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HomeMy WebLinkAbout020-1011-60-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAM /V1 ILL E,&- ADDRESS 106 3 T A N N y SUBDIVISION / CSMV T"A NNY 21D(o - )((.5,A. I/0( I0P4f--a930LOT V SECTION 1 T Zj N-R / W, Town of 144 D50 N ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Tp NN Y ~ANF 45 WELL ! t'~ i pio >SE Z8`XSo i ~ If Sd ~pQ A4E B.M. P'S PC S9 44 c ~ INp~PP. E6-iD~~ 04 of Provide setback and elevation information on i-everse of ttii-, form. Provide 2 dimensions to center BENCHMARK: TOP e r- -Pier- .07- PC E/ . / o v 00 ' _ ALTERNATE BM: 70? SEPTIC T TK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: k/E I S E /Z Liquid Capacity: /600 6A1 Setback from: Well S D House /6 Other i $ ~To SE!oQNEIC of HouiC Pump: Manufacturer Model# Size Float seperation Gallons/cycle: I Alarm Location----- SOIL ABSORPTION SYSTEM Width: $ Length '46 I Number of trenches Distance & Direction to nearest prop. line: 75' To NA/a ST- Lp*'"L / NE - Setback from: well: 9v, House AP? Other 1(o6tT-0 SOV'Tj4 Ly7-41#F, ELEVATIONS Building Sewer ST Inlet.-1 3 -1- ST outlet 3.10 PC inlet PC bottom - Pump Off Header/Manifold 10,45- Bottom of system 11,(00 Existing Grade (p110 Final grade (r 10 DATE OF INSTALLATION: PLUMBER ON JOB: (LL/ LICENSE NUMBER: /t~f~(Z S Os'SDO INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division • (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Pla M9 MILLER, SAM i{ CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A -0 4- 0- 0- -2 9 3 TANK INFORMATION ELEVATION DATA 2~Z3 95 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4wiTe_~ Benchmark /sI 4~0 Dosing '37' Ife, Aeration Bldg. Sewer H61 Ing St/ Ht Inlet 6-y'- TANK SETBACK INFORMATION St/ Ht Outlet 3 9j~ 97 God Verit ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic >/d~ }ZS ' Ad- NA Dt Bottom Dosing NA Header afr. -)1/011-) n. 9 Aeration Dist. Pipe o-9 , Ho ~ Bot. System Rsa ~ Q 66' PUMP/ SIPHON INFORMATION Final Gradej Ma er Demand 031 Model Number GPM TDH Lift Fr' S stem TDH Force Length Dia. Dist. To we SOIL ABSORPTION SYSTEM BED /TRENCH width p , Length i No. Of Trenches PIT No. Of Pits Inside Dia. Li ui th DIMENSION DI SYSTEM TO P / L BLDG WELL LAKE/STREAM tEACHING acturer: SETBACK C E 2- INFORMATION Type O System: 1 -1/ DSO OR UNIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole Spacing it n i Length 11L Dia_ Length ~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade IS Depth Over O , Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / TzeTuUkenter 3 - (p Bed /ZrrgolEdges Topsoil E] Yes I-] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson-11.29.19W, SE NE, Lot 1, Tanny Lane i,,~:z.~...