HomeMy WebLinkAbout020-1009-30-000
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I x u A N N n■ i M~N~` ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
n. ' - Hudson, WI 54016-7710
_ (715) 386-4680
February 9, 1994
First Federal - Hudson
201 Second Street
Hudson, WI 54016
To Whom It May Concern:
Regarding Hudworth Homes - Jim Zeleck.
An inspection of the septic system for the Jim Zeleck property in
Document No. 509162, Vol. 1049 at page 501, Lot 1, Burkhardt
Station Subdivision, located in the SW; of the NE; of Section 10,
T29N-R19W, Town of Hudson, was conducted on January 5, 1994.
At the time of the inspection this septic system was found to be
code compliant for a three bedroom home.
Should you have any questions, please feel free to contact this
office.
Sincerely,
0000--
Thomas C. Nelson
Zoning Administrator
js
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER .I vh Zeleci
ADDRESS /U , Co /4 )e
,7 ~ Sd► j . 5/d
SUBDIVISION / CSM ~p~ do ~ SlAjyt LOT
SECTION. / Ir T_29 N-R CJ W, Town of f7lads~y/
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
LAW
D~S~,ne~. ~~arr~ G.~GI ~o Sa~2iEcC,{~~ io~r
Q 13 m £c lbv
d ktt,v L, 5 x LO'
30'
A~ ~Cr►w~ ~
Aw,
o- = - - -
--yr_-~°--------
l
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ~1` //NDYI L'~ G~~ S~'Gdl%I9✓
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION
Manufacturer: Gc.~mkS l`D. Liquid Capacity: X41VI-0
Setback from: Well 5o, House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/.cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 6p Number of trenches 2
Distance & Direction to nearest prop. line: 1-6 5/7 "
Setback from: well : ,d o House 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:
INSPECTOR:
3 / 9 3 : j t
oTnZfustry0. 29-19, ^.~I~ji IJ?t`~'ayS~ YT~T County:
I'RiscoTlQepartmlenP
Laborand Human Relations t'K INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) sanitary r it
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ village '7( Town of: State PAW
ELECK JIM 1HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9300350
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic +e 7d~0 Benchmark lDG,S~ G.yB ~a6-~$
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic /p f .SO 18 NA Dt Bottom
Dosing - NA Header/Man. 7.yL 1 OG
Aeration - NA Dist. Pipe 7.5 98-y'8
Holding Bot. System g,s 97 9y
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syestem TDH Ft
Forcemain Length Dia. FFii Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S 6 a L DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing vent To Air Intake
Length Dia- I Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HUDSON 10.29.19, SW,NE,LOT 1,SCOTT RD.
Plan revision required? ❑ Yes ❑ No
/m Z 7 y
Use other side for additional information.
SBD-6710 (R 05/91) Date ICert. No
r y
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
(~y SANITARY PERMIT APPLICATION
u ®~LNR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
~ ~s~nwu~s.sww.~w,s~
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ l q q q (p
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 O VER PROPERTY LOCATION
YA 2 lec" SUJ %4 NC '/4, S / 6 T ZS , N, R / Ir &.(o
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
Sc cr4
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMB
11. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) 11 State Owned O VILLAGE : Sed ~
-3 [9, TOWN OF: ao~zz -1 ❑ 42
Public J9 1 or 2 Fam. Dwelling-# of bedrooms PARCEL AX Nu
III. BUILDING USE: (If building type is public, check all that apply) ` r l~D - a
1 ❑ Apt/Condo o~
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 1120 Service Station/Car Wash
5 El Hotel/Motel 9 ❑ Office/Facto 13 1:1 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~K New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 19 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
D ~9 J DD . *I ~ ~ Feet /o% & 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 orHoldin Tank 07td QC~~ Gc
- - "I a =0=R=1
Lift Pump Tank/Si hon Chamber El I El El 1:1
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 Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
d. Y-7-/ ter- `22 71e '>72 Z
Plumber' Address (Street, City, State, Zip Code): f
IX. COUNTY/DEPARTMENT USE ONLY
e I ng gent Signatu (No Stamps(4
❑ Disapproved Sitary Permit Fee USurcna~rg rF~ water 71743
Approved ❑ owner Given Initial Adverse Determin tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: t1v
I
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber
~ t 4
INSTRUCTIONS
I
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 revisi;,,ns to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit ? ransfer/Renewal Form (,SHED 639') to be
submitted to the vounty prior to installation.
