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HomeMy WebLinkAbout030-2085-40-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~Ul~c' t+ l~ 4.~ CZ T'~ a f ADDRESS IAA. SUBDIVISION / CSM#U~o ,~rVy~ W LOT SECTION- 3 a T~_N-R~_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM fi(st, Se $I C. mw ~ i s oven out' kt v N Se 6) x 7.1 7f 3o' QS" 3 1 Y 31 4 ~eo~z~vr~; N0nw tU T INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK' i~ live ALTERNATE BM: SEPTIC TANK HOL ION Manufacturer:- QQRh5 Liquid Capacity: Setback from: Well N!-6 N House JQ Other Pump: Manufacturer Modell Size Float seperation "Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM i Width: Length Number of trenches Ne~ Distance & Direction to nearest prop, line: y8, Setback from: well: IJ01Po House Other 3 C4VM97. (PS Q ~ N p S. 0 1 ELEVATIONS Building Sewer ST Inlet. 90.17 ST outlet S. / 1 PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9~.a 0 Existing Grade V .SU Final grade TO.U DATE OF INSTALLATION: Zj~ S PLUMBER ON JOB: LICENSE NUMBER: 3 `}Oy INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hsman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit H Ider's Name: ❑ City ❑ Village p Town of: State Pi g"#? QUAUE, ROBERT & LAURA X CST BM Elev.: Insp. BM Elev.: BM Description: St. y ~ se Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6 Donn ~ , f3,rv - s /07 '13 Aeration Bldg. Sewer Holdi St/ rL, Inlet TANK SETBACK INFORMATION St/ Outlet 9!-5-, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic /C2 ' NA Dt Bottom n Dosing NA Headep**ft►* 2, 1'3 Aeration N Dist. Pipe 9~// - Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade . -77 Manu r Demand S ' Model Number ~---GPM TDH Lift Friction System Ft mead Forcefnain Length Dia. Dist-Tower SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches T No. Of Pits Inside Dia. Liquid Depth DIMENSION DI I N SYSTEM TO P/ L BLDG WELL LAKE / STREA E G Manu acturer: SETBACK ~ INFORMATION Type Of tir , 6, ' A System: OR UNIT DISTRIBUTION SYSTEM Header. Distribution Pipe(s) THole Size x Hole Spa Vent To Ai take Length Dia_ Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra y nl Depth Over Depth Over xx Depth Of _ xx Seeded/ Sodded xx Mulched Be enter Bed/TMkazb-Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ~fSt. JosBeph. 32.. 30,x.. 1y9W, NW, SW, Lot 4, Johnson Drive yr' 'y IC✓ ~ ~'?'~-~'=~~(~C Plan revision required? ❑ Yes ❑ No Use other side for additional information. f~ y SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I SANITARY PERMIT APPLICATION i'~'■•iR , In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITT/~ ERMI -Attach complete plans (to the county copy only) for the system, on paper not less than o~ o(P5. . 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. ERTY OWNE PROPERTY LOCATION f ' ,n IAUro, L(~ G/v/'/a f 4,S T N, R E (or) W R# P ER OW~NF~B'S MAILING ADDRES LOT # BLOCK # 1U CI , STATE ZIP CO E PHONE NUMBER SUBDIVI ION NAME OR~SM NUMBER II. TYPE OF BUILDIN : (Check one) 1:1 State Owned 1:1 W40WN OF: -TcstA E] CITY IAD ❑ Public 1 or 2 Fam. Dwelling-## of bedrooms PARCEL TAX NUMBER(S) 1111. BUILDING USE: (If building type is public, check all that apply) 30 -4/0 1 ❑ Apt/Condo c'3 T 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 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TY;New OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pr ssurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE Q V REQUIRED (s . ft.) PRO~O~ D,(sq. ft.) (Gal ay/sq. ft.) (Min./inch)—ELEVATION ~7/ , eet SS(-)Peet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank D 0 Q .e S FZI, Lift Pump Tank/Si hon Chamber Vlll. 