HomeMy WebLinkAbout020-1066-30-120
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER_ f10
ADDRESS Inc 4:01L.:/ a l
SUBDIVISION / CSM# l r'c / 7 airs c>'~of'2. LOT
SECTION 2 f T N-R f W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET STEM
Izl r i fJ' C
o
31
• Ez is kiell I
ja -Ae 41-901,1 !w-=A 9o'
S1s ,4~ /Z)
d /~eKC 1p s 6~ 78
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
PA OA ~,OA
G•ni
~ BENCHMARR:
ALTERNATE BM:.
1~Cl
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 1Jee ks e, 00, Liquid Capacity: / zc,)02c-. '
Setback from: Well House Other
Pump: Manufacturer 440 Model# Size
Float seperation /,t/,f - Gallons/cycle:
Alarm Location 4~1
SOIL ABSORPTION SYSTEM
Width: Length 78 Number of trenches Z
i
Distance & Direction to nearest prop. line: 70 1v r
i
Setback from: well: /o/ House 34~ Other
I
- I
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: /J - 2d " f/
PLUMBER ON JOB: ern
LICENSE NUMBER: 5`
INSPECTOR:
3/93:jt
Wis'consinDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 21 RR71
Peugi f'Jer's Mt C & MARY PRAYFROCK ❑ City E] Village (1} Town of: State Plan ID No.: Hudson CST BM Elev.: Insp. BM Elev.: B
M Description: R Parcel Tax No.:
7 A9400155
00 /06 J Oft.
TANK INFORMATION if / ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / J Benchmark /60'
Dosing
Aeration Bldg. Sewer 77,
Holding St/ Ht Inlet to-U 97,
TANK SETBACK INFORMATION St/ Ht Outlet glc, 75-
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic >a 5^ 9b a S a7 S NA Dt Bottom
Dosing NA Header/ Man. 7, J Z s,9el
-7. 4S4U
Aeration NA Dist. Pipe -7 ~q ?
z9 •77
I 'f, Bot. System Vf 6 9 4, z
Holding
PUMP/ SIPHON INFORMATION Final Grade - 3 7 47,
Manufacturer Demand
Model Number GPM
TDH Lift `ri ion System TDH Ft
OSCS Head
Forcemain Lengt Dia. Dist. To Well
SOIL ABSORPT ON SYSTEM
BED / TRENCH Width / Length 8 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER q Model Number:
System: -rAC* Lai' 70' 3 / /06-11 4J/ ,4 OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
i xx Depth Of xx Seeded/ Sodded xx Mulched
Depth Over Depth Over L,
Iti
Bed /Trench Center ~ Bed/ Trench Edg s Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Hudson.24.29.19W, NW, SE, Lot 3, MCDiarmid
eF}lCd~ r.Yi:~/l7!(Nl+./ry r~F E !i/ti / ♦ r~ - _ ,
111,44"
4414, e -It ~11 H _Y J r
taJ~,-,.~F~''.:n fir, ~ ~ I ~ * `
c~l~f 7 3,% q 1 4 F G
J ;
0axw
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date ns "e or's Signature Cert. No.
SANITARY PERMIT APPLICATION - ILHR In accord with ILHR 83.05, Wis. Adm. Code
Co '
_..a.
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than I199_1 1
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
kJ Y.& Y6 Y4, S o2 V T N, R (o
PROPERTY O NER'S MAILING ADDRESS LOT # BLOCK #1~
Ae 3 11
CITY, STA E ZIP CODS PHONE NUMBE,~i SUBDIVISI
ON AME QR`CSM NUMBER Z "
11. TYPE OF BUILDING: Check one) 'w" I 7 L 1,22 ~ 0, NEAREST ROAD
LILLAGE 15%C
( 1:1 State Owned V VIL
QWN OF
❑ Public ❑ 1 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX . NUMBER (b) III. BUILDING USE: (If building type is public, check all that apply) Q _ 1 Zd
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 El Hotel/Motel 9 El Office/Factory 13 El Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.0 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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 ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
U 6 `780 ~V'Z Feet 97 516Feet .74 -Z
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank UT I El El F] I
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumbe 's Name (Print): Plumber' ignature: =_1 MP/ RSW No Business Phone Number:
Plumber' Address (Street, City, State, Zip Code):
31 g,y 1-h ka ~~Cs
IX. C TY/DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater Date Issued Issuing Ag t Si ure No m
6e~/
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11188) 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 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 systCM. 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; (Jose 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)
JOB K. //!~-4
TIMM EXCAVATING SHEET NO. OF Z
Route 1 Box 192 r- J
WILSON, WISCONSIN 54027 CALCULATED BY DATE J- ~7 Sy
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205-1 Inc., Groton, Mess. 01471. To Order PHONE TOLL FREE I-BW225-6380
TIMM EXCAVATING cos Z
OF
SHEET NO.
