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HomeMy WebLinkAbout040-1013-10-001 Q o ° I 03 61 I 0 c d a 0 ~ I a o I h o I O d ~ Z I tl I CD 1 Z C LL C 3 Q I i I ~ w II Z ~ I Y p a m 04 0 E Z a~i Z ~ c o N H r ~ ~ Z v N M CL (D 4) N c c L p L p C Y 0 U 42 c r_ Z 1 I- D 0 co z o C c E N V a a •M r c It LO C H d N O O y a o G G a n N 0 U) U) CL Z N a N 0 o Z 0 O O 0 4i '0 0 CL IL M V51 Z4 a IN* B U) -i U 0) rn CD o O v N N o m co O O CO c L Q 0 y N O N v O C M C IV O L- Op' C j r-- M I~ O t+ O y ~n co 0 cm 0 a) t) d 0) O (D o~i 0! U a o c a m U G p p E 7 M o N T c~D w N I- c L o LO a 2 cc O O F- N O Z c fA c~ e~ V II of EL a d Z. rrw~• Q d C A c°~CL i0 _1 E c 3 U) ti ST. CROIX COUNTY WISCONSIN ZONING OFFICE Nil a it an ■ ,,,,i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road = Hudson, WI-W16-7710 (715) 386-4680 FAXED TO YOU THIS DATE March 15, 1995 Mr. Roger Bevers River Valley Abstract & Title 206 Second Street Hudson, Wisconsin 54016 I RE: Septic Inspection Dear Mr. Bevers: An inspection of the septic system serving the Chris Yaritz property was conducted on December 7, 1994. This property is located in the SW4 of the NE1/ of Section 4, T28N-R19W, Lot 2, Town of Troy, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please feel free to contact this office. ncer ly, e10~ J es K. Thom son ssistant Zoning Administrator St. Croix County, Wisconsin mz , STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S!! f~ r-z ADDRESS ~ 5 a-j 6--)1' tc-yo ~ ! SUBDIVISION / CSM# VD - ~ifl~~ /~{S'n LOT # SECTION 7 T -~Y N-R W, Town of % y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM q0 qS p ~oPoSEe WEtt ~R~ooS~ 0 1 E s /rOE.uc /oo &'1L '5k?71 '~WK '~9L' 57' ~ SOQ 5 r~t~'TLNE ~ £!'fnSi ~E H0. 4-fK' SA/KF Y~iv~i/rf'f ~c 0.0 1?,E c AI've 'g7j" 5I)• GJE S i Odd/~P~y 4i ~~T N RPo®E7'lY ~lN~ p INDICATE NO /VO ![•fL£ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. J BENCHMARK: tjl," /,V 4~E,pe Td_4 C[r% = A00.0' ALTERNATE BM: LowF,e LE!/L! Ff_ E y = /05! Af SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~icf5~~1► Liquid Capacity: /ooo Ito Setback from: Well 9G' House Other i Pump: Manufacturer - Model# - Size Float seperation Gallons/cycle: r" Alarm Location SOIL ABSORPTION SYSTEM Width: ;C- Length 7~ Number of trenches a Distance & Direction to nearest prop. line: ~_f~f sr Setback from: well: House Other - ELEVATIONS Building Sewer T ST Inlet. ST outlet 9V. 95' PC inlet - PC bottom - Pump Off Header/Manifold Qg.9? Bottom of system 4 ff.3A g$:oo' Existing Grade,4 Final grade f4 5V 7S' g 9Q- So DATE OF INSTALLATION: PLUMBER ON JOB: ---~~PO'~ LICENSE NUMBER: MPIP5 33 SS INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LabDr and and Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI YARITZ, CHRIS X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA X2107 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 14 ( ~ ,+05 D Aeration Bldg. Sewer Co cam/ Holdin St/ Inlet TANK SETBACK INFORMATION St/ IJK Outlet , Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic say a NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe cgs 24 Holdin Bot. System 3. 