HomeMy WebLinkAbout020-1266-10-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Pa"I ~OY► Yti') a
ADDRESS
wfs-~
SUBDIVISION / CSM# _5-LL 17 R1 9 LOT
SECTION _T _N-R_,j_W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
er,
Y a3
a ~ • Rio .
INDIC TE NOR 'ARROW
v
Provide setback and elevation information on rever of this form.
Provide 2 dimensions to center of septic" tank manhole cover.
1 -
5 &A,
BENCHMARK:-
ALTERNATE SF Co rM~►he~l
ALTERNATE BM:
II
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: W e~.-- Liquid Capacity:
Setback from: Well House 6a / Other -
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle: -
Alarm Location
SOIL ABSORPTION SYSTEM
Width: A,? Length >D Number of Ue=
Distance & Direction to nearest prop. line:
/
Setback from: well: House D' Other
ELEVATIONS
Building Sewer ST Inlet; /4, sy ST outlet f 9 J, 09
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 29,°
Existing Grade /1) , Final grade ~d 3
DATE OF INSTALLATION: -01 6
PLUMBER ON JOB:
LICENSE NUMBER: l~~ (Q3
INSPECTOR:
3/93:jt
i
L '~'s , rert~4?~,st • 29.19W, AWE S A8RWT?VVe County:
Labor and Human Relations INSPECTION REPORT
' Safety and Buildings Division
' (ATTACH TO PERMIT) sanitary ermit o.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan D o.:
S BM Elev.: Insp. BM Elev.: / BM Description: Parcel Tax No.:
4~z ,CCU
TANK INFORMATION ELEVATION DATA A9400069 7/-2(o
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ZSd Benchmark
Dosing 0,4LII,I>Irr 3.3¢~ ~co•e6Aeration - Bldg. Sewer dot e~4_
Hal St/)~f Inlet 7~ 9(0. S(o
TANK SETBACK INFORMATION St/~,4 Outlet 6,OA~
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
Ar I
Septic NA Dt Bottom
Dosin NA Header4d 60-6
Aeration NA Dist. Pipe P7i
ing Bot. System
PUMP/ SIPHON INFORMATION f%166r+de
Man`ufactu Demand
Model Number GPM
TDH Lift F ' n Syestem TDH
For n Length I Dia. FFii Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tre ches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSI N
7(9 1
DIMENSION
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING anufacturer:
, i umber:
INFORMATION Type O e<-cr 2l~ 5-, CHAMBER
OR
System: i. 7 44
DISTRIBUTION SYSTEM
Header / M&N494 , Distribution Pipe(s)/ x Hole Size x Hole Spacing Intake
Length _6L Dia. Length 4 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys
o=4 5:Z;ZN
Depth Over Depth Over xx Depth Of xx ded / Sodded xx Mulched
it
Bed/ Trearh Center o~5 - ~ Bed / ~TiCh Edges 5 cw Topsoil ❑ Yes ❑ No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATrION: Hudson.24.29.19W, Lot 5,/ M7ccDDiarmid rive
Plan revision required? ❑ Yes
Use other side for additional information. 17 [;Z6
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert No.
SANITARY PERMIT APPLICATION
DIL HR COUNTY
In accord with ILHR 83.05, Wis. Adm. Code f, (h o t
El=~
STATE SANITARY PERMIT #
=Attach complete plans (to the county copy only) for the system, on paper not less than aoB 9
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.
PROP TTdylk\ OWNER OPERTY LOCATION
Y-A o l) Y4 5 (J Y4, S T o7 , N, R / or) W
PROPERTY OWNER'S MAILING ADDRE . LOT # BLOCK #
.a5o"
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
k b 55/1 N Son r 18 Q
II. TYPE OF UILDING: (Check one) CITY NEAREST ROAD
State owned ❑ VILLAGE !1 _I a 014 1 4kV\,C1l _5
W _j ❑ Public 1 or 2 Fam. Dwelling4of bedrooms 40WW OF:
PARCEL Ax N M RGI
III. BUILDING USE: (If building type is public, check all that apply) 0Q0
1 ❑ Apt/Condo
20 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) 1.)Q 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 Seepage Bed, 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 N 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
boo Bab 121 -7 < 3 98.9 Feet 63 Feet
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 S 'e
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.
