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HomeMy WebLinkAbout030-2086-00-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ~~2 arc/fem.! Li/T . SUBDIVISION / CSM LOT SECTION~T_36 N-R" /c/ W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f 77 rl I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK: D4r2 does ,Z hn/9,D ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer:S Liquid Capacity: C_j Setback from: Well House f Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ;SOIL ABSORPTION SYSTEM i Width: Length Number of trenches Distance & Direction to nearest prop. line: ~f~ yN Q Setback from: well: - House_:~L/~ Other ELEVATIONS Building Sewer ST Inlet; 6p, ST outlet PC inlet PC bottom Pump Off Header/Manifold 9% /,.~2 Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Ls$~s,'srtn~'rof'r~i~H 32.30.1VTEWAGE STE HILLS U~TE ou ty: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CST "R, KEVIN 119T.30SRIPH Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300222 c 3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -As d iv, , l e7jd_ / Benchmark 7• ~S 1,-Id,L1 Dosin axa- •,~,/r/_ l Aeration Bldg. Sewer Holding St/O Inlet TANK SETBACK INFORMATION St/ Outlet (L gyp' (P3 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake NA Dt Bottom yi Septic d-4 - Dosing NA Header: q113, 7 l0 Aeration Dist. Pipe 60 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~{rd Gq~ 163, 12-2 Model Number GPM TDH Lift Friction st TDH Ft Forcemain Length la. Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S}` DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O //Q<.r CHAMBER Model Number: System: C-) ~ OR UNIT DISTRIBUTION SYSTEM Header / Manit&d- ~i Distribution Pipe(s),, ,r ° x Hol ize x Hole Spacing Vent To Air Intake Length 6 Dia. Length ~S / Dia. Spacing (0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onl Depth Over Depth Over U x xx Sodded xx Mulched Bed/ liaffcaS Center Bed / Edges - Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH ~32.30.19.349,NW,SW, OLLING HILLS LANE, /LOT 9 / Plan revision required? ❑ Yes B-IN-o Use other side for additional information. SBD-6710 (R 05/91) ~ ~~~G~ Date _ Inspector's Signature Cert No. ~yC f ADDITIONAL COMMENTS AND-SKETCH SANITARY PERMIT NUMBER: i I DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ I9 90/ 8% x 11 inches in size. Check if rev ion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION 1/4 '/4, S Tj , N, R 19 JE PROfIg RTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY STATE ZIP CODE PHONE NUMBER SUBDIVISI N NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEA S ROAD TOWN QF: ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PARCEL X NUMB R III. BUILDING USE: (If building type is public, check all that apply) d©-ioq~- 9S~ 1 El Apt/Condo 2 ❑ Assembly Hall 60 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 120 Service Station/Car Wash 5 ❑ 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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 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 2 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 El Seepage Trench 22 El In-Ground 42 ❑ Pit Privy 13 El Seepage Pit Pressure 43 El 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 (s q. 