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Parcel 030-1071-30-000 02/10/2005 03:47 PM
PAGE 10F1
Alt. Parcel M 26.30.19.253M 030 - TOWN OF SAINT JOSEPH
Current X: ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* BENISH, ROBERT K & CAROL J
ROBERT K & CAROL J BENISH
854 WYLDWOOD LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8040 BASS LAKE REHAB DIST
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 26 T30N R19W PRT GL 4 COM W 628 FT, Block/Condo Bldg:
S 269.5 FT, S 43DEG E 484 FT & S 50DEG E
396 FT FR NE COR NW NE, S 50 DEG E 66 Tract(s): (Sec-Twn-Rng 40 1/4 160 114)
FT, S 54DEG W 115 FT MOL TO LK NWLY ON 26-30N-19W
LK TO PT S 54DEG POB N 54DEG TO POB ALSO
THE SE 10' OF PARCEL DESC 1250/60
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 883/99
07/23/1997 838/565
2004 SUMMARY Bill M Fair Market Value: Assessed with:
5330 174,200
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 105,300 66,100 171,400 NO
Totals for 2004:
General Property 0.000 105,300 66,100 171,400
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 52,700 52,900 105,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
040-OTHER ASSM'T SPECIAL ASSESSMENT 425.46
Special Assessments Special Charges Delinquent Charges
Total 425.46 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER } _ rim
ADDRESS J,.
SUBDIVISION / CSM# `Si=2-2 LOT #
SECTION _T T. ;Fj N-R ,Z W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ySC t+I
Q
.1~
l-MiS
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: dVA / , L-- Cl lfe D
ALTERNATE BM: ~Z Z f .6. ,
SEPTIC TANK l/ PUMP CHAMBER HOLDING TANK FORMATION
Manufacturer: acity:~--
Setback from: Well House - Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
lS 93.a ~s'- 987
Building Sewer ST Inlet. ~7~ ST outlet,,;~,.. -
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: C
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
LQiTCoYrS~~++~~",,,'TT9#irtArr~~tbfj~.TT PH 2 6. 3 ®.19~jW2ATE 3~ 5M ;~j~ jQT z~, FROG P
;Yr9,§~ P$AUt'SfST?I, ounty:
Laborand Human Relations INSPECTION REPORT
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.:
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan R64?
BENIS RT K & CAROL J ST. JOSEPH
CST BM Elev.: Insp BM Elev : BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9300081
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 9 d /GCU CrJ
Dosing ~=7 `3 i
Aeration Bldg. Sewer 3
Holding W Ht Inlet
'
TANK SETBACK INFORMATION / Ht'Outlet 16, 1,5 ? 7
Vent
TANK TO P / L WELL BLDG. Air Ito ntake ROAD cr
Air
SepT-ic- NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
9
1v, 37
77,
Manufaccurer Demand
Model Number GPM
TDH Lift Friction System TDF Ft
Forcemain Length Dia. 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/ STREARA LEACHING Manufacturer:
SETBACK
Model N er:
INFORMATION Type 0 CHAMBER
System: OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake
Lef"jtl Dia'. Length Dia.
SOIL COVER x Pressure Systems Only xx Mound Or Ar-&ade stems Only
Depth Over Depth Over xx Depth Of xx Seeded/Sodded Iched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ o
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH 26.30.19.253M NW,NE,LOT 211 FROG POND LANE
-
t
Plan revision required? ❑ Yes /
Use other side for additional informati 'z-
SBD-6710(R 05/91) ~,//ALA{ Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH 1
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION couNTY
TDILHR In accord with ILHR 83.05, Wis. Adm. Code
L t
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Aw if sloe to pre ous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. -
PROP TY OWNER PR PERTY LOCATION
T , N, R i(oryw)
PROPERTY OWNER, S MAI ING ADDRESS LOT # BLOCK #
_,Z~;R,m AJ4 o; -,2 ) d,~
j Z, ZIP CODE PHONE NUMBER SUBDI SION NA E OR CSM NUMBER
cl ST
-0 ITY
11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : NEAREST RO
❑ Public ~ 1 or 2 Fam. Dwelling-# of bedrooms, P EL Nu BE ( )
III. BUILDING USE: (If building type is public, check all that apply)
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 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. 9 Replacement 3. ❑ Replacement of 4. ❑ 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 ther
11 El Seepage Bed 21 ❑ Mound 300 Specify Type Holding Tank
12 r_1 Seepage Trench 22 1:1 In-Ground 42
13 ❑ Seepage Pit Pressure 43 F-1 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
Feet 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 strutted
Se tic Tank or Holding Tank S [Z F1
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for install ion of the onsite sewage system shown on the attached plans.