Plumber's Name (Print): Plumber's Sign tur : (No S mps) /MPRSW No.: Business Phone Number:
Ca~1Vl t~owev,s l5 r93 a~~-535
Plumber's Address (Street, City S, S te, Zip Code):
/6 ita IF~S-r e S ai
~
IX. COUNTYIDEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamp /
Approved ❑ Owner Given initial Surcharge Fee) ll
Or-
Adverse Determination - o~
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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. ff 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 systElm. 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 mainsiwater 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)
Z~~ V~C'1
spa yp"
lg6 Dk~c,s~ ~d P uds a n
w~ fur/ / tv, 55119 d". OT - J
t
1o25b ~,o~G ltS~-r
aal kwfrel f-1900,9
1563
i
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~ 33a ~
4
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Ws"
t
• 1 ~ f v S S ~ t e 1 O r'~ p r'l ~ t f) S ~ S ~ ~ n-1 Ssicr~'~
bu~'y j 7Y1 Cj~S~~/ Frt1A Air 1111016 And ODstrrallon pip,
w (-J^- Appro•id V.nl
F11 1 C•►
n mu,e
12• floor.
FhH Cr•a•
20. 42' Above Pip' 4• Coil Iron
To Fln•I ar••• Vent PIP,
14r.A N•± Or Srn~Mlk Cev.rlny
lun 2• A90rotolo
O..r Plpo
Ol~lrlpvllon
Plp• 0 0 0 -T•• 1
0• AtO~otUO
B.n•ol~ Pipe 0 P•rl•rol•d pope brl•.
0 Co.Wlnt T•rmin•llnt At
• Bollom of Sr.l•T
PPOPC) t D pino. 1191%clt
SOIL FILL
DISTKIBUTIOP•1 PIPE
r•, Y APPROVED Sj9P-IETIC COVC
2"OFAI,GGREGA7E---~~ -/IAT9W,. OR 4" OF STRAW
OK MAKSN "A,%j
ELEV. of FED I:' 01- P-'/,' AGGRCGATE ~pwV.
DIS'•RI51JTICUU PIFE TCP BE AT LEAST b
AUL AT LEAST LO IUCHES BUT 1.10 MOR W 47. uCNES BELOW FINAL GRADE
DE
tWMUM DEPrH OF EXCAVAT100 ROM OR16 NAL 6
91\0R WILL BE 1i,lCHES
/11N1►111M pEPn{ OF EACAVAT10" rAO/'1 0~1(.IHAL (jRAVF_ WILL »C _
INCHC 5 ~
SIG►,►CD:
LICCUSC DUMBER:
DATE: /
110
TMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
UBORMAN REAND.LATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707
HUMAN (ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHPL)AS6W 11 j4H+@tP*t+T-lt: LOT NO BLK. NO.: SUBDIVISION NAME:
LO 1/a SW !/a 24 /TZ9 N/R 19 E (or) < 5L~N QI IN 4k k
C UNTY: O NER'S BUYE NAME: MAILING ADDRESS:
s CRO I h d M ~,eUS«i ~-r N 5-t 14U &SO/ I s4a i&
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: FI DESCRIPTIONS: e LATION TESTS:
Residence ISJNew ❑Replace VN ( 9 7d .Ly 1, 6
Sous 416, s°3 So1LS etCz-& krlal2,,T
RATING: S= Site suitable for system U= Site unsuitable or system l OUND-PRESSU
END COI.ESTEIU IONAL: IMOUNSD: S❑U IN-GRXS ❑A RE: SYSI❑Y LHO0L S TANK: REC CON V (INTION Ml,on~t_b\TRay_4
If Percolation Tests are NOT required DESIGN RATE:
If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: L I~s`j I Floodplain, indicate Floodplain elevation:
11cFr PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH"R~ ELEVATION OBSERVED S HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- lo'Z~ n > io .zS /6 8cL-r-- z '8PNSI L z 1 "SeN SC S9 "B csf 6,9-
B- Z rZ.'5 s /69.37 N NIZ > IZ.s% 2 LLTS 33"'YBQ,~,S►C 7"$~ SL GS;t6te
B- /1.33 i~6.93 N > 3.3 c4- >o" S I L "$a,~ MS C6"$Q~, cs~G
B- ,,a /v3 9 > scrs 37'' aa, S -S~ SS B cSd-6 k
B- 33 /02.g4 onltf > .33 ''i$c.t LTS n"&4zN Si L Z4"$aUS L 40*'9,P..►CS*6,1Q
B-
c PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTER SWELLING INTERVAL-MIN. -PERIOD 1 PERIOD PERIOD PER INCH
P- ) t%. 00 t4oPill v6. Z > > <
P- 2 .[O Nogic 63.0 D "z /'z / z 7
P- S,UO Now .4 u > > L > ~
P-
P- L1CV T 1, pT 40CI&C- _J
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevati in at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION C?a '9 g-Z FAsr Limit mr
6 J Lo
-
a
sg ~ . .
r f
g 3 t
Nvis. r6
s , _N
~-3 71Nlk-_TQ .ica ~s~ Lin d a I__ } - ' I ' P~~r AT SCE
d 5
As
_L;o~_~NR
,
1
i ~ j ~ K1T101~
T t
( I i
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
ay ol~ sav JoN>Jsa.► Sc,re 6Y,(AL /NC J (JL ! /490
AD ESS: ICERTI FI TIO NUMBER: IP ONE NU BER(optional):
07 SEcom& 5'r dohs -w W, SW~ '34% ~
CST SIG TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INDUSTRY " 114PURT ON SOIL BORINGS ANC) SAFETY & SUILCtI
LA573R ,r NJ DIVI *
HUMAN HhIATI[7N5 pERCOLATIQN TESTS (115) MADISP~0, 80X
ON WI S.
(ILHR 83.os(l) & Ch&ptar 14$) ~L A r TowlYSH
w ; - < 24 %Ti~ RJR rq. E (or, K• UBDIVI IOn; -
C LINTY
IS we ri NA 4SQ ~7(.+N 1 O G~
CQo I n 5 4C.A C
use 4
U !i"SiN ! -54 o) 6
OATfES aaSRAVAT,ohs Mare "
~e~,JencA U►J +QJ'd8W CJR404e4 1Ti~'~V
T,TY
J~ X990 3~,~ ~g~
.96
RATING: S- Site eultabif for stfm U~ Btta Gtgy( ttabloL5 + fa~v sot SO
-.5c)
j ~L+ ~ ("'"~`f f p~ . -F1i.L O1,D1r6 A11KP REGCJ~iM$~VDEC SYSTEM:{oDtiCn ,
~..J (~.,,,J ~l L...,J V ~ J ~ ~ ~ •7 1J ` o N V ~ N ~ r,o w +o ~ ~ L~' A ~T(2E~JC
Ii Pfrco~atiors Tflb Ere NOT rfqulrld DESf RATE:
~ndAr t, IL~SR 83,091lsilb3, fndldltr 44 ►f Iny portion of tho t.aet$~rea it in thl j
w1S~► I fi10odpiain, Indicate F(6Qdpfaln.elfvationt A
c PROFILE DESCRIPTIONS
BOPIN TAL H T ~J ATEA•IN H S HAS _
'VLM18es~'DEFr ~l1 ELf;VATiQN TO E.D80 .K kN-
IF 3 $E VE H(S E, ~BERV 'ON BACK TEXTURE, AN0 UcV
oa ~d.z ,6l <<rls Z _'S L er,, S S "8" cS Gfz
vT% 09,v -NONE
z c s 3 Y I Sl " CS'tG
yC
> 6, .58 'AL /zl~ SIT. IRRI, C <11t/4 11k.-
/0Z 04
tio n > 13 r' L5 ~"'S 'S It Z4"' U L ~ C:S~C
PERCOLATION TESTS
Tlb-rl DEPT M IN ATE IN HOL 5 TIME I
NIA!$rR AFTERSWELLING I T;FIVAL•MIN PCs
RATE 1NLITEL'
P~>a V ,y ~~a INCH
Lp.. =7t
C
57 _
la•
PLOT PLAN: Show iOWJOns of percolation tfitf, soil borings and the dimonsions of tuiteble toil ortn. InoleetA ssau or distencei, Describe what are t
zP+%tel and vertical 01ly1tion teferen4A pBintL and show tReir :vration on the
p! Plot Plan, SNOW the #V60,91 111vati n et.al! boning, and tN diffellon and p,.
