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HomeMy WebLinkAbout020-1033-40-000 zz j z3 1173 5E-P7rc 5;157eAf Ivs7*&. STC - 104 AS BUILT SANITARY•SYSTEM•REPORT OWNER ` 51 'TE- ADDRE SUBDIVISION / CSM# /V/f- LOT # SECTION. T 2'f_N-R W, Town of ~ft7DSo.v ly'ly~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF. r-v y _ C: P L~o r. P fi'4~' , 3 o 3 O INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ?S - I df 3 O~ CS T- $ Tn Ll'$ ~.l..~ PU C. pi 61d akh-oj loop C F~oo~ pl~t~ BENCH ARK • 4 7/4 9/ ' N *3 ALTERNATE BM: =P E(~-y T~O~ _ 10~, bZ R SEPTIC TANK /PUMP / N Manufacturer: Liquid Capacity: Setback from: Well 7 S House 20 Other ` Pump: Manufacturer Model# -----Size Float seperation Gallons/cycle: Alarm Location / T/?ec~GGi ~ Fi4GCi .SOIL ABSORPTION SYSTEM Width: 5 Length 749 Number of trenches • Distance & Direction to nearest prop. line: UfST _ 77 Setback from: well: House Other t ELEVATIONS Building Sewer f ST Inlet: 161 ST outlet. PC inlet PC bottom / Pump Off Header/Manifold Bottom of system S~ b C Existing Grade Final grade 3 (~J DATE OF INSTALLATION: Ili 0 U • 2.-2-3 2-3 1 c(q 3 PLUMBER ON JOB: RO13 ERT- Z{ LQ R i ck-r- l~ S 33 O LICENSE NUMBER: INSPECTOR: Al 4P 3"eA.)k(.vs' 4SST, 2dAc'/O 3/93:jt ,2of3 Y W w o - y o o Q ~ > Io w o ; , ~~i o vl ^ m t i I i d • I, I I K J cn` R1 I ~ I I ~ '++6 N 16 n . o I I I I C.A ,r Y CIO -6 I I i D o ' r -_O (A I (n C -N 1 ti > s`, U s t~r1 Z y -N 15 rn 9 ZT- C O o L' ~o m ~ j 1. rn ti ZZ) IT, o m 7 w 0 w L' OCATiIpNartm~eTno~d'ustry? • 29.19.1kATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary flit GENERAL INFORMATION Pgrmit Holder's Name: ❑ City ❑ Village RTown of: State Pla CHRISTIANSON PAT HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300349 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j . Benchmark JU p Dosing. Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 166 C-7 Verit ir Ito ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Air Septic ~S"~ l 75~ a v' 71? p NA Dt Bottom Dosing NA Header/Man. 7~Z ~Y Aeration NA Dist. Pipe 7_ J / 9S S -7 Holding Bot- System, 1 q7 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand /i)~;/ / J - Model Number GPM TDH Lift Friction System TDH Ft / Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM'` r" 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 CHAMBER INFORMATION Type O -7~~ J -7 7 i 3~ 0„q OR UNIT Model Number: S stem: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 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.)- 7% LOCATION: HUDSON 17.29.19.1461 ?9p. 1-x uM 3 rt-, rJ . Plan revision required? ❑ Yes ❑ No ~l d Use other side for additional information. 14, SBD-6710 (R 05/91) Date inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: [Z-71 N DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE Min, Y E # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Cheiontoiousapplication -See reverse side for instructions for completing this application. STATE P N I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. N PROPERTY OWNER, 4 PROPERTY LOCATION ^-l- C1f11'(S iV `6'N 511MY RC a4~ 54J +/4 Alid y4, s / 7 T 24, N, R P? E (or) W PROPER & OWq t MAIS T ADDER - LOT # Al+ BLOCK # CITY, STATE ZIP CODE PHONE NUMBE SUBDIVISION NAME OR CSM NUMBER R"So'a 49/• Sys/~ 1(3961B Al+ II. TYPE OF BUILDING: (Check one) CI NEAREST ROAD ~-y ❑ State owned ❑ TLAGEu~Q,/ ~dOU T12, IC ❑ Public U 1 or 2 Fam. Dwelling of bedrooms L_ PAR LT NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) :10 - /a 33 4/000 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 QF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 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 ❑,~eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 k Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure , 43 ❑ Vault Privy 14 El System-In-Fill Z 7RENC#E3!; X 76 "Z-4e4, VI. ABSORPTION SYSTEM INFORMATION: ~•O S 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM EL 7. FINAL GRADE ~D REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) p7 Si_.~*j m ELEVATION 1-75-0 '760 ' d A14- 97 d Feet a2 ' v Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret structed glass App. Tanks Tanks Septic Tank or Holdin Tank / /2G0 Lift Pump Tank/Si hon Chamber iff (mot C 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 Sig ature: (No Stamps) MWMPRSW No.: Business Phone Number: 'o r 2!/6/CIci' T 3367 7/S 3,0010--f195 Plumber's Address (Street, City, State, Zip Code): 65-5 a ' A'oe ez 44. ~~o-~ ~S. SSias Cp IX. COUNTY/DEPARTMENT USE ONLY ❑ /A Disapproved Sa*tary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) pproved ❑ Owner Given Initial Surcharge Fee) Adverse Determin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary. permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary -Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to :3 years. 6. 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'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, dravrn 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 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) . ,y~f»E•~DU~ 7'0 ~°E~vO~° j off' / 7- l 3 Wisconsin Departrnent of Industry, SOIL AND SITE EVALUATION REPORT Page of z tabor and Hunan Relations Dnnsan of safety & Bindings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5T, Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BWq, direction and % of sbpe, scale or PARCEL I.D. 8 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 1919T % C~iP/Sfi~j,(/SF~ , J SZ,Div R GOVT. LOT 5k) 1/4 AW 1/4,S 17 T lI~ N.R /I E (o W PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK: SUED. NAME OR CSM # (ov 6 y,'4 5 r. 71,o. CITY, STATE ZIRC E PHONE NUMBER []CITY [VILLAGE NEAREST ROAD UO~D~, ~i"S. SYoiG (71S) M6-&570 6"ana", I r ac, seoo& [lew Construction Use [ Residential / Number of bedrooms y Addition b ebsfifg building l I t [ ) Public or commercial describe Code derived daily low &00 gpd Recommended design fading We ~ bed, gpolft2 IF trench, gpd412 Absorption area required gS 7 bed, ft2 750 trench, ft2 Mai irnum design loading rate ? W, gpo0 - F trench, gpW - Reo mntended infiltration surface elevation(s) S-aC ~ S • 2-- It (as rowed b site plan benchmark) Additional design / site considerations VSL'- 7N s - Parent matew-!S* 5 S8 t~µ• g - ST.Pf~•~ TE7~'/P~f«- Flood pk in elevation, d applicable Toy It S - Suihhttible for system t(CONVwnoNAL MOUND d'S LJ U ml- ~J'~ [ u FIN-GOMPRESSURE u AL~J'S a u 0-s- 0 u HOLDING U - unsuitable Ion stem SOIL DESCRIPTION REPORT FDDepth Dominant Color Mottles Structure GPD/ft Boxing # f rizon . Munsell Qu. Sz. Co nL Color Texture Gr. Sz• Sh• CansisOenoB Boundary Roots Bed TWO O S ~rff2 CS .S 6 7 E LION So i0 ye 7 3 - s O.C. S dill- r •7 S' Grand CZ o -yo /o ye Depth to limiting (actor > O Remarks: Boring D /p yie 1~1 OPSAat' c S D, . 