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HomeMy WebLinkAbout020-1011-60-300 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S A M M 1 ,L1-C ►2. ADDRESS- C1 e> X -2- £s SUBDIVISION/ CSM b GC-- S J" LOT # SECTION TAN-R / , own of /-(U DSo N ST. CROIX COUNTY, WISCONSIN PLAN VIEW ~l SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A Nit " oh At , z M w .w,M.-►~P,ac cI. _ rev ©v' S S b R l v e w N Y _ 1b sv')r r=' Q, y ~ l i I IZo ADy S E- I tiJ I I I ly'Al : As o~ 11;o-fy A~ RTH ARROW INDICATE NO ,Provide setback and elevation information on reverse of this fOrm- Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: l o P o~ P/ P0 I77Al k) ele-a ~ /D~~C~ ~ ~•~2 ALTERNATE BM: I EPTIC_T=KK~)( PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: J Oc)4n Setback from: Well House Other k, Pump: Manufacturer Model#- Size' Float seperation T--------- Gallons/cycle Alarm Location -:SOIL ABSORPTION SYSTEM Width: S` Length Coo , Number of trenches -Distance--&-Di_rectian--to-nea-r-est prop-. 13ne: / L4Jc -sT Setback from: well: 1 2-D House g~ Other 91s S 7 9r ~3 ~ ELEVATIONS Building Sewer ST Inlet. ST outlet? s• S~ PC inlet PC bottom Pump Off Header/Manifold674::9.5 Bottom of system 07 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: U ~ INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lab'orand 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 o : State PI . MILLER, SAM CST BM Elev-: Insp BM Elev.: BM Description: littelsen Parcel Tax No.: 'I A TANK INFORMATION ELEVATION DATA //-3:;) TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic UJrP ~.critC G~) Benchmark Dosi n CJ/ ,1 / o . / Aeration Bldg. Sewer Holdin St//W Inlet 3,05' ' A2 TANK SETBACK INFORMATION St/ Outlet 6-1, j/ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic A_ NA Dt Bottom Dosi n A Header / Man. 9 03 Aeration NA Dist. Pipe s , Z ! X9.9 Holding Bot. System 07" PUMP/ SIPHON INFORMATION Final Grade <_13 , Manuf cturer Dema d 0, 7 Qr/ 99 Model Number GPM TDH Li Lriction System TDH Ft oss Dia. Fi Dist. To well Forcemain Length SOIL ABSORPTION SYSTEM BED/TRENCH Width i I Length No. Of Trenches PIT Inside Dia. Liquid Depth DIMENSION ( oa ::Z- I DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING M u act r: INFORMATION TypeO )jt,L , Ce If a CHA Mo a Num er: System: -1,-t ~?X / ~ / /~A- OR UMBE 57 DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe (5) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length S7 Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra stems Depth Over Ca) Depth Ove 3 xx Depth Of xx Seeded/ Sodded xx Mu C aSo-Trench Center -Q9241-rench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson-11.29.19W, SE, NE, Lot 3, Tanny Lane o Plan revision required? ❑ Yes 93-WO Use other side for additional information. O 9 SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i ; :SANITARY PERMIT APPLICATION r`'~'I~~■i In accord with ILHR 83.05, Wis. Adm. Code CQU!AY ZI: STATE SANITA Y P, MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 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 SA LL,62 5C '/a E '/4, S T2-I, N, R / 9 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # All CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER O-So/a' c u.r S o /G 3 y~ z -rAHiV Y -10 if. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned O VILLAGE : So T~NA1y L IV 1Q, TOWO OF: ❑ Public ~Rl 1 or 2 Fam. Dwelling- # of bedrooms3 ARCEL AX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) -4: ®'LO 3 06 1 ❑ ApVCondo 20 Assembly Hall 60 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) 1. IX New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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-Pressurized 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 JLEV. 7. FINAL GRADE /'y REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) A) W-00 LEoV~ATION IJ ~~Sa g ~l%oa~ Feet L,00 Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank / l W6 1.510 2-F1 p Lift Pump Tank/Si hon Chamber 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: (No Stamps) MP/MPRSW No.: Business Phone Number: Dove STP-a# ZSFelX f =f"~3Z z y7 3433 Plumber's Address (Street, City, State, Zip Code): r1p C> Z- /YEW R/c/, of fo Cv~ s d 7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater 77te'I ssue mg t sign re (No ps Approved I ❑ Owner Given initial ' ~ Surcharge Fee) ! r 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. 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 mush 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) SA~'I M/ZL SW 2-441Ny 73 ,nl1, 1 o P of 1" f /tar NVV Co2NERtt= /040,g)o' t t N II I ~ o J 1 G ~AP 5 CALF) , l NoL7N ~ ~ 's/ P Is-CA; -r nor 3 Tg~ ` It, t i La[ - AE SIf i i ~7 ofC,f6E ARi vE w~Y r~ I .o s 1 t~ 3s' 7D w F I L i t ~ i /vG i i~o'fi Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Ffuman Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % 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 PROPERTY 0 NER: PROPERTY LOCATION Q ' f ML- L&,E $O>i .itw- j,L 1/4 N Lf- 1/4,S T ZC N,R I E (or) W P IOsPE OWNER':S MAILING ADDRESS LOT # BLOCK # SU . NAME OR CSM # CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VI GE OWN NEAREST ROAD u ®~vQ~ 590 ( ).<o,.~ `TA IA~lr f9~ New Construction Use [P(] Residential / Number of bedrooms 3 Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0.1 bed, gpd/ft2 O•Z trench, gpd/ft2 Absorption area required & 4< bed, ft2 5 C< trench, ft2 Maximum design loading rate t7.7 bed, gpd/ft2 a• 1~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ®rl Ne c:3 o F 3 ft (as referred to site plan benchmark) Additional design/ site considerations `TAE NCUES 14I4.14tV gcoftlmQ--~JdE N Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL ND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING K U=Unsuitable for system ®S ❑ U S❑ U W S ❑ U R S ❑ U S❑ L [3 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 Trench 13 A 0-9 , S Z/6 L ~ r A~ C S Z M 0q 671. ~.