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HomeMy WebLinkAbout020-1111-00-000 ~ I Q o (D ° N O 1 ~ ~ f a 4 ° C o .S I N O x N 01 L y I' C N O s, Y c y n O o Z C N 3 RS LL C co O O 01 N O N Q N N III 3 ~ I a Z N N Z w o Z E y0 d d I N N 6. m O 75 0 2 ! c O d 2 c to F- ~ I ' ~ ° ~ I N CL ° w I NwJ c cn U) *i c • Ati L s ° = C 0 J Z F- Z o -TD N E N d L ) CL ~I a '.g w c co (O CO a m ° a~i g °o O o c c a 4 E N o U) U) U) o Z > LO W-- Cj d m ° + o o o O 0"016 CL CL CL a 0 N g 7 p W c O0i 0) aa) co r V = rn rn } Z 7- 7- to to N O O 24 3 101, Coll O U) Q) L n m Q r Q `tv m N C) C> ►ly~ C C) 1 O p o N to 0 a o o O o V 3 CL 7 ° m P O C N N V _ O p~ E C N O tp o a) M .O Q (D w N C N L r~ N N tn^ N Z• N N > (9 in g N U C, C) ~ E d `m m a 9t EL i a r a v 'c c 1 A 0 a m j 0 0 U F n~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER DA-~'~ M A SO H ADDRESS 165I w ~S Iy Nun~oN SUBDIVISION / CSM# LOT # I SECTION 1 a; TD I N-R a d W, Town of Nub S pr.; ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM hYt o o Upr Yo d ay No~~ rnpti~Gi~ is T _1 N 9 : Neu st 4- B A~ (S x (-7 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. S BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W RQ 5 Liquid Capacity: ? U~ Setback from: Well NoT', N House S a~ Other i Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length (0_7 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: PJ ~r House GVeYt Iu° Other l o l_ 09 - o o , $-1 rr\ 49.~a L 7% .90 ELEVATIONS Building Sewer ST Inlet: 10 3. U ST outlet: 10 3. PC inlet i PC bottom Pump Off Header/Manifold Bottom of system l Igo UU Existing Grade SyarR }A vU. 3 u g $:s b K.A'r Pd to Final grade M - i Oa, ~ 0 g7, S o DATE OF INSTALLATION: PLUMBER ON JOB: avV LICENSE NUMBER: INSPECTOR: 3/93:jt r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State PIA S70 MASON, DAVE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /r /DO r ~C.t Y TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic oo Benchmark S, - Dosing Aeration Bldg. Sewer Holding St / Ht Inlet , 0 S TANK SETBACK INFORMATION St/ Ht Outlet 5_3 Ventto TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift F ' tion System TDH Ft AlLoss mead Forcemain ength Dia. Dist. To Well 7 F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of eriches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S 7 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System bL~ la ? j~6 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 u Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.12.29.20W, SE, NE, Lot 1, St. Hwy. 35 2 120 VD, aq YS_1o,_ 9.4s _ 5 /uRS 4 7, 51 Plan revision required? ❑ Yes ❑ No Use other side for additional information. q ~O Rq J-2 6 SBD-6710 (R 05/91) Date In or's Signature Cert. No. c ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY era,, STATE 'NITj -Attach complete plans (to the county copy only) for the system, on paper not less than 41- 7 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. PMRTila Y OWNER PROPERTY LOCATION %41,,E'/a,S 44 T49,N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 6 44 1 41 N CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR SM NUMBER C.3 S 'n V II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE ❑ Public V--I►1 or 2 Fam. Dwelling- # of bedrooms 'PARCEL TAX NUMBER(S) III. BUILDING USE: (if building type is public, check all that apply) O(A0 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 80 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. 