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HomeMy WebLinkAbout030-2070-30-110 . - I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER-SA-/V1 $Ij uO- e - Jit ADDRESS garf'-1 U D So Al GPIT S"S/(/6 SUBDIVISION / CSM# [ z(o ~7 S TiC~,E7- LOT # SECTION _T 319 N-R , Town of d ~p s f,oy~ ST. CROIX COUNTY, WISCONSIN -m PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6h PAGE a,~XzB ' ~ Q I V E ~v i? 4' E- %NE 111o7E: ~(S 0C rz-zZ-g V (fogs a8'K S o' VVEL ! Al/ IlET / 95TAU-60 (Ala,~A1F1 r~n r TCe WW DoT L / S'nu~N F INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK:a oo'= ALTERNATE BM: _[ay Oj~ !b C4 ?DC/ AI,40 /O/ EPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Q©© Setback from: Well Houseze Other -2) 7'0 of s~ Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -.SOIL ABSORPTION SYSTEM Width: Length Number of trenches Z Distance & Direction to nearest prop. line: 46 to FAST LOTLir,cL__ Setback from: well: House Other Gs~O.S~af.C 1oJ`- 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: PLUMBER ON JOB: _,p~a-o LICENSE NUMBER: ~C INSPECTOR: 3/93.:jt Wisconsirf 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 Pgrrni M'' Ngwei ❑ City El Village R Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No TANK INFORMATION ELEVATION DATA ~ 9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n * Benchmark Dosing- AV, ILI/10' Aeration Bldg. Sewer I Holding St / Iw Inlet ~f 302 Jd~, 3 TANK SETBACK INFORMATION St/W Outlet 9,70' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ~S NA Dt Bottom Dosing NA Header / Man. ' Aeration Dist. Pipe i r ' Holding-- Bot. System 98.3 PUMP/ SIPHON INFORMATION Final Grade Man curer Demand 99 /O f ' r Model Number 03,7-2~ TDH Lift Frict' System TD Ft Head Forcemain " Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 5 Cl? DIMEN SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACMNGI ManuactManufacturer.: INFORMATION Type Of /7 cu <Zk, (o5L M B E R i1 model Number: L1 System: -~~¢r g ! OR UNIT DISTRIBUTION SYSTEM Header / eW Distribution Pipe(s) x Hole Size x Hole Spacing Vent To ake Length Dia. Length ZCL Dia. ~Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste Depth Over Depth Over xx Depth Of xx eded /Sodded xx Mulched 4gjtJTrench Center :4Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 4'~A-S 1-~x LOCATION: ST. JOSEPH 36.30.20.612A10,SW,NE,LOT 1, 27,TH STREET Plan revision required? ❑ Yes 9-60 Use other side for additional information. SBD-6710(R 05/91) Date Inspector'sSignatur Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e i,, _i SANITARY PER PPLICATION ri'~L~7f~1 In accord with ILHR 83.05, . Adm. Code COUNTY Si6 STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not ess than g~ 8% x 11 inches in size. ❑ c4feck 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 1111,2Z1-,&_ S~'/aS ? T.v, N, R 2!0) E (oKCP PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER vD S Sys/e, s86 z7~-y S INA S 7 Z 7-1 II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned 13 VILLAGE ( SoSrPI~ Z-7 IA STQE~T ❑ Public >N 1 or 2 Fam. Dwelling-#of bedrooms- PARCEL TAX NUMBER(S) /n III. BUILDING USE: (If building type is public, check all that apply) S nn 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) 1. 