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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I IN P O R N n■ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
- - (715) 386-4680
March 27, 1996
Mr. Mike Wilson
410 St. Hwy. 46
Amery, WI 54001
RE: Septic Inspection for Stephen Paulick Property:
414 Monument Road
Dear Mr. Wilson:
An inspection of the septic system installed to serve the above
described residence was conducted on March 14, 1996. This property
is located in the SA of the SE; of Section 9, T28N-R18W, Lot 7 of
CSM Vol. 11 pg. 2996, Town of Troy, St. Croix County, Wisconsin.
At the time of installation, this septic system was found to be
code compliant for a four (4) bedroom home.
If you have any questions with regard to the above, please do not
hesitate in contacting our office.
S' erely,
mes K. Thomp on
Assistant Zoning Administrator
St. Croix County, Wisconsin
C ro'~' ~ D"riy
win Department of Industry, PRIVATE SEWAGE SYSTEM Count:
Labor and Human Relations y
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City El Village ❑ Town of: State Pla
PAULICK, STEPHEN R. .
CST BM Elw.: Insp. BM Elev.: BMscription: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 2/Benchmark ~ 2",,
Dosing ~'/I-/~Z.4,/7/
Aeration
Bldg. Sewer
Holding St/ 111 Inlet ✓ ' '
TANK SETBACK INFORMATION St/ Wt Outlet i 9 - 7
TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet
Airlntake
Septic '
NA Dt Bottom
IZ4
i
Dosi n - '
NA Header
13 '
G, 2-6
Aeration NA Dist. Pipe -
Holding Bot. System i
a 96-6 7
PUMP/ SIPHON INFORMATION Final Grade
Ma;1N jer Demand
MoGPM
TDLriction System TDH Ft
Forgth Dia . Fi Dist. To Well
SOIL ABSORPTION SYSTEM
DIMENN RED/TRENCH Widfcc-~ gth No. Of Trenches No. Of P its lnsidebia. Liquid Depth
DIMEN N
SY-Manufact
SETBACK P / L BLDG WELL LAKE / STREAM HINGINFORMATION TypMo el Number:
Syst,5 /6& J >SU I OR UNIT
DISTRIBUTION SYSTEM
Header/ idt3d , / ,7 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length D i a Length Dia. Spacing -
SOIL COVER x Pressure Systems Only xx Mound Or At-Gr d6ISystem Wy_
Depth Over
Depth Over xx Depth f
O xx
f Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Kinnickinnic.9.28.18W, SW, SE, Lot 7, Monument Road
(h d-~c C,
Ir 6
~ - ~ % ✓;~t=`~ ii - ~t~c.:.L.C,(, ;f~t~' ~ iL~'-r-. _ G' ~ -
Plan revision required? ❑ Yes L~~"N/o
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signat re Cert No
w
STC - 104
AS BUILT SANITARY SYSTEM REPORT
w
)4,e re,
OWNER A ,
ADDRESS/
~~5'
SUBDIVISION / CSM~# r LOT #
SECTION _T N-$: W, Town of r*N
i L r}A , 1 f
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Y P
d
Gt/
1`nt..
INDICATE NORTH ARROW
Provide setback and elevation inforrion on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
n ~
BENCHMARK:
ALTERNATE BM:~
0
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer- Model# _ Size
Float seperation Gallons/cycle:
Alarm Location
-:SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Aqd Other
ELEVATIONS
Building Sewer 3. i°(,0 ST Inlet, ST outlet
PC ~'TTT~e w w.__- motor ` u
Header/Manifold L
L~.
~t Bottom of system ,S'`'~..
Existing Grade 3-S Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: y~ / 1 LICENSE NUMBER:
INSPECTOR:
3/93:jt
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 Pla .
PAULICK, STEPHEN R. X
CST BM Ell v.: Insp. BM Elev. : BM Description: nniekinnie Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic r Benchmarks
Dosi ng / -0171
,
'
Aeration ""~--,---.,,z--.- Bldg. Sewer
Holding St/Fn Inlet sl~~ 39'
TANK SETBACK INFORMATION St/ ~ t Outlet 9 7
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic ~7g NA Dt Bottom j
Dosin NA Header kilkin.