5;~ New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 ❑ Seepage,Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 9 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 - 0-0 LO D (sq. ft.) PROPOSED_(sq. ft.) (GaT sq. ft.) (Min. inch) 0 E LabTbON 0 0 l o O o 7.QFeet 0% 1 y1 ii eet VII. TANK CAPACITY Site - O in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic xper. INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks Tanks strutted Septic Tank or Holding Tank f' a U 0 c. S Lift Pump Tank/Si hon Chamber 01 117:11 11 10 F] Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Nam (Print): te,,~ Plumber's Signal re: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address Street, City, State, Zip Code)- 0'7 0 1A 3 osoj W s L S C~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sary' ary Permit Fee (includes Groundwater Date ssue Issuing Age Signa No Sta s) Surcharge Fee) Approved ❑ Owner Given Initial 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 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. 11. 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) ' P. B.L.._... 67 PLOT ANN) c.: I \OS S S~-~, N A M ED Pv ~s G N NAME 3a ~ Twee -e t----- .__ea1 fl.~L _1c E N S E ILL.. _ . T 1~a2 K r P. L 0 A P _ ----G 3- 8Y 01 10 CoRN~R A I t I-Qv - /UU .0 S Ito 90 ~ / p j`a N O~~ A d P c.cl 14's I~pa )0 . 3 00 100 +t s IJa'~e : (tJe11 j s '~i~~ e~, y GQ1* ooh d S Sep' ~ ~orn,,~ 1~~ : w 531' r' ~l7C 1♦ trip FRESII AII: 0DSERVAT10N•'PI.PE CROSS SECTION Approved Vent Cap Minimum 12" Above F; . Via,, y,.,~~ •I , Cast Iron Above Pipe's Vei~~ Pipe To Final Grade . Marsh Hay Or Synthetic Covering Min. 2" Aggr.c(J. ,11 I Over Pipe 1 Distributio~~ Tee j Nr . Ibu,~ Pipe _........_.I Aggregate Perforated Pipe Celo'r Beneath Pipe \ --coupling Terminating' r l- . Bottom. of. System... a v .S'I'TE UE~ii<<?,f7 7o._-, 7"4.0. P So Aj Zo A.3 ►J G- l e P T' • .y^/.7-9.5 Wisconsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3 Division of Safety & Buildings in accord w' 133.05, Wis. Adm. Code 9.9uG_ 5740,4•)S6AJ ~p COUNTY Attach complete site plan on paper not less than / inches in s I must include, but 57 OHO %k- not limited to vertical and horizontal reference dirt nd % e, scale or PARCEL I.D. # dimensioned, north arrow, and location and di to n 02 O O b APPLICANT INFORMATION-PLEASE ALL INFQRMA~B,N REVIEWED BY DATE PROPERTY6WNE-3: RTY LOCATION f`71jV4F_ solo -SOn/ 7011LOT - 1/4 .vE 1/4,S ~ z T Z9 N,R 2 0 E (o W PROPERTY OWNER':S MAILING ADDRESS tltdv # BLOCK # SUED. NAME ORCSM # f/ 1+4j01>v'Er I- A-1 • .SM yo 7 z U./- r- p$ • I5,961 CITY, STATE ZIP CODE PHO U R i [:]CITY ❑VILLAGE N NEAREST ROAD fl<o% f,6AI 44//5 . 