88.32 , LIZ s. o3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand °p 0,,- j~~' 7 /p, j o3~ Mode ber GPM TDH Lift Loss I S stem TDH Ft Forcem ' Length Did. Dist. To Well I F S ABSORPTION SYSTEM BED/TRENCH Width i Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ~7 DIMEN DIMENSIONS nufacturer: SYSTEM TO P / L BLDG WELL LAKE/STREAM ]CHHA SETBACK INFORMATION TypeO - 70P 57 A N IT Moe um System: y DISTRIBUTION SYSTEM Header/Ma nifold Distribution Pipe(s) x Hole Size x Hole cing Vent To Air I `ake Length -Iff Dia. 4z: 1 Length Dia. --Z- Spacing -z~ SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystems J Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center- Bed/ Trench Edges T E] Yes ❑ No ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: f~Troy .n4 ..2/8 ..19W, SW N.ELot 2, , Tower oad I i Plan revision required? ❑ Yes to Use other side for additional information. ~,2 d7 9 T-~ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: C ILHR SANITARY PERMIT APPLICATION T In accord with ILHR 83.05, Wis. Adm. Code x STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than aA 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 J),., % A/5 Y., S ~ T N, R / E (Or PROPERTY OWNER'S MAILING ADDR~SS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER A4 o o CITY NEAREST ROAD 71 II. TYPE OF BUILDING: Check one ( ) ❑ State Owned VILLAGE : ❑ Public tZ 1 or 2 Fam. Dwelling-# of bedrooms A ELTAX NU BE W) Ill. BUILDING USE: (If building type is public, check all that apply) -~0 _ 0Cv 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 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPPiE1 OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. I~SJ New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE J REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) iQ 01>9. 30 ELEVATION FT eS.OU Feet g 391, 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 Lift Pump Tank/Si hon Chamber Vlll. 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 Si ature: (No S tamps) ietP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary ermit Fee (include g round water ate Issued Issuing Agent Signature (No Stamps Approved El Owner Given Initial/4jr Adverse Determination 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 (SE?D 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, 6138-266-3815. 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. Vlll. 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'/z x 11 inches must be submitted to tho county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of molding 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; soli -i5sorption systems; replecement system areas; and '.he location of the building served; B) horizontal and vi.rrtical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences, friction loss; pump per-forman-,e curve.; pump model and pump manufacturer; D) Grose, section of the soil absorption system if required by the co;snty; E) soil test data on a 115 form; and F) all sizing information. I GROUNDWATER SURCHARGE 1933 Wisconsin