'
Aeration NA Dist. Pipe :50 S '
Holdin Bot. System 732' 9S, ~7i
PUMP/ SIPHON INFORMATION Final Grade 3,~O ~S
Maguf turer Demand
Model Number GPM
TDH Lift Lriction System TDH Ft
Head
m Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits wed-e Dia. Li Depth
DIMEN I N S ,?J DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM L RING r'
SETBACK
INFORMATION Type 07,7_ C4mT / HAM IER Moe Number:
System: e,,CAS 7,P& LSD OR UNIT
DISTRIBUTION SYSTEM
Header /*1 d Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length -9-Z/ Dia. Spacing /l
SOIL COVER x Pressure Systems Only xx Mound Or At-Gr System
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: Kinnickinnic.9.28.18W, SW", SE, Lot , Monument Road
+
V
dae~j
Plan revision required? ❑ Yes 2-160
Use other side for additional information. - 1w I
SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i'
I
° ;Sale" and Buildings Division
C~'■•iRi SANITARY PERMIT APPLICATION Bureau of euildingwaterSystem:
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 81/2 x 11 inches in size. • '
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check if revision to prbvious application
IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
$ A^ kf fj~ L% C k SW 1/4TF, 1/4, 5 C T .2e , N, R /rE (or)o
PropertOwner's Mailing Address Lot Number BIOCk Number
P. 0. 4 7
C ty, State Zip Code Phone Number Subdivision Name rr M Number
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Nearest Road
Public 1 or 2 Famil Dwellin - No. of bedrooms /'~lo lam[.
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
} l ~yy
Q ~!~V '
1 E] 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. jNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-___System System Tank Only______________ Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30E] Specify Type 410 Holding Tank
12R~Seepage Trench 22E] 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
c'1 U S'OfJ i'Se?c~ ~.S ; f Feet Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper-
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Exist in structed
Tanks Tanks ~y
Septic Tank or Holding Tank Y3 ► 41140 ~ a }i ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PPRRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved S itary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Signature o Sta ps)
Approved Surcharge Fee)
❑ Owner Given Initial
Adverse Determination /G8 .2
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1- A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by.a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/orexisting 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.
Vlll. 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 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
'r
++x~:;^~,rtL•.t~t.,^-.... *_-«ss-s.:xsacr:~7caw:..:._.. _ .:..r.~ +'~7~1~!!!.• _
FROM : eD I NA REALTY HUD^01\1 1~ ~s, to-tea 12:12 414:3-- P. 04/04
PLOT PLAN
SCALE 1
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T ? i
lG' 7-v_ J
"IT7 X7'
0
Z.t
L-L
~ _ _ ~ ~ ~'rI ISM t
41
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Sum ,
` 4r
s Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pam l of 3
Labor and Human Relations
DWgion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
k'REVIEWED Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but S~ ' C
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or L I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION BY
PRO PERTY OWNER: PROPERTY LOCATION y
114,S C~'t T "LB N,R 1 01(ora
G~ 6 E S lEr- L G91FFt6T SW 114
VIt
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SU .-NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®I OW NEARFIS
z~u~ ~-+~.c, t~ sy,o~.z c~tS~ ~LZS-Saq ~r'~.~~~~e.\-+✓wiv ,--w-___:"~°
New Construction Use (,SQ Residential / Number of bedrooms ty kryO w Nj [ J AdditiQn to existing building
j J Replacement Public or commercial describe
Code derived daily flow gpd Recommended design loading rate_ - bed, gpd/ft2 0 • Y trench, gpd/ft2
Absorption area required bed, ft2 ? trench, ft2 Ma)omum design loading rate 3 bed, gpd/ft2 • trench, gpd/ft2
Recommended infiltration surface elevation(s) S k_%- 'Pty-6 E Z. ft (as referred to site plan benchmark)
Additional design/ site considerations S kFt iu bY~ Q Q l~t-GE Z
Parent material SLL~ 4 SFM11M L IT ouffTL S 4 0- Flood plain elevation, if applicable N • R - ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM Ia~nn FILL HOLDING TANK
U = Unsuitable fors stem EKS ❑ U ® S ❑ U [OS ❑ U Ks ❑ U ❑ S ICU ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftin. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed
Trench
_ .j p_1S 10`1 \ZZ(Z - S Zh'l CuV - O•S 0A
Z 1S-39 10'~1Z 31(0 5l~ Zis)Dk 'Y- CS b. S 0-6
Ground 3 3 9 -9 D to li Y~6 - } s 3 •~S 0S.3 - 6-W, m v'Tlr ln, - 6,
° • y
elev.
aa.5 ft
Depth to
limiting
factor
7 R o
Remarks:
Boring #
0-1b lb-m- zLZ 1 S L) Z►+~ S X12 1^'~~h Ctv - o S `:0.