4 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 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE q q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION , REQUIRED (sq. ft.) PROPOSED (s `7 3 C? J7- ~ % 69 Sip 0,7, `~G> • Feet Feet VII. TANK CAPACITY Site in al Ions Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed _77 __LH R El Septic Tank or Holding Tank D Oc) f S 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: ( , MP/MPRSW No.: Business Phone Number: Doo(o ST Qo h13aA) 7 ~ Plumber's Address (Street, City, State, Zip Code): ,So :P~ / e- Z ~ R/ c &//(O N P c e~T 9D/ IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved San' ary Permit Fee (Includes Groundwater ate Issued Issuing A nt Signa NOS ps ,~Q/Approved F-1 Owner Given Initial ~~j j urcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s 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 r 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 i 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) I~ f n r `o ~I m OO~ y ~ as G ~ ~ ~ s N N ° \ a V t~ -I 1 ~ ~ li ~ 1 ~ ~ '1 cM11 ~ t~ I I ~ r C t1,~.1 61 G ~ ~I ~v 1 0 n o ~ o 0 . ~ • ~ III 00 U tom- 44- . I G s I S N` I~n p I ~ I MM 1 N I f IN oU ' a (/1 r I i 1 -lb I t r~ m 1 i ~w ;I I 4 N } n}I i J I 'O 40 VLV I \C/. ~ j 1 Iti-DU DEPAPTNIENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IMDUSTRYTR,Y, - DIVISION -LABOR AND PERCOLATION TESTS (115) MADISON ° 5370 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: sw 1/4 ms-1 6 Tao N/R E ( s r- : o s - - COUNTY: OWNER'S/ UYER'S NAME: MAILING ADDRESS: Z~- Z $O k, 1Z. S Si - C?AlK 1„~.~~-~ L tr-L SOty /.cJ t S 4~ O 1(0 USE DATES OBSERVATIONS MADE ER OLATION TESTS: I NO. BEDRMS.: COMMERCIAL DESCRIPTION: R New DESCRIPTIONS: Residence 3 elNew ❑Replacee I g -10_4O 9-Z) _ 0 G RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 1ZS O U EIS o u X S a u IEI S Nu o S OUP Z_nRZU0t% - VKC-1 Six , s L~ * IUvE ?'o S LOit-ES - If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the tom' under s. ILHR 83.09(5)(b), indicate: L° LRS S Z Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-Ili CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I;l, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 ~.y' q`1.p' _ NowE 6•y~__ °'B~hnsi Ts • Z.3' ►3n s 3.a U~n__G 0 , °f > S. b •7 r G1- 1-S i D, 8 3l; . Z_3 -2.d S I!' 1. 1 . "x.13, W g S a (Sii,- 3' `►~h h1aeQ S w B _ S e y b. o' 96.y~ tl X6.0' o.7'L3nsil T5;~.3'8>~GYSif ~1•Z.'Q~s~;l.g' Qr,~(. S- _.h•4.'__ R$.7' Ghsi TS; 3.0' _Z e0A S~Gi- ; 2.13n ma.St .S B- ~S - S l w/6H • c>,(.'13,\ u_ - 6•e' o.~'~Y 3h si I TS ; 1,p' @nS1 X3__1_,'_Rt3y\_ IS-sI _ 1N 6M ' O.'? E~A • 2.3' -%y\ hlaeQ S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. -PER-155i PERIOD 2 PERIOD 3 PER INCH P_ 1 so No to 4/1>!z I!z Z.o ~S!! 6 P_ Z S ►Jo LIQ) P- P- N o `'R`'S l 'R#NMS J 'SLI G L P- L . u P- ~ O 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 elevation at all borings and the direction and percent of land slope. Q 4 0. T-'YN 6E L41 Q_IR ~ - 0K10-P-1 J IA SYSTEM ELEVATION C~ '96-9-" - v s a IN W_r AT LftsT' '1'I _eva.I'+es',. W ALL --m a . ART. LQO.Q Ox) .5~3=__ al?R1 ItST So' l=ftc~r+ TIaE~ICt{t~S, TZ,R4!!