5'x{63 ~ (&O~ H u s a sr• t4w y 35~ [#rhew Construction Use [ Residential / Number of bedrooms Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 /,00 trench, ft2 Maximum design loading rate X bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) S-~ ~t ` 3 ft (as referred to site plan benchmark) Additional design / site co ' erations 2YSE 1VWej#O40 7ipE.041!~eS 0,,j 4- Parent material 51 - O.vA,Ki~ vTi l~ 4o,. Flood plain elevation, if applicable N>¢ ft w s ,f f5 ov S = Suitable for system CO_NyENTI❑ L MOUND INN--G ND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable fors stem [ C1 U BS 11 U 0.8- 11 U El S D41- 1 El S 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 Tltrch 4 I o- /0y 3/~ /oil ti Z 441 sde 1~v,vf/e C5 344,, . S 2-3 10 v y/y s I f be Ik►f 2 cs . s 6 Ground 3 - y~ /o VW sly . 5. 0.5 .H,, X_ • elev. /a 53 ft. Depth to limiting factor Remarks: Boring # - 5. / Z f 5l~~ n,~uf R c S 3 , S o /0 /0 yp 3/2- /0 0 y~y s1/ 2 f 56e ron -F R CS l Uf S :M...; 3 3 3 7,5 yie yl~/ - 5,1 2 f 56& nM~ s of Ground y/ ~->~'Sh.~ /I'~f/Z y • S elev. ~ 3' 9 7. S Y /d S r ft. Depth to limiting factor . 1 Remarks: CST Name:-Please Print ` C)BER r 7AL 3 Rl C_1+T- Phone: 71.` 3 606 - S`>/e,,5 Address: 55 p'at i L I~~• ~uDsoA.) C,t,~ t' S L!o I Co -'/-/3 -yr- C'ST•-f2 qpZ_ Date: CST Number: Signature: G J- ~CO/3 ~ s- (3 3 , ~S J S 7RE,ua"_e 5 0 ,u y. PROPERTY OWNER SOIL DESCRIPTION REPORT Page 1 of 3 PARCEL I.D.I LD % --0 / 02-0 - -'O O Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou Clary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ir- ...3 h 0 - (~o /o yi2 313-- 511, z," S6& 4%-• f R 5 3 , s G :r.. z 4-,201 /o VR y/y 5-11 2 f fhk fie s Z f , s . Ground -3 20- y 7 Sys y~7 51 2 n+~ 5' J, ~►++~Q S lv S G elev. /INS-fit- ioG • ft. •57 7,rYle O' S n•~ AL . 7 1,00 Depth to /0 Y/f S/ S • limiting factor Remarks: Boring # : l O- G /0 vfW CS 3 , S . G L (P - z3 /v Ykc V41/ S : . Ground elev. /o YR S/ S ~„h 7 ~0 it. Depth to limiting factor 10 51 Remarks: y - ZIS~ syST~r LO~l1~/~1(r /PT O . / . z- Boring # a^ S/~. 2 ~w► Jb~ f~Q S 3 S G 7 /0 y12 y~ S./ ifsb,~ -Foe s if s •G 7- in, q I'S Ground f /O !Y, 05- ft. p ~0 SA S. D, S 4*, Depth to limiting factor Remarks: Boring # ~ti....n .y} :y Ground elev. ft. Depth to limiting factor Remarks: con 0o1-0 ^r1Mn% /f N n v) sQ LO ? A , G 0O i OM m z z m ~ ~ LP Q/ x ~ 0 O ~ N ~ L w r o o o w Q o i \ o o ~ 0 0 r `n y o N ~ W r W O W I L i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR P.O. BOX 76 HUMANA EDLATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME: sg- 1/ *1.4/ a /T a9 N/Rao ► W uas~,✓ / COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 57- ,Po/ AV /n/ o[FF a / ,80 1X5- eK"j-041 It& Sao/6 USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCR PTION: I PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ®Residence NA New ❑Replace L S/3~/mss RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: 11'' IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ® S 11 U ❑ S ®V IRS EA I ❑ S ®U ❑ S ®U C'oN~'E.L.T~o,✓AL 8~~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: All to I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH O GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-3a a, AIRh' Bn 8~ Bn /G,• s9n /s, a0j Bp C J, 70 DAIK 0-1 / •7dJ• Bp /s, :~G, Bn s 9~~ B-33 ~~8 /~/ONe 7 //8 Gr enict, s c /O , 'P44K do 8, Bn /G,' Bn /s G~, Bn s/ 7 B-3¢ /08 51/919 /✓ON~ /08 /9oZ / 7, /1/O~✓~' 6,' B.. s G 4474 /s, /a J • 6n s~ S9c oa 8-36 /a O a3 O ~6NE /.?o ~•►,.K ey s • e., ; J/,' B'7 /s, /aJ ' Bn rot y., 7a,' / w/sue 0~9 ' Bn s 5+c Go B-37 96 Dww.r B n 7,; An 7 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME OP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PER INCH P. P 2 P- P_ VIC p- i P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ,447 •o / r_. i i I r .ep•✓ ~ Cop 4+Alo • 2 y /%PE O / w/.eaA//PE/ SEr T" 0054 O OR/6e%t/AL A.CEA 14 i 71111 B`~ ' 691 ~ ,Q L~L.bC'Ni+tr(,t_ K ~ A AG T~wrNATB ,9.ta.V 'TOP OA 3a ■ ; 0 1 9 ~p $7 /~2a.✓ P/Per= a/KEQYityA/ St o%~ N o. v 9/,(. 80 w D • S. 1. ✓NB . ;LOS' BL N1; ov. *K - Tq I° 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin j Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. i NAME (print): TESTS WERE COMPLETED ON: 5W.41AZZ-061 ADDRESS: CERTIFICATION UMBER: PHONE NUMBER(optional) 3 A/ AA T A L LS / SS-o7/S~ / CST SIGNAT F.: ,uki,.. :.loner uu: ;;wd 406462,* CERTIFIED SURVEY MAP LOCATED IN THE SE1 /4 OF THE NE1 /4 OF SECTION 12, T29N, R20W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN OWNER MARY ANN WINDOLFF R.R.#1, BOX 195 HUDSON, WISCONSIN 54016 1 VAR1gg~E ?~s: 1 FILED CCT 24 198:, 2/l 6S' / J"1123 O' CONNELL 0 Qot7 tV Of Deed, P 4 Golx Cc"fy' l / N T vrl„oo„h 700, ° w . S7go TED L 15 tU l 1140, 2O'S611E A N D 80, 226. 21, - , S v~~oti^o00 Ut;~ityr age aid Q/ / O ~0) aseinent IT/ I / 4(, Z I 740, Cy of LOT 1 A 4.215 AC ± N F-I 183,601 S.F.± ¢I A. 'A, LU oa I APPROVED Z C4 o o Z N O Z I Qv X~ OCT 2 4 1985 Z Z <v ? v 700, ST. CROIX. COUNTY p0 op V COMPREHENSIVE PARKS PLANNING AND ZONING COMMITTEE 1 354. 92' 531 . 99' 758.00' 2644. 91' S 89004'1 7"W LL M o / SOUTH LINE OF THE NE1 /4 oZ~ o w0 , UN PLATTED LANDS Zw^ Uj I-I--Z wZ N Z U cn SCALE IN FEET E- 0 0 Z U (7) LL 0 00 U O N ~ o U Of 100' 200' LLI V) . W LEGEND N UZ~ wcnf- Z J Q COUNTY SECTION CORNER MONUMENT, FOUND, i m UNLESS NOTED OTHERWISE. Q F- UjZx ® 1" IRON PIPE, FOUND. CO 0 U 0 1"x24" IRON PIPE WEIGHING 1 /68#/LINEAL FOOT, SET. w w 3:: Q 2"x30" IRON PIPE WEIGHING 3.65#/LI.NEAL FOOT, SET. Ln O LEI This instrument drafted by James T. Swanson. ¢ I- Z Volume 6 Page 1596 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER G: v j S o 'IN c" ~i L, /vat.; a h MAILING ADDRESS l D Y /9Z,,1 h f' L C F 1 W, 3 b PROPERTY ADDRESS A!5) 3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE d 5 ©I~ t S PROPERTY LOCATION 1/4, 1/4, Section Z' T q1 N-R W TOWN OF S o ti ST. CROIX COUNTY, WI SUBDIVISION &.14 LOT NUMBER CERTIFIED SURVEY MAP U0(04 ? VOLUME-L-1, PAGE 3y , 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 iration date. SIGNED: 2-L-- DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner ofProPertY 00,V--, 1 L, S o e\ Location of property_E 1/4_VE 1/4, Section T_ZJ_N-R__2,0 W Lgti Township A So" Mailing address 6 DLL/ I,d,n vo 12 L1:2, e W;S, 5-V-4 3 6 Address of site Subdivision name Lot no. AIM Other homes on property? Yes____/_No Previous owner of property n A ~ e 5~ c rA Sc.v~ n S0 kA Total size of property - y, 2 a c r r 1 Total size of parcel Date parcel was created (9 D 5 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes __Z No Volume and Page Number 1576 as recorded with the Register of Deeds. ®oC :e y Oro qZ 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. 