w 3.58 Acres± ~ 'ao ¢I I w o c; 155,814 S.F.± J I Y Cl I I ¢ Z a. 00 ZI I `Q N I I I N 33' 3 3' N 87°25' 301111 W 429.20' 4°2111011W NORTHERLY RICH'-OF_ TRUNK HIGHWAY T- WAY LINE OF COUNTY 142.801 This instrument drafted by James T. Swanson. VO J LM c A Pam. ~~w-I Z Parcel 020-1099-70-000 05/23/2005 10:57 AM PAGE 1 OF 1 Alt. Parcel M 34.29.19.402B 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 HOLM, JAMES K & SHERRY A JAMES K & SHERRY A HOLM 3883 S WICKIUP RD APACHE JUNCTION AZ 85219 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 690 BAKER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.460 Plat: 0335-CSM 06-1673 SEC 34 T29N R19W NE NE 3.46 ACRES LOT 1 Block/Condo Bldg: LOT 01 CSM 6/1673 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-29N-19W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.460 48,800 143,900 192,700 NO Totals for 2005: General Property 3.460 48,800 143,900 192,700 Woodland 0.000 0 0 Totals for 2004: General Property 3.460 48,800 143,900 192,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i IORTH LINE OF E 1/4 OF SECTION 34 S 89°53'E 1317.39' NE CORNER 392.00' 567.00' SECTION 34 358.39' .OT 10 - co w LOT I I 0 ACRES 0 5.22 ACRES o moo' ~Z LOT 12 6.23 ACRES NE 1/4 OF NE 1/4 89° 58'VI( N?4 o p 392.00 8a4o' ~O'zA N64 Ao 334. 75 150.35'' 9°58'E 0V w CURVE NO.~~\ ,o LOT 13 0 OF T = 233.41' It 5.01 ACRES 0 '4 OF R=233 z' 4 OF W' =80°06' I 61.59' 570.25 CDJ 'ION 34 0! N.89D 58' W 01 w - rn co (o nl ACRES 5.0 A z LOT 14 M CRES 5.01 ACRES 17 LOT 18 '54'30"E N87054'30"E ( IV87025',WW 322. 05' 429.20' 84* 2 1" 1 O W TRUE aEARIMS, NORTH RIGHT-OF-WAY 28.69' LINE OF COUNTY'HIGHWAY"N" N87023'50 "E - UNDERGROUND TELEPHONE CABLE 0 1 " IRON PIPE SET Pli, ST. CROIX COUNT1l ~,P~,. SURVEYOR' RE AS BUILT SANITARY SYSTEM REPORT 5 I4e , TOWNSHIP P ~_SEC.~_ T o t N, R j W . R AIN .0.`-'ADDRESS Jp , ST. CROIX COUNTY, WISCONSIN. UB61VISION 21-, 2 4p, 5 nA Ai nw , LOT__/_3 LOT SIZE Sac, PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 5 4 . 57 ti STEEL OPTIC TANK(S) OO MFGR. (AI;C!F CONCRETE N0. of rings on cover Depth DRY WELL .ENCHES NO. of width length ar D no. of lines -width V/ffiength area depth to top of pipe :9& GREGATE ,RK RATE Q ^ /rn AREA REQUIRED (o/~ AREA AS BUILT S~ p 'sciaimer: The inspection of this system by St. Croix County does not 1Xply complote -mpliance with State Administrative Codes. There are other areas that it is not possible 3 inspect at this point of construction. St. Croix County assumes no liability os -stem operation. However, if failure is noted the County will make every -Affort_ta termine cause of failure. :EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~INSPIECIOR DATED 7S PLUMBER ON JOE LICENSE M3MSER. REPORT OF IT1SPECTIO11--I:dDIJIhUAL SE1,4AGE DISPOSAI, SYSTEH Sanitary Permit 1,2 r State Septic 1 .,A' IE TOWNSHIP • t. Croix County SF.DTIC TA..K Sx2e gallons. `lumber of Compartments / Distance From: Well ft. 12% or greater slope eft. Building ft. Wetlands ~ f: L Highioater ft. DISPOSAL SYSTMI Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope k`~ ft = Building JC'' ft. Wetlands FIELD 1-Up, water It ~ ft. Total lenZtlh of lines ft. Number of lines ~ LefiSth of . each line ft. Distance between lines ft. Width of the trench eft. Total absorption area sq. ft. Depth of rock below the / in. Dp-pth of rock over tile -2- in. Cover over . rock , J!,~,;) Depth of tile below grade { in. Slope of trench in ner 100 ft. Depth to Bedrock ti ft. Depth to Around water ft. PITS Number of pits W-* d ar~eter ft. Depth below inlet _•__,__ft. Gravel a-rou es no. Total absorption area __•-___-_s q . ft. Square feet of seepage trench bottom area required Square feet of seepage nit are required 1 Inspected b Title: Approved Date 197. Rejected Date 197 E 115 • ` . > WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Section~~, ~N, R If W( r)~ownship or Municipality w syk Lot No. Block No. County Sl, CrwrAx Subdivision Name Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence X No. of Bedrooms -3 Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS_s -PERCOL ION TESTS SOIL MAP SHEET IFF-I3 SOILTYPE r AYC`al ;4 T/ d Q PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS ICHARACTERN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P p ~tG &r4- v- f` f 1 al- aVe y, 2- P 3 4'" ,Scam. wee ~y ,tla Z 3 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 3 ;20 x/. 4 (fir. X/0` B Q~ I`'~u~N. Q- 7 t* l " S4 ~ is B_ J L6`• /`~7Ale_ -7 `o /~'t~~ ~I " 'N~) (mot/'' C > 04 PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square feet f suitable areas. Indicate n fiber of square feet of absorption area needed for building type and occupancy. W4 0~ 'J' IndLy'cato scale or distances. Give horizontal and vertical referent i In ate slope. S/S ~~e ,I~IPe II ~ O A//1 i r % t I rN a ' 0,5, 1) 1 1 4 W_ 'T tA_ w. 00, A a~ ? d bLoo 0 0000 ' y 2.- 3Y6'°~s"~si I, the undersigned, hereby certify that the soil tests reported on this form were fnade by me in accor with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. , Certification No. S l9 Name (print) Address e SOAu a Name of installer if known CST Signat Ar COPY A - LOCAL AUTHORITY \ L' i 06 \ PLB67 State and County State Permit Permit Application County Permit ' for Private Domestic Sewage Systems County LL *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: / eI . Tr,. N, R ~ B. LOCATION:'/ Section , T N, R,/ (or) Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCU ANCY *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons_ D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste GrinderYESANO # of Bathrooms Automatic Washer X YES NO Other (specify) E. SEPTIC TANK CAPACITY ldOO Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete X *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2)_OZ_3) -3 Total Absorb Area . ft. NewX Addition Replacement Fill System y«( Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. .of Trenches Seepage Bed: Length,6, Width Depth JIX # Tile Depth " No. of Lines a Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land TDistance from critical slope C C p-/ 'std At .41 I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Ce ified Soil ste NAME 't r P --OC.S.T. # and other information OE - obtained from t er Plumber's Signature MP/MPRSW# Phone #;Il1 3A- 3GZ3 Plumber's Address l PLAN VIEW: Provide sketch below of system (iriclude direction of slope and all distances in accord with H62.20, including well). 1. r,4~ /a y d7o l r /l % l 46 _0 3~,' 2Qo f coo` 4~ ~ ~j~y0 G Jam...... ~ e Y Q~ Do Not Write in Space elow OR DEPARTMENT USE ONLY .r~ Date of Application " 02 3 Fees Paid: State DD Countty/ -cal Date Permit Issued/~Iip ( ate) 7 9 _Issuing Agent Name Inspection Yes-,K-IN o Valid* Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 t ~ r r ` ,y /r ` 'TW