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE
SCALE
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PRODUCT 2051 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-6380
SAFETY b ItU1
DEFOAfiTMEPJT OF REPORT ON SOIL BORINGS AND DIVtStf?N
INDUSTRY; VISION
LABOR HUMAN NDATIONS PERCOLATION TESTS (115) MADIP.O. BO 639 707
(H63.09(1} & Chapter 145.046)
OWNSHI UNICIPALITY: OT NO. LK. NO.: SUBDIV
N w 1/sd/ 7_4 /Tz-;N/R ic) UDso,J 3 g-opose5o C"S
COUNTY: NER U R' AME: MAILING ADDRESS:
ST ~ t oo rJ-r -P I trS 4 z O (o-L~ nSoti tj /
USE DATES OBSERVATIONS MADE
NO. CO TION: TESTS:
OResidence ~ New ❑Replace 1 -5 C) 1 2 S 79
RATING: S- Site suitable for system U- Site unsuliable for system N0T-E= ; `Ti-S-T p or3 i~C~~ {ZE V I Ev./
ONVENTIONAL:
0 ONK: RECOMMENDED SYSTEM:(optionaq
S MOUND: Qu IN- El S . ~ ~
Elu rrjs [K]
V U
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s,1-163.01)(5)(b), indicate: I Floodplain, indicate Floodplain elevation:
DEG t"n _ PROFILE DESCRIPTIONS
FEET
BORING A ATER-IN H CHARACTER OF SOIL WITH THICKNESS. COLOR, TEXTURE, AND DEPTH
NUMBER pEPTH in ELEVATION O_ BSE V D FS.M SIP TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1.0&tgL S;L T5) Z,oa' 3" S%LjO,Se' P_0 SL
B- 8,c~o' 4r~ l`(oN c Y c5, 00' Z' 00, aN CS "'/ax; z.¢Z.' L_-r, 9AjMrm"b S w OK B4 61aaS
o•58' 151- SQL _rS~ /.75'Dr`, L- j SSG' BN AIZc S
B- 7.33' 97-44 N r~ N ~ 7 -7. 6 3'
e~ G' S & /L
0.4Z' 5L• S. 'L TS; Z.no' 13N S~_; 4,7S' S.J MISO
0.$-5' aL SQL TS) t~ °!Z. ~N L~O.4Z~ B.v L'S w~
B- IloNE U 60- (0,33' "i Ma
u~3~ S; L.~ r,~ r3ti Sri_~ o.gz' R~ 13,vt , AAeo
B~s o~ ¢z Nb'i IE S,o12~' ,,j 2M2 T
B.
DsGtf✓1J}L PERCOLATION TESTS NOTIE=' NUMg>=rL em.=~~SPo•~os ~e~rerN
P`StST d c-ft" T i`ic~K H o~8
DEPTH WATER IN HOLE TEST TIME MINUTES
DROP IN WATER LEVEL-INCHES RATE NUMBER AFTERSWELLING INTERVAL-MIN. PER INCH
P. 7- s3~ NbNC Z
P- 4-. 18 39-1 O n(C G -S < Z.
P-
P- E LE.v+h~l' I OrJ
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. In to scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location the plot plan. Show the surf elevation at all borings and the direction and percent
of land slope. No A:r-S P=i -r ow ~.UT
SYSTEM ELEVATION ~4 Z~P_iC~ INA4_ Aa a
8 ENC-1•l MA R. r~ i s A
o~\\ t~o~J POE A-PPO-OX,
'Fl ~J ~ pN L07 L t NC -
v L?L~V, /oo,oQ
t,
ScA LE + 0'
01
t ~
00
A ~ i J P
'K tN
y
'Sag--L \t N
p PeRr_0L_AT1a^/ ?•E: r
B-Z-
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM print : - TESTS WERE C MPLETED ON:
J
ADDRES : CERTIFICATION NUMBER: PHONE NUMBER (optional):
38C -36-74-
CS IGNATURE:
DISTRIBUTION: Unpin; 1 ;,nd mw cOpV to t ocal Aullim nV, Protwi ty llwnrn and Soil 7eslel.
