HomeMy WebLinkAbout030-2004-60-000
I
Q o o
3 0
~ I
M C
O
is
C
O
O
ti
Illy i '
v
h I
Er I
~ I
' c Z I
' LL p I
'O
Q
C` )
rn z E
cn o
N 0
LL ~ L
Z £
d
O d
a m
Cl) H (n
C
2
O Z d c
V ce r o .N. -
O
m
N a)
m
= d
co (1)
O N C
d -C O
U O
O o a Q
Z CO Z o
z I
OII =
C
m
N
m N d
O O. a+ J C O
mn cc v O C d y N
Q o iA to fn to o
3 T w N
Z co >
I N
►~i c O O O z
• *rl o a a a
a
N
O V) = rn m m
vi ..r U a~ rn rn }
~ m d
~ v> aNi us) as
a) Q
7
~i O
~ O i N C I
CSC O Q 30 d O N O six =
O (n IL O
O (D
G GO M = ~ d -0 -
O O a) M C EO a)
0 (n '2
N O a) 0) a) 'D H O N
}r]V]/ O O O CS to O E U
L' O M (n U O z y Z:=i CA
CC
r.r
w
a a
~#6 n `a w
~`FV a 2 'c c
I
Parcel 30-2004-60-000 03/13/2007 08:26 AM
PAGE 1 OF 1
Alt. Parcel 33.30.19.366A 030 - TOWN OF SAINT JOSEPH
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - COVERDALE, RICHARD
RICHARD COVERDALE
513 SPRING LAKE DR
MELBOURNE FL 32940
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1217 52ND ST
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 15.000 Plat: N/A-NOT AVAILABLE
SEC 33 T30N R19W SW SW BEING LOT 6 OF Block/Condo Bldg:
CSM 9/2700 15 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/07/2003 708859 2135/224 QC
12/04/2000 634595 1564/116 QC
11/03/2000 632931 1556/100 QC
07/23/1997 1055/81 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 15.000 143,900 184,100 328,000 NO
Totals for 2007:
General Property 15.000 143,900 184,100 328,000
Woodland 0.000 0 0
Totals for 2006:
General Property 15.000 143,900 184,100 328,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 218
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
'~i~if''r~st~partinfof5~~ufFypH 33.30. PRjVATE S`EWWidE SSTE~ 52ND S oun'ty:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division ST_ r_RQTX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
FPermit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.:
ERD JEFFERY & PAM ST.JOSEP
BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.:
14,60 1 _:5aw-e ay 030-2004-60-
TANK INFORMATION ELEVATION DATA A9300365 3;3j
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Gc1~ Er°yy Benchmark
Dosing L-{ gy
Aeration Bldg. Sewer
Holding.h St / I,1 Inlet - Z-5-Ids. 9 ~
TANK SETBACK INFORMATION St/yroutlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 21 NA Dt Bottom
Dosing NA Header / Man.
Aeration IVi9~ Dist. Pipe
Holding Bot. System /ICJ Z~Zj
PUMP/ SIPHON INFORMATION Final Grade io 13~ , F6 i
Manuf rer Demand a_t 0
Model Number GPM
TDH Lift Friction System
Loss d .1 F
Forcemain Length . Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width i Lengt / No. Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIME I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN Manufacturer:
SETBACK CHAMBER
INFORMATION Type O 1j47,1AjC11. e. Number:
System: , ~ OR UNI
DISTRIBUTION SYSTEM
Header / rcr_ Distribution Pipe(s) i Ix 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 odded xx Mulched
Bed/ nter Bed / @"dges - Topsoi ❑ Yes ❑ No ❑ Yes ❑ No IV 3
'Xi COMMENTS: (Include code discrepancies, persons present, etc.)"
62ND STREET
LOCATION: S/T. JOSEPH 33.30.19.366A, SW,SW,LOT
I _Z1
Plan revision required? Yes E] No
Use other side for additional information.
SBD-6710(R 05/91) Date Inspector's Signatur Cert No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
-
,ov 1~ ~r i o
,._._Y
'PAOee5
~
To fail
G
I~o~ s ~r
400
i ~ v _ ' ~dJ G rA''i.
*tt
SSrra
~ tb ! 5.33
. / T3 v N, 1~u1 s-z.. r - 1
~ ~o sc~o,,.f 9D 'i . ~_c=tt~ l8X 3G ' E
7 ~ 1
r,
Yea
S
tt.~ s
Y
!S-14 C4C75
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code Co
STATE SAN A Y ERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~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 OWNE PROPERTY L ATION
q( PAL.", I If - '/4SU %4, S :5Z T:3®, N, R / E (o
PROPERTY OWNE S MAILING ADDRESS LOT # BLOCK #
ZSa 11 a :S
CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME go CSM NUMBER'
WI d C.: ff/ oc 7Lt
II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
) State Owned VILLAGE
❑ Public 211 or 2 Fam. Dwelling--# of bedrooms3 PARCEL TAX NUM ) 36 6 A
III. BUILDING USE: (If building type is public, check all that apply) O 3(n -2 oO D ~O
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. KNew 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 9 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
T REQUIRED (sq. ft.) PROPOSED (sq. ft.) `(Gals/d /sq* ft.) (Min./inch) ELEVATION
0/ ,7,3 tk~ '7 7 Feet Q3, `r Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank d C
Lift Pump Tank/Si hon Chamber Frec- 7-opol_ F-1 F-1 0 [1 1 Fj
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 'gnature: (No Stamps) P PRSW No.: Business Phone Number:
.2 zS~~4
Xfi --f L°/lS IL,
Plum 'a Address (Streity, S te, Zip Code
IX. C NTY/DEPARTMENT USE ONLY
❑ Disapproved Sa i ry Permit Fee (Includes Groundwater Date Issued Issuing A nt Sig ture (N tamp
Approved ❑ Owner Given initial surcharge Pee) r~
Adverse Det rmin tin ~
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, 606-266-3815.
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 pla63 and specifications not smaller than 13% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawr to scale or with complete dimensions, location of
holding tanks , septic tanks 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)
C ' to"o C--7L, 4 r ~'To. v
Lo ply, s 33 T3v 2, r 4
rJ> , ►.i ~e L) E7Z- z uJ s 7 . Sa 5 ctr l
Lk) r 5 yon 6 SAY , -1' '
pt u
7-
LL, ~t J ry?
'r'YI P f 9 25
,Ln
fLpe~AA
S At
aewe,~
t
b6
~Z4
i ~ t3 `l
i
~ r
Labor and Human Relations use' SOIL AND SITE EVALUATION REPORT Page dl= of 3
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croi,c
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Fa and J. Quinn GOVT. LOT SE 1/4SE 1/4,S32 T 30 N,R 10 `1~Qa) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUB?.. NAME OR CSM #
12.15 52nd. St. n/a r n
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY QVILLAGE ®(OWN NEAREST ROAD
ITti.dson, T,11. 54(116 (715) 549-6781 west art St. Jose_h 52nd. St.
( New Construction Use (x}Y Residential / Number of bedrooms 3 Addition to existing building
[ ] Replacement (J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate Z bed 9PdIft2.4 trench, gpdtft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd$ • ? trench, gpolft2
Recommended infiltration surface elevation(s) 9(1.4n It (as referred to site plan benchmark)
Additional design / site considerations n/a
Parent material outwa sh Flood plain elevation, if applicable n/a It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable for system B S ❑ U Ct ❑