5. 'Onsite se-&Lt Ue :-~ywfems must be properiy maintained. The se tar k(-) must be Fa:rr;,~~d 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 ouilding 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 requeste=d in #1-7.-
VII. Tank; irjormation. Fill in the capacity of every new and/or existin, Lark. ist the total t t;l!•. r, numt;er of
tanks and manufacturer's name. Indicate prefab or site construct~)d r., tank materia . Gornp]ete for all
septic, pump/siphon and holding tanks for this system. Check oy;--r rne- r;al approval oniv if'anks received
ekper rsental product apprc:r.,al from DILHR,
VIII. Responsibility statement. Installing plumber is to fill in name, ls.:F , P nt,mber with approprvile prefix (e.g.
MP, etc.), address and phone number. Plumber must sign app11r stsosl fc: rrn.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 81h ? i inches must be submitted to tth(-, county. The
plans must include the following: t) riot Dian, drawn to E.C:» U with t;rnr,pieie dimem_,ions, location of
holding tank(s), septic tank(s) or other tre=;tment tanks; 1 r, wells; water mains Rrater service;
streams anti iakes; purnp or siphon tarrk~,; distribution box* systems: replac ernert system
areas, and the location of the building se +es; B) horizontd g i}i ?5- levation ref^rencF~ point;;
C) complete specifications for pumps and cont,ols; dose vc' lm-a, a evat!on differences; frict cin 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 -affect groundwater.
The monies collected fhrcugh "hese surcharges a.=. ~jced for ,idwater, grC un,:f-
water contanoination imves[icaf ins and estahlishnt.°-rt o rstnf--ird; -
SBD-6398 (R.11/88)
JOB Z~le,4
TIMM EXCAVATING SHEET NO. / OF Z
Route 1 Box 192 - ii z z
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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line lrf~....:....:
e e kes 66 _
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PRODUCT 205-1® Inc„ Groton, Klass. 01471. To Order PHONE TOLL FREE 1-BDO-225-6380
1 JOB ~i 2e 1PClc,
TIMM EXCAVATING SHEET NO. OF 2
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY 2 DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE
SCALE
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e
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PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-M
r •rr %K#
LNtsUli AN
HUMAN•REi;ATIONS PERCOLATION TESTS (115) DIVISION
P.O. BOX 7969
11LHR 83.09(1) & Chapter 145) GS MADISON, WI 53707
LO Al"ION: I IN: p P C-.I G--
4'V~ 4 /0 IT4 N/R / E (or1 w TOWNS .'J OS0P/N► (""o lam- OT NO LK NO,: SUBDIVISION NAME:
COUNTY: guR 41/1/2,07- STi}TjO~J
I ~AIE MAILING ADDRESS:
51 CRO1(
G~Jt/G~iE,QE.u..l 1
USE 17 f VA V I' j) /4 (/P ti- E St,, P 1 E $ & ! AJ.v of. SGy7
tGlt-p~Residence NO. DRMS.: COMM R IAL S RIPTION: DATES OBSERVATIONS MADE
2
3 ~K '41. New ❑Replace
- ~Pt2i l4- foiSO 'lNjel 114-1 5Sv
RATING: S= Site suitable forsystem S So
ONVE TNONVE TN IQANAN L:M U' Site unsuitable for system J ~ pi l 10'~` s ( l W/ CS S V a S,T~
~U n ND. IN-GROU ND-PRESS E: SYSTEM-IN-FILL OLDING TANK RECOMMEfv "UED ; ; i rY -If. T ~
U V El S X STEM:pt•.ona1)
S ❑U ❑S aU Ca9.:~uEaT-i o.~~ c. TV2ENCkCS
If Percolation Teits are NOT requi DESIGN RATE:
under s. ILHR 83.09(5)(b), indicate: CLASS If any portion of the tested area is in the
Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS ✓ DEc,'~t,,~ FT.