>4 Zvi; Z 16-~1 s 1uK~ ~1 ` sit zil ~k li't S 6. ~
Lu `-L 1Z ~ ~ 5 O 1M v ~ h
3 i4s qo 1° R s vn - 3 ° `I
Ground \
elev.
g8- S ft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165
4dd
egerer Soil esting & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: p `Z~ c S CST Number:
M00576
PROPERTY OWNER SOIL DESCRIPTION REPORT
Page L of 3 .
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 Trer&
3 L I o_L ZL _
. w~2 i sif Z sbh -~~h cw o.s o.~
'}4`~fi $ Z (b-q) `W-t {Z 31 L S1 Zh'lQ P t Wl,~~- e--s
Ground 3 yf_g~y Xby,-3L6 - Sl ti1S le-sbk'
elev. - 'VA u'~ to o . 3 0 . ~
ft.
Depth to
limiting
factor „
Remarks:
Boring #
d..t 10 2 z lZ s L 1 Z` Z5
Z Iq-3-1 Lu,-t2 *N1 L. StI ZWISb~T W1 TV
- o.S o.L
g %3
Ground 3 37.$x{ lu~'1.iZ3~6 ~ ~ p
elev.
CJU ft.
Depth to
limiting
factor
Remarks:
Boring #
o_ M I b 2 Z L- SL 1 Z'F 3~1~ v►1'~r~ C.LUU
S Z 1~ yZ L~ `ttZ 3l6 s t I Z Sbk yvt~Fy, C5 - o, s 0.6
1 c
Ground Z-$ b LOk Q-. VL S i shy- wt U o.y
elev.
48.6ft. i
Depth to I
limiting
factor
6 y
8
Remarks:
Boring #
f 1~ci 3 B D 3 S' S' L ok./ 6
3 s x t ea` taJU6.
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05192)
PLOT PLAN Page 3 of 3
SCALE 1"= y.0 '
MAO Vbll?e
i
3!y" ~tR. n~c PiP~t
O L
qs ( lv Rb•w -
07
N
1 ~LI
L't-48 s
(715 4L-0169 _ M00576
CST Signature Date Signed Telephone No. CST #
FILED
sEP 2 8 1995
osteNat
Deeft
534324 S.a0,XC0,VA
U Is
r N
CERTIFIED SURVEY MAP
GREGORY AND ROXANNE BISEL
Part of the Southwest 114 of the Southeast 114 of Section 9, Township 28 North, Ranse
18 West, Town of Kinnickinnic, St. Croix County, Wisconsin) being Lot 5 of that
certified survey map recorded in Vol. 10, Page 2911 of St. Croix County Certified
Survey Maps. C. S. M. VOL. 9 PA GE 2624
N114 COR. SEC. 9, T28N, R/eW, \33 \ Owner's Address
(COUNTY SURVEYOR'S MON.) 66' VALLEY VIEW RD. 1157 Coulee Trail
NPLATTED LANDS I Roberts, WI 540?3
NO/•34'48"W 3884.62' N,L/NE SW //4 SE //4
M N 89.53'03"E 663.40' ` 66' COUL EE TRA /L
40' 347.00'
3 /8. 40' 346.22'
-*Indicates o 664.62'.100• o ^ Indicates 1" iron pipe found.
° M Olndicates 111 x ?4" iron pipe weighing
_r ROAD SETBACK L/ E _ / -
- ~I ' 1.13 1hs./lin. ft. set.
DWELL/NG M R() Indicates previously recorded data.
f
E9
r ~ X ^ W C. S. M. VOL. /0, PAGE ~
b SEPT/C N 2911
q ~ b M W
This instrument drafted by Lrurence ?