9R nMu-F/e s s 7= '7 15 O / c s a 1 y Lj 15 7, S \/R - s O, ,W, . S aQ1L CS • 7 y~ Ground C d elev. v -yo /O Ylp 5 CP iG Depth ~i to limiting factor d Remarks: T Name:-Please Print 'P-o u3E P 1 Z(L 13 R %'G L4 Phone: 7is ,3 ~STiy 2y Z Tess: S S O' tip/ L ' ~[9DSo~ 4)1 • 5~ea4, OG~ Z-5`13 Date: CST Number Y 13,f oo,F- 'D cLp lei l~ o In t W N r 4 ~ m o ° ~ o 0 0~ ~ ~ ' w 0 ~ i 0 0 Vl vi `I z h i ~ mot. ~ (V~M o e ' O ~ w G y 2 Q'I \ O O r . tj c 16 c 4,97- - L.;uE- LAI l fi,P~ 00 o STACK -h W r, Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12' Above Final Grade 2 ' Above Pipe _ 4" Cost Iron /1o Final Grade Veal Qlpe' Synthetic Covering Min. 2" Aggregate Over Pipe Distribution - Tee pipe 0_0 0 0 0 G Aggregate o PerfOroled Pipe Below Beneath Pipe 0 -Coupling Tuminatlnq At 6 ys,~~ Bottom Of System ~7, std Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade vim. D • ~ ~ . "Above Pipe 4' Cost Iron -Yo Final Grade Vent Pipi Synthetic Covering Min. 2" Aggregate Over Pipe Distribution - Tee pipe 0 0 0 0 0 (o "Aggregate. a, Perforated Pipe Below 8eneoth Pipe o -Coupling Terminating At SySTt^~"I r~/a Bottom of System . . r q-7,0 • r, 7- 13 /P (f2o ~t (n L P _ m 81- 0 i ' 1 I ~a 70 0 IA y N W 1o c 1 Q7o m y m r j ova,, c PRcsv-y ~0 4:5 r Q f/iQb ~v00 O STACK i i W A Wisconsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page / of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 5 E -Vue tL Z)/ ,v /01s' 1'01.1.7_ & 4'pro') Buis . COUNTY 3 8!o - 3119 ST Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL 1.0.11 . dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY-SWN fi $ v Yj6" PROPERTY LOCATION P+7- e lfiP. sr~;t,v s ,ti GOVT. LOT 5w 1/4'V ~1/4,S 17 T z 9 N,R [ E (or)., PR ERTY OWNER':S MAILING ADDRESS LOT a BLOCK a SUED. NAME M~ s Ca & y7y, S T-. 7W . CITY, STATE ZIP CODE PHONE NUMBER rICITY ❑VILLAGE ®fOWN NEAREST ROAD Uos o v Z"IS. JV014, (76)396-615"70 1- -U DSo-j [rl] New Construction Use [1`] Residential / Number of bedrooms Addition to existing building -----_•1 j ] Replacement [ ] Public or commercial describe Code derived daily flow (00 0 gpd Recommended design loading rate bed, gpd/ft2 trench, gpW Absorption area required bed, ft2 7,~D trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpol112 Recommended infiltration surface elevation(s) See P2- . 3 ft (as referred to site plan benchmark) Additional design / site consideration cA ES SP - sreE.t--► TRQ<FS `l° "sV` T Parent material SC--5' P&-i B Flood plain elevation, if applicable ft $ =Suitable for system CONVENTIONAL ~DUND IN-GROUND PRESSURE 7T-GRADE ❑ U SSYYST ❑ U HOS INC TANK W FILL I HOLD U= Unsuitable for system W S 11 U S11U7 IRIS ❑ U S MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botndbry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench ©-~D /O y'e 21-2- /ht v~,e S 2 r o. 1 • 7 • 7 . /O /y r %/f y~ /S 1, , Sbr i 1/;119 eS t --7 oc' Ground T3 i ~y-y -S y p y S O, S -2 cs - , ~ elev. C y~ 90 /o Y~ S D e. s Z ; •P lim 6ia ng factor -0131 NA 90 t Remarks: Boring # ,q 0-1.2, 10yX 2/2- ~S /,4fl 5/t z~ • 7' 'ZI Ground elev. ft. Depth to `ThI test Its AP ROWED rvnven nat c eyst me 199 Remarks: p*1x CST Name:-Please Print TOBEhO T