Act 410 included thet creation of surcharges (fees) for a numnr of regulated practices which can effect groundwater. -f he rt~:-,nie Gc':Iacted through these surcharges are u.,;ed for monitoring, groirrrdwater, ground- water contamination investigations and establishment of staridards. SBD-6398 (8.11!88) A rII PJ~E~I±/ q INE PLO 87 4 0 PLOT do CROSS SECTION PLANS tAPPA DIWSi. It=AVAfINQ M- PLUMBING UNIT r cl••Scrr ~d S~w£~ ~,NE s~ ~S PROJECT /OOd ~if~. GJrESlR pfU19ENT`; t Sc,P9'/ C N/C ~ ~~E ELJ C F T/ its C.t/G 41 y" SOq 3 t~fLu<c`lIT so, nc.JE 4, AjE ,c7 S ~..J r ~En1G,l/11~rQ - SP KF ,y ~ Jfnt~ 3g ST ~iPv/ COU,II'T ' A CEpAR TR E EGE✓. /vo,oo' _ r.~' ~\R g' ~ AtT `R o 3~ ~ovos~a D ,/c4,,~y c ry/~pK° ~Pi.tE iN ~f~AR a Ba T~r'E E~.K U . /00. N Snu,N Q~QoQEP~Y~~NE NO SCALE ~owEn Ro.4n FRESH AIR INLET AND OBSERVATION PIPE r APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE , SIGNED: MARSH HAY OR SYNTHETIC COVERING i LICENSE: MINIMUM 2' AGGREGATE DATE:/~~ OVER PIPE DISTRIBUTION PIPE TEE SOIL TESTING BY: ✓Ef' t~thu5 ~w ELEVATION BED W AGGREGATE • BOTTOM PER SOILBENEATH PIPE PERFORATED PIPE BELOW TEST IS • I COUPLING TERMINATING A 89.30' FT. AT BOTTOM OFSYSTEM TS. co, a ~.j ate, . ;i r i ~1~.. ~ 1 r . i~~ _ _ ~ ~ r ~ ~ 'f~..nt ~f tea. r rte; . r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ~C►~o / k not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN R: PROPERTY LOCATION q fS I GOVT. LOTS 1/4 Md, 1/4,S 4 T 2 $ N,R /7 E (a) W (21 4k PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 7- C5? Y6L s lib l4so CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAA ( ) -Vb /dwi`~ 1C0~ Q(~ New Construction Use "~4 Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0.7 bed, gpd/ft2 d ,3 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0.7 bed, gpd/ft20 .F trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system QQNVENTIONAL MOUND U ROUND ROUND PRESSURE AT- GRADE SY TEM IN FILL HOLDING JANK •U = Unsuitable fors stem S❑ U S❑ U S❑ U S❑ U 1S ❑ 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 b-$ 0 4 Z - SL I Cr rv+ Q W -Z Q.S -4`2- 7-S,O 4 _ 5~ R a LJ 1~ 7 Ground ~j 14Z °11O 16'14 1 l ~S elevG,% ft Depth to limiting factor > 9.17 Remarks: Boring # 0-24 !O~ 3 I 5~ Z r 2 CA a.S Z -41 .syk 41-4 - 5 © A, l w 1-~ o? o & z~ 44 s n %r M~ 7ag Ground elev. 9S. 51 ft. Depth to limiting factor 716,S6 t Remarks: CST Name:-Please Print Phone:` Address: ~ ~ , k ~ ~Sv N Signatur Date: 7 CST Number: PROPERTYOWNER C't, IS YA'klTC_- SOIL DESCRIPTION REPORT Page?. of 4 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerrch 3 Cr M r w Z m 04 O.S $ I Z -64 7.Sye, 4 S r r►n 1 p.7 Ground 64-8 /ovk 4 4 S r ri 1 ~ -T 6.7 SS ele /02•~~ft. Depth to limiting factor Remarks: Boring # A®-1 b b~? 3 I S L I r~ r ,S 6`2 -7,26,414 Ground 9-2- -'S-/ 1/9 A. 4- S r h it p, `:0,3 elev. 16--7-7ft Depth to limiting Remarks: Boring # QA bS /YA o 3 - 1 I o7 a,k El 1g, r ` 1i 0.7 Ground Ceev. Depth to limiling factor Remarks: Boring # El -3g ov R 3 - s 1-n I C,LJ -F 0.7 10.6 Ground elev 18~ ft. Depth to limiting tor > 9,6~ Remarks: SBD-8330(R.05/92) PROPEFFYOWNER SOIL DESCRIPTION REPORT Page ofA- • I PAREEL I.D. . Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 ow 4 5 n? / C w 0.7 Ground elev. Fs3•c~ ft• - Depth to limiting factor > MAZ Remarks: Boring # Z rU'1 5 L. r 1 w -Z, A7 6A o .s ISZ 44-rzs s fi~ Ground elev. 9z .s34 ft. Depth to limiting factor FT Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PALE d~ 4 r I 0 LA A fi 5 D z u f ~ ~ v NN i y G Q~ °'o ~t z ~ D ~ i► U C L ?c ~ Z A ~ P Al ~ fro 395 39 , CERTIFIED SURVEY MAP 66, ~ SCALE 1 N FEET TRUE \~g ~oN BEARING o) i000100 200 Z: I i % o 31 S 0 p P~~ g't O d 0 \ N co 5 22\ oo ' 1 71 °3930" r O G 03 ~1 to 0) _ O I:W r ' /p6 aN, `n - I r` i , -0 ° ti O 1.10 0 (D LO 3.72 ACRES r„ It It 1 °~rMj i o •-J 10 N 1 0. c 1BE; 18. w i ca SW-NE 00 N L3 r I Z: rn 0 r z N CO • " -N 398.21' c), r SI°43'36"E r Q 00 rte. ~ ~ r a. M 6 6' w 2 rn F- i < wI a. W 1 z I -N I ~ TO 2.72 ACRES N N r 11 Z2 L M vIV X1984 ooti h W MAaUn "ft Z 1 of D"ds w O`0 0, 5.6 2' ~.tn S S 0 04,W a 5.41 50.21 224.64 F 3 r rr S6°pp,W Or rr ` POINT OF BEGINNING w U ~r UNPLATTED LANDS N IN N 1/4 CORNER 't 00 SECTION 4, 89° Z X T28N,R19W p 2542.20f 4S% _ w This instri rent ° O dr f d by SO 23'W z WEST LINE OF NE 1/4 OF SECTION 4 CENTER LINE OF STATE TRUNK HIGHWAY "35" f U sow Volume 5 Page lb50 051T a~Jsd S BUMTOp OL'Z9H 01 ~,7, ? T1.313AS :)11d3S Z10 S30(1 NOISIAICSIM Z20?vI"N Si ;l _-'C VAOUdb • ~iawrroa ~rnNOa crv 'EMINNVld S)raVa ?AISi°N3 dv~C)? A NIPIOD XIClK) 'IS Mt 8 I X10N s,•oti~,~ a3AONddd 0/ Sim = zsas fir= zzobs 'IM `SgItld UUAIU N-Cc'O 3f1NgAV 11ONx XVO ££8 ~.'H SIONd23a Qq. JV'dOdubDNI It V : S11RNh10 Istv 0,-) >l flt;.~~rg'od~d ~-f''••r W~M•`'~'~`''s, ' QNf103 `dd'J IaS M:-Ig `.LKUMCK ldat' 00 NOI DHS kLNnOO MUD 'ZS d 0 •Sirn 4 ' $lls:~ ?'=r,ta *19S ,1003 IV9NI'I/#S9'£ 9NME)I3A1 ZdId NONI ..0£X„Z 0 M 4~ ~sas : ~ M W1090 y •19S ZOC3 WU-NI'I/#89'T 9NIMIMM ddId XTOUI .VZX,,T 0 4 'H Si~o: ZZOvS 'zA1 `sTTUd aGAT-d Iaa-IIS IUTd •d £ZI -OD 2UTaaGUT?U3 uGp!3O •H stouEad: 19- 'ON "P130 . 9L6T `LZ aagwajdaS :pa;EQ • aouEuT a fuTuo X:IunoO XTO.IO IS! P O Z 0 Z'b'S o. aS pup sainjuIS uTSUOOSTAI 011: _T o„V £'9£.Z 'oaS Jp. SUOTSTAo.zd u)j Xw jo..1soq. aL{a LIB cni patTdwoa ~(ITn anUL1 I JELtj pup jazTaq pup '~a~3pap' 10 . ails of joaaaoo aaE dvw pup UOTIdTaosap `AaAans anoqu aqj juLL 43T-4aao I •8utuuiuaq jo JUTOU @Ljz 01 :~9•ti~Z l•i:0009S o'Duatjl `29' 8 M,tOoCS aouaLjI ZS'8SS At„8T,T0obLS aouaL[I : ►L:6'9SS Al„6£,0£aZ£N aoLIGIII ,90'OVZ II„££,£Oo88N aouGLj:. ' , OT ' L9T :I„LS , S£a£gS s-Troq paoLjo asoLjM ACT zaljInoS anUouOO an.zno snTPP.L ,00-00L U uo Gull A-cm-30-IL11311 XIa0111.aON pzUs fuOTU , OS 'L91 Al. S'e7 GouaLj4 :ppOU .zan;OI Jo auTT AUM-30-11j2Ta ATaaLj4.'ON pzEs 2UOTE ,06'£SP ?i.SVt £o68N aouaq-4 :13UTUU12aq jo juTod at[I of PuOE aGMOL -40 auTT X-PA-JO-11113za KTaagjaON, 01I4 fuOTE ,T6'STV :I11SV,Z£o68N aouatll. :,,S£„ (UML{~3ijl >junU alUIS -juasaad jo. auTTaa;uao 011:1 PUV V/TRN pzEs. jO auTT 4SOM at[I ~WOTE OZ'ZVSZ To aauaoo t/TN atP IV (~3utaUag anal.) AI,£Z003 GoUZ)q-j : `,ti16_IN `NSZ.I. `V UOT:IoaS - !UTOu@mWOD : SMOTTOJ se pogTaDsap 'UTSUOOST,ti1 `XJUTIOO XTOID 'IS `AOa,L }o UMOL `M6T2f `N8Z.L `b UOT-400S -O /T3I~ @1111 Jo WINIS Oq-4 LIT p@jr.ooT pueT 30 Taoapd V NO 11d IJOSdQ , 4 y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS b d w c d~ h 0~ . S y O PROPERTY ADDRESS %T9 , c R' (location of septic system) Please obtain from the Planning Dept. CITY/STATE /~ucYSo Gu , y / 6 I PROPERTY LOCATION f ~..i 1/4,/v,- 1/4, Section, T o N-R_ZY_W TOWN OF ~fLU " ST. CROIX COUNTY, WI 1-4 SUBDIVISION , LOT NUMBER _o`. CERTIFIED SURVEY MAP , VOLUME _,J7, PAGE SO , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: 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 y -2 Location of property i, 1/4 .,VIE 1/4, Section Y ,T_222LN-R_,Z~_W Township Mailing address o 7ouj4z !a Q. Address of site -T w e PC- R._ Subdivision name Lot no. Other homes on property? Yes ) No Previous owner of property r~~~-~e c., oe y Total size of property Total size of parcels ,gcs Date parcel was created Are all corners and lot lines identifiable? ?C Yes No Is this property being developed for (spec house)? Yes X No Volume ~ and Page Number LS?e 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 in the office of the County Register of Deeds as Document No. °1~ y~2) , and that I (we) presently own the proposed site or 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. Signature o Ap ica Co-Applicant Date of Signature Date of. Signature 51 J ! DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA • 519+4 rO STATE BAR OF WISCONSIN FORM 2-1982 VOL 10~T~a; 568 - REGISTER'S OFFICE A & R, Inc., a/k/a A & R, Incorporated, ST. CROIX CO., W! _ Recd for Record - JUL 2 0 1994 . Q- conveys an~d~w~arranU to .-Christopher a single 9: 30 „ A. M II rson ~ - j - Re®st~ of Deeds I y - - . r of Is},p e'rr,L1 (*-I (c To w e,.- Rd d the following described real estate in Str. Croix ~t~d-501 wr- SQ0 1(0 . ---County, State of Wisconsin: Tax Parcel No- Part of SW 1/4 of NE 1/4 of Section 4, Township 28 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 2 of Certified Survey Map filed August 8, 1984, in Vol. 5, page 1450, Doc. No. 395439. i , .050 This - not homestead property. (is not) } Exception to warranties: Easements, restrictions and rights-of-way of record, if any. day of - Jima- Jul y Dated this - _ I9. 94 nc. - - - - (SEAL) B ' - - - - - - - - -(SEAL) By:-- (SEAL) ACKNOWLEDGMENT r Signature(s) STATE OF WISCONSIN ss. ~ County. authenticated this t ~__.day oF__,lt 19Pe-son;:l,y comf bc-fore :-"L this - - - - - -day of 111 . 19----- the above named t ----------------D-------- - - - I~ TITLE: MEMBER STATE BAR OF WISCONSIN ' I (If not- authorized b - by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - - - - I Kristina 0 gland • - - Attorney at Law - - I - Notars Public Count. s, Wis. _ (Signatures may be authenticated or acknowledged. Both M.% Commission is permanent. (If not, state expiration are not necessary.) date: 19. ) •Nam- of persons signing in any capacity should be type-I or ant d h,h- th-sir kv WARRANTY DEED STATE BAR OF W,5consin Legg! Bark Go . Inc. R-[i. p~;SI1 s FORM No 2-- 1-2 M,Iwaukne. Wisconsin 'C