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 Signat e: (No Stamps MP/MPRSW No.: Business Phone Number: m Our eS,fe M ~S~ 0 71~ 38b'9 PI ber's Address (Streit, City, tate, Zip Code): A T7 0 8 rn) & 4 ) o-t') S l~ up1o~j V d ) IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag it Signature (No S ps Approved El Owner Given initial ~j Surcharge Fee) 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, 603-266-3815. 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. 111. 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 followin : A) plot drawn to scale or with complete dimensions, location plan, 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. I SBD-6398 (R.11/88) P B. L E~7 P EC~TA J,,I1)OSS `l.- NAME v ~>z LAU~-Ae NAM E ~;m f~oum~es~ ~ lL 0 C 10 ICI .h 9~q Lk..I-.1 C E N S E- 3goV At eeu J ~I~x~ .E LeY; tx~ Nye SAX 0.4e4 10) PAQ ~AUO T 70 ~ 6y~ i o 51o X f .o Q , es i gM'~',': la7' ~A ~tl~Fa $c1FJ _ ' FRESII A'L1: IfJLnND ODSERVII'fl(}tJ''YLP]; CROSS SECTION Approved Vent Cap Minimum 12" Above g~3.5C~ Final G>s?Sle______~ i~ ~INA~ C~KI~~ZQ 11'1 A-x 4 11 Cast Iron Above Pipe Vent Pipe To Final Grade- Marsh Hay Or Synthetic Covering ~ Min. 2" Aygr.ef.j 11 _ Over Pipe Dis t•ribu Cio_ i Tee j • Pipe I ..r Aggregate rer-f.orated Pipe Below I flu ,6r. , Rev ncath Pipe c, __Coupling Termina(Jng• T . Rol•tom. oE• System... ice..-. • ._r_• • _1•. ..NIN II.M~N~1.11 I 1.1 M11~1 K'~ttontm Deorlmrrt of Industry, Wll UCbl.h1Y I Ivie nor vn 1 `.a0or and human Relations U 90e --to (Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Madison, :,r • ` Page _L .2 / " eel&Vra. art e1,11eeRI04 eso C~ 4 7 Myyr rtMy al0►Vaa1 a 8000 •a a Z 72 rdlOriesa cRy - ~ ar t ar t:atarrr tnr leaoa oro.. e IOCAt af:1x71 low Mw WWVAL Mx/MiCRra~lil B0RWC CSMI LOT BLOCK SUb01V1310N Jl~ 146 S maw _ Rtrtact (3 • Houton Depth Dominant Color Mottles Structure Limiting Faeteey 1.e46n9t;P0 sr) M. t^ Mvnsell u St Cont. Color Texture Gr. St. Sh. Consistence Root n ar Depth Trench Dee Elt:v = I.L.L~J h of-10M Depth Dominant Color Mottlet Q Structure l•mrnng faetery lwonp GPDso n In Munsell u St. Cont. Color Texture Gr. St. Sh. Consi tense Roots boundary Depth Nrich Bed /V Al 14 Elev k .4 I Horizon Depth Dominant Color Mottles Structure Umttleg Factory loadrngGPDay A. D In Munselt v. St. Cant. Color Texture Gr. St. Sh. n ist n e Root Sunda Depth Trench Bed Elev - r Ile B , I Houton Depth Dominant Color Mottles 'Structure Umtnng Favod loaangGPD.w n. In. Mun eft . St. Cont. Color Torture Gr. t. Sh. Con isten a Roots Boundary D ih trench BN Elev a of I Al /V Z/ /f 7 4~t S [3. Horuon Depth Oomrnantcolor Mottles Structure limning Factory UwangGPDrq n. In Munsell Ov. . Cant. Color Texture Gr t. Sh. C n r oncs Roots Boundary Depth Trench bed Elev r - Additional Remarks: RECOMMENDED SYS EM TYPE: Other Site Features: 9i Sys(cm Elevation CST 111e atssigned elephoneNo. CST • CST Name (Prkq) City Slate Zip hsc~J GvI.Z' S®/ /~h1 ~`~~S6v ~d see ~0~~'l 9G x / 'V7 /o, O ~ a d i IX a~. I G3 t i Y~ n 3~' xanaas asK xraawcao It .4 ass aara g ar ra s.•.