ZfGlW/'cfT Phone: 7iS =3 ~hGE 'q Address: ~5S d ~Nt /L L7. h1olps t..? GCS/S Sya/~ g - 7 ~i 3 Signature: Date: /0 4,0 1~o 1-7 2- -E PS) o~e p k /ff Z TK6A 3 Ce, e-S) 57~eoy6-1-1 /ti f/ ;vim- s~-~v soy/s- PROPERTY OWNER SOIL DESC TION REPORT Page of PARCEL I.D. i De th Dominant Color Mottles Structure Consistence 8our>vary Roots ,G 2 Boring # Horizon P Texture in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed d 1~J d S l,^-1, ah/r All vfR 13 ~6 Y/? Ground ~o ~ 4 S S / • '7 elev. i ft. Depth to limiting i factor Remarks: Boring # d d -l Co / O cwt of /Z S 2 f- { 100 3 /0 f13 /0 ye S Ground elev. ft Depth to limiting Remarks: Boring# 4.1 S V-1 4 C S AM, t Ground elev. ft Depth to limiting factor Remarks: Boring # i Ground elev. ft Depth to limiting fictor . Remarks: 00M W212wo ACM" Wl 13,C' oo- ~`t to FtT I w N rn Ln ~i I z o ~ ~ r o f yi z 62a U3 s 1- ~ \ U-1 v N I'Rcsv ti o CAST _-_--1 ~ fi,PE woo o s7.a~K 4 w 2 0- /03 ;~(O 000 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Av- .01 ADDRESS ST' 2W FIRE NUMBER CITY/STATE ZIP J~ryO~ G PROPERTY LOCATION: 540 1/4 &)l/4 , SECTION 1 7 , T I ~ N-R l9 W TOWN OF St. Croix County, SUBDIVISION NCI- , 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 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. "he 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 Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 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), thenta second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. - f owner of property ~ Location of, property5/t/ 1/4 AlW 1/4, Section 17 , T_` N-R W Township _14 1/©SG,~ Mailing address 606 K A- 57 ` Ad-" p3'a) . Gc~ ! S . ~-Q< Co Address of site subdivision name /V Lot no. other homes on property? yes,_No Previous owner of property SOSAM S r F ^t•"~/ K1 Total size of parcel 3 t (41 S Date parcel-was created Are all corners and lot lines identifiable? _Yes _No Is this property being developed for (spec house)? Yes No Volume !,')33 and Page Number L~ of as recorded with the Register 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. SD 5 3& , 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. F1,C J- ~ Signature of applicant Co-applicant l!/G S Date of Signature Date Signature A 5._ 4f1,; ~Jt'.wit~r?~!`'h,~ DOCUMENT No. ~;STATZ BAR OF WISCONSIN FORM 1-1988 ( T.I. SPACE RESERVED FOR RECORDING DATA I WARRANTY DEED + 505367 I ~I~t U` Ime dW r.~CIST~R'S OFt=IC~ SUSAN This Deed, made between G. SIF EL-DIN_._________. I Rec•ii fnr Rowed .f/-k/-a._SIISAN_.G..__WILLMAN..aA/a..SUSAN_ G... GROTHE................ ! SEP 13 1993 Grantor, at 9.00 A.(A and ---PATRICK T. CEiRIS'PIANSEN AND SHELLY J. SHRINER, Q 6) ~n as joint tenants +{C^ •-z •'x f xeas Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN TO a~ C ^ . conveys to Grantee the following described real estate in -.Str..CroiX ~D 4, County, State of Wisconsin: o Tax Parcel No- Part of SW1/4 of NW1/4 of Section 17-29-19 described as follows: From the SW I. corner of said SW1/4 of NW1/4 go due E a distance of 392.0 feet, thence due N a distance of 780.0 feet to the point of beginning for the parcel to be conveyed herein; thence S28 581E a distance of 473.1 feet, more or less, to the S line of grantor's land, thence S57 121W along S line a distance of 394.2 feet, thence N23 501W a distance of 83.5 feet along the