~5 8j PL-53 I& P, 4 14- J'fa S f 2). 7 Ground 3 !U yep S 4/7 I t elev. 95; ft. Depth to limiting actor . for Remarks: Boring # l q -r Ct- rn C s 2 m n ©._3 o e, 13, 6? 16"1 k 4-1 In. Qr M l I l E 9-2 3 V,3-IZ4 9r 3 S d t'h~ Dg Ground lev. ft. %1 Depth to limiting factoQr~ > J0,3~ Remarks: CST Name: Please Print y 30 NNSn Phone: :3&6- TA p~:o Address: U ~~(>>J W / S40 / t; Signature Date: /c) 7Z2 4 CST Number:34~'4 ~Qer, PROP~RTYOWNM -S M1atf, SOIL DESCRIPTION REPORT Page? of PARCEL I.b. # L Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0-17- .S 6 S< ® r /h w Z t1 0 5 $ Pz-40116 / w , YR 4 4 :5 ~ r n'1 Ground 3 r N7 / d 4 elev q9.s~ ft. - Depth to limiting fact >9j7- Remarks: Boring # A6 0-1'Z 7sY -Z S r n,I CL'i 2/11 03 d-6 ILI 4 14 Q, ~-F al 0. pz 7-a/ d 5 rh l 0.7 Ground elev. 93:~C' ft. Depth to limiting factor ? 1®~ Remarks: Boring # o-il 7s YA n, c 2 ,-7 0S S 8, I9-43 0#e 4/f A w - ,710% Ground 3" /0 s S ~ r ~ ~ Jt 7 `T7 f ft. Depth to limiting factor >9, 3 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) • e r I V o~T1.1 r~ PAt-,E 3 eF 3 L 4- n~ r , Fi ~LE\-A i0r6 0 n(~ f\ T k -694 00)(12.06YO r ~ i o~c ~ sOc~rN -~91.ooXQ9.o0~~~.aov] cw NS '3 T# tu , I ~ t T7 I i, C, -S M i g a i Q RK a i If it f M~ CY) ~ a 0 1~ I ~I r \O ' V kl O O d M I i 9- A po Od o v ~ ~ o ~ .Q ~ I ~ =tr ~ d d I Oa r W W r u I ,I -lam I - W QA4 Y, I A- I AZ/ FILED Q C T 1 7 1994 r C~ JAMES O'CONNELL Register of Deeds ~~25 6 St, Croix Co,, WI -PA W CERTIFIED SURVEY MAP Located in part of the SE4 of the NEQ 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. OWNER N APPROVE Sam Miller P.O. Box 282 Cn . • CO co ° Hudson, Wi. c° r m w° r' AEI i~ 941 54016 C2 " =Lo o M N 0 o m CD ST. CROIX COUNT' CD y ; . ~xnprahensive Plarhnir SEE SHEET 2 Zoning and o MATCH LINE 0 F-rks committee 0 18 / / rt a rt 11 not rocordc3d N within 30 days of 'D (0 c rt r y approval datb rr a w approval'shall`be /r mar/ a o n►►11 A void c s c,Vj i Jr m 0) N rt 1 r / r ~j / 19 0 C) o CD / CO w VARIABLE r N / o ~ o RIGHT- OF[ WAY / S89°30' 00"W S89 30 0011W _ 2f S8 90301 00"W east-west 1/4 line Ej Corner 3942.19' 99 , 00 , of Section 11 1212.32' Section 11 W} Corner Section 11 VARIABLE RIGHT-of-WAY ' L~J SCALE IN FEET SHEET 1 of 3 SHEETS 100 50 0 100 200 VOLUME 10 PAGE 2830 0£8Z S9Vd OT HM70A • auiss buTddgw pug 6UTAGAanS uT xToaD •3S 3o A3uno0 aq3 3o 9OUguip20 UOTSTATpgnS pueq ag3 pug sa3n3g3S uisuoostM aq3 3o tE'9£Z -793dggO 3o SuoTSTAOid 3uaaan0 91q3 gjTm paiTduwoo ATTn3 angq I gggj :pagTaosap pug padanans Xzgpunoq aotaa3xa 9g3 3o 6TROs o3 uoTgvquasaadaa gaaaaoo g si dvN AOAans p9i;Tja9o sZg3 4gga A3FlaaO osTg I • p-70091. 