N 3
3 DRA/NA6E WAY SHED °O W. Murphy J
W
7 b ^ h N 89 • 36' 05 "E 668.33'
644. 06' I
M 24.29'
L0 T 6 1 h z
Q~
z b \ ~ 5.362 ACRES ~ q LOT 7 ? ( q hl J
b 242, 292 SO. FT.
W N 5.300 ACRES EXC. ROAD N 3 4
2 r~ 6. 073 ACRES V I 3 to 41~
R.O.W. 264, 54/ SO. FT. Q
230,858 SO. FT. % ~O O
1 N 5,8/6 ACRES EXC. ROAD R.O.W.
• 253, 325 SO. FT. O I QI
Z 1 1 S 89.53'03W 330.04' O O 1
O 675.36' R 32.8 h ° I ZI
/1 82.29'^ Z 642.47'
S 89,19' 27 "W 757.65' R l S 89.20' 48"W 737.90 3' 3
-i1-OT 8o~
2I y ~ p l
110411.96
Q _ 2 ACRES air3 „ 2 O
M
W ~
~J '560, 290 SO. FT. C.S.M. VOL. /O ~ O ~ ° ;t
r
Q /2. 62/ ACRES g~R R.D.W. in „ a ,
W 549,"T83~3Olfr_= 3 3 PAGE 2706 W : 411
~I m Q W ~I
' o Dated: August 10, 2 W 3 3
O "Revised this 28th
' o° dayof Sept. 199'5 m
MINTY h R Z 0 q
f:ompreks~n~rc~4;aatrsc 2090.74' Q J N b b
3 4,ad€d'S~a+t 3'a ~
ark jP4* kb" W 2638.71SE CO R. SEC. 9, T 28 N, R law,
UNPLATTED LANDS /COUNTY SURVEYOR'SMON.J
S114 COR, SEC.ft,,ZeCFSCJf W, S LINE S£ 114
!COUNTY SURV yypp/~'s p «~IIIIII//
i^ R33 aQS O
SCALE / 200' r rt a8I
p 50' /00' 200'-' 500 600' p A' EI..
voi Page = •LAUR C•••
CertifieH, Survey Maps m W M DLJ
C •
St. Croix County, Wisconsin. t 13
ER ALLS,; • ~144
WISC.
LAND
,4*188111610t
rence W. Murphy
SHEET 1 OF 2 ReZistered Land Surveyor
VOL. 11 PAGE 2996
From PHONE No. vec. eb 1'=Z) ii • IUr9•,
Is T C 105
NiAINTENANC.E AGRE-E.MENT
SEPTIC TANK
St. Croix County
OWNEWBUVE1t
Z
MAILING ADU1tES5 _
PROPERTY AnDIMSS s_..
(lueation of septic .1'slom} Vloas%. obtain from the Planning Dept-
'CITY/STATE
PROPERTY LOCATION 114 Section T ~U N-IZ~~.W
1/4,
y ST. (1101X ("C)11N'1'v, Wi
1,t)'1' NIIMi3ER
SUDDIVISION
CERTIFIED)sjun,EY MAI' PAGE,2gf~ , LOTNUMBER ~
Improper use and mainletlftnc,: of your septic system could resell. in its premature failure to handic
wastes. Proper maintenance cotisist.s of purliping 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 it maximum of GO% of tile cost
of replacement of a failing system, which was in operation prier to July 1, 1978. St. Croix C:otm(.y
accepted this program in August of 1980, with the requirement that owners of all new syst.Gmti agree to
keels their system properly maintained.
The property owner agrees to Submit. to St. Croix Zoning a certification form, signed by the Towner
acid by a mater plumber, journuyrnan plumber, restricted plumber or a licensed pumper verifying (flat (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic lank` is less than 113 full of sludge and scum.
1/We, the undersigned have read the above requirements and- agree to maintain file privaic Sewage
disposal systelll iii i1~:o.rdancc. \Vlth the standards set lleretll, tiSa b the ~11iSCC)llSttl DNR-
Certiflcatlon Stating thcai svpuc 11i1S 1)een lnalnt:iin _ 1 I11USt be coll-pleted m-I tit ih ' ~t
County Zouitlg (_)ffic.er within 30 days of the three year expiration date.
