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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER - ~~454n
ADDRESS 3 3( f~~f
fs-o,)- uJ•'
SUBDIVISION / CSM# ld-y"~P o~ 7 7 LOT #
SECTION 7 T 3~N-R I ~i W, Town of r
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
JJ
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Qu i
B 5 ~ B,
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I DICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
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BENCHMARK: ~D~✓ / ~~ai/ ~li~e / eL1,k2fv~;~ dy,,"xv
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Gt/.P~~'3 G/~ Liquid Capacity: /~0'00
Setback from: Well- /,7/_ House 161, Other
Pump: Manufacturer W/y_ Model# Size
Float seperation Gallons/cycle:
Alarm Location
':SOIL ABSORPTION SYSTEM
Width: 45 Length 60' Number of trenches a
_Dist-ante...-&-Direct ion to-nearest- rop-.---l -i.ne;.___
Setback from: well: 77 House o26 Other
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:
LICENSE NUMBER: i~PS 3~a
INSPECTOR:
3/93:jt
Wisconsin, Department of Industry, PRIVATE SEWAGE SYSTEM County:
.Lab=.>r and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
PeJACKSON,a Name: E] City E] Village Town of: State Plan o.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / Benchmark 6 -
Dosing !w -k:ff 1,1)1,17 1,I)d
Aeration Bldg. Sewer,
Holding St / Ht Inlet 3,17 105, W -
TANK SETBACK INFORMATION St/ Ht Outlet 3 / p
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
Ar I
Septic ~~Ur / ' ((p > r NA Dt Bottom
Dosing NA Header / Man. S, S /03, q
Aeration NA Dist. Pipe
7 c~
Holding Bot. System r-6 ° 7 7"7
PUMP/ SIPHON INFORMATION Final Grade 7, -75 /v S P9
Manufacturer Demand r;; f 7 t ! O~ ,l
Model Number GPM
TDH Lift Fiction Syetem T
I DH Ft
Forcemain Leng h b H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length 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 Of IV p CHAMBER Model Number:
tA)
7-7 OR UNIT
SystemC(/~, n~;,' 61
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER ~.f f x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of Fx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil Yes ❑ No E] Yes E] No
COMMENTS: (Include code discrepancie, persons present, etc.)
LOCATI Nib Somerspt.7.30.199f; bSE,'NaLot~
! f
Plan revision required? ❑ Yes ❑ No d
Use other side for additional information. L) SBD-6710 (R 05/91) Date 'r Inspector's Signature Cert. No
=:Eff a SANITARY PERMIT APPLICATION •
In accord with ILHR 83.05, Wis. Adm. Code COUN
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than Q0,901
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.
PROPS PROPERTY LOCATION 3e I T
5' Y4 AU X, S T , N, R .ix(or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
53 /I.=, 1S/_ IL Are '.3 1
CITY, STATE ZIP CODE PHONE NUMBS SUBDIVISION NAME OR CSM NUMBER
. TYPE OF BUILDING: Check one CITY NEAR T ROAD
II ( ) State Owned VILLAGE Sm ~l
❑ Public Xi or 2 Fam. Dwelling-# of bedrooms ~ PARCEL A NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) O 32 - 2-01 -7 -/be,
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1 S New 2.E] Replacement 3. ❑ Replacement of 4.E:1 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 E] 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 EV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 77/03, 7 ELEVATION
95 .15-11/ 411m> r 75- TZ LC • AFeet 9 Feet
CAPACITY
VII. TANK # of Prefab. Site Fiber- Exper.
in allons Total Manufacturer's Name Con- Steel Plastic
INFORMATION New istin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber I r-1 I F1 F1
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum is Name (Print): Plumber' ignature: (No S ps) MP/XPRSw Na • Business Phone Number:
Plumber' Address (Street, ,State, Zip ~pde):
6 r~~o 7~'J21 r j6py (44 Z
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sarary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signatur (No Stamp;)
Approved ❑ owner Given Initial Ifj/ Surcharge Fee)
Adverse Determination 167441
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 rern~;w Li 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 (S131-11 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.
111. 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; (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.
SBD-6398 (R.11/88)
14-~ JOB -;~e,/SCYJ
TIMM EXCAVATING SHEET NO. OF Z
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY 6---l--DATE e-' 1
7 ~T
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 Inc.,Groton,Mess. 01471. To Order PHONE TOLL FREE I-000-225-6380 J*'.