E boundary of parcel heretofore conveyed to Nord, to a point that lies 343.6 feet N47 591E of said SW earner of SW1/4 of NW1/4; thence Nly along the center of the town road to a point 327.0 feet S61 021W of the point of beginning; thence N61 021E a distance of 327.0 feet to the point of beginning; above parcel being subject to an easement for an access road over and across the S portion as now traveled and also an easement for a roadway 60 feet in width along the N border of such parcel lying immediately S of such N line. TRMSF y-!-_ - This ,g _T1Qt homestead property. sl ( - i (is) (is not) FEE Together with all and singular the hereditaments and appurtenances thereunto belonging; And ....anG. warrants that the title is good, indefeasible in fee simpt., and free and clear of encumbrances except easements, restrictions and rights-of -way of record, if any. r II 4. and will warrant and defend the same. !I Dated this Iq day of 19.93... AM<.~Cl 5!t lt!~L .............(SEAL) -----------------------------•---------....-•-•-•------------•-••--.(SEAL) Susan G. Sif E1-Din f/k/a Susan a G: ~ WiTTmari- a/Tcra'"Siisan-'G: "~Grothe i --(SEAL) -----------------------------------------•-••-•-••------••-•---••...(SEAL) • ' If AUTBBNTICATION ACKNOWLBDOMBNT Ii Signature(s) STATE OF WISCONSIN ss.:. St County. . Croix authenticated this day of--------------------------119 onal cam before me day of 19._ the above named _ _ . S1>tsan G: Sif -EY=nI.n fJkTa" iisari_G........... TITLE: MEMBER STATE BAR OF WISCONSIN __________________________________________________1ti1 (I! not, authorized by $ 706.06. Wis. State.) :,%I • to me known to. be the person ..l ,.executed ~}l~ fo tng instrument and nowle e same. L) J THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland ' a.. .'j a Attorne ~t"TAW -1~ e-- e :a...::..---,: y - J' Notary Public is ' 0only'4 W& (Signatures may be authenticated or acknowledged. Both My Com fission is permanent. (If no(,, etate.."piration are not necessary.) date: , Y9- sNames of persona signing in any capacity should be typed or printed below their siEnaturee. c WARRANTY DBRD ETATE BAR OF WISCONSIN Wisconsin 1"al Blank Co. Ine. FORM No. 1-1982 Milwaukee. Wis. 9 A tik 3• r, r.e r r e..,.,:. a,.. •I . fi ,1+)"!.. A ,"Y i,+ `y .F "d"r ST. CROIX COUNTY . WISCONSIN ZONING OFFICE N a N r n ■ ST. CROIX COUNTY GOVERNMENT CENTER _ 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 5, 1994 Mr. Dan Foust c/o Viebrock Construction P.O. Box 187 Osceola, Wisconsin 54020 RE: Septic Inspection for Pat Christiansen and Shelly Schriner Dear Mr. Foust: An inspection of the septic system for the Pat Christiansen and Shelly Schriner property was conducted on November 23, 1993. This property is located in the SW; of the NW; of Section 17, T29N-R19W, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four bedroom home. Should you have any questions, please feel free to contact this office. Sincerely, Mary Jenkins Assistant Zoning Administrator mz Parcel 020-1033-40-000 10/18/2005 08:47 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.1461 020 - TOWN OF HUDSON Current [X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CHRISTIANSEN, PATRICK, &SHELLY SHRINER PATRICK, &SHELLY SHRINER CHRISTIANSEN 961 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 961 TROUT