- aH SOU;~ Plan re n required? ❑ Yes 111-14`0 A Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I SANITARY PERMIT APPLICATION ~::°::r+ co TY In accord with ILHR 83.05, Wis. Adm. Code < STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a l -106+ 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. PROPERTY OWNER PROPERTY LOCATION SIRED') 1#11-L115e, TL 9, N, R,f1 E (or~e) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 13oX W,2e2- / t! ZIP CODE PHONE NUMBER TA& /V /e r P G` ICI ~ Z'Z S 7 ~ CITY, S 1TE a N ~O ~ G.t GZ7L ~T SUBDIVISIONy ME OR CSM NUMBER II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑ State Owned Q ja TOWN OF IN VILLAGE : L) O R f ❑ Public 01 or 2 Fam. Dwelling-## of bedrooms,. PARCEL TAX NUMBER() /r/I r III. BUILDING USE: (If building type is public, check all that apply) D ~0 / 0V 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 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 in line A. Check line B if applicable) A) 1K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 X 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) / ELEVATION G y g fn -0,-7 ?0`00 Feet Feet [VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- 4Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic I 1 Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber El El 11 1 El F VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (N2122-e-1 MP/MPRSW No.: Business Phone Number: 5112-O i°--53 z s~7 z 3 Plumber's Address (Street, City, State, Zip Code): oK _1* / 2 -a-- g 7-/Gf/ AA oL2 v/ IX. COUNTY/DEPARTMENT USE ONLY V ❑ Disapproved Sanit , Permit Fee (Includes Surcharge Fee) Groundwater Date Issued Is uing Agent Si re (No Stamps) Approved F-1 Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: UU( SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 1£ 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. 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 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) • - Tijif//l~`' Life \ A-1 2 ~ i g ~0 3 r m o rn ,I G m y , J71- coo oc f' U 'o. ~I m #1 r 1' Q ~ b` m a C.Q ° m o a P4 At r 0 m~ . m cu t m I i---------r--------- •I I I Q z I ~ < I I I O II~ " rn I ~ I t I 1 < it* I I I l7 O I z I I 411. j bb I ~ ~ ~ I I -D I ~ I ~ h I I ~ I m I ~ z I I ~ I od -o -o I I I ~ I m I I I m I I U I rn I rn i U'C I I I D I I I I I ~ I I I C7 ~ m I I I 1~~ -v cn z 0 I 1 I nC I I I rr I I I i -u CA I o I I 1 mo I -o I l I m t I N w I 0 EA z op I I M C ' z 4, x o A~ , 00 D , 9 O O O F; x D ~G7 2 mm ~ j J O ' --1 x0 m G- b m F; ~ co T M~7 CO u O 0 0 z 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page j of Labor and Human Relations Divisior;'atSafery & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY / Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ..T66 IX not limited to vertical and horizontal reference point (BM), direction and /o of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PRO ERN OII~NER: PROPERTY LOCATION 't>4 M r~ ) LL A GOVT. LOT 'SC 1/4 qt 1/4,S j ~ T 29 N,R /Q E (a) W PPPEERTY WNER'-.S MAILING ADDRESS LOT BLOCK # SUBD. NAME OR CSM # qIT1', STATE ~~ZIP COp E PHONE NUMBER ❑ CITY OWN NEAREST ROAD Nf:/~U W r 6. b VILLAGE ~b T New Construction Use [G~'f Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow AG5 gpd Recommended design loading rate 07 bed, gpd/ft2 og trench, gpd/ft2 Absorption area required 645' bed, ft2 5-K trench, ft2 mum design loading rate 6:7 bed, gpd/112 0Y trench, gpd/ft2 Recommended infiltration surface elevation(s) C~tJ fA4 3 oP ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL UND IN- ROUND PRESSURE T GRADE SYSTEM IN FILL HOLDING TAN U=Unsuitable fors stem S ❑US ❑U S ❑U S ❑U 14 S ❑U ❑S ®U 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 tench 0-2g 6v 3r// .54k r+7 C w 2 0,4 a.5- C, Z 6Y+~ 3 S L j s b,~ ref r S s n S Q r J'yi + 0•7 Q'& Ground -8 16 ye 4 4 elev. ft. Depth to limiting fac// 60 7 Remarks: Boring # A 0-1-3 6Y4 3 1 L 2 ti? r- r- rfy C w 2, 13 3 6`14 ~ 4 5 r ro , S 6)7 6.3 67-as! 4A S 1; ir- ,r, Ground elev. Depth to limiting 7 facto( Remarks: CST Name:-Please Print 1,10VLy JQ 0 Phone: Address: um rj 1 Signature: Date: n q~ CST Number: ~4 g~ PROPERTY OWNER 5041 MILS SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. j L Z Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxfary Roots Bed TM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch 0-10 1OY4 1 L c r r W 0.4 0.5 is, !0-~~ / 3 - S L I cr t 0.4 Ground 120 16Yie 414 l d ~ elev. 9~3ft. Depth to limiting factor 7 /12,12 Remarks: Boring # _ /6YA 4 - L bl~ 1'yJ C S Z rrI 4,4 p,S 4 6 .2 4 by 4 S ® r Ground 9ellew9 ft. Depth to limiting J fi or. F Remarks: Boring # P Q /l~ 3/ L r 1^~rT Y` C s fi O. iA>~ -3`~ /b 3 S C Q r m ~ S 4 lb.S 13 Ground 9- ! 6 Y S r III/ A.~ $ ft. 9av* Depth to limiting Remarks: Boring # 3 Ground elev. ft. Depth to limiting factor Remarks: 3330(R.OM2) Tau,~y C,~~r w~ p R rib rr, ` r S ~ ~ ly Vb a, a~ ovie 3 a 1~ U, } r ~ ~ r W ~o CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 11, and in part of the SA, of the NA of Sectionl2, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. N LEGEND co M w r r• to 4- W Aluminum County Section Monument Found o co 0 O 1" x 24" Iron Pipe Set, weighing 1.68 O o, -n lbs. per linear foot; v, f9 Ul ~ ~ 501 Roadway Setback Line - - - 121 Utility Easement C' ! y O ® S co N d N rt m O cA rt I M I a, M . ~ 7 N - - rt s S22o rt /THE co 331,E 2 AveC y~, 66. 63 , / le N? o \ \ 380.00 l / i i 1....... 1,50.00 ~ 380: 00 C4 2W rt 33 / CL -j/ fo 0_ C) l LOT ° 00 n m m t`' ° 2.69 Acres pC N z o z o 117,233 Sq. Ft. C= r, CD Ln 0 o w Z w ~o o 100 ° tr1 6 6' _ I o nJ O co ` . . r 1 0 ~!d 1.3 v a° S.89°30' 00"W 385.00 MATCH LINE S- • C,-jOtX COUNTY SEE SHEET 1 !'r.-nensr;e Ptannu OWNER Zoning and Sam Miller -ks committee P.O. Box 282 Hudson, Wi, if not focord(ad 54016 witoin 30 days of approval date -)hproval shall be n(A R void SCALE IN FEET 100 50 0 100 200 SHEET 2 of 3 SHEETS VOLUME 10 PAGE 2830 0£8Z 219Vd 01 W'I0A f4,lihEies OHS M1i0010h0ESS 1E8'hhi 1hc'OhT MnLT16% HS u9ZI1h06h 10091 pN TZ-OZ Mii00i0',ESS Mn0Z1E0o00S 1Z0'8iZ 1ST'01Z MnOh1TSo9ZS IIPI9EOES 100'EEZ P8 61-81 M110ZIE'000OS MnEEII10ZLN 190'hTE iR' 