ORING TOTAL H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE A % UMBER DEPT}i IN, ELEVATION
I f BSERVED TO BEhROCK tF OBSERVED ISEE ABBRV. ON BACK.)
Q AND DEPTH
• /O/. (o y ] 0 si / T S
S/ S 0 T7ti cs
-L 6.0 /oz.7y > /o' /ale- s.r TS
/ 4--kj OR 6,
r ~D 1; G G ~I D p ' . J i/ ot5 ' d T•} v UE CS
/O
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S 103,3Y' -ko > S /-6' 131,f- r,/ .s.'1; s, l~ s ~T~S s,/ S
i• = s, ~T A At v c
At nr ti / . I
I~ ) 'e u E 4
f o u.,jo o N !Jo R 7 t . S % D E 4rt
PERCOLATION TESTS ~a U E R y C-5 a
TEST DEPTH WATER IN HOLE TEST TIME J
JMHEH INCHES AFTERSWELLING INTERVAL-MIN. DR I WATER L V N H
- i P i tz) RATE MINUTES
2 2 PER INCH
IT PLAN: Show locations of percolation tests, soil borings and the dimensions of ~
M
ra
suitable soil a e s. Indicate scale or distances. Describe what are the hori•
nd slope,
nl and vanical elevation reference points and show chair ►ocation on the plot plan. Show the surface elevation at all borings and the direction
Dr O ~ and percent
STEM ELEVATION Cl = ~ A 12 c t f3-3
elelleoz- '0/7's, ~ 3 Vo
x ~~k~ s•rFS ~
- - lob J3 ,
/vo
to
U ~
a u, a.I1. 3 IJEPt- RIFF
T'tiis test site APPROVED PT. = Top 01=
for a conventional septic system. S R oevo e s s, t.
I r, D o T I Q U v
13,
1
9S
SBUff. LpT - - - - 76
idersrgned, hereby certify that the soil tests r••pc„cd on this form were made by me in accord with the procedures and methods specified in the Wisconsin
trative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON:
_ 655 O'NEIL RD., HUDSON, WIS. 54016
WIS. MASTER PLUMBER l IC NO. 3307 M:~R $ CERT ATION UMBER: PHONE NUMeERlopptionaq:
!1 CST SIGNATUR : P(; ~P/a
UTION: Original and one copy to Local Authority, Property Owner and Sod Tester.
')D-6395 (R. 10/8:i)
- OVER
S FILED
0
ti MAR2 919)931&.
JAMES O'CONNELL
Register of Deeds':
467700 9L Croix Co., WI. ; I
CERTIFIED SURVEY MAP
Located in part of the SEJ of the NEJ and part of the SWJ of the NEJ and part of the NWJ of the NE},
all in Section 10, T29N, R19W, Towns of Hudson and St. Joseph, St. Croix County, Wisconsin. i
LEGEND OWNER
19 Section Corner Monument - Aluminum cap in concrete. Dale Wucherye ooq
1718 Ravilla Ave. NE
• Found 3/q' iron pipe set in concrete. Staples, Mn.~ 56479
o Set 1" x 2411 iron pipe weighing 1.68 LBS/linear foot.