Plumb is Nam (Print):, Plumb 's gnatu :7 to MP/MPRSW No.: Business Phone Number:
j _?2_0 _
?--j 9
r
umber's Address (St e , City, S fate, Zi Code).
X11521 Z:;~;1` C11 B
IX. CO /DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a issued Issuing A vent Si ture ( o m
Approved ❑ Owner Given Initial /~~.,~~SurchargeFee) 10 1 Adverse D termination/o0 S '
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A.sgnitary- permit is valid for two (2) years.
2. -'Yoar 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 mustbe 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`administeator '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'f x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served;.B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER'SURCHARGE
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 ani, establishment of standards.
SBD-6398 (R.11/88)
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM
Labor Safety and Buildings Division
Arid Human Relations REVIEW APPLICATION Bureau of Building Water Systems
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
4109 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Sox 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8
Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-86146
Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and Plans/information. Your submittal must be received at least one working day prior to the appointment at the office
where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference.
1. APPOINTMENT INFORMATION -If ou have scheduled an appointment, fill in the information requested below to save time:
Appointment Date Reviewer Name
Plan Identi ' a m
-
2. PROJECT INFORMATION If this review is a revision or extension to your existing j
Project plan identification number, provide that number here:
N me .
❑ City ❑ Village ®Town Of: County
Project Location
GOVT. LOT AIAJ 1/4 hlx 114 T ?/)-,N ,R or
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type r (include new and existing tanks)
A ❑ At-Grade Up To 1,500 gallon septic tank $110.00
® g 1,501 • 2,500 gallon septic tank $120.00
H Holding Tank
2,501- 5,000gallon septictank $160.00
M Mound 5,001- 9,000 gallon septic tank $ 200.00 .
N Non-Pressurized In-Ground (convenaonaq 9,001-15,000 gallon septic tank $300.00
P ❑ Pressurized in-Ground Over 15,000 gallon septic tank $500.00
0 ❑ Other: Up To 1,000 gallon dose chamber $ 70.00
1,001 - 2,000 gallon dose chamber $ 80.00
Building Type e check one): •
g yp ( 2,001 - 4,000 gallon dose chamber $100.00 _
D ❑ Dwelling, 1 or 2 Family 4,001 - 8,000 gallon dose chamber $120.00
• • • •
y 8,001 -12,000 gallon dose chamber $140.00
P Public Building Over 12,000 gallon dose chamber $160.00
S State-Owned Building
Up To 5,000 gallon holding tank $ 60.00 .
Code Derived Daily Flow 5,001-10,000 gallon holding tank , . • , . $100.00
gpd Over 10,000 gallon holding tank $150.00
❑ Check If Replacing Existing System Experimental System (additional onetime fee) $ 300.00
Revisions To Approved Plan 2 $ 60.00
Petition For Variance: Setback $100.00 .
❑ Petition For Variance Site Evaluation $ 225.00 .
Plumbing $225.00
Revision $ 75.00
❑ Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
❑ Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
Subtotal: . , /~jJ O6
Priority Review: Enter same amount as Subtotal:
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee:
5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) Comp ny Na
( ) Cont Pers n
~9;~)
No. & re et Address Or P.O. Box City, T wn or Vill e, State, ip C e
1 Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers.
2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals.
NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually.
SOD-6748 (R. 03/93)
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Docum6nt No. This space reserved for recording data
HOLDING TANK AGREEMENT
Agreement Dote
This agreement is made between the
County or local Governmental Unit I Holding Tank(s) Owner(s)
$T. C,RaT e 0u.N 1-r I o B rs`R f -,r C.f~lzo t_,?