• a xiswr x, sssowae n U LA TED LAfCS asr ua a .n! nl.. a. xcne■ » 300.04'47•E 1323.01' Y I 1r ~ w I 8` O 12 8 m g» r if \ I t R' 0 Io ~~'rna.` f• f ~ROLLIIyG- 8 O p + , ' Y N Z 1 a' r Ir rj I t7i gg r 8w r0 l+S W IW 0 f = O ' 8 + S :m I A ,M g V I N g x. ?i E .a+'s`s I soa•n'oa•r ! rT A I 273.V A x im ! 8 i V R z O - •ol.a•' 8 ~ti r N 11 a"N - - ~x r •8t : Im O A z4 : r 0 33 . .r s o N 1 p rn fn \ w~ Tpy I_i I Z we , IN -oz 8 t3 D /r/~ I '°°•°'°°i ,a p ~ VA :0 z • ! r) N 00 -n I i g ~ IZ m / 8 I 'v z - r • r 3 = iL`D m ~ a Twa s.,.• m 8 r0 e• i an.• ar c swu• \ O =81 AD Rn 8 O / »I» 'n s ' NOO'00'00•E 635.00' $.-.•n \ M Iy D if) i0 It= I Ic- R •"I I .I + ars.n' Z 12! rc~ \ Ir In 8 8 Im IS o• Vn S 0• M $ co / • I 305.17' IF :-J-i C n~ w b• I. • N00.00.00•E N 1T lp i-- on a ;T / J - m IR IZ• ~(~1 A 1 A I•I • \ 8 IA 1D IC7 4 im Iv, \ la, irn u 81 "AoC 33oC O c- z :"a 2F Iw m to - ~ -;y~' N I \ ly C - tea/ . / • / J'•~.. O i n Ed D i '3 m „r~j na N I I S' :R d iix z Iv, w y rnci " C nD C :t Ba t~ 3 / I~cn SS 0 I-IT = m I.. ft a i I I 7e in .R • N I D I to 1 t t 3 rIn y m Z9 itI ST. CROIX COUNTY WISCONSIN 14 N 0 N N ZONING OFFICE - " ST. CROIX COUNTY GOVERNMENT CENTER AN. , 1101 Carmichael Road ' Hudson, WI 54016-7710 _ (715) 386-4680 April 18, 1995 First Federal Savings Bank 201 South Second St. Hudson, WI 54016 Attn: Fritz Meyer RE: Gerald Johnson soil evaluation Location: Lot 32 Johnson Parkway, NW;SW;, Sec. 32, Town of St. Joseph, St. Croix County, Wisconsin Dear Mr. Meyer: The above referenced soil report was conducted by Kim O'Connell on June 6, 1992. I have reviewed the original which is on file in our office. I feel that the information contained within the report is acceptable so long as the physical location of the soil pits can be recreated. This would require that the original horizontal and vertical reference points still be present at the site. If you have any questions or concerns which I can address for you, please contact me at the Zoning office between the hours of 8:00 through 5:00pm, Monday through Friday. Since ly, Ames K. Thompson, Assistant Zoning Administrator cc: file ° S 81 N LAND SURVEYING* HUDSON , WISCONSIN 54016 (715) 386-2007 Name J & L Land Developer's, Inc. Address 1230 Rolling Hills Lane Hudson, WI 54016 Description Part of the NWo of the, SW~ of Sect4.en 32, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being part: of Lots 3 and 4 of the Plat of Johnson Parkway in the Town of.St. Joseph.~t (Further described on Sheet 2.) N I W} Corner of Section 32 County Section Monument S89056'57"W 175.00' I 1f~0 S6 312. S0 , r°s fs. 6o46i44n~ t' S66046'44"E 96.47' LOT 3 LOT 4 'ZZ F yc'o 20r0 ski ~`~O J6S LANE 10 - '0 PUBLIC CURVEO-0 Radius- 322.01 Central Angle- 7009140" Chord Bearing- S53043111"W Chord- 40.22' Arc- 40.251 .J j I ~I tote of Wisconsin 0 IRON STAKES DRIVEN ounty of St. Croix ) ss. SCALE OF MAP - I INCH: 100 Feet ® IRON STAKES FOUND Allen C. Nyhagen , registered Wisconsin Land Surveyor,do hereby certify that. n_ July 15th 19 92 , I surveyed the above described and mapped property according to tie official records and that the accompanying mop is o correctly dimensioned representation to scale of the boundaries,that !I buildings and improvements lie wholly with~5ttb*0- bdfigtgr~ lines, and that no encroachments by adjoining owners appear om said survey. .trap No. 77-84 -192 •.l