3o s3uaw9'sta Ile '03, 3Oa[gns si Taoaed pagTaosap anogV uruur eq go 3uro 9g3 04 3999 E8*tVT 9Aan6 pigs 3o oag 9q3 buole ATaag3nos 9au9g3 :3aa3 t,E'ObT saansgaw pug M„LT,6tro.8ZS sagaq paogo asogM '„9Z,Tbo6V sa.znsgaw 916ug IEI3u90 asogM 'AI2QjSg99AROUOO 'aAino sntpga 3003 00'L9T g 3o aan4gAano 30 3utod aqq o3 3993 LT'Z6T 'M„OO,O:~oESS aouau3 :3993 ZO'8TZ 'aAano pigs 3o aag aq3 buolu 1dTa9g4noS 90uag3 :3993 ST'OTZ saansgaw pug M„OtF,T9o9ZS saeaq paogo asogM '„0V,9£oCS saansgaui aTbug Tga3ua0 asogM 'Ala9lSOM 9APOu00 'aAano snipga goo3 00'£EZ g 3o aan3gAan0 3o 3uzod aq4 o3 3aa3 00'S8£ 1M„00,0£o68S 90119143 :3993 VZ'OVZ 'M„80,VboVON 90ua143 :3983 T8'STT 'M„Z9,SToS8S 9Ou9g3 3993 Z6'OTV 'M„£O,Ltpo8ZS a0uag3 :3993 9S•VE '9Aano pigs 3o oat aq3 buotg Alaa3sga aouag3 :3993 ZS'V£ saansgaui pug S„S'TO,89o9SS sagaq paogo asogM '„TS,6Zo80 sainsraw aTbug Tga3uao asogM 1.ATx91q3aou• 9AgOuoo 'aAano snipea 3oo3 00'EEZ g 3o aan4RAano 3o 3uiod ag3 o3 3993 69'b9T 'M„L9,6To6£S 80uag3 :3a93 E6'Z9 'aAano pass 3o oat aq3 buole ATaag4nos aouag3 4993 ZE'T9 s9ansgaw pug M„ZO,LboT9S sagaq paogO asogM '„OT,bOost saansgaw aTbug Tga3uao asogM 'Aliag3nos OAROUOO '9AInO snipga 3003 00'08 9 3o 9.zngEAan0 3o 3uTod aq3 o3 3aa3 OE-66Z anano pigs 3o Oig aq3 buoTg Alaag3nos aauag3 :3aa3 98'ZS1 saansgaw pug 2„Zfi,T9oZLS sagaq pa,ogo asogM `„8E,TZotFTZ saansgaw ajbug Tga3ua0 asogM 1ATa9gs9mg3nos 9Au0u0.0 'aAano snipga 3oo3 00'08 g 3o aan4RAano 30 3utod aq3 o3 39a3 T8'8SV '2„T£,ZOoOVS 90uag3 :3a93 ZL'T8i, '21„OZ,£Oo00N 90u9143 :3993 £9'99Z 'S,;££,TToZLS a0u8141 :3993 8T•8E'V 9Aano pigs 30 OJR 9q3 buOT9 A1294sg9 aauagq :3aa3 TV'9L£ sainsgaw pug S„5 £5,S5o£SN sagaq paog0 asogM '„LO,SVoLOT sainsraw aTbus Tgaqua0 asogM 'dTaag3nos ang0uoa'1anan0 snzPei 100'EEZ g 30 aanq?Ajno 3o 3uzod aq3 oq 4999 LT'6LT '2„OZ,EOo00N 9Ou9g3 '49a3 9Z'99T 9Aano pigs 3o Oag aq3 buoTg ATaag4aou 90uag3 :gaa3 Z9'05T saansgaw pug S„OV, TS o9ZN savaq paoga asogM ' „Ot,, 9£ oES sa znsgaw 916ug Tga3u90 asogM 'A1194S8M OAROU.oO 'OAano snzp.ga 4003 00'L9T g 3o aangRAano 3o quiod aq3 o3 g9a3 OV'OSE 'S„OO,Obo£SN aouag3 :39a3 bZ'£8 1211OZ,£Oo00N a0u9g3 :39a3 00'66 'auTT 3s9m - 3sga pegs buOIR 'M„OO,OEo68S butnu*r3uoo aouag3 uruur aq go 3uro aq3 04 4993 ZE'ZTZT 'uoi309s pegs 3o 9uTT V/T 3s9m - 3s9a aq3 buOIB 'M„00,OEo68S aauag3 :TT uoi309S 30 a9u4OO T,/TS 9143 4e 6uTOu9wwOD :sMotTo3 se pagTaosap aeg3jn3 ;uTsuoosTM 'A3unoo xToaO •3S 'uospnH•3o uMOL 'M6TE 'N6ZS ut tig 'ZT uOT409S 3o y/TMN 9q4 30 V/TMS aq' go 3aed uT pug 'TT uOT309S 3o V/TSN 9143 30 b/TZS 9143 3o gaed ui pa3gooT puvl 3o Taoagd V :sMOTTo3,sg pagTaosap si paddgw pug padaA;tns Taoxed pugs aqq 3o Aispunoq aoTa93x9 9q3 ggg3 :dgW AaAans pai3T3a9o sTg3 dq pa3uaseadea ST gOTgM lamed pugT aq3 paddgw pug pagTaosap 'PaA9Aans angq I '2911.TW wgs 3 . o uOTj09aTP aq3 Aq 3gqq X3igaa0 . Agaaaq 'aodaAjns pug? uisuoOSTM P9194ST69J 'uabggdN '0 u9TTV 'I SIVOIS NHO S , HOXSAHLIS CERTIFIED SURVEY MAP Located in part of the SE k of the NE k 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 y co LEGEND co d Aluminum County Section Monument Found Rv <y oo ~ y O 1" x 2411 Iron Pie Set weighing 1.68 o w lbs, per linear foot N fD a• m 501 Roadway S etback Line ~~„I~, r N - - - 121 Utility Easement d M. N O a s CD m a rt w O N rt ~ I L A'11 a - - rt --1 O 7• S720 11 , 3 _ AVeC HE - 26 M , - 63, -39 001, I1133nlV ro , U I~~/ 33 / / %.~1._...• 150.001 390:00,y H ti~ -h rr Ji O I CL 1AJ -n c_+ r` _D' - ' LOT I F i3 LLJ 3Q Q 17 °o, co (yj m m C.- p o0 2.69 Acres x = z o o 111,233 Sq. Ft. r o p I - I cr, H ~t O z 0 0 l0 O ,E Cr1 r 1 w 616 c L~ - v ~1 N I I - O Q co PPRO d ED C17 Q - Nr 17..:'94; 2 S.8903000"W 385.00 MATCH LINE 5'•,' • CROIX COUNTY SEE SHEET 1 ---irehensi•:e Plannir OWNER Zor&,g and Sam Miller i--7ks Committee P.O. Box 282 Hudson, Wi. it rat rocorded 54016 within 30 days of approval date ,pproval shall lie nt~dt void SCALE IN FEET 100 50 0 100 200 SHEET 2 of 3 SHEETS VOLUME 10 PAGE 2830 , 0IE8Z HOW OT aWR'I0e M1i7E18S0EOs Mu0010hoESS 1CO'h T 1hEMnL116h08ZS u9Z11h063 100L9l PN TZ-OZ M11001070ESS MnOd1£Oo00S 1ZO'8TZ 1ST'OTZ M1101TS09Z$ u0h19E0£S 100'EEZ Pb 61-81 M110Z1E0000S Mii££iIToZLN 190'hTE 16L'69Z M1i5'ES1SSp£SS uLOiShOLOi i00'L9T I LT-91 MuEE1TToZLN MuCOISh609N 10S'Z9 1£T'Z9 Mn8T18Z019N 110E19ZOTZ 100'L9T Z ST-ti Mn£01Sh00SN Mu90iChOZSN 100'8 100'8 MuS'hOihhOTSN IICO189010 100'EEZ Z ET-11 MiiM SV00SN MuL51Zi0T9N 19S'Zh 105'Zh M110016SoSSN uhS1LZo0T 100'EEZ Z ZT 3A0 i E7oZSS 3uLS1Z1019S 19S'h£ 1ZS'hE 31iS'T018So95S uIS16Z080 100'EEZ Z ZI - II MiiLSihTC,6£S MnL016108S 1E6'Z9 iZ£'T9 MnM LhoT9S 11011h00sh 100'08 P8 01-6 MnL0i610178S 3u6Z1LS06hN 10£'66Z 198'ZST 311ZM SoZZS 118E1TZohlz 100'08 P8 6-8 3n6Z1LS06'7N MAIi6,hoSON 188'LL 1h8'hL I.Mi1 0oZZN nZh19 99 100'09 £ 6-8 MnL016lohH MnET16h090N" 161'LLE 100'EiI 3uE01Sho05S u0Z1800OLZ 100'08 P8 6-8 MuET16h0SON h LS1hT06EN 1E6'Z9 1ZE'19. IiM Zh091N 11011h005h 100'08 E 8-L 3n9M1 0ZSS 3u££1TToZLS 16l'6L 1T8'8L 3uS'611LZ'oZ9S uLZ18Z061 100'EEZ E 9-9 3ACill oZLS h0Z1£Oo00N 181'8Eh 1Th'9LE 3,G'£S1SSOCSN uL01Sh0L0l 100 'CH P..a h-E 3u0Z1E00OON 3u0010hOCSN 1'9Z'991 1Z9'OST IiO M S09ZN nOh19Eo£S 100L9T Pa Z-T 9NIaV30 9NI8V38 H19N31 H19N31 9NIHV39 319NV HION31 'ON 'ON 1N39NV1 1N39NV1 08V WHO 080HO 1VEN30 SMOV8 101 h8n0 Vida lA no CERTIFIED SURVEY MAP Located in part of the SE4 of the NE4 of Section 11, and in part of the SW 4 of the NW k of Section 12, all in T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. I t= I s~o N f °0 IJ co C:) en co m w r r• O \t o m H N Z --3i CD 0 CD If 1> ct* -h o :3 (D 7 ICJ " d~ LOT C re 2.19 Acres CO / 95,187 Sq. Ft. a J o y M _ \ d 7 N PROVED 2 11 ~3 66 ti w '63, S'7?°~ 0~f1:7'94 4, 2 . ~ 1 1331i ~F J R04Q~ 3g0.0123.3ji~ of N7 01 0f _5 Cht~1X COUNTY 1'33nw •io ;;.!;i~!•rhe~siv©'Plarcrtir ' . 