5-r. -:'o SE-p g ?"d wK s,µ % I E Nis /t
Called Municl ll below I
We acknowledge that application is being made for the installation of (a) holding
tank(s) on the following property, (Provide legal land description:)
/38a rq0& f1bNo [,41V4 -004,eeE4- 26.3o. /q. .253m
Ila- e . 2 6 T 30A/ A/ 9 [cJ Per G4
¢.,a>'-, W yap "1-' T', 5a691 S
S'. sa X 96 YT ~,.q /Ve' d' bR Al W NE ys k4l r- 5'br d Return To
SS t,/ ter. S 3"y a W //S rte: >'a t;r ~wor. r~ o t
f1+R',E ' µ ~h►c /Lr ~G oN l~ 2,x.9- C X40tC- .9 A-
- p,~,. Nf" GJN11CH /C if S'y o zoc uF ~,Ik4 o
f nuFf /Aof"ta TNCNpram"sesC /e/ ss f 9 ho r ' ~ f s'.~vivr~v useNo the e~t(sling regLlres a71cin tQn a ed on the property for the purpose of
proper containment of
or that continue
sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under
Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. ~jl
As an inducement to the County of to issue a sanitary pernlil to th above s bed property,
we agree to the following:
1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders Issued by the municipality to prevent or abate a nuisance as described in as. 146.13 and
146.14. Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by
placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by
a. 66.80, Slats.
2. Owner agrees to pay all charges and costs incurred by the municipality for Inspection, pumping, hauling or otherwise servicing and maintaining
the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify
the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the
costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess-
ment for the abatement of a nuisance, and the tax shall be collected as provided by law.
3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who Is licensed under Ch. NR 113, Wis. Adm. Code to
have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner
further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within
ten (10) business days from the date of change to the service contract.
4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a
report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under
s. 146.20 (3) (d), Slats., the owner shall submit the report to the municipality and the county.
5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that
the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit
the existence of the certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to
the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement
to be determined by reference to the property where the holding tank Is Installed.
Owner(s) Name(s) (Print) I Owner ) Signature(s)
~0 Eli T K , -l CU i Subscribed and sworn to before me on this date:
Municipal Official Name (Print) I Municipal Official Signature Camille Grant"olary Public
-TOWN OF ST, ~'0 SC9 I1 My commissioM&N Public
Municipal Official Title (Print) I heel l8/ isconsif
*t O-BApmerk ptum f I -o wad C2/!1 Ap,-J 41-0-sawbaR -
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SBD•6123 (R. 10/85) This Instrument was drafted by the Stale of Wisconsin Department of Industry, Labor and Human Relal ons, Bureau of Plumbing.
HOLDING TANK SERVICING CONTRACT
Contract Date.
Q.3 This contract is made between the
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Holding Tank Owner(s) Name(s) go e /~-r and I Pumper's Name
C/ 1?20 /,I
0_ s
A w z-
t .J P -7- 436 s a L''~/ C'
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
130-0 r20c. Parvt7 ~ l~o~~ ~/fY1ccL ~llo. ato. 30. /mil', a6-3
See, aG 7-30N R/9w f 2t-~L 4028
3 FT Fie PV e C 6 r2 Ned D ' L
A115 fS~ 5o D 6-0 G- 6&
_~7-~ SAS ~/n
- - - - P 6,r Sr# AIL ~ J 7 -,9 T C r,1, >4 n EF ~~~inrti cu~s.*,~icrr- VAS-,.
/4FArce Al S;i°'C ?a : NE p~oi&-r o ~ ~El3~~vntinL4 .
1. The owner agrees to file a copy o(this contract d4ith the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of 5~7 CRO=X
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to
enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access
road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay
the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper.
3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis.
Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees
to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality
and the County named above within ten (10) business days from the date of change to this service contract.
y
Owner(s) Name(s) (Print) I Owner's Si(
gnature(s)
rlO t3 E)CT k. C-A/T-s H
Subscribed and sworn to before me on this date:
I
nature Nolary Public
Pumper's Name (Print) P5
PouJ~f,trs Ligwd WAS+( My commission expires:
Pumper's Registration Number
f0 '
SBD-7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department
of Industry, Labor and Human Relations, Bureau of Plumbing.