69Z IMuS'EsISSOCgs nLOiShoLOT 100'L9I I L1-9T Mi1EEII10ZLN MuE01Sh60SN 10S'Z9 1EI'Z9 Mu8T18Z019N u0E1RIO IZ 100'L9T Z ST-fiI Mi1E01Sh00SN MAOiCtl0ZSN 100'8 100'8 MuS*tO 0t oTSN n£018SOTO 100'EEZ Z Z i}~rZT MuEOiSh00SN M11LS1ZI019N 199'Zh 10S'Zh MAGI 6SOSSN utGILZ00T 100'EE7 3A 01E70ZSS 3,, LSIZIoT9S 99 'h£ 1Z91h£ 3119*1018So9SS niS16ZO90 100'EEZ Z ZT - II MiiLSIhIC6ES MiiL0i6Toh8S iE6'Z9 1ZE'19 MnZ0lt% l9S 1101000Sh 100'08 'Pa 01-6 M L0 6h8S h 6ZILSo6hN 10E'66Z 198'ZST 311 Zh1TSoZZS 118E1iZohTZ 100'08 'Pd 6-8 h 6Z1CS06?N MueI16hoSON 188'LL 1h8'hL 3u801']OoZZN nZhi9hoSS 100'08 E 6-8 MiiLO16iohe S MAI16h090N 161'LLE 100'EII hCOiS%OSS r10Z18000LZ 100'08 'P2 6-8 Mi1EIi6h0SON h LS1h106EN 1E6'Z9 1ZE'T9 3r1Z91Zh09TN 11011h009h 100'08 E 8-L h90 E z SS 311FE1TTOZLS 16T'6L 1T8'8L 3uS'61iLZ'0Z9S uLZ18Z06T 100'EEZ E 9-S !S 3110ZiE0000N 181'8Eh i1h'9LE 3,,S'ESISSOESN i,LO,S70LOI i00'EEZ 'Pa 7'E 3iN 'E,0CN 34010%Cl]N 9Z'9SI Z9'OS1 3A0 iTS09ZN 1i0h19E0ES 100'[91 'Pb Z-1 9NIdV36 9NI8V38 H19N31 H19N31 9NI8V38 31ONV H19N31 'ON 'ON 1N39NV! 1N39NV1 38V 080HO 080HO 1VE N30 SM OV8 101 3A8n3 Vida ]Ann i CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 11, and in part of the SW4 of the NW4 of Section 12, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. I r_ ' Imo' J s~ro °o N CD 01) CO co \ N -I O or W r, 0 I~ Lw \t\7\ o N \ I r CrJ ~`rcA \ m rt co d rt LOT 3 _ ~2.19 Acres CO 95,187 Sq. Ft. v / ort rt ~ N S720 PROVED 1~ ~ I ~ ~ 266.6 1 3 1?0 1j~33~~f Rp N,q \ 39p• 00~ \ \ 5 \ \ r:, !b 33 / s S•i . CRtUIX COUNTY 11'33uW OED/CqT io ~1p:ehe~~sivo Plartnir 90.001 FD , co s (v 2ar,i; and -240.001 ,~'r h^ r~rks Committee 7 Is ~ rt T0\ 0-y If not rccarddii m a NSOoys, co vaiGlin 3C7 days bf Q 3~~W 14 \ C~ ti approval date m p~ 0.0 m © i3 ' . Ir approval 5ha11'be ° M (n r zo 2 \ • nl#l & void It 12 N z OWNER a F F ~ LOT 2 Sam Miller M P.O. Box 282 a 2.66 Acres Hudson, Wi. d 116,077 Sq. Ft. 54016 s L w t c:- o o? N 61111 O SCALE IN FEET S850151 52"W 100 50 0 100 200 115.81 <i ~Y/SHEET 3 of 3 SHEETS VOLUME 10 PAGE 2830 O£sZ af)Va OT rBM'lOA agsa x1910 'qja Wiv, r TOf •papog uMoy uospnH 9144 Aq panoaddp sz dpw dananS paT~t~xa~ sit; jptjj d3Tgjao Agaaaq I alvo I lq it IHO NOSQIIH 30 NMO,L I M r'~i• ~~•y M v 10~ .T 1p~ 41 aaTdxa OTSSiwwob AN UisuoosT ~ yrrrr ' OT Tgnd ,Cipgou ,awes 9t;*4 pabpaTMOUNOp pup quawnigsuT butobaao; atg4 pagnoaxa ot4M suosaad atgq aq of uMoux aw 04 IQ T T tw wes pawpu anogp aqq 6T go AppV sitT4 aw aao;aq awpo ATTpuos-19a c (XTOID •qS go Aqunoo SS ( utsuoasTM ;o 94vgs 2911TH WES ssau.iM i :;o aouasaad.ag4 uI .T6T go Xpp-r sTT44 29UMO pips go Tpas pup puptI aq4 993NLIM •uospnH go uMoy aq4 pup aaggTwwoo juawdoTanac pup buiuupTd dqunoo xioao •4S :uoT4o9Cgo aO Tpnoaddp jo; buTmoTTo; aqq of p944zwgns aq of ZT'9£ZS 20 OT'9£ZS Aq p9aTnbaa ST dpw AananS pai;T4jaO site 4puq 4;t4aao OGIR I •dpw AananS patgigaa0 aqq uo paquasaidal sp pa4potpap pup paddpw 'paptnzp 'padanans aq o4 deli Xanans p9z;i4aaO sit;-4 uo pagTaosap