BROOK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.800 Plat: N/A-NOT AVAILABLE SEC 17 T29N R19W SW NW FROM SW COR GO E Block/Condo Bldg: 392'N 780' TO POB TH S28DEG E 473.1 FT TH S57DEG W 394.2' TH N23DEG W 83.570 A Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) PT 343.6 FT N47DEG E OF SW COR SW NW TH 17-29N-19W NLY ALG CEN LN TN RD TO A PT 327 FT S61 DEG W OF POB TH N61 DEG E 327 FT TO more Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1033/464 WD 07/23/1997 802/201 07/23/1997 774/190 07/23/1997 732/184 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.800 52,000 295,300 347,300 NO Totals for 2005: General Property 3.800 52,000 295,300 347,300 Woodland 0.000 0 0 Totals for 2004: General Property 3.800 52,000 295,300 347,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 wisoonsat Departrnent of Industry, SOIL AND SITE EVALUATION REPORT P Lager and Human Relations / z Division of safety a 841dngs in accord with ILHR 83.05, VVis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Git'a/fit' not limited to vertical and horizontal reference point (13M), 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 OWNER: PROPERTY LOCATION G S~,f~&e GOVT.LOT SGV 1/4 A/&)1/4,S 17 T .2 / N,R /1 E(oo PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # lad6 y 5r-. ytp CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE NEAREST ROAD UDsD4~, LcJi"S. SYoiG (7!S) 3,666-8S'70 apso.•~ T C'V 184049& [ Construction Use ( Residential / Number of bedrooms y Addition b existing building l 1 Replacement [ I Public or commercial describe Code derived daily flow &049 gpd Recommended design loading rate bed, gpd1ft2 `0 trench, 9pd/ft2 Absorption area required gS ? bed, ft2 750 trench, 112 Maximum design loading rate bed, gpd/ft2 trench, gpd* Recommended infiltration surface elevation(s) S~ Z ft (as relerred b site plan benchmark) Additional design / site rations ZlS~ TipE s Parent material-rC5 .S'8 ~iw• 8 - STi f+-r 7-,6 '-166 Flood plan @I Yom, d app6pble 7py ft $ : Suitable for System ❑ U ~ ❑ U 9 U PRESSURE A T-GA&DE SIS1131 IN ILL HOLDING U 0-T ❑ U ❑ S [~}tfJ U = Unsudable for system M'T FO [~S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Commence B=daly Roots GPD/tt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mnM O 0-311 ""ff.c S o.f, r- .w, Oft CS Z .5 . ~ C, 3ySo /o ye y 3 s d.~. s 'q_ low- -00 Ground C'Z O -50 10,0e .S% S D,C, S aP.2 elev. ft Depth b limiting factor0 Remarks: Boring # D /0 yR Z~ t O (25~ai G 9R nMv-F/e cs w S 13 ~-lo /b~ie 3/~ - 15 C'S ' 1 C , -.!5 o, . S aQ~ cs - Ground elev. C v 9U /O YR 5/60 S tt Depth 110 limiting factor y Remarks: T Name.-Please Print `_o6E12 1 Zu L-13 p t"G WT Phone. 7/✓~' 3 606 - c?/c9 s ress: & 5 5 O' iUje/ L ~ep ' 4J s 4fGVla ZS -73 CSTiy 2 Ile 2 Sgnahxe: C~Z Date: CST Number: C n , t 1 l" ~n ` r r PROPERTYOWWR SOIL DESCRIPTION REPORT Paged PARCEL 6D. # 7.1n Dominant Color Mom Texture Structure Cor~nce Bourx* Roots GPO Bed Txnch Boring # orizon Munsell CAL Sz. Cont Color (3r. Sz. Sh. Ground Plow. Depth to factory Remarks: - - Boring # Ground elev. ft Depth to iff" Taft Remarks: Boring # E3 Ground elev. ft Do to (actin Remarks: Boring # 13 Ground elev. ft Depth to 9 factor Remarks: eon 612-1^10 ^cinnx C~ L-P tVi c D oj 4 c n~ O N N~ Q~ 0 I I w p p ~ ~ o L LA ~ G O V v a Ilk ,V~M o r o 1 N y L.,. fri y i Ln (1J fi,P w~ 00 o sT.vcK I r