r,4 y 11 22 )Town By B. SHEE 1 OF 2 SHEETS t ` Sll S 81 N LAND SURVEYING* HUDSON , WISCONSIN 54016 (715) 386-2007 Name J & L Land Developer's, Inc. Address 1230 Rolling Hills Lane Hudson, WI 54016 Description FART OF LOT 4 OF THE PLAT OF JOHNSON PARKWAY A parcel of land located in part of the NW1/4 of the SW1/4 of Section 32, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being part of Lot 4 of the Plat'of Johnson Parkway in the Town of St. Joseph; further described as follows: Beginning at the W1/4 corner of said Section 32, said corner also being the NW corner of said Lot 4; thence S66046'44"E, 312.50 feet to a point on the easterly line of said Lot 4; thence N42016'54"W, along said easterly line, 166.74 feet; thence S89056'57"W, along the north line of said Lot 4, 175.00 feet to the point of beginning. Parcel contains 0.248 Acres (10,802 Square Feet). PART OF LOT 3 OF THE PLAT OF JOHNSON PARKWAY A parcel of land located in part of the NW1/4 of the SW1/4 of Section 32, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being part of Lot 3 of the Plat of Johnson Parkway in the Town of St. Joseph; further described as follows: Commencing at the W1/4 corner of said Section 32; thence S66o46'44"E, 312.50 feet to a point on the westerly line of said Lot 3 being the point of beginning; thence continuing S66046'44"E, 96.47 feet; thence S42016'54"E, 220.00 feet to the northerly right-of-way of Rolling Hills Lane being a point on a 322.01 foot radius curve, concave southeasterly, whose central angle measures 7009'40", whose chord bears S53043'11"W and measures 40.22 feet; thence southwesterly, along the arc of said curve and said right-of-way, 40.25 feet to the southwesterly corner of said Lot 3; thence N42016'54"W, along said westerly line of Lot 3, 303.58 feet to the point of beginning. Parcel contains 0.240 Acres (10,455 Square Feet). 4'.. r1 '"M• 1' \1ap No. 77-84-192 v )yawn By F.B. t LAI 71 PZJ I SHEET 2 OF 2 SHEETS ~l • ~j afwaa r~af%sa~•w•r fw.u Y U\f.A"T°D -ANCS Y4 u•a (soo•w'fr Y: 4 .aar a~.c o• r•i o. aa(r,er ae ' 8•m II cl) Y~ $ m ♦ F •r I i l v o X0-1 Z r`.y o ROLL O " a yZ 1! ~f . If' 'r'r 8.. p • S o s C- m lc) T ~I• $ ni r IF (o:•noa'r ~Z 11 I ;0 m im a ~ ••••i 8 / $ ~ 7 Qom.-- it 0 N .oa. s.• 8 ♦f. H E i" X rc? 2 - ( - X -I u gs r? " n as ,S x Y" O tg T { O x I• I i s" z Y 0 om: I-i Imr CD ~ e Ala ar V) D Y - "J n fOp•w'OD•( IC) Z ~ O aff.Ja' i (n 0 s. / i o I .L m C/~ o z A D Y n fr,.•~o r,•( f...• O (O d 8 I o T 8 r 4: A oa.oo' • NOO.00'oo•E 675,00• / e$,-, \ a I~a D a uri Q rv va g - 7os~ oo•n~ to IL IT \ N IL I-, .r S W r 8 I. ' Noo'oo•E r..' m .L g sg~ 12 -i it CDT~G7 ~ ~ o ,q i K) r r ~ . ( ro 3oC Im 'r!r Irn im uy ~ Y' i •JJ. oC 3 Z IIV ~S µ IN . ✓ / a V ra ILIA 1~ \ N O r a° ; L- \ . / • f •e` ` eZN 'ori~C~,C ~•C~, J Z \ Jam/ 66 ~ I '~a^ ~ I• m ~ R R.e glt i -tv ~2 IS ~ " r I' ;a r Im • • [ a w i i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT i St. Croix County OWNER/BUYER ~QBC-2~ C~ 4,!1 'al Z4-um zt~~ MALLING ADDRESS /,0 1.49 QL,Q c,, I ASS LV . /i/ D60Al Lt~L S //10 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Hu~SOAI - PROPERTY LOCATION n/ 1/4, Sk 1/4, Section JA T_ 30 N-R / 9 `w TOWN OF ST. CROIX COUNTY, WI SUBDIVISION JOHA1,50AI YA.