pupT aq4 pasnpo I 4eg4 d;t4aao Agaiaq I 'iauMo sV NOIILKOIQHQ 30 3ZEIOI3Ilaso S,ZIHNMO •aOinpp 10; papog uMoy ajeTadolddp pup aat;;0 butuoZ Aqunoo xtoao •qs aq4 goe4uoo Taoapd Cup buzdoTanap :zo buTsegoand aao;ag •(•aqa 'Taoapd oq ssaoap 'azis 401 wnwiuiw 'spupT4aM '•a•i) suoTgelnbaa pup saTni 'smeT digsuMos pup A4unoo 'age4s oq 4oalgns sT dew stt;4 uo uMOtjs T901pd uapg FILED 12 0 C T 1 7 1994 g JAMES O'CONNELL Register of Deeds 522546 St Croix Co,, WI -A W CERTIFIED SURVEY MAP Located in part of the SEa of the NEQ of Section 11, and in part of the SA- of the NWa of Section 12, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. OWNER N t'-'Elt'"PROvE Sam Miller P.O. Box 282 N W co M c° r d Hudson, Wi. 0 -1 o 0CI'll 7.;944 ! 54016 - =ra O M N O = O W N ST. CROIX COUNTY y co -3 0 (D ~)mprehensive Piamir SEE SHEET 2 o Zoning and MATCH LINE rt P.-,rks Cornmittee O 18 a If not recorded rt o N 0 ° within 30!days motif / w m ro approval fate approvai'shall` e d 0 ° nc41 & void Cr J, 3 % J ,o , r . 00 P o AL D~0 1~ ^ O OGO C'~~~~1 13 0 o Co L) VARIABLE p- ; N % o Np RIGHT OF~ WAY o n S89 30 00 W S89 30 00 W 2i S89°30' 00"W east-west 1/4 line E} Corner 3942.19' zwi 9 9 , 0 0 , of Section 11 1212.32' Section 11 Corner Section 11 VARIABLE RIGHT-of-WAY U L,J C VL e rSCALE IN FEET SHEET 1 of 3 SHEETS 100 50 0 100 200 VOLUME 10 PAGE 2830 OE8Z H0Vd of HNn'IOA •awps buiddsuc pus 6UTA9Aans uT xToaD •3S 3o d3uno0 ag3 3o 9OURUTpa0 UOTSTATpgns puRq 9743 pup se4n3e3S uTsuoosTM aL3 3o pZ-9£Z aa3de74o 3o SUOTSTAOad 3uaaano ag3 g3TM paTj4woo Alln3 9Ae74 13pg3 !pagTaosap pup paA9Aans daepunoq aoTaa3xa ag3 3o ajeos o3 uoT3e3uas9id9i 3092aoo a sT deli A9Aans p9T3T3a90 sTg3 3pg3 A3T3a90 Osjp I •paoo9a.3o s3uawast?a IIp'o3,goa[gns ST jaoved pagT.zosap anogv uruur aq 3o 3uro ag3 03 3993 E8'tbT 9Aana pTes 3o oag ag3 buojp Alaagqnos aouag3 :3993 vE'OtT saanseaw pue M„LT,6ipo8ZS sapaq pao74o aso74M '„9Z,TVo6V saanseew ajbup jpa3u90 9SO74M 'Ajaa3sp9 anpouoo 'aAano snTpe.z 3003 00'L9T e 3o aan3eAano 3o 3uTod ag3 03 3993 LT'Z6T 'M„OO,O'voESS aouat13 :3aa3 ZO'8TZ 'aAano pips 3o o.ze ag3 buojp 'djaa743nos aOU9743 :3993 ST'OTZ sainseaw pup M„OV,TSo9ZS sapaq paotjo aso74M '„Oj,,gCoES saanspaw 916up jpa3u9o aso74M 'Aja9gS9M 9APOU00 'aAano snTpea 3oo3 00'EEZ a 3o aan4gAano 3o 3uTod ag3 o3 3aa3 00'98£ 'M„OO,OEo68S aou9g3 :3993 tZ'OtZ 'M„80,ttobON aOu9743 :3aa3 T8'STT 'M„ZS,STo98S aoua743 :3993 Z6'OTt 'M„EO,Lto8ZS 9aua743 :3aa3 9S'VC 'OAano pips 3o oap atj3 buojp Ajaa3spe aouag3 f4aag ZS-VC sainseaw pup S„S'TO►8So9SS saeaq pao74o aso74M '„TS,6Zo80 saanseaw ajbup jpa3uao aso74M '•djaa743.7ou•anpOuoO 'aAano snTpea 3oo3 00'EEZ p 3o aangRAano 3o 3uTod 9743 o3 3993 69'tp9T 'M„L9,tTo6ES 9ou9g3 :3993 E6'Z9 '9Aano pies 3o Dip ag3 buojp Aliag3nos aouag3 :3aa3 ZE'T9 seanseaw pup M„ZO,L:VoT9S SIRaq pio74o asogM '„OT,YvOoSV saanseew 9jbup jpa3ua0 9so74M 'djaa743nos QA9OUOO '9Aano snTpeJ 3oo3 00'08 a 3o aan3eAano 3o 3uTod ag3 o3 3aa3 OE-66Z aAano pTps 3o oag ag3 