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 Septic Tank or Holding Tank - S F1 F Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installat' n of the onsite sewage system shown on the attached plans. Plumber' Nam (Prinffl: Plumbe s n ur N to ps) MP/MPRSW No.: Business Phone Number: )jrd Piu be r' Address reet, City, State, Zi Code): IX. OUNTY/DEPARTMENT USE ONLY sue I ing Agent Signature (No St}prps) ❑ Disapproved Sa M Permit Fee (Includes Groundwater a "es-5-69-j- 4 1 Approved ❑ Owner Given Initial Surcharge Fee) Adverse Doti rmination X. CONDITIONS OF APPROVALIREASONS 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% 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 and establishment of standards. i SBD-6398 (R.11/88) DILHR SANITARY PERMIT APPLICATION Y 7DILHO 1 In accord with ILHR 83.05, Wis. Adm. Code COUNT:~~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Check if revision to previous application 8% x 11 inches in size. ev9 -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION ' 4 t/4, S / T-3;9, N, R /91 40r PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # / CITY STATE \ tZIP.,C0_DE PHONE NUMBER SUBDIVISIQN NAME OR CSM NUMBER 0 j CILTLYAGE : r NEA ST ROAD II. TYPE OF BUILDING: (Check one) El state owned =N OF: ;i /A 9 ❑ Public M 1 or 2 Fam. Dwelling-~# of bedrooms ~ PARCEL TAX NUMBER(5) 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 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 OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 [A 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min. inch) ELEVATION Feet Feet VII. TANK CAPACITY in allons Total # of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank - A1,1,7 F1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati n of the onsite sewage system shown on the attached plans. Plumber; Nam (Prin1J: PVmb s S' n ur NStamps) MP/MPRSW No.: Business Phone Number: 1 C2/ Plu ber' Address rest, City, tate, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Ssue issuing Agent Signature (No Stgrrlps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination (ill I/ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: J 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. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all informat°on 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, pum.p/s ;)hon and holding tanks f(.- t'!-Js 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 ,3'h x 11 iches must be submitted tto the county. The plans rw.-st include the following: A) plot plan, drawn to scaie or with complete -.iimensians, location of holding tack(s), septic tank(s) c:r other treatrnant tanks; building sewers; wn ,i;:; water mains/water service; s-cams ^nm' pump or siphon tanks; Itstribution boxes: soil absorption ~-ystems; replacemen* system areas, and .,_>cation of the „u. Wing serve,'; B) horizontal it vertica elevFtion reference points; C) complete sperifl,.,ations for pumps and controls,' rose voluime; elevaf,•n dit`erences; friction loss; pump performance curve; pump model and pump manufacturer, D) cross section o.f 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) _ L ---7 - - - - - - - I L-L ~I I I ~ ~ I I f ~ I y~~li, i I I z ~ I ~ ~ I I I~ i~ I i I I i I I i I -T i f I i ~ I I i i ~ I ~ ~ I I ~ I - -1 - - - - I -r-- _ i I IN i + i ~ I ~I li ~ 1 ~ I I I~- I I ' i l i I I I ~I i j i ~ ! ~ ~ I I I i j I ! I I ; I ~ 1 l I! I, I I ; I ; I j I I I i I Ji - I i _ I I - ~ V I I I I I ~I i I I I I I I i I I ~ I I I I ~I I I I I' i I T T I I I - - - - : PA6C or 4.1t 10 11 ' Q t• • flesh All Ia1~F~. AAA Obim.40 l PIPS MN••11 veal Cy or, • ff"91 goody ' M 10. 