SIONED:
DATI,:
St. Croix Count), Zoning Office
Gove-rnnlcnt Center
1101 Carniichael Road 11/93
Hudson, WI G 1016
8 T C - 100
Thia 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 pa.ritilt iUcuance. Should this
development be intended for regale by owner/contractor, (opec
house), then a second form should be retained and completed when
the property is gold and submitted to this office with the
appropriate dead recording.
Owner of property
Location of property ~J~l/4 S 1/4, Section N-R W
Townab+P 4Z"*Vll~C,4~xII-rvl G Mailing address 64-pco. Sja"
*Addrar,s of rite
, Subdivision name (~-Soj L/W //"j. Lot no. 2
Other homes on property? Yes-2-(-No
T ~P4 X/I//1/1`~ . ~92'SE~
Previous owner of property C7 ~60~!__.d -447I............__-..... ,
Total size of property 4O. O 73
Total sine of parcel_
Date parcel was created 7- .2 -13
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? . -Yes No
Volume I/ and Page Number 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 GERTIPICATION
I (we) certify that all st_:4tem~-nts o» this form are. true to the
il 't,i'~- _.i` a. (tiJ Ll a:•) ~.Tlc)°vJ~f'.c7Ci? Crla -t-.r (we.) an
dose:' -LiDed .lt, t:tlis intormat ion for,rj, by virtue of a
warranty deed recorded it"t the. office of the ('ot.lni-y Keg inter of
Deeds as DoQume-lit- No. and that. I we rosclit'l
own the Proposed site -fur- the sewage disposa] system or Y (we.)
obtained an casement, to run the above desc.ribecl for the
c`.onst.ructioll c>f said system, and the same has been duly recorded in
the off: ice of the County Rc-ginter of feeds ri s Document No.
s
:~ic~nature Co-Applicant -
- 198'_
State Ba: of W tsccn,,t` Form - - _ . _ _ - 1
53651' WARPArTY DEED a'
Q~ ST, C, { C' a 11
F_
' OCCUMENT NO
Gre NOV z 0 :995
Bisel,
A _ Bisel_ and Roxanne _1), fit 9,45 A
crY-
an_d_ wife -
hus and - - -
_
Stephen-, R_ Paulick ard Aarbara-
-
conveys and warrants to
e,
,aulick}_husband and
D A' A
^C 1"Nli
THIS SPACE qE tiEgv Ec.>
-
vAME ANO q'TU'; N An DPES.
fiat Matiorl ;l $ink Gf Riser Fails
.0. D ;c6
- C~Qix---- River Falls- '4 Sc.u^yin 54422
the following described real estate in County, State of Wisconsin:
(Parcel Identification Number)
ertified Survey
rta recorded in V011J a 11 of C `,aps
.
of Certified survey p 324 be ing a Part of the SWl/4 the S
I.ot y ulnent No. 534 t TM-n Of Kinnick innic, S Stt.
at page 2996 as 1~ 28 North, Range 18 4~es
of Section 9, Township
Croix County, Wisconsin.
homestead property-
is notof record, if any.
This -----~(is not)
Ease _way
ments, restrictio;~s and r.ghts-of
Exception to warranties: 95
:0ovember
t day of
Dated this - (SEAL)
- (SEAL) el
A0J - (SEAL)
' (SEAL)
ACKNOWLEDGMENT
AUTHENTICATION STa?E 01F WISCONSIN
ss.
{1~
Signature(s) St. County. day of
~i - ~,.4 sully came before me this 19-95 - the above named
19-- L_ • , 4 -4isel,-
A_8isel and RQxat~n
authenticated this day of -
b usbend and wif a
- w executed the
TITLE: MEMBER STATE BAR OF WISCONSIN ~c.wn to the person 5------
(If not - to sac
706.06, Wis. Seats.) f~ instrument and acknowledge Me saris. -
authorised by § THIS INSTflUMENT WAS GRAFTED BY Barton •~County. Wis-NotaryPublic • N ry►t is state expiration ate: i
ermanent. (If not,
Out VfRCOIISt caission is p )
-a r) Attorney
(Signaturw may be authenticated or acknowl necessary.) ,
rated WssiAnscn Legal Blank Co.. Inc. it
,
belor their s,gNwm. Milwaukee. W's
signing is any capacity sbnuld be typed M Dn STATE BAR OF MISCO>r
'Names of Pew M No-
WARRANTS DEED iOR