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JOB
TIMM EXCAVATING SHEET NO. OF 2
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 Inc., Groton, Man. 01471. To Order PHONE TOLL FREE I-800-225-M
Wisconsin Department of Indusry, SOIL AND S ALUAT I ON REPORT Page of -3
bor and Human Relations
Division of Safety & Buildings in Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less th 2 x 11 ten o size. ust include, but St. Croix
not limited to vertical and horizontal refece (EINM an Flo of scale or PARCEL I.D. #
dimensioned, north arrow, and location and a to nearest rQaka pt
APPLICANT INFORMATION-PLEASE T Alt+1F0,FTION REVIEWED BY DATE
PROPERTY OWNER: O`~ C pv `~s~<< PR ERTY LOCATION part NE-NW +
~ yi~1 G4'1VT. LOT SE 1/4 NW 1/4,S 7 T 30 N R 19 FX*kW
Brant Jackson
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
2011 Northwood Drive - - CSM
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
North St. Paul, MN 55109 (715 )247-3253 Somerset 165th Ave.
New Construction Use [X ] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .65 bed, gpolft2 •75 trench, gpd/ft2
Absorption area required 693 bed, ft2 600 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 103.9/102.1 It (as referred to site plan benchmark)
Additional design / site considerations install 2 - 5' x 60' trenches on contours 15' apart CL to CL
Parent material fluvial outwash over till Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem riS ❑U ®S ❑U ®S ❑U US ❑U ❑S ~]U ❑S ®U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-3 7.5YR 3/2 - is 2 f cr mvfr cs 2f .7 .8
2 3-9 7.5YR 3/2 - is 1 m sbk mvfr cs if 7 8
Ground 3 9-14 7.5YR 3/4 - is 0 sg ml gs 1f/m .7 .8
elev.
106. Oft. 4 14-35 7.5YR 4/4 - s 0 sg ml gs 1f/m 1.7 .8
Depth t0 5 35-60 7.5YR 3/4 - s 0 sg ml gs if .7 ::.8
limiting
factor 6 60-86 7.5YR 3/3 - s 0 sg ml - 1m .7 .8
8601
occasional g below 9
Remarks:
Boring # 1 0-2 7.5YR 3/2 - is 2 f cr mvfr cs f/m .7 .8
yet 2 2 2-12 7.5YR 3/2 - is 1 m sbk mvfr cw 1f/m .7 .8
3 12-23 7.5YR 4/4 - is 0 sg ml cw 1m .7 .8
Ground
elev. 4 23-84 7.5YR 4/4 - s 0 s ml - 1m 7 .8
107.8ft.
w/ ccasional gr & / irregular & discontinuous 5YR 3/4 is ands: 1/4" 47; 1" @ 60-61 & 6 -67
Depth to
limiting
factor
~ 84"
Remarks:
CST Name:-Please Print Henry F. Grote Phone: 715-665-2681
Address: PO Box 57, Knapp, WI 54749-0057
Signature: Date: 5/2/94 CST Number: 3065
PROPERTY OWNERBrant Jackson SOIL DESCRIPTION REPORT Page 9 Of
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Tnch
3 ? 1 0-7 7.5YR 3/2 - is 2 f cr mvfr cs 1f/m .7 .8
2 7-24 7.5YR 3/2 - is 1 m abk mvfr gs 1m 7 8
Ground 3 24-80 10YR 4/4 - s 0 sg ml - if .7 .8
9$I w/ occasional gr & w/ irreg'& discont 5Y 3/4 is ands: 1/2" 59, 63, 6 & 1" C 1-72
Depth to
limiting
~Wgr
Remarks:
Boring #
1 0-5 7.5YR 3/2 - is 2 f cr mvfr cs 2f .7 .8
2 5-10 7.5YR 3/2 - is 1 m sbk mvfr cw 1f/m .7 .8
4
3 10-24 7.5YR 3/4 - is 0 sg ml gs if .7 .8
Ground
P2v9 ft 4 24-78 10YR 4/4 - s 0 sg ml - 1m 7 .8
w/ o casional gr & irreg & discont YR 3/4 1 bands: 1/2" C 46, 55, 8, 62, 5
Depth to
limiting
factor
Remarks:
Boring # 1 0-4 7.5YR 3/2 - is 2 f cr mvfr cs 2f .7 .8
:tii
"...5..... ~ 2 4-12 7.5YR 3/2 - is 1 m sbk mvfr as 2f .7 .8
:.w:
3 12-18 7.5YR 3/4 - is 0 sg ml gs 1f/m .7 .8
Ground
elev. 4 18-44 7.5YR 4/4 - s 0 sg ml gs 1m .7 .8
98.2 ft.
5 4-74 10YR 4/4 - s 0 sg ml - - .7 .8
Depth to
limiting occas onal gr below 1 & w/ irreg & disc nt 5YR 4 is bands: 65-67 & 70-71
factor
74"
Remarks:
Boring #
1&2 -30 R-Bn - is
6 3 0-60 R-Bn c1f Gy s w/ alt rnating bans R sl; s mottl between bands
4 0-80 dense R till sl
Ground
elev.
v►- 93 ft.