4V A!s•• PIS „4' C•N yM i* 1" 0•400 vM ►y • w• 1' A~«q•N ' 01•au.ll~ « P4• ~ T•• • h1 • 1`00,010,44 pipe below • ~'C•y~l.l i«wMpM~ AI 1.11•• 01 i N w • • Pro pus co~IA•.1 grAA-c. . . wit. ►ILL• 0I3TRI9UTIOij PIPE APPP wiltG S`twpivric COVC MATCR1^I• OR 1" OF i'1'f1A1• oF I~GGRC6A1~, OK MARV1. NAy AGGI%CG Pop. OISTRI15UT1OW PIP1 TO pC AT 4EA1T INCHES BCLOW ORiVIWA1. •,~ApC AUV AT LENSTIO INCHC OUT 1.10 MORC THAN YZ INCIiCS OCLOW FINAL. 41;AOC M11XV1UM DWH.OF E CAVAT100 FXorl OWWAL 69 og wlLl. ac -SZ_ IucHCs rJH1MVM OEFni OF EXCAVATmW f~oM 0~14INgL. GRAPE WILL, BC INCHCs sle+uco: LICCusC uum,9s14. • OAT C : ISO wmont,n Deopimotl of Irdutlry. Uoo► and human RfIaUo►tt WIL Utbt mh 1 lvts m.l vtt t (Attach Soil Profile Location Map • To Scale • On A Separate. Signed Sheet) Madison. :.I 51::' _r rage c~s,oee eeafv.►.eere _ eu~rr wo sari ere co.ers ewe rem woe •oo~a ^ ~3 8000 at ern I fare 40 .2j, $Vol0406o Goole a ►ocuor, fetrLl If, rowrww WCrK -21T r til- R, BORWG r..Pwrcw►wa CsYI LOT n BLOCK sueotvlslom f •J~ Mew _ eeet..es 13 • / Hor ton Oeoth Dom~nfnt Color mottles Structure In Mvnsell t. C nt. Color 1fe r Urhwne Factor/ LeaongtiP0IQ it, t Gr, t. W n Htme Roots n at Depth 1119nch eed CICY a ell tc~ J- :7 zj Al f3 I HOrUan Depth o0minanl C010r Mottles Slru<lurf In Muntfll u t Conl. Color T f r Gr, Sr, h. COnN ten R 4rrrune Fecterr Le.o-e GPG>,o n ots eo n err oepr T,fncn led Eley . Ail I-Ise I Horton Death Dom nant Color Mottles Structure In Munsell Con t. olor T It r Ll~Ntlne Fecterr LeadrngCP004 n. 2-511 Gr, t. h, n i t n Roo a nda Owe Tench sod Eley m -7/ 0A) 4 (j , I Horton Oeolh Dominant Color Mottlet Structure am, In, Mun tll (.Ir1MIIne Fact to loadw4CPD,e4 A. St. on , Color T M r Gr. t. Sh on ilt n Rots 0 n • DePth Tench e.a Eley . , a IaA B- s Horton Death DornColor Mottles In M n ell Slru<Wrf n, I r Liam Fecterl, LaonpOPOw n. 1 et r Gr st.sh. Con"' n Roots eo ndar Depth Trench sod Eley a r' C;- A 11A E _2 AZ Additional Remarkt: PLECOM •NDED SYSTE TYPE: zo- Other Site featu►et: , $yt(Crt1 Elavation '9^•'"'• ate igne ele0hone O. -CA CST Namrs (PAM) city starer Zip X 6C~r~•o.J ~~s~'f IT' 6 D~ I 4 w C3. UP LLS is I S f i Qi ~ N * to r `g a R ,,,,rl I M r - ~P 3333 ,6 Nye.(` \s a ~S A \ _ ~ a.1 aJ rr) It rFi''' of uJ .0. UP ai 1 CJI w,, o r~ of V x 8 / \ R~ pW yN ~I n W. 1~ ml N e 3.00,00.00" I R 01i II"" ,uisof 1 'M vY q si vl \ 'XI Q. 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CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road w _ Hudson, WI 54016-7710 (715) 386-4680 January 12, 1994 Fritz Meyer First Federal Bank 201 South Second Stree Hudson, WI 54016 Dear Mr. Meyer: An inspection of the septic system for the Kevin Tonnar property in Vol. 960 at page 184, Lot 9, located in the NW4 of the SW, of Section 32, T30N-R19W, Town of St. Joseph, was conducted on December 3, 1993. 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. ,-S ncerely, James Thompson Assistant Zoning Administrator js "VII(ont-n OtOi'11"►nl 01 lmovIVy, Labor SAO MvmanRNlbont NUll Utb0fl'IIVII Ittr1 VltI r (Attach Soil Profile Location Map • To Scale • On A Separate. 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O k r f i I R~ O O g rn r R~ -i ~ '+'Ix' !S A Bi o z rr, -IV J y ° ROLLIIYG" d T o` N ~7 _ yy Ir 1~ I ° Z \ $ rO 10 1 L m \ Q -1 i Q R g w U7 Z S J O 1O S = ° g A is , u N $ 8 Y ; VI 0 0 r 4 r4 1 -i X iD ~ n'sw - ~ I sw•n'oa•. i i~ A I Im • 'N• • $ \ Iz 0 o ws.M 8 $ f 4__ 1 III 1 Y 1't• C: C. • OO lie g, 3 -4 6 33' 33• r 4t ;r- O O It lol Iro !y -OZ 8 4 CNl D ♦ "02 •a'm•G - 1 O A e - 3x.v' r9o Z O I .s o 0 ~ Z I AD f M O .c v. a r"c s.ii~ \ m 8 i / a o v' v' _ i • $ I O I S \ • ° a „I I ' NOO.00'00•E 635.00' th IT b 1 1z K~ _ 1 . 