land sjcPe. ,
Irr~ d
SYSTEM ELEVATION a4~gr
F `7"
T-~
i i 1IC~ y. -•q
_
lie
1
less k-M rtN r~ Cu't' N Iz~a R4 , b . ,
_ I I j ~ l ~ I
• r
, the undersigned, hereby oertify that tho Ipli fafti ttPgrted on this form ware triad0 by me In 11mrd with tha provedures and r+mwods speoffied in the Wii,;
dministretiye Coda, and that tho data racordfd snd th1 iocw1lpn'o.f tho testa art. carted to 4ha bolt of my knowled" and beli►L
AME (print
y ~ ~lo~t~~ INC WFfae MPLETi=(7 4N: •
07 -
~~.~?M>;f ~T• .y / CZ ~ fl RTIF~A N•Uh~tBEa: ~ ONE NU BCAM-7 y
u A sdia 1 0i
ST SI E;
STRi$UYI4N: 00rlginel end One cony m '.anal Authority, Property Owner and Soil Testor,
1.HR460-638,5 (R. 10!83)
TrlT01 G7 IA'7
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER /4 to L_ //1~ 1 Dam 0,0 L
MAILING ADDRESS /$(o5 OL13 I OSoN ~yAl1, 600066Vc Y, RAJ ~S/lq
PROPERTY ADDRESS $ q ~L D I A2--M / 10 Dot Vj
(location /o/f~ septic system) Please obtain from the Planning Dept.
CITY/STATE O S o W, S y o l~o
PROPERTY LOCATION SVV 1/4, S W 1/4, Section T 2-q N-R~W
TOWN OF A4~OSON ST. CROIX COUNTY WI
SUBDIVISION SU! N/C/ d o c LOT NUMBER S
CERTIFIED SURVEY MAP , VOLUME 7 , PAGE"-3 Z-, LOT NUMBER S
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, ein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained t be c pleted and returned to the St. Croix
County Zoning Officer within 30 days of the three ye expir date
SIGNED:
DATE:- co _ 9
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
STC-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 ~.n delays of the pdrmit issuance. , Should this
development be intended for resale by owner/contractor,(spec
house), then Ia 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 LL- boa-M,0,0
Location of* property=l/4 5 Wl/4 , Section , T 9 N-R_W
Township 7-bOSo1,J
Mailing address r8 (,o S (-)t_6 PuD So t4 /Po,4Q .
WOOD A Al S5/jq
Address of site /y4C1JGA2/VIiP , 10'e4l!