Depth to
limiting outside system area
factor
30"
Remarks:
SBD-8330(8.05/92)
. \ .W N h a c 1~ S o., 1 `o 't w p~'t N1e' - N w
. S li N. w r -Z a • 11,w
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RLE®
JUN 1 6 1994 ►
JAMES O'CONNELL
Register of Deeda
517926 St crD1x cD., w1 ~i
CERTIFIED SURVEY MAP
LOCATED IN THE NE4 OF THE NW4 AND IN THE SE4 OF THE NW4 OF SECTION 7,T30N,
R19W, TOWNSHIP OF SOMERSET, ST.CROIX COUNTY, WISCONSIN.
OWNED BY: Ted and Josephine Langford
2 S63°57'17"E
W 101.09'
x
~Z 0= SET 1"X24"IRON PIPE WEIGHING
c~ 1.13 LBS. PER LINEAR FOOT.
wa
UW
Zm 1" IRON PIPE FOUND.
Wo
W O N.T.S NOT TO SCALE. Z
W0
N. U
W W
W " 1n
aZ C. S. M. VOLUME ..9.. to
rn ~ O
ZW I
WQ PAGE 2643 W
W M H
I- 3 _ H
2W M
Z
O in - Q .
M m U)
Z N M J:
N
to
Q .
t~ PROVEO 3 W
rn
S 86022'24E 282. 16' M Q;
J.
Ail, 16 W-1 33.0 249.16 (D N IL •
O Z.
U)
10
n. o u'
ST. CftOIX COUNTY LOT 3
(:crnprohensive Plarx* I N N 6.07 ACRES
Zoning and {33 33' W (264,452 SO. FT.)
Packs CornrWttee I W I M 5 . 7 3 A C . EXCL. E A S E M E N T
(n• I (O (249,812 SO. FT. )
Io
If not recordedz. M I M
within 30 days nt: l 0 z o
approval date J: I z I o
;approval shall be . M
•"A Z void I
•
\ N 26°27 X05"W
33 '-5 105.38
N 26027'05"W \63
103.35
\~S EXISTING ROADWAY EASEMENT
, j o VOL. 1020 PG. 546.
W ~W
W W o
F-
I O N v ~co '
27 T8. 7 2 Q~iii0Gd80~g~0
Q• I co
' O M 12 $ W4 463 ♦♦me►
Z'
046 2
76
2 35.9 ~ s JAMES M. S
' WEBER
S 1804
33• b SPRING VALLEY
'.~3.~ SCALD I 100' ' Wis.
I~ 0 50 100 200' r~4br~~•~
N U N t
®d~® o~ +J
W 1/4 CORNER SEC.7 E 1/4 CORNER SEC. 7. ®a-~+--
( COUNTY MONUMENTFOUND) (SPIKE SET FROM TIES JAMES M. WEBER S-1804
E-W I/4 LINE DATED AP4i~~ Z\, \9~`~
1631.37 333 9.06
S88046'41 N88°46.41 W
94-37 THIS INSTRUMENT DRAFTED BY JIMWEBER• SHEET I OF 2
VOLUME 10 PAGE 2774
e
0
QJR.VL DATA TABJI
NO. CENT. ANGLE RADIUS ' ARC CHORD CHORD BEARING
1-2 13014'12" 260.00' 60.07' 59.93' S70034'23"E
TANGENT BEARINGS: AT 1= S77011'29"E AT 2= S63057'17"E
I''~ DLSCR I PT I O1V
A parcel of land located in the NE 1/4 of the-NW 1/4 and in the SE 1/4
e of the NW 1/4 of Section 7, T30N, R19W, Township of Somerset. St.Croix
County, Wisconsin, more fully described as follows:
Corrmencin8 at the W 1/4 corner of said Section 7: Thence S88046'41"E
Along the East-West Quarter Section Line a distance of 163137'; Thence
N0000'00"E 1120.49' to the POINT OF BEGINNING:
Thence N10006'00"E 132.82';
Thence N26027'05"W 103.35';
Thence N3037'36"E 212.56' to a point on the South line of the Certified
Survey Map recorded in Volume 9 of Certified Survey Maps, Page, 2643;
Thence S86022'24"E along said line a distance of.282.16' to the SE
corner of said Certified Survey Map;
Thence N3037'36"E along the Fast line of said Certified Survey Map a
distance of 606.37' to a point on the northerly right-of-way line of the
now abandoned S.T.H. "35";
Thence easterly 60.07' along said right-of-way line also being the arc
of a 260.00' radius curve concave southerly whose long chord bears
S70034'23"E 59.93';
Thence S63057'17"E along said right-of-way line 101.09';
Thence S0026'33"W 852.35';
Thence S76046'28"W 463.72' to the point of beginning.