N APPROVED
--ire----x-- existing fenceline
ovD
rt i~ ! 0 1990
Water Retention Area Q r 'IX 0,
this instrument was drafted by Douglas Zahier N C04"XM%Z PAW PLAfMt4IN0
Z (D Aim Z0,14N6 (-'0MrvqWe
job no. 90-02 d °o 0
O --h M
rt o
" NE corner
SCALE IN FEET_
z Section 10-29-19
o E m m
300 200 100 0 300 w 0 N
IS N r rt
N y W
a rt
Z ~ O t.••
m
a l a * N ro
S _
'O O O
unplatted lands owned by others Im unplatted lands owned by others
NI fenceline 9.5' north
2' east of fenceline S890401O611W I' north line of the SET of the NE} m
~e 433.01' b S89045113"W 1319.14' rr
south fine oFth NW of- the NE cn c
C) r
E oo o J cott Road has a 66' right-of-way width & is °
4- o0 1 co in :"DEDICATED TO THE PUBLIC / o Cn
I - y r rn to 1
rt ° N8904010611E i- /
N
0 1 M E 425.70 io •/O
I
rt l a r Ia l o
I ~I N lO N 10 `t
I rD 1 F O+ i~ t0 i. ~ V
I I N F V W Z• / m
I N 1 7 11 r/1 ~
10- cn 'D L O O N o`~ O+
I N J r r
fenceline 12' west 424.741- q
Q
N
457.75' f
N890471161IE o rn / " rely
F? / 1~ b~/',/ fD
LINE DATA TABLE S89045' 13"W ' i a
LINE BEARING DISTANCE I _ e
556.45'
Q corner
a - b N890401 0611E 6.371 Section 10-29-19
a- e S8904010611W 426.641 i o I '-1.-
b - c S0000312911E 9,691 i n u,
c - d N899451 1311E 59.49' i o
f - g N8904711611E 33.011
7 /
/ C~ fenceline 1' LOT 1 105,600 sq. ft. (2.42 acres)
northwest LOT 2 105,595 sq. ft. (2.42 acres)
CURVE A - B Lot 3 133,081 sq. ft. (3.06 acres)
ID of Lot 4 693,634 sq. ft. (15.92 acres)
Radius Length = 2814.681 A B
Central Angle - 005713211 N I i fenceline 4.51
Chord Bearing = N4502911911E 66'I northwest TS
Chord Length = 47.11'
Arc Length = 47.111 CURVE B - C CURVE A - C
Radius Length = 2814.68' Radius Length = 2814.68'
Central Angle = 304115811 Central Angle = 403913011
Chord Bearing = N4704910411E Chord Bearing = N4702011811E c t'° `''1•_;
Chord Length = 181.71' Chord Length = 228.78'
Arc Length = 181.74' Arc Length = 228.64'
Tangent Bearing = N45°00' 3311E GVCh6 „
Tangent Bearing = N4904010311E
VOLUME 8 PAGE 2342
SURVEYOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify
that by the direction of Dale Wucherpfennig I have surveyed, described,
divided and mapped the land parcel which is represented by this Certified
Survey Map, that the exterior boundary of the land parcel surveyed and
mapped is described as follows:
A parcel of land located in part of the SE4 of the NE-4, the SW4 of the NE%
and the NW4 of the NE%, all in Section 10, T29N, R19W, Towns of Hudson and
St. Joseph, St. Croix County, Wisconsin, further described as follows:
Commencing at the E4 corner of said Section 10; thence N00001151"W
1207.56 feet along the east line of said NE4 to the point of beginning of
this description; thence continuing N00001151"W 114.16 feet along said
line; thence S89045113"W 1319.14 feet along the north line of said SE4
of the NE4; thence N00003129"W 9.69 feet along the east line of said NW4
of the NE4; thence S89040106"W 433.01 feet; thence S00047'07"W 495.78
feet; thence N89047116"E 457.75 feet; thence S01000'12"W 749.90 feet
along the centerline of the Town Road; thence Northeasterly 228.84 feet
along the arc of a 2814.68 foot radius curve concave southeasterly whose
central angle measures 4039130" and whose chord bears N47020118"E and
measures 228.78 feet; thence N49040103"E 1503.52 feet to the point of
beginning. Subject to an easement to Northern States Power as shown on
this map and all other easements of record.
I also certify that this Certified Survey Map is a correctly dimensioned
representation to scale of the exterior boundary surveyed and described;
that I have fully complied with the current provisions of Chapter 236.34
of the Wisconsin Statutes and the Land Subdivision Ordinance of the County
of St. Croix in surveying and mapping same.
'j f M1 s t
Y.. ~ :rr ''lo,
i
Fix/
Q, ku
mac'.°~,~^. ~ -OWNER'S CERTIFICATE OF DEDICATION
As owner, I hereby certify that I caused the land described on this
Certified Survey Map to be surveyed, divided, mapped and dedicated as
represented on the map. I also certify that this Certified Survey Map is
required to be submitted to the Town of Hudson and to the St. Croix County
Zoning Committee for approval or objection.