390.0 2oni,.g and O.Op, 0 ?4 Fmarks Committee ~ 15 5 TO N oti rot rc4cor ddd m so n N50°4S, !o WiViin 30~days;of N x Sp.OQ3" W ! ti approval date = i 13 approval'5hSIIt re a C) 12 nail a void OWNER F Q LOT 2 Sam Miller M P.O. Box 282 a 2.66 Acres Hudson, Wi. 116,077 Sq. Ft. 54016 g w C w v- <J O o Otiy J/ o o o ° N (0 cb , O SCALE IN FEET Ed= n S85015152 '~W 100 50 0 100 200 115.81 SHEET 3 of 3 SHEETS VOLUME 10 PAGE 2830 a 0£8Z S9Vd OT MM IOA a-4 pQ a 10 ` 4aa Fl r • papog uMos uospng aq4 Xq panoadde sT dew XaAans p9ijTgz9o sTg4 gegq 4JTga9O Xgaaaq I HIND I A 11HRO mosanH 30 NMOZ 1,1 JO Oki, e0i n d U iy S v4 ' o N,.. r v aaTdxa OTssTunuoz) AN uTSUOOST 'oTTgnd Xjegou auras aq4 pabpaTMOuXOE pup quawnagsuT buTobaao; auq pagnoaxa oqM suos.zad auq aq o4 uMou){ aW 04 10T T TY4 weS pameU anogp aqq 71- L 6T go Xepv sTgq aw ajo;aq auzpo XT Teuosaad c (xT010 *Is go Xqunoo SS ( uTsuoosTM go 94egS ae T T TW ores ssau TM e-V r To aouasaad aT4q uI '7T6T go Xpp'z' sTgq aauMo pTps go leas pup pupa aqq SSSNSIM •uospnH 90 uMOs auj .pue aaggTwwoo quawdOTanaa pue butuueTd Xqunoa xioao •qS :uOT4091go 20 TpnOadde ao; 6UTMO1103 euq of pajgTuigns aq of ZT'9£ZS .10 0T'9£ZS Xq palTnbaz ST dew XaAinS PaT;TgaGD sTg4 4pu4 X;T4a9O osly I •deN XaAans paT;TI200 aql uo paquasaidaa sp pageotpap pue paddew 'papTATp 'paXaAans aq of dRK XaAanS paT;Tgaao sTgq uo pagTaOsap pueT aqq pasneo I IRg4 XgT4aao Xgaaau I 'aauMo sv NOIZfloiazQ do SZKDIAI Luzo S'?I3NM0 'OOTnpp .ZOJ papog uMos ageTadoadde pup aoT;;p buTUOZ XqunOO xTOaD *IS aqj IDEJUOO Taoapd Xup buTdOTanap ao buTseuoznd ago;ag •(•oqa 'Tao-7ed oq ssaooe 'azTs qoT wnu1TUTW 'spueTjaM ''O'T) suoTgeTnbaa pup saTna 'sMeT dTUsuMOs PUP Xqunoo 'ajels oq goaCgns ST deui sTUj uo uMOgs Taoaed govZ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER SA M M ( L1.491Z MAILING ADDRESS J3cOX--#- Z e- f/Uj>So LLLZ S PROPERTY ADDRESS I 0 ~ d TA IYY f 1-1444f /_1U D Sam 4~. S1y~/1 (location of septic system) Please obtain from the Planning Dept. CITY/STATE D Sf>/y L I .T S 5"D 14 PROPERTY LOCATION SE 1/4, WE 1/4, Section T Zy N-R TOWN OF #UO -50 j/ ST. CROIX COUNTY, WI SUBDIVISION 1~4 & ISM 3;- LOT NUMBER 3 CERTIFIEDSURVEY MAP SZS~4, VOLUME /o , PAGE a$30 , 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 expiration date. SIGNED: ` DATE: G XJ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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 of property _SA / A /,vN / ALE/•~ Location of property 5~ 114 AIE 1/4, Section TAN-R 19 W Township 11&050/y Mailing address z8z- 4 up-5'n& IV It: jElv"6 /x; Address of site -10("-7 T.4~A/f 4,1N0- Subdivision name 7 Ntiy ,e/Q6,jE Lot no. -3 Other homes on property? Yes_,k No Previous owner of property R,4NQgL11 :Z rla h Total size of property 2• +:C' Total size of parcel 9 AZ' 6e ES Date parcel was created AD / 7- 9S~ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? k Yes No Volume 693 and Page Number vL 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 y, 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. ~'p y f g s 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. D y ~ ss- ICI Jggnatur~--~CApplicant' Co-Applicant I Date of Signature Date of Signature DOCUMENT NO. STATE BA F WISCONS1, ORSI 1- 1982 Twis arse[ R[s[wv[n FOR R[coRO wa DATA • ARRANTY D D so~ass - VOL 1031►IIGE 45 f r.