@KLJAC/ LOT NUMBER 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 1 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 purnper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and i pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/Nkle, 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 SIGNI.:D: ..~J, i - 9~ St. Croix County /.olling Office 1 Govenunent Center 1101 Carmichael Road II/ Hudson, W1 54016 `~3 r • 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 7o, 6e7- &,4, GAGC cs. ~~cADE Location of property /V jnl 1/4 5W 1/4, Section T_,ALN-RAW Township Si. T056P,4 __.Mailing address /09!~ 1104b w ©ars N ASoAJ ~v 5 aye Address of site 40 oNK/ a 2 6oxl L y0%40 Lot no. Subdivision name aI Son/ Other homes on property? Yes ✓ No Previous owner of property T+ L IA V o De oo is :Qne- . Total size of property . ( (a A"6s Total size of parcel OCo ACQE Date parcel was created S 7 /S 9a e-d Are all corners and lot lines identifiable? t/ Yes No Is this property being developed for (spec house) ? Yes i✓N0 Volume 1119 and Page Number 0,7,R 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. jdg? 43s" , 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 o-Applicant ,z~5 -95 -ate- 9s -c Date of Signature Date of Signature T7 o 15-V 7 • DOCUMENT NO. wAltit.'NTY THIa •FACI< RC16RV[D FOR RCCORDINO DATA ~~y••__itlIOl~ STATE, OF wtaCOr~i I-FOIM 2 ~ ~.1~•9~a~~022 REGISTWSOfCE i ST. CROIX Co., WI This indenture, Made this.... y Reed for Record of da of ...An.......ril...... APR 2 5 1995 F 5 & L Land Devel oper A. D., 19--.. 9......, between J S! Imo' , a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin located at.....__......_.........._.........._........., at 10:00 A. Quade,' pYiuty sbaof the nd andpawif~eda............ vr vo s nar Eat p aapert'_~_~__ e of De =...j partleS.._ of the second part. WItnesseth, That the said pa rt of th first par for nd in on tde not the sum DL> 440, twenty-seven thousanivelundrec arx no/ ~ 0?~ co°lars of..._.... _ R m° to it paid by the said part.. leS of the second part, the receipt whereof is hereby confessed and & Wertheimer, 430 Second St. P. O. Box 106- acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and con- Hudson, WI 54016 firmed, and by these presents does give, grant, bargain sell, remise, alien, convey, and confirm unto the said part I..._..-.,,pp the econd part,.......... ~elr _ heirs and assigns forever, the following described real estate, situated in b roiX the County of State of Wisconsin, to-wit: l i See legal description on reverse. State of Wisconsin County of St. CMk r , I hereby a!rtify dot d+k inMwrMnt b a MI. - true and eon eW of do document on • file and of nxwad in my office and ho loan compared by me.. Attest April 25 .19 95 Kathleen H. Walsh Kat H, W ister of Deeds (IF NECESSARY, CONTINUE DESCRIPTION ON REVS^-~IDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said part. Q5.._......... of the second part, and to.......... their heirs and assigns FOREVER. And the said - --L...Land. Develc ers.,._-•Inc................. party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said part.. es....._.._... of the ..i heirs and assigns, that at the time of the ensealing and delivery of these presents it is well second part, their _ r seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever and that the above bargained premises in the quiet and peaceable possession of the said part of the second part, ..1elY....... heirs, and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT and DEFEND. J & L Land Developers, Inc. In Witness Whereof, the said party of the first art, has caused these resents to be signed b Gerald A. JOhnSOri Linda D. Johnson its Secretary, its Presiden and countersigned by......... _ _ _ Y, at Hudson Wisconsin,-vrM-rts-e&rpemkr-oea4-4o-49,r-kereatOr-a4iixed; this day of......... _ ..