Contains 6.07 acres subject to existing roadway easement over the
westerly 33' as shown. Also subject to any and all additional
easements, right-of-ways or conveyances of record.
SL1R VEYOi2 ' S CER.T ~)F I CATL'
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 provisions of the St.Croix-County Subdivision Ordinance
and under the direction of Ted and Josephine Langford, owners, I have
surveyed and mapped the above described parcel of land and that ~MIr~~
is a correct representation of the boundary thereof. a'e ,~a~,
Dated thisZt-!rr day of 11994 r ~ z
Revised this z4"tiay of ,1994. 11~t JAMES M. g
WEBER
S-1804
James M. Weber S-1804 SPRING VALLEY
NELSEN-WEBER LAID SURVEYING < Wis.
J* 0
N_OM : 'TYKE PARCEL SHOWN ON THIS MAP' IS .SUBJECT' M STATE, ~ S U
TCWNSHIP LAWS, RULES AND REGULATIONS (i.e. wetlands, minimum lot 10AIS",
access to parcel,etc.). BEFORE PURCHASING OR DEVEWpING ANy PARCEL,
CONTACT THE ST. CROIX C U-NTY ZONING OFFICE AND THE! APPROPRIATE TOWN BOARD
FOR ADVICE.
SHEET 2 OF 2
94-37 This instrument drafted by Jim Weber
VOLUME 10 PAGE 2774
U32_ ~.oz7~ 95-tao..
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER
MAILING ADDRESS °Zd 6/ ~1rr o~1i ~ra.l /Qrr✓'e Mn
PROPERTY ADDRESS 3 S
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Q2!z,.er5.-A &
PROPERTY LOCATION 1/4, /y ~1/4, Section T_3r,* N-R__/2_W
TOWN OF ~em4r SQ-~ ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE 97-2 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: jM&- FlekcrU
DATE: YN 4 - c ct _91
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
B 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
Location of property 1/4 1J1/4, Section T_30 N-R__Z9W
Township Mailing address W-E-
'7611 /d/a~.zLh ~ ~r v c I?/o, Q f~2 ~S~9
Address of site 3 3-ep L (5 " Ay~
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel [o, 0"7
Date parcel was created Co- - 14
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes _21,__No
Volume 1003 and Page Number 17 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded 'n the office of the County Register of
Deeds as Document No. and that I ~~7~~~ (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.
Y
6. ~r'7
Signatur o Applicant Co-Appli nt
Date f ignature Date of Signature
F I DOCIJMENT NO. STA'rl!: 13111E OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA
V~U
IT CLAIM DEED
'5171967
VOL 1083PAGE 98
Josephine N. Langford and Theodore Langford.,.......;Y..„
wife and husband..----------
. 1 ~ :rn
JUN 17 1994
quit-claims to ....Tamarah--Langford--JacKso
1: 05 A , I
FY
the following described real estate in ..............CrQ.IX............ County,
State of Wisconsin: ;,F,tl „N TO
Lot 3 of Certified Survey Map filed as Document No.
517926 in Volume 10 of Certified Survey Maps
Page 2774 and recorded on June 16 , 1994, Tax Parcel No
Subject to and together with an'easement for roadway purposes over and
across the existing roadway easement recorded in Vol. 1020, Page 546.
EEE
it
I~
I~
li
i
This `'S ~O>omestead property. ~I
(is) (is not)
Dated this ..................16th. day of June 94
1 19.........
JL. - - 1......... (SEAL) ~,.r.... .Gt.... .(SEAL)
* am~lYYa ~....._/....:tksd............ ~;Jo ephine N. La fo...............
. .
.............(SEAL)
. ...................(SEAL) l
* 3Kanr Jacicsc~ * Theodore Langfo
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF I-N
ae,
•--...------.County.
authenticated this day of 19..._.. Personally came before me this hl;h...day of
June 19. 94--- the above named
Josephine N. Langford and Theodore
Langford; wife and liusbarid
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized b •
y § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BV
HOLSTEN LAW OFFICE PA
124 S. Second Street, F.O. Box 206
St•1.1-lwate-r-;--MN-----5-60,8.2--------------------- Notary Public ........................County, Wis.
iviiatures may be authenticated or acknowledged. Both My Commisa a expiration
:ire not necessary.)
date: ROY W.'HOLSTEN
)
N0TARYPOsu1C-MiNNEW*- 19.........
-._-WASH1hiGT0N-C41
M Comp. U*p"W" ' . II 1997
•
QUIT CLAIM nr(~n
RTATfi nAlf OF wIF!'ONRIN R'~sr.ur::n L~enl Rlnnk C.. 1..,.