DILHR-SBD-6395 (R a2182) OVER
/
07 O
PILED
• JA sY ~ ~ 1989►
0 Lf~ of I ~9+sler~COIyN~r~L 1
44`453
i
CERTIFIED URVEY MAP -ra cN
Located in the NW 1/4 of the SW 1 /4 of Section 24, and in the NE 1/4 of the
SE 1/4, and in the SE 1/4 of the SE 1/4 of Section 23 (being also part of Lot
21 of the Plat of Fox Valley), all in T29N, R 19W, Town of
N W Hudson, St. Cron County, Wisconsin N
= NWI/4 CORNER I
F- cpQ1SECTION 24 LEGEND
o; ~M T29N, 818 W 1-1/4" round iron bar found ; i
w -1 vy • 5/8" round steel bar found =F
z O1 POINT OF BEGINNING 0 1" round iron pipe found ~
Aluminum monument found 0N
W at S 111x24" round iron pipe weighing 1.68 08 o
lbs. per foot set W W W
~ W
cv 39, O 2"x30" round iron pipe weighing 3.65 W N
N
103 Olbs. per foot set C
IN F II' UTILITY EASEMENT PARALLEL WITH LOT LINE o0z"0
/ 2 i SCALE IN FEET Z; N
T N
O 100 200 400 600 W W a
L_ATTED LAND m=0
/ o 19' UNr ~
yl
= 3 1 S'S LOT 2 <1 a t =
c~dl a=N i N ?039, 0001
% 4`2 0 o N? W
I O r'p 6 Cb0 < j cc
of j O OF N,1\~ 0 0 0
1. a " 'P IDr AREAS
L34' p 1 gs9 -"5051.1 f
Z "-V3MCP Lot Sq. Ft. Acres
N 10 S!b' a' Q s 1 87,487 2.008
2°` 3g33 s 2 132,775 3.043
m LOT I 630' 3 111,475 2.559
NI 4 105,623 2.425
01 % OT 4 UNPLATTED- LANDS
1
I 1 000'4% pSo I ~40 OWNER 8 SUBDIVIDER
ei At \Q" X VO
o 00 GREENWOOD ENTERPRISES, INC.
a`'~• m O ,a\~' y 420 61A SIrest
yap°1~ 6~ \ LOT 3 HUDSON, w1. 54016
. y~ b~~o',8 ~9 ZA+ E 4 5 8,u 1^01~ Y IG S
\ m W (AECORDEO SE66 04'~p9v~ I MAY V
` ~7n1j
3T CQpD( CC)UN 'v
o_ ~CERTIFI ED_ OUR V_E_Y SOUTH LINE OF THE NW 1/4-sw1/4
1 ` MAPS IN Vol. 1, i UNPLATTED LAN °v`'
do _Pagg-288 and in-
Vol.
0 _7,_Page _1913- ( OR'S CERMTCATE
;I N
SECT RN2R I, Harvey G! Johnson, registered Wisconsin Land Surveyor, hereby
A' certify to the best o my professional knowledge, understanding
H and belief: that by the directs of Greenwood Enterprises., Inc., owner of
_ °-a'i the following described land, I have surveyed, divided and mapped part of
m, the NW j of the SE of Section 4, and also part of the NE I of the SE
Mi and part of the SE ~ of the SE ~ of Section 23 (being also part of Lot 21 of
-41 the.Plat of Fox Valley), all in 29N, R19W, Town of Hudson, St. Croix County,
Wisconsin, more particularly described as: Commencing at the W j corner-of
said Section 24; thence S 0°39'2"E (assumed bearing referenced to-the mon-
umented We,3t line of said SW 1'09.68 ' along said West line and•also.along
the East line of said Plat of Fox Valley to the point of beginning;'thence S 52039'E
727.18'; thence N 60°04'52"E 178.05'; thence S 29°55'08"E 66.00'; thence S 28°56'59"E
204.96'; thence S 27 °00' 08"W 339.75' to the (South line of said.NW I of the SW a thence
S 89°36'09"W 700.00' along said South line to said West line; thence S 0°39'24"E•105.95'
along said West line; thence Northwesterly 02.98' along the Northeasterly right=of-way
line of Will Bradley Drive East on the arc f a 334.557' radius•,cdtve'concave'SOUthwest-
erly whose chord bears N 18°02'16"W 199.88' thence N 54°34'52"E,72-,:68' to sa.cd West
line; thence N 0°39'24"W 770.29' along said West line to the point.of begirini:ng',.:.ron-
taining 498700 square feet, or 11.449 acres more or less, and being subject to all ease-
ments of record;
That the attached map is a correct reprez;entation, to scale, of all the exterior
boundaries of the land surveyed and the subcivision thereof made; and
SHEET 1 Of 2 THIS INSTRUMENT DRAFTED BY J.E.R.