5 2~ 4 4 ~ , 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. Signature of Applicant Co-Applicant 7-22_9)- Date of Signature Date of Signature :..;'C wf. Th:-1~ jt-' -3 , "i.~ 2L S.' ~ ~ . 3i - T+ - - •~$G~t-~ J.~1M~:.- ~ sx.. Yj~i, a ~4~.'R. ;I l DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 1-1982; THIS •IAC[ R[9CRVlO FOR RECORDING owrw WARRANTY DEED 11 f 52844' r~ I vn~ r~aE lG ~I JiEGfSTEA'SCFFiGv ST.CROIXCo,,V1f1 ' This Deed, made between _.-David R. Swanson and i Ree'dforP.x~zi - - If Rebecca L. Swanson g formerly husband.. and. wife,.. MAY 2 1995 now. sinle persons _ .R , Grantor, at 11:20 A. ir, - - and.-__Dav1d__C.__Maso-- an8_.Tammx L,.-Mason.--- _ _ husband and wife, as survivorship marital property - ReglatercfDeeCa ;j Grantee, I Witnesseth, That the said Grantor, for a valuable coniideration_..... i of one dollar and other valuable cors_ideration _j St Cr -1 conveys to Grantee the following described real estate in O-___..1.. RarURN TO County, State of Wisconsin: I i i Tax Parcel No: . Part of the SE 1/4 of NE 1/4 of Section 12, Township 29 North, Range 20 West, Town of Hudson, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed October 24, 1985 in Vol. "6", Page 1596, Doc. No. 406462. o FEE This -_...-i8_ homestead property. (h) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And__ David R. Swanson and Rebecca L.__Swanson warrants that the title , good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and restrictions of record, if any, and will warrant and defend the same. Dated this 28th day of ----•---_---------------April.... 19.95... •----------------••--•-•--•-.....-••---•_.....-•-•--.........-.---.-.(SEAL) 6 0!^'^ (SEAL) David Re Swanson ' (SEAL) ..(SEAL) Rebecca L. Swanson ' . )iII?H$NT>fCATIONI ACHNOWLBDGMBNT Signater-- - STATE OF WISCONSIN - ST. CROIX ss. _ _ ..........................County. p aatheagested this --...,,..day of----------- Personally came before me h' _Q78!~ .....day of _ Ap r i 1..........., 19.9 the above named __~aX1S~_.A.e.SJdal'1SS~~1._r:1nS~--------------••---..°°---- " Rebacr-a--L--•-Swanon,.-f.0=erly---------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. State.) to me known to be the persons----_---.. who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - Jennifer A. Olson Robert F. Wall - - 1-----NOieryP6bf1c..-.._ 572-•'Sec6rid•--St-'reef-' J er A. Olson HudSAA,__WI........ 4D.15..................................... Nola-y public ~I:Q13L ................County, Wis. (signatures may be authenticated or Rcknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: .~r--~.-t~- D~Sft , 19..) eNamea of persons si[nln[ in any capacity should be typed or printed below tkeiw aitaaturn. WARRANTY DEED STATE BAR OR WISCONWN Wisconsin 1e sl Blank Ca Ise. FORM NO. I-Isa2 Milwaukee Wis. n~I l' '17 hs "I A .J V a•s°°~`t7~. i e * YitV~t d 1. aT };r # t A~ l