Witness the hand and seal of said owner this 29 day of Nlf-g C-1V ,19?Z.
In the presence of:
Witness Dale Wucherig
State of ra/ls )
County of SJ-C~4(k )SS
Personally came before me this ~ day of 199,11 the above
named Dale Wucher~, to me known to be the person who executed the
foregoing instrument and acknowledged the same.
N ary 4PublicL
My Commission expires
TOWN OF HUDSON CERTIFICATE
I hereby certify that this Certified Survey Map is approved by the Hudson
Town Board. ,
+r V
Clerk ate
VOLUME 8 PAGE 2342
>4
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
►w Z e !ec
OWNER/BUYER_ -1-1
ADDRESS FIRE NUMBER
CITY/STATE !Y-~t 1AIL ZIP_ 67014
PROPERTY LOCATION: Sk) 1/4 , SE 1/4, SECTION /0 , T Z~ N-R / W
TOWN OF L"ds~'t st. Croix County,
SUBDIVISION 46ar ke,.-J ~ Z , LOT NUMBER__L_.
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 a 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 t
he 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 Co. Zoning Officer within
30 days of the three year expiration te.
SIGNED:
DATE:
St. Croix co. Zoning Office
911 4th St.
Hudson, 111 54016
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 in delays of the permit issuance. ,Should this
development be intended for resale by owner/contractor,(spec
house), thenia second form should be retained and completed when
the property' is sold and submitted to this office with the
appropriate deed recording.
Owner of
"'v 1 ~n.
property Ze 1 e c-k-
Location of, property 1/4 tU£ 1/4, Section !v , T 25' N-R ~_F W
Townships
Mailing address SGa~
Address of site
Subdivision name ,U (IdA6eld i- S"_wrL Lot no.
other homes on property? yes ._No
Previous owner of property W Lk e ,Zfe4n
Total size of parcel
Date parcel -was created
'Are all corners and lot lines identifiable? yes No
is this property being developed for (spec house)? Yes _k _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 & 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. , 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 county Register of deeds as Document
No. .
Signature of pli ant Co-applicant
L
Date of Signature Date of Signature
_ I
DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
509162 5 ASTER'S OFFICE
Dale G. Wucher and Sandra S. Wucher Mfi1 •~1
-7 keew
husband••and•-wife.~.. NOVl a 1993
.
at 8:50 A.M
nna Zelek,
conveys and warrants to ..James W. Zelek and Do -
husband.-and.•wife-,•-as--survivorship-marital........................ property-
Register of Deeds
RETURN TO
the following described real estate in St_..Croix .......................County,
State of Wisconsin:
Tax Parcel No:..............................
Part of SE 1/4 of NE 1/4 and Part of SW 1/4 of NE 1/4
and Part of NW 1/4 of NE 1/4 of Section 10, Township 29
North, Range 19 West, St. Croix County, Wisconsin
described as follows: Lot 1 of Certified Survey Map
filed March 29, 1991 in Volume 8, Page 2342, as Document RAN
Number 467700. 1112
s
r.
This is not homestead property.
(is) (is not)
Exception to warranties:
Subject to easements, lr`eese~r/vations and ~re~js~trictions of record.
Dated this --...1--.. day of AYY!!. 19..93...
(SEAL) eCy~ W'GC44,en. -----...------(SEAL)
w DALE G. WUCHER
--------(SEAL) . /W..LL/ ...............(SEAL)
SANDRA. -S....WUCHER---------------•-....---......
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
St. Croix ss.
County. authenticated this ........day of 19 Personally came before me this day of
U1Pl!1L 19_.93._ the above named
Dale G.-- Wucher_-and__Sand..... _.Wuoher.....
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.)
to me kno to the person who executed the
foregoin ins u ent and acknowle the same.
THIS INSTRUMENT WAS DRAFTED BY
--.....STEPHEN....:...DUNLAP----------------------•-------•--
24---
m' l~
sudson, Wisconsin Notary Public St,_- Croix-.................. County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is perma/vent. Iff not, state expiration
are not necessary.) date: . 1 19
-Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
pr)Rm Nn P - P~3^ MilW2nkea Wiscnnsin
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