VOLUMC 7 ` pAGL' 2092
i
I
That I have fully complied with the current
sin Statutes and the subdivision r Provisions of Chapter 236 of the Wiscon-
egulations of St. Croix County and the of Hudson
in surveying, dividing and mapping the same.
Dated this 3rd day of March, 1989 s S~ti~s
HARVEY 0. '
rib
JOHNSON
Harvey G. ri S-18 9 9
RLS No. ~ E 9 H W S,
C ORPC1RATE OP91M' S CEMM LATE OF DEDICATICN,40 1V0 SU RJf-~
~~/lt/<<t
Greenwood Enterprises .
, Inc., a corporation duly organized and existing under and by
virtue of the laws of the State of Wisconsin, as owner, does hereby certify that it
caused the land described on this plat to be surveyed, divided, mapped and dedicated
as represented on this plat.
Greenwood Enterprises, Inc. , dies ftther that this plat is required by s. 236.10 or
236.12 to be svbtatted to the fallowing fcr anx0val: t. Croix County; Town of Hudson
IN WrINESS WHEREOF, the said Greenwood En rprises, Inc., has cowd these presents to be
si•grred by Jertes E. Ri zch, its president, and by Mary R. Rusch, its secretary, at axbm,
V L--03,sin this 3rd day of M3rdz, 1989. '
In presmoe cf:
With ~
James E. Rusch, president
Witness
. Rusch, cretary
STATE OF WISCONSIN)
ST. CROIX COUNTY )SS
of the abo,.s c~ befcre me this 3rd day Of Mme, 1989, ajes E. Rath, Pre idmt, arri Mbry R.Rxxh, seamy
I I to be and Secre bo 1x: the per=-s ~1'» e»aated the fc~cec3airg i,►ztnr~(:, aoxi to
f tom' of said a=pmatirn, aryl ada=le ged that they exwkdd the
uzta mt as s-r-h cfficers as the del of said axpcaat.Icn, by its auth=ity.
. Z~ & I
Ibtary Rlatilic, St. Croix , min
yy
oaf e4nX,
9 90
We, Verlyn E. R3enoy, Arlyn L. 13en~oylS CONSENT MORIGUMES
lard, cb oa sa t to the a.iveying, dividirg, uq#m and dEdira of the a =i
Ling of the land gbed on on ft s
map' aryl do hereby oast to the abae oertfficate of (r enwood Enterprises, Inc., oar.
42
3 day Of 1989.
arri 1 saV~;L:ZjBetoy* ' `
Ver yn E.•Beno Q
Y Way A. EWty
STATE OF WISCONSIN)
ST. CROIX COUNTy )
Personally came before me this
Verlyn E. Daoy, Arlyn L. BmW, and day of 1989, the abom nerd
W%re A. BmW, to pre kxn to be the Peso Q'o exsated the fare-
gaim irstr t =1 eck-adjead pd the saw.
Can
r~ . aarrc ty, hh 9oa-sin
e~q~ires J u~ I`
phis trap is hereby aRavmd by the T,.v n I3:erd Of the T:Un arbc •
Rita Fine, Cleric 11 ABLE
CJRVE RADIUS ARC CHORD DATA
NO. LI.3VGTH LENGTH LENGTH CENTRAL CHORD TANGENT
1-2 283' BEARING BEARINGS
27.17' 27.16' 5°30'00" N 57"9152"E N 54°34'52"E N 60°04'52"E
3-4 217' 20.83' 20.82' 5.30'00" N 57°19'52"E N 54.34'52"E N 60.04'52"E \
5-6 334.557' 202.98' 199.88' 34°45'44" N 18° 2'16"W N 0.39'24"W N 35.25'0811W
I V01,UMI3 7 PAGE 2093
I
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER S/ rri
MAILING ADDRESS M CA410 1t ( /141
PROPERTY ADDRESS c~
(location of s'e~ptic system) Please obtain from the Planning Dept.