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER- fi DBCV--r k 4,D 0-,,RoL 3 BeNrS14
ADDRESS dab yc, -~/V FIRE NUMBER /390
CITY/STATE ~i cHr►-~ ° n"~ j-y T ZIP W o / I
PROPERTY LOCATION : IV C-1l/4 , _ _C114 , SECTION T 3Q.N-R j g W
TOWN OF ST' ~esF,~ St. Croix County,
n~ A m Es a EaYq ~//Y!(.ti(' ~
SUBDIVISION 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/tae, 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.
_ Clc-a Q . /c
SIGNED:
DATE : a 3
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
STC - in
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), thenla 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 _ 1~o /3F~2T k C oy _T ~457 /t~r sy
Location of property k(J 1/4 AIE1141 Section R4, , T 3o N_R I9 W
Township I& , ~o -
Mailing address
5~5_1 l b
Address of site 390 ro-)2d a,~ .
04
Subdivision name_ ~S a~ C Lot no. /
Other homes on property? ves_ No
Previous owner of property /'n A k'y Just L a L ~Z L z 5w1,9,,y,50n/
Total size of parcel _ (aX 14/0 .6-
Date parcel -was created ~~lo~'
'Are all corners and lot lines identifiable? ----._-yes ✓ No
Is this property being developed for (spec house)? Yes ✓No
I
Volume 4 3 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 tie ffice of the County Register of
Deeds as Document No._ q6 a S _ , 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. Y ~jQrj
AIX.,
S gna ure o applicant Co-applicant
e of Signature
Date of Signature
, DOCUMENT nlo. WARRANTY DEED '"'a g°A`r "gag"vg° ""°"°I" °w"
STATE BAR OF WISCONSIN FORM 2-1992
- 46987 883PASE 99
Vot REGISTERS OFFICE
ST. CROIX CO., WI
Lyle E..single _person .and Mary..W....Juhl.,, a Reed for Record
single person.
GC i 0 51990
CO 11:15 A. M
conveys and arrants to .-Robert K... Benish..and Carol -J...Bef1i51t,
husband and-wife as marital- property--with rights- of
survivorsh.ip
- -
-
_ RETUaN To
- -
the following described real estate in ..St. CrO1X County, - -
State of Wisconsin:
Tax Parcel No:
Part of Government Lot 1141' and part of NW} of NWf of Section 26-30-19 described
as follows: Commencing at the NE corner of the NWT of NEB of Section 26-30-19-10
thence W 628 feet, thence S 269.5 feet; thence ; 43°30'E, 484 feet; thence S 50E
396 feet to the point of beginning; thence S 50 E 66 feet; thence S 54 W about
115 feet to the E shore 8f Bass Lake; thence NWly along the E shoroe of Bass Lake
to a point which is S 54 W of the point of beginning; thence N 54 E to the point
of beginning. The above described property is also known as Lot 21 on James and
Edna Simon's Hill Addition to Bass Lake.
TOGETHER WITH easements as described in Vol."838", Page 565, Document No. 447194.
M_ NSWA
S 3S
FEE
This IS - homestead property.
(is) (is not)
Exception to warranties:
Easements and restrictions of record, if any.
Dated this 4th day of ........October...--------- 19_90..
.I ....................(SEAL) .....(SEAL)
I e C. Swanson
I
- -..(SEAL) ........(SEAL)
- Mary- W. Juhl-
-
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
as.
_-.-...St....CrmX...-........County.
authenticated this .--..-..day of 19...... Personally came before me this 4th--...-.day of
------Octpber 19.9Q-.. the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. State.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law
502 Second St., Hudson, WI 54016
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary) date: -JW,IE...NEI. - . 19..------)
N9hiy PW*Slna of n
'Names of p- signing in any capacity ah,,Id be typed or Printed below their signatures. D"`~1"°"
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank V, In.
FORM No. 2- 1982 11 i:..a l~.hec. {Vie.