8 i IS s I . Z 1 ~ 8 ' ~ ~ I• 272.17 It "Al 117 K) an \ b° 17i x17 / 305.17' r m S 1a W g I. ° NWOO,00•E N Im if, g z r \ w) rwwnn yJ UJI t \ g u GT,/ V Jy~' n, G I'D 1r t_ sue. •6 ;bin a 0 /nom an i r Y ]y S. Y n izc3 O z 0+ : S d4~ a / / izrn ~ 9S F i I I is a I f z A ° s t.• it Y I 1 S• $ 1m I ~ M • 1v " S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ hejjjr1A C~~ lcJ 1 11~ TQ~tti~ T ADDRESS CO - k d E FIRE NUMBER CITY/STATEOls-L._TZ7 t~1 L~U 1 ZIP PROPERTY LOCATION : lit, .~J5, 1/4, SECTION 37- , T_29>N-R~_W TOWN OF T, V 1-V4 , St. Croix County, SUBDIVISION s,~mAt\A(~.btj i LOT NUMBER___g__. 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 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. Zonin Officer ithin 30 days of the three year expiration ate. SIGNED: 1 DATE: ~s Aic-,,2) St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 I I 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), 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 L IS TA t1iK, `~~►U N Location of property- _51AL1/41 Section _,:~L Township _51, 3©sEPH STS Cv_o\X CO►LN-rLj_) Mailing address 3cob C.a. e- F 14dress of site Subdivision name C) L1~ Lot no. • q Other homes on property? yes__-)( No Previous owner of property CtiE~ZP•l-~ ~..~~.iba A6%VrX>K1 Total size of parcel q•1 0► F'T or, 4.069 AU.ES 0et* `parC*1 -was oveAw 'Are all corners and lot lines identifiable? Yes No i Is this property being developed for (spec house)? Yes 4NO Vol o and.Page Number as recorded with the Register f Deeeds. of De 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. 4$Cs~ C9 z. , 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 reco ed in the office of County Register of deeds as Document No. AP-1.0 I 2- ~ I Sig a re of ap scant applicant QQ Date of i gn ture Da of Si nature I DOCUMENT NO. WAR1tA'.IiW DrZD THIS SPACE RESERVED FOR RECORDING DATA STATE OF WISCONSI;1. FORM 2 48; 1€ 2 ' fl, u OFFICE This indenture, Made this day of....... J'...]"y................... _ ST. CROIX CO., d A. D., 1992.-., between ...-J ...&...L.- Land .Lk'..SIejnn,-r.-, Im. w Reed for Record a Corporation duly orgaAl_ze and existing under and by At. 2 21992 virtue of the laws of the State of Wisconsin, located at .............-SOri - + - _ Wisconsin, party of the first part, and Kevin R...Thnnar...and Christine K. Ct 12:45 P. M • ....__...••.I!onnar. husband and wife.... as suvivorship marital - prof?erty--._.-.-_-.-------...... w_.. , part ....leS_........ of the second part. Re9iSiet of Dnds Witnesseth, That the said party of the first part, for and in considerationof the sum of. - _ - _ - - Ro+iv p & Wertheimer S.C. to it paid by the said part..1C'S _ _ of the second part, the receipt whereof is hereby confessed and 430 Second St. P. O. Box 106 acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and con- HUdson, Wi 54016 firmed, and by these presents does give, grant, bargain, sell, remise, alien, convey, and confirm unto - - the said part --_--1eS of the second part,....... their the County of. - - _ heirs and assigns forever, the following described real estate, situated in - St ----..._.......-Gr. State of Wisconsin, to-wit: See legal description on reverse side. s f, (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said part. les of the second part, and to..__......