buojp Alia743nos aouag3 ;3aa3 98'ZST saanspew pup S„Z~,TSoZZS sapaq pI'O740 9s074M „8E,TZotTZ sainspew ajbup jpi3ua0 aso74M 'dja93s9mtj3nos 9Avouo.o 'OAano snTpea 3003 00'08 a 3o aan3eAino 3o 3uTod ag3 o3 3aa3 T8'8SV 'H„T£,ZOoOts aouag3 :3aa3 ZL'T8t, '21„OZ,£Oo00N aouag3 :3a93 £9'99Z 'S,;££,TToZLS 90uag3 :3993 8T'8£b aAano pies 3o oap ag3 buoje Alaa3spa aouag3 :3aa3 Tt'9LE sainspew pup S„S'£S,SSo£SN sapaq pao74o asogM '„LO,SVoLOT sainspaw ajbue jpaquao asogM 'djaa743nos ane0U00''aAano snTpez ,00'EEZ e 3o aan3eA2no 3o 3uTod 9g3 o3 3993 LT'6LT 'S„OZ,£Oo00N 9ou9g3 :3993 9Z'99T aAano pTps 3o oag 9g3 buojp d119743.Ou 90u9g3 :39a3 Z9'09T saanspew pup 2„Ob,TSo9ZN saeaq pao74o aso74M '„Ob,9Eo£c, saanseaw ajbup jpa3u9a 9so74M 'dj193s8M aneauo0 '9Aano snTppj 3003 00'L9T e 3o aanj?Aano 3o 3uTod 91q3 o3 39a3 Ob'OSE 'S„OO,Obo£SN 90749743 :39a3 bZ'£8 '2„OZ,£Oo00N aou9g3 :39a3 00'66 'auTj 3saM - 3se9 pTps buoje 'M„00,0£o68S buTnuT3uoo 90ua743 uruUT aq jo 3uro ag3 03 3993 Z£'ZTZT 'uOT309s ptes 3o auTj b/T 3s9m - 3sp9 ag3 buoje 'M„00,0Eo68S 9ou9g3 :TT UOT309S 30 aau'o0 t/TS 9q4 3e buTOUawwoO :sMojjo3 sp pagTIOsap zag3an3 .UTSUOOSTM '~qunoo xTOaO •39 'uospnH 30 uMOs 'M6T8 N6Z,L UT jje 'ZT uOT30aS 3o b/TMN ag3 3O t/TMS ag3 3o 3ved uT pup 'TT UOT309S 3o b/TSN ag3 30 t/TSS 9g3 3o 3apd uT pa3pooj puej 3o jaoaed V :sMOjj03.se pagT-'asap sT paddpw pup padaAans jaozed puej ag3 3o Aippunoq aoTa93xa ag3 3eg3 :dPW AaAinS paT3T3190 sT743 Aq pa3uasaidaa sT goT74M jaoapd puej 9g3 paddpw pup pagTJOsap 'paAaAans 9ne74 I '2911Tw lips 3o UOT3091TP 91q3 Aq 3eg3 'A3T3a9o Agaiaq 'zodaAans pupa uTSUOOSTM p9a93sTbal 'uabegdN •O uajj'i 'I 21V0IALLUSO S , HOX2AHfIS STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUY I R -L A /rl 111114F-le- MAILING ADDRESS f: r)I' g 2._,., H o l) sQ W l- --s- Y0~ (0 PROPERTY ADDRESS G ll' N 1 N o~so 4 u Z a (location of septic system) Please obtain from the Planning Dept. CITY/STATE W:177~ PROPERTY LOCATION 1/4, NF,._ 1/4, Section T N-R TOWN OF VL)Z So N ST. CROIX COUNTY, WI SUBDIVISION T-A YN? R / .I) fb E LOT NUMBER CERTIFIED SURVEY MAP SZZV(o, VOLUME O , PAGE 2a3l~ OT 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, joumeyman 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. [[We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St Croix County Zoning Officer within 30 days of the three year expiration date 4.1 D SIGNED. St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, AV'I 54016 11/93 1 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 5 A 1/1'1 (K ( L 1- -F- (2_ Location of property 5LE 1/4 NJ5 1/4, Section I/ T21 N-R_ Township 1+0A)-<'6 Mailing address .$oX # 2 ~Z- I tf yl)soN L-0 rya/,6 Address of site t/o ('0 -t TAKN r I-ANE 4-) S O N = fyp Subdivision name TX K Illy X l DG E Lot no. Other homes on property? Yes J~ No Previous owner of property e f h.0 Y S yet Ar Total size of property -2t Total size of parcel Z, Q /~l Date parcel was created 4 - / -9 3 Are all corners and lot lines identifiable?