Subdivision name 5lll~/,~lO67 C Lot no. f'
Other homes on property? yes X No
Previous owner of property _ ZHOA4, -S ~ArVYy
Total size of parcel
Date parcel .was created-
Are all corners and lot lines identifiable? X Yes No
is this property 10eing developed for (spec house)?„_,Yes L _No
Volume /052- and. Page Number 3 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEbD which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & TIIE 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. 509 $ ZZ , 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 1
the construction of said system, and the same has been duly
reco d. in t e office of County Register of deeds as Document
No 9 8~ .
gnature of applican Co-applicant
Date of signature Date of Signature.
APR-06-1994 09:35AM FROM DORMODY 040/065 TO 1715246494835 P.04
A 50952 329
_ . REGISTER'S OFFICE i!
=.Thomas P. Dat.wYle.f, " ST. CROIXCO., W1
Reed fb~ Record
Ilk' "
his e d, ~ja~w orce ...'hu9Vt[. . iii::-&n w3 t
y ere amx .
.
• a•'
z r
~t
~Taz ar A'. nor( ocdX;
.......•F:...L1ot Y?-Y...:.
• Paui ....dt1`~~~ g
,
and .
as survi~v0~ _ship..ma>: i•tal:::::; -
hu,band art. w
prgPextY..►... Grantee, ~a~,;M~Ml+rdAR~ .
Grantee.
1
Witnesseth, That thu said f:rantor for a valuahlo cpyidcratictn...•-•
of one do_lar and other valuable,... $1Craaxion nmrv
a" TO
convey.; to Grnntce the following described real estate in s
i
County, State of W i:consin :
1•L~~-~..~.~.-~=
of Sun Ridge in the Town O:E lludson
Lot 5,. Plat o. }
St. Croix (rOlltlty, Wisconsin. Tax Parcel alt: -
in the.sw 4 of i
ALSO, A Marcel 0` land located 29 North, Range 19 west, Town of Hudson, ;
SW 1/4 of Section 24, Township at the SW j~
St. Croix County, Wisconsin cence1Ne0 Coencing W
r of said Section On 24; the 4 of Section 24, 1
corne
,i
(bearings referenced the of07said SW along said lest t line
li rs~i
oil the to bear IN . degrees
of the SW 1/4 of Section 24, 1306.21 feet/ thence N 89 doc'ca
of Section 24x;1
1{
18 second, E along the r of line beionninsaof this/dESCrip 1/Lio4n; thence
1043.47 feet to the point
.
S 0 decrees 12 minutes 49 seconds W 17.14 feet to the North line of thatIl
383, Doc
r 1992 in Vol. "8", Pa a0 20feet
C:ertifzed Survey map recorded s Jul 4y 25,
X minutes 00 seconds We 63
e N 88 dec~reeified survey map recorded in Vol. "8"r :1
No. .O. 471834; the. 1
along the tor line of said Cert.
a 1383 to a a 3/4" zeb f0uat the IJE corizer of that Certified Survey;'
in of that 'I
-ape Page 1913 (said map being a re-/nape
Map recorded in Vma• recorded in Vol. "1",'Page 288) ; thence N degrees ,
C5 inute Si 0 se p 12.38 feet along the N1y extension of the ys 'k
25 minutes 40 seconds We Map^recordedoftreat in,Voi. "7" ;
urvey Map i~
. 1 Pag
lines of said Certified Surv~yle or Lot 44that b also ng ,Se 1913, tale to North
on the ( Li eded.
line of iron pipe 'outn ifi
FN812/049;2 thDcenc e N $ 1 0 •9 dec r,rees. 5e 'minutes $ seconds
recorded of said Sr . "7", red E) on said
ecodegrees 6 minutes 09 snC
ded as N8 '
(PzCVZC7u Y es.exd PropertyV ol S uth7 }ln,Pe'doge 2092, anatallso onuth~y5otai
Thin hom hl~?
a
€ s. ge, 631.05. I~
nt
(is> (,s not) line of Lot 5 of Plat of Su Rid
' Together with all and 3inguiar the hereditamcnts end app~atwnclet~ereunto belon n-•.•• Eet to nee,gpoz
gint .