_t:heir heirs and assigns FOREVER. And the said Land Developers, Inc. - party of the first parts for itself and its successors, does covenant, grant, bargain and agree to and with the said partiig of the second part, "".elr heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever and that the above bargained premises in the quiet and peaceable possession of the said part e-s....... of the second part, their heirs, and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT and DEFEND. J & L Land Developers, Inc. In Witness Whereof, the said C,eiF A. Johnson party of the first art, has caused these resents to be signed by its President> yyriUcl.on terslgned by........p -D .JOonson its Secretary, at .Q _ Wisconsin awcl-it~~er~erata-soc+~~a~e-1+QfcweES ix ad, this qq day of......... -------.July-------••-•--•-•.........--•-....................... A. D., 19 - SIGNED AND SEALED IN PRESENCE OF J & L Land Developers, Inc. Corporate Name %y Res . Gerald A. Johns President COUNTERSIGNED: - I,1Tlda D. J Son Secretary STATE OF WISCONSIN St. Croix ss. County. Personally came before me, this 0---•--•..._.......... day of-------••--•-`7 y A. D., 19...91 Gerald A. Johnson nda D. ohnson President, and. Secretary of the above named Corporation, to me known to be the persons who execut a ego' inst ant, and to me known to be such President and Secretary of said Corporation, and acknowledged that they exe t d t fo ing i umeRt as such officers as the deed of said Corporation, by its authority. Lv - ...f!.----..... -b .L H . Gain THIS INSTRUMENT WAS DRAFTED BY NO I" .1?Y St. Cr013{ = S^.AL . 7etary P sic- County. '.TJ. Attorney Hugh H. Grain permanent. My commission (e (ls).................................................... (Section 59.51 (1) of the Wisconsin Statutes r,oixdr°.: that all instruments to be accorded sha°) have plainly Printed or typewritten thereon the names of the grantors, grantees, witres es arA noiry. Section 59.513 similarly requires that the name of the person who, or govern mental agency which, drafted such inst..1ai_ ab'41: t z pr,taed, typ.wnt' acnl ed or thereon is ' gI le manner.} 3.r 71t,, 1- W) t)16:3I q V~_ 90 r~~.f 1.85 011 A parcel of land located in the Nh of the SW4 of Section 32, T30N, R19W, 3b b of St. Joseph, Ste. Croix County', Wisconsin, described as follows: Lot 9 off Johnson Parkway. .T A fife foot wide Private Road Easement for ingress and egress over a private road named Rolling Hills Lane, from the Town Road now named Rolling Hills Trail to the easterly boundary of the Plat of Johnson Parkway. The southerly 33 feet of said Private Road Easement is as shown on Certified Survey Maps recorded at Volume 6 of Certified Survey Maps, at page 1514, as Document No. 401074; and Volume 6 of Certified Survey Maps, at page 1652, as Document No. 412061; and Volume 8 of Certified Survey Maps, at page 2233, as Document No. 459864; and Volume 7 of Certified Survey Maps, at page 20f O, as Document No. 444406; and the northerly 33 feet of said Private Road Easement is as described in a Warranty Deed dated December 29, 1987 and recorded December 30, 1987 in Volume 800, at page 98, as Document No. 433351, and as shown on a Certified Survey Map recorded at Volume 7, Certified Survey Maps, at page 2060 as Document No. 444406, ' it th office of ti. c' ;is:er of Deeds for St. Croix County, Wisconsin. Exceptions to warranties: TOCEl'HFR WITH AND SUBJF,CT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall note be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. I rY, , i ; ~ r J: C! ` r s ~ ~ .1~/ ,lG-rti. c:: r . t ~ = ~ ~ r l~ , c:. II