/( Yes No Is this property being developed for (spec house)? ot-' Yes No Volume 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 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. S'-D 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. sa ~g ss-Si nature o Applicant ' Co-Applicant (5 / Date of Siqnature natP cif sinnatiira DOCUMENT NO. STATE BA F WISCONSI ORM 1-1982 THIS ar ACI Rg3lRV[D FOR RECORDING DATA " ARRANTy D YO 504855 v _L 1031pia 456 r:_CISTE_R'S qIRC This Deed, made between Randall W. Synan and Patricia E. Synan, ,'tbrReohusband and- wife - ~ Grantor, SEP 1' ` and .-Sam E. M31ler,a sngl -e person 10.45 A. M . . - . Grantee. R-^IS*V d Des" t witllesSeth, That the said Grantor, fqr a valuable consideration--..-. L Randall W. Sxnan and Patrlcia_ E. Syrian conveys to Grantee the following described real estate in ---St . CrOI RaruRN To County, State of Wisconsin: :i fi 1 Tax Parcel No: The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of s NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. Fri AND '.i A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the Ai E1/4 corner of said Section 11; thence S89 3010011W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of Beginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence S00 28103"E, 500.00 feet; thence N8q 30100"E, 44 along the North line of Certified Survey Map filed in Vol. "3", Page 722r 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58'34"E, 351.07 feet to the point of beginning. This _-........11L.AQ-t... homestead property. (is) (is not) Together with all and singular the hereditament& and appurtenances thereunto belonging; And . 13?ias ~ W. Synanand Patricia _ E Synan . . warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. w and will warrant and defend the same. Dated this 03.'............................ day of AUgUSt-....................................... 19..9.1. (SEAL) ~O~LF.t~lv.C6. !h!~.............................. (SEAL) } Randall W. Synan a Patricia Synan . . . . ef,~ (SEAL) - (SEAL) i i t. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN s - - - - St. Croix. Countya& authenticated this day of 19 Personally came before me '31 4-1 of a I August , 19. . the above named 41 1 i r-------------•------ Randall W. Synan, Patricia E. TITLE: MEMBER STATE BAR OF WISCONSIN Synan (If not. ~~{Cl- ~-~OMO~S authorized by 4 906.06, Wis. State) A~,. I~ to me known to be the person $-...---Iyawy. 4'the going instru nt and a n wle~fte*M&CaDJIM THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland y 0 ors Jo a AE carnep a t T;aW Alice at o- . Notary Public - ..-County, Wis. rY (Signatures may be authenticated or acknowledged. Both My Commission is permanent. f not, state exp' ation ' are not necessary.) - la-77.) '.r date- ----'Names of persons signing in any capacity should br typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Loral Blank Co. Ina FORM Ns. 1- 1982 Milwaukee. Wis.