•~r~ltUL~_ "['R4 Sj I'm lr-o a t 0 t-4" OF T1iE S cnR+v~R y E s ~ too a ova s = ` N - S. i - s' - s. spar., w- JIM r SfL 3L 1, 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: ADDRESS: '2uUZ'r-- L/ 'so x C. CERTIFICATION NUMBER: PHONE NUMBER (optional): ~L o Vol S76 )s_ yzs- ol~y CST SIGNATURE- DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - 1 ')Cr I .ET NG Fl- 115 • 6396 ' T1J To accm at_e soo test, yow sport roust E 1. C cst,°,xlr tion', 2. t he zasr -.Iaarly ,his is )r rxTmme,; cial project, . MAXI f bedroc a arsr, 4. Is this a rcr.r~e; Via. Compl, ty r ISSUITAB' ~)II~ IF ALL T"~E ON Si !f i. ?'t r t rstir=. i flan, t you, t. A sup 8, Ma e „r I, 1 do; . At- , B FI EI.) ,iii TAE L a" v 1 C'~ ? _FTIO A. l- TI N FOR CE `4 ~FTESTERS Scan si Texttues Is uak ` r Ht 01 V . r.. r', rned s Vil B1{.i~ 1- f y O AHE M. _.....i This soil test report is the first step In perrnit. Th3 y request verification a,- this sail test in tP a private sewage s- Ti and a perMiL applicat„ order to obtain t. The sanitary permit must be c",~ ir- +c ion. FILED JUN 2 01990► 9 JAMES O'CONNELL Register of Deeds 0 SL Croix Co., WI 459724 CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION 36, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX CO., WI. OWNED BY: LLOYD DAHLKE RT. 2 HWY. 35 HUDSON, WI 54016 NOTE: BEARINGS ARE REFERENCED TO THE E-W QUARTER SECTION LINE. (RECORDED BEARING). UNRECORDED SURVEY ( OWNED BY OTHERS) 4- SEE CURVE DATA ON UNPLATTED LANDS SHEET 2 oF2. 33\33, N89007'55"E 505.89 QI 472.68 I 2 33.21' 0} { w 1 > 2 -Z I - ° N I LU J Z } ~ co Ix W E o L 0 T I I QI - LL W o ° S o 3.94 ACRES = co M l 3 O~J ( 171,685 SQ. FT.) NI M la1 I =w . 3.69 AC. EXC. R.O.W. w 2 V(nu (160,771 SQ, FT.) I N m2U) I LL osz v, O a N I 02 In I O W W• Ow Z 8907'56"W 533.51 in OQ O.. Q• w~ N O 500.45 33.0q' } o I 1-ZQ'' - ZmI^ m a' Z N J m a W to n I CAI -J* Ir W w 0 o I I ° m _ r I I m 0 o m W 0 L 0 T 2 atn o;w I W . z W ww _o 3.74 ACRES o1 N • - 3 z (162,955 SQ.FT.) , -q FO 3 3.51 AC.EXC.R.O.W. I NN (153,047 SQ. FT.) Q' J' z I w ' W. tl' a' S89° 07'56" W 551. 24 ' co Z' Z 518. 22 ' 33.021 I - 2 I O > N u w W w ~z N N °a ~ M N I w w W N oa z ° F w o 2 N 4.23 ACRES 0% zf pp (184, 422 So. FT.) I MN I M m 3. 39 AC. EXC. R. 0. W. I ro u n of MN (147,633 SQ.FT.) 5 ao uz ♦ OUTLOT "A' ~o o _ u No \ _ u n r~J 0.01 AC. w 3 - 44.39' (2~-24. SO. FT.) n _ S88134'38"W 8 - 25 6' T N _ ..Sag ..1.3.1.4.45' rn SA2 aaL 89°04'24'E 3336.64' M S89 04 24 W 567. 99 ~~y --w QUARTER LINE 125.TH..AVE,. ~Gp~iONs►j UNPLATTED L.A.NDS. O =SET I"x 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAL FOOT. JAMES IL X = IRON PIPE FOUND. wEBrA APPROVED 5.1804 • =3/4"RE-BARFOUND. ~ SPRING VA VALLEY SCALE I"= 150' . JUN 20 1990 F+ ,7lp~ St CM CCAJNTY .4 0' 75 150 300' CONBVOV~ ARK PLANNING of;11*~ ~S U R ~ ~ S H E E T 1 9 PITc°nnnn~t`"" 9s~o~ JAMES M. WEBER 5-1804 DATED R S- 1 90- 34 TH I S INSTRUMENT DRAFTED BY tea-- VOLUME 8 PAGE 2224 CURVE DATA Curve No. Radius Cent. Angle Arc Chord Ch.Brng. 1-2 1150.00' 2°51'04" 57.23' 57.22' S5°51'.-OL"E 3-4 1117.00' 3°02'28" 59.29' 59.28' S5°56'43"E 5-6 47.00' 91°21'56" 74.95' 67.26' S42°53'40"W 7-8 113.00' 15°58'22" 31.50' 31.40-1.- S50°07'33"W TANGENT BEARINGS At1=S7016153"E At2=S4°25'29"E At3=S7027'57"E At4=S4025'29"E At5=S2047118"E At6=S88034'38"E At7=S42°08'22"W At8=S58006144"W DESCRIPTION parce o and located in the SW 1/4 of the NE 1/4 of Section 36, T30N, R20W, Town of St.Joseph, St.Croix County, Wisconsin, more fully described as follows: Commencing at the E 1/4 corner of said Section 36: Thence S89°04'24"W along the East-West Quarter Section Line a distance of 1314.45' to the point of beginning: Thence continuing S89°04'24"W along said line a distance of 567.99'; Thence