CITY/STATE ~ . ai 6
NIAI
PROPERTY LOCATION 6%=r 1/4, akf- 1/4, Section gr , T__2Z_N-R_~f W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION c,709oZ 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.. Whit you put into the system can affect the function of the septic tank
as a treatment stage in the waste dispo system.
(St. Cro' County residents may be eligible to receive a grant for a maximum of 60%, of the cost
of rep cement f a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted is 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: 1-1
DATE: 51171 ~
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property .-e
Location of property-&d 1/4 5.v- 1/4, Section TAN-RAF W
Township Mailing address
Address of site
Subdivision name CE -M (`d/ 7 6 2b ~ Lot no. 3
Other homes on property? Ye No
Previous owner of property (91za-cn A'ed4 e.r~►'~SEtS
Total size of property
Total size of parcel
Date parcel was created 5 -
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes,C No
volume 16 35 and Page Number o' U7 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWr .
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PA
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. .57'7"7 , 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.
Signat e of Applicant Co-Applicant
Date of Signature Date of Signature
WARRANTY DEED THIS SPA':E RESERVED FOR RECORDING DATA
DOCUMENT NO.
+ STATE BAR OF WISCONSIN FORM 2 - 1982
505777 v'oi i=mt219
_ r.-CISTE. i ^.i r.tiG
Greenwood Enterprises, Inc., a Wisconsin Corporation, Zrx d brRaoo~
' . • . SEP 2 0 1993
12 : 25 A~ ;!1
conveys and warrants to ...Graig.A.---S-irek..and.Mar_y_5...-Ps-ay.fro.ck,
..as.-joint-.tenants
x~► .~n~a+
RETURN TO
Heywood S Cari, S.C.
- P.O. Box 229, Hudson, WI
• ------....St. Croix _
the following described real estate in County,
State of Wisconsin:
Tax ParcEl No.
Lot 3 of the C.S.M. filed in the office of
the Register of Deeds for St. Croix County,
Wisconsin on May 1, 1989 in Volume 7, Page 2092,
as Document No. 447453.
z
This is..not-------- homestead property.
(is) (is not)
4~ t
Exception to warranties:
f 3'- September is 93
- - day of
Dated this
SEAL)
~s - - ~ - - (SEAL) -
Mary Rusch, Sec ary/Treasurer -
James..E._ Rusch-,. Presi_dent.._
(SEAL) - (SEAL)
f -
AUTHENTICATION ACKNOWLEDGMENT
James E. Rusch President STATE OF WISCONSIN
f.; Signature (s)
3~ ss.
ST. CROIX County.
.w
suthenti t this /%day of September lg_. 93 Personally came before me 9k3m ay o
September 19____._.. the above named
WalL.:r HodynskY Mary R. Rusch, Secretary/Treasurer
- - - - -
-
? TITLE: MEMBER STATE BAR OF WISCONSIN
J.. (If not,
- - - .
authorized by i_,766.66, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
r. THIS INSTRUMENT WAS DRAFTED BY
-
He}tsTnod_.b..Caxi_,._S .CA,-.bX--Wad t~z__HodYnsky .
St. Croix . un y, Wis.
P_.0_...Bnx.229.,._H>1dsQn_,_.hlz_.5 4Qi~--------------- Notary Public n is -n t, s to p
M?" C
(Signatures may be authenticated or ackno•-Aedged. Both Commission s Permanent. (If not, state expiration
:r are not necessary.) date: - 19
-
g 5.
~tl
~J *Names of persons si[ninR in any capacity should be typed or printed below their siRnatu reg.
STATE BAR OF WISCONSIN A'i-.n,in T..gal HIaIIk l" Inr
~I .I-k.z. wie.