=CJSTER'S OF JCF y 40.8 1114 , This Deed, made between i ,ec Randall W. Synan and Patricia E.._Synan, '4 'br Rfioord husband---and-.wife--------- - t Grantor, 1 SGP T 1993 and Sam E...M3l,ter, a single Qerson Lt 10:45 - A. M , Grantee, I R-,+e~. ~1 Ossdn >t Witriesseth, That the said Grantor, fir, a valuable consideration...... l . Randall W. Syna_n and Patris E. Synan conveys to Grantee the following described real estate in St . C... i X County, State of Wisconsin: 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 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. AND 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 E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1 4 of said Section, 1212.32 feet to the point I of :.eginningthence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N89 30100"E, along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 1113311W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This i.$.. nQ%e homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances ti,ereunto belonging; And ..R4ndaU w Synan_-and--Patrici-a 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. aA ?2 and will warrant and defend the same. Dated this .3 day of ALIg.ASt-....................................... 19-_9.1. JqY~_~, ---(SEAL) ~2lQflF_rtity-t6-A~ l!✓........•-•-- ------(SEAL) • S Randall W. Synan a Patricia ) ynan ----(SEAL) (SEAL) i*. AUTHENTICATION ACHNOWLBDOMBNT ' Signature(s) STATE OF WISCONSIN St. Croix sa. 1C -•-••-•--------•----------------...county . ; itj authenticated this day of-.......................... 19...... PeTonally came before me J-l--------day of August 19. . the above named -•r-••----•-. i Randall W. Syrian. Patricia E. TITLE: MEMBER STATE BAR OF WISCONSIN Synan (If not, Alict Jo.... authorized by 706.06. Wis. States) to me known to be the person -NzREE>i•t~F a I~ Iftgoing instru nt and a n wle&9*"# ~RfCO"n THIS INSTRUMENT WAS DRAFTED .1 ' t+ Rristina Ogland Alice J 0 ors AVcorney--a-t--hav-•----------------•---------•-- o st..... cr.al-x--------------------------------- Notary Public County, Wis. l (Signatures may be authenticated or acknowledged. Both My Commission is permanent. f not, state exp' ation are not necessary.) date: l r--6----------------- 1Q'7.•) •Namea of persons . inin an capacity should be thped or printed blow their signature.. WARRANTY DBED STATE BAR OF WISCONSIN Wisconsin I,e[al Blank Co. Inc FORM N. I - 1982 Milwaukee. Wis.