NO°07'10"E 960.29'; Thence N89°07'55"E 505.89' to a point on the centerline of 27th Street; Thence southerly 57.23' along said centerline, also being the arc of a 1150.00' radius curve concave westerly whose long chord bears S5°51'11"E 57.22'; Thence S4°25'29"E along said centerline 361.181; Thence S2°47'18"along said centerline and it's extension a dis.tance of 542.39' to the point of beginning. Contains 11.92 acres subject to 27th Street right-of-way over the easterly and 125th Avenue right-of-way over the southerly portions as shown. Also subject to any and all additional right-of-ways, easements or conveyances of record. SURVEYORS CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisons of the St.Croix County Subdivision Ordinance and under the direction of Lloyd Dahlke, owner of said lands, I have surveyed, divided and mapped the above described parcel of land and that such plat is a correct representation thereof. Dated this S day of r^A`~ ,1990. \ScON iZEV~5 E9 b - \y-~U James M. Weber S-1804 WE86A WEBER LAND SURVEYING SI'R G 804 RIVER FALLS, WI VALLEy (715) -425-0164 9 WI& O~ TWO; SU RV ~~~~r~ttsN This Certified Survey Map is hereby approved by the Township of St.Joseph. Dated VOLUME 8 PAGE 2224 SHEET 2 OF 2 This instrument drafted by 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 5,4 //f ✓0 /4 E.~ Location of property5 W 1/4 Mr- 1/4, Section T_~!,, N-R _,,D<D Township ST J-oz ~1~ Mailingaddress PL-10 Se,y VJT S `70 / 6 Address of site /Z [v Co a7_'4- Subdivision name C S jG\ zl3'9 7 Z Lot no. Other homes on property? Yes No Previous owner of property ~_p Y~0 0,¢ 1-f / /c45 Total size of property 3, Total size of parcel 3, s"el'f Date parcel was created 2 ' - 8 Are all corners and lot lines identifiable? K Yes No Is this property being developed for (spec house) ? 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. i 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. / 03sc' , 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. s~ 03-g S' natu of Applicant Co-Applicant -95~ Date of Siqnature Date of Sianat„ra STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 0WNER/BUYER S,4 MAILING ADDRESS ,$QZCz~Z s~r~ PROPERTY ADDRESS /Z (12(,2 ~L Z 7k- (location of septic system) Please obtain from the Planning Dept. CITY/STATE `/dif- PROPERTY LOCATION S Gy 1/4, NE 1/4, Section T 3o N-R ZO ~ TOWN OF S! T6-ir, ST. CROIX COUNTY, WI / SUBDIVISION C LOT NUMBER CERTIFIED SURVEY MAP Vf 9 72yVOLUME ~ , PAGE ZZZ , 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 Count), 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 o"vner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal systern 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. St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 1 I /93 "i~ F; 1 ; rlyyl ~4;.. ;~,~s t` •t.<< - ~t.';4:y~ w,1~ _ h`' , . r DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1--198S THIS QACS 01"CRV[D FOR VINCOn011410 DATA WA RANTY OL 105 ED PA SE 41~ j 510358 Y _ - - REGISTER'S OFFICE This Deed, mad., between ._Ll_ ..._oYd-Hr.. !KM..-----• ST- I C ~0 ReaYd He~c le ---•------..._,•Grantor, DEC 3 193 at 8:3q,- A. M ans.. Sam_E~._.Mi11ex a-CA Grantee, RIO to ofon& Witnesseth, That the said Grantor, for a valuable consideration.. . II RETURN TO ~i conveys to Grantee the following described real estate in ._.St..-CrO1X___...