~rll _.`f A. D., 19c~5 SIGNED AND SEALED IN PRESENCE OF J & L Land Developers, Inc.. Corporate Name ~r. Gerald A. Johns President I' COUNT REIGNED: . ...!lf.!~/. Ll a D. TOhns 8ecretnry STATE-OF WISCONSIN St. C.roiX ss. County. April 95 ~(~j Personally came belOre me, this Z_.!_. y of.............. ~ld A. Johnson nda D ~~.....1......._ o President, and................ QIS9I1..........................._........., Secretary of th Qbp+r~'iramed•.~;pora,tion0 me known to be the persons who executed the foregq' g nstrument, and to me known to be such Pre~Tt'ay~.~gEr ary,ii s3;d Corporation, and acknowledged that they axe d f oin instrument as such officers as the deed of • • fi . said Gor~l'StI., Yts nutharity. "-WO `\TAAP r" sill v '%os 4sAiTED BY h ;~r NOTARY Notary Ihlic , ...C~t.•.......rO~ ............................................CountYWis. • • C-) Jlri My commission (is) permanent _ 10 59.5 (1) o ' e Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names the. antors, grantees, witnesses and notary. Section 59.513 similarly requires that the name of the person who, or govern. menta ncy which, drafted such instrument, shall be printed, typewritten, stamped or written thereon in a legible manner.) STATE OF WISCONSIN -i,,. T.-I }flank Cn. lnr. IY • VOL .11.9r ~r C 3 A parcel of land located in the Northwest Quarter of the Southwest Quarter (NW4 of SWh) of Section 32, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Lot 4 of the Plat of Johnson Parkway, EXCEPT a parcel described as follows: Beginning at the West Quarter (W~) corner of said Section 32, said corner also being the Northwest corner of said Lot 4; thence S66°46'44"E, 312.50 feet to a point on the easterly line of said Lot 4; thence N42016'54"W, along said easterly line, 166.74 feet; thence S89056'57"W, along the north line of said Lot 4, 175.00 feet to the point of beginning. Also conveyed is a parcel of land located in part of the Northwest Quarter of the Southwest Quarfar FN,H of SW-~), of 'Section 32, Township `30 . North, Range 19 Wjgrt,, ,,Town !of St. Joseph, St. Croix County, Wisconsi.p,Isijq4om~p4sVwltgf• 1,ot '3 of the Plat of Johnson Parkway in the T©w~+}nS~►bi~7ep1~;=~futher described as follows: Commencing at tit, LQftrt6+ "W' ~ corner of said Section 32 thence S66046144"E, 312.50 feet-t"d:pnint on the westerly line of said Lot 3 being thiq point of beginning; thence continuing S66°46'44"E, 96.47 feet; thence S42°16'54"E, 220.00 feet to the northerly right -of---waj- --of- Rol- rinq Mills Lane being a point on a 322.01 foot radio§-'~6urve, concave southeasterly, whose central angle measures 7009'40", whose chord bears S53043'11"W and measures 40.22 feet; thence southwesterly, along the arc of said curve and said right-of-way, 40.25 feet to the southwesterly corner of said Lot 3; thence N42016'54"W, along said westerly line of Lot 3, 303.58 feet to the point of beginning. Exceptions to warranties: TOGETHER WITH AND SUBJECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. RAJ J1>