Ana .T,zomas_.1?.. llatwxlcr anc3..`~amw... .........y.......... of be
warrants t'r.at the title is soot(, indefeasible in fee simple and free and clear of encumbrances except
easements, covenants, and restrictions of record, if any, i'
end will warrant and defend the sE,me• n~ 9
93
day of
Hated this
Thorna5. P. IIat e If
(SEAL)
er........... ;4.
Talni M. i;atwy1
;.i •
!i
Ac%X0W]':3AOMZNT
j ION
AuTZENTICaT
STATE OF WISCONSIN
I s
GRO X ss, j}
Signature() ,
.....Coantlr• l~
19...... personall• lzefore me this ac of
a,lthenticatc,i Lh 'it .......day of._......_............ I the above n=
~r on~3s P .Jp twy;.ger93.n9 3 4..........................
. _ .T ' _:M'._Dat~ayler... . . •
. {I
TITLE: MEMBER STATE I13Ft OF WISCONSIN ,
........~•r...
$ who executed the
1
(If authorize not..
d i;y z(i6.06, W+s• Stats.l to me 1r- w o a it per e' cam
•!I for rg ' str R it acknow
d.arknopledg
L~4lI.. S'fiGe•... .
THIS ,uSTR N`N Wn~A DPnFreD 9Y
1 Rr,,ort ~ . `W'a`1~ 'rig Irk k . .
.
IAA
TOTAL P.04
5-'z. c~azx cxx.rrrrY >
:s a I, Rita M. Horne, being the duly elected, qualified and acting T tiown Clerk of the
:ied TpF of Hudson, hereby certify that copies of this plat were forwarded as required
bly § 236.12(2) on the day of _ Z.i 1989, and that within the
20 day limit set by § 236.12 (3) (iae~ -Have--sear-fi~e44 (all
objections to the plat have been'met).
Date Rit M. borne, 'ibwn Clerk
ERESY RESTRICTED FROM ALTERING THE DRAINAGE PATTERNS BY SUCH EARTH MOVINS WHICH WOULD
A WATER RUNOFF TO THE SOUTHEAST. THIS SHALL NOT RESTRICT THE CONSTRUCTION OF HOUSIES
CONSTRUMON OF DRIVEWAYS, PROVIDED DRAINAQE TO THE SOUTHEAST IS NOT INCREASED IN AREA.
UNPLATTED LANDS OWNED BY OTHERS >f''
'09.50
337.00 150.00 225.00'
W w
X
w
f~ m 0O
.C m 3
AC. ~qti. 45 6 z w
q f= t. Of
2.673 AC. `
116,442 Sq, Ft. RD U.
W
3.479 AC.
1511546 Sq. Ft v ..I
p
~D
~ 29
~ I
H
5.`..
,o »w---
~1 s• r~.\ CERTIFIED SURVEY MAP
• VOL PAGE 20_92_
to
'0 ASSUME.D ,8E•ARIN,G R.SFERENCED• TO
THE MONUMEN-TED Wt§T. LINE OF
THE-
SOT
SW 1/4 241'. LEGEND
5 - SECTION CORNER MOUR4ENT- ALWMUM CAP, FOUND
f • 2" ROUND IRON PIPE FOUND
r ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
N oil p p p N p .~..d ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
i
August 2, 1994
Derrick Construction
P.O. Box A
New Richmond, WI 54016
RE: Septic Inspection for Paul Dormody
To Whom It May Concern:
An inspection of the septic system for Paul Dormody property was
conducted on July 26, 1994. This property is located in the NW 1/4
of the SW 1/4 of Section 24, T29N-R19W, Lot 5, Sunridge
Subdivision, Town of Hudson, St. Croix County, Wisconsin. At the
time of the inspection, this septic system was found to be code
compliant for a four (4) bedroom home. If you have any questions
with regard to the above, please do not hesitate in contacting our
office.
incer ly,
mes K. Tho
mpso
Assistant Zoning Administrator
js
E