___._. i County, State of Wisconsin: - Tax Parcel No-.............. i Part of SW1/4 of NEl/4 of Section 36, Township 30 North, Range 20 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed June 20, 1990. in Vol. 8, Page 2224, as Doc. No. 459724. F , 11i This 1S.nat.......... homestead property. (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; I And...... L1Q d.Ei... warrants that the title is goods indefeasible in fee simple and free and clear of encumbrances except I it easements, restrictions and rights-of-way of record, if any; ! and will warrant and defend the same. 993__.. Dated this 7...................... day of Der-ember - I ....(SEAL) (SEAL) Llo H. Dahlke • .....(SEAL) ij (SEAL) : II II AUTHENTICATION ACSNOWLBDOMBNT Signature(s) STATE OF WISCONSIN es. St. Croix County. , II - 19 Personally came before me this ---..day of authenticated this day oi-------------• December 1993.--- the show named 'I ------Lloyd-H._-Dah---e........................................... - TITLE: MEMBER STATE BAR OF WISCON3IN (I! not, 1 antborized by 706.06. Wis. 3tata) to me known to be the person who executed the i e ing ins t and wledge the same- ` I THIS INSTRUMENT WAS DRAFTED BY ~p Kris-tlnra-OSlmd Alice Joy 0r R - St. , Wis. Attomey_At:_~.v.................................... No-te! - c - CX~? 7C' state ezpirstlon (Signatures may be authenticated or acknowledged. Both my Commission is permsr .1 are not necessary.) date Wanneo of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Iaga1 Blank Co. Inc. WARRANTY DE>SD FORM No. I-1ye1 Milwaukee, Wis. fa~12-)q 03(3 CID 112 56 FILED 5 L) AI JUN 2 01990•' 9 3 JAMES O'CONNELL - Register of Deeds 1-7-6 J ,O Al - fl)IX CO„ W 3c> - 32a YI SL C I CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION 36, T30N, R2OW, TOWN OF ST. JOSEPH, ST CROIX CO., WI. OWNED 8Y: LLOY AHLKE .2 .S' y4 - H t-T65n, -W_1--_5-4 016 NOTE: BEARINGS ARE REFERENCED TO THE E-W QUARTER SECTION LINE. I RECORDED BEARING). '.UNRECORDED SURVEY (OWNED BY OTHERS) *SEE CURVE DATA ON UNPLATTED LANDS \ SHEET 2 OF2. N 890 07'55" E 505.89' 472.68 33.21' p ®r 2 oZ I ii1 _j p/ L 0 T I OI _ - \ 4py 3 ~Z~ S o 3.94 ACRES = co n M 1171,685 SQ. FT. I l h =a 3.69 AC. EXC. R. O.W. ~LO a w I = U,z (160,771 SO. FT.I I N CYN I ~ ~Oy N I a i m 0 I O Z 0 ~ _ Q' N• q 0 w 0. a% S89.07'56"W 533.51' N' "pQ WWI N 500. 45' 33.061' _ .J Z. Z, b 001 N Ln G• v, ca ca n' Q J . C > ~ t l ~ 0 1 1.4~ ° m _ r ° / 1 m co W o L OT 2 Z W °W M 3.74 ACRES W. o N N 1-• o 3 1162,955 SQ.FT.) ° p 3.51 AC. EXC. R. O.W. NI ^ N Q Q' 0 1 153, 047 SQ. FT.) 0 1 r~: QJ•' z S89.07'S6"W 551.24' I w N' Q.' 00 Z Z' 518. 22 ' 33.021 M. T I , I t`' p to LL cli. M t0 M al .I V W z w WE a~ oa~I i (A L0 T 3 M °'m (A~ at N ^ 4.23 ACRES zF W 0 07 1184,422 SO. FT.) r M CO 3. 39AC. EXC. R. 0. W. 0 M- MN 1147,633 SO. FT.) 5 a~ a Z OUTLOT uA" . . ° O V 0.01 AC. W U J V ^ 6 in _ S88.34'38"W 484. 2 (2.24. SQ. FT.) , 45' N89.04'24"E M _ Rd 9 6 ' T S89.04'24' ..1.314 3336.64 n S89 04 24 *'W 567. 99 ~D ' 2 TH. _ M V7, QUARTER LINE . . AVE. UNPLATTED LA.NOS• O SET I"X 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAL FOOT. JAMES AL - I" IRON PIPE FOUND. WEBER t • = 3/4" RE • BAR FOUND. ••~y4~J' p 5-1804 SPRING VALLEY SCALE I" 150', JP 11 `7 [I fC~ jl.~ r~9 WIS. 0 751 150 300 K ANF) PARICS Pf ANN Ir!C: If* S U Mtn?C) '~0!!69eLOtwo »n. SHEET 1 OF JAMES M, . WEBER 5-1804 DATED_ s wvo 90- 34 THIS INSTRUMENT DRAFTED BY VOLUME 8 PACE 2224