WARRANTY DEED FORM No. 2- U82
--7 zs3
CERTIFIED SURVEY MAP
N Located in the NW 1/4 of the SW 1 /4 of Section 24, and in the NE 1/4 of the
SE 1/4,.,and in the SE 1/4 of the SE 1/4 of Section 23 (being also part of Lot
w 21 of the Plat of Fox Valley), all in T29N, R 19W, Town of
w Hudson, St. Croix County, Wisconsin N
N NWI/4 CORNER F o3-+
t- aDp)SECTION 24 LEGEND
n ~
<L 01, ~0oT29N, R19W 0 1-1/4" round iron bar found ;i
w I 100 • 5/8" round steel bar found W N
Z 01 POINT OF BEGINNING 0 1" round iron pipe found c
' Aluminum monument found ~N
o; 0 1 "x24" round iron pipe weighing 1. 68 °wo
3 `SS2 lbs, per foot set W 8.w
O
;cv 39, e 2"x30" round iron pipe weighing 3.65 ~UN
O lbs. per foot set W°Nm1
O~
I'OD F II' UTILITY EASEMENT PARALLEL WITH LOT LINE y~0
p i SCALE IN FEET 2; h
~a 1>2 Z-9)
40
/ 0 0 100 200 400 600 m = a
o UNPLATTED LANDS o~W
ids att 0 LOT 2 o~~q ? 0
y) N 1 N 39p O00 y 0 a J 10
Xi P M I 1 94 9 I O ~F c~6N01 o;s~, ICT AREAS 0 04. "1 0)
T'I - Lot Sq. Ft. Acres
yZ ,0 ° s 1 87,487 2.008
/g3'' S 2 132,775 3.043
Ja. 10
ICO LOT 1 30' 3 111,475 2.559
Ni , 6 4 105,623 2.425
1 1 SCE/
ai ~g2 LOT 4 UNPLATTED LANDS
I 30 ~ZE 2
0
O~ ' FSo OWNER d SUBDIVIDER.-
4Q6 0 o0a N°," AO 00, Q~ GREENWOOD ENTERPRISES, INC.
Ck I-'0 O ,Q~y' F O h) O 420 8th Street
° t2~0 LOOTS ~3 9,° o~ HUDSON, WI. 84016
G~ 0\
66 mpg '62-
0S o$924 45 •g1,
w./ 1~ vFV
s-S89°3609°W----700.00--------------
MAI' 0 t 1gf~~~
~ 388°39'37 408.94 ~
Im W (RECORDED 988°04' I SOUTH LINE OF THE NW 1/4-SW 1/4
o,a„CERTIFIED 9URVEY~ r ry~ y
1 %MAPS IN Vol. 1, I UNPLATTED LAN--_~ ~
4-1,11 do _Page 288 and in
W' oy Vol_ _Page 1913
I SURVEYCDR'S CER'=CATE
I 0
>1 N
SW CORNER I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby
3 AI SECTION za certify to the best of my professional knowledge, understanding
m y, and belief: That by the direction of Greenwood Enterprises., Inc., owner of
°i the following described land, I have surveyed, divided and mapped part of
U. cdi the NW j of the SE of Section 24, and also part of the NE 4 of the SE a
z mi and part of the SE of the SE j of Section 23 (being also part of Lot 21 of
5 -41 the;Plat of Fox Valley), all in T29N, R19W, Thwn of,,Hudson,.St. Croix County,
Wisconsin; more particularly described as: Commencing at the W corner of
3~. said Section 24; thence S 0°39'24"E (assumed bearing referenced to..the mon-
umented West line of said SW 4) 409.68' along said West-line and-also.along
the East line of said Plat of Fox Valley to the point of beginning;-,thence S-52039'E
727.18'; thence N 60604'52"E 178.05'; thence S 29055108"E 66.00'; thence S 28°56'59"E
204.96'; thence S 27000'08"W 339.75' to the South line of said NW z "of •the,SW ';.thence
S 89036'09"W 700.00' along said South line to said West line; thence S0°3.924"E:105.95'
along said West line; thence Northwesterly 202.98' along the Northeasterly. right?-of-way
line of Will Bradley Drive East on the arc of a 334.557' radius 6Ai ve'c!oncave ;SoiA'thwest-
erly whose chord bears N 18°02'16"W 199.88'; thence N 54°3452't 72;68' to sajx[ West
line; thence N 0039'24"W 770.29' along said West line to the point.dt.begirin n9 on-
taining 498700 square feet, or 11.449 acres, more or less, and being:>ssubjec .ytc,all ease-
ments of record;
That the attached map is a correct representation, to scale, of all the exterior
boundaries of the land surveyed and the subdivision thereof made; and
SHEET 1 of 2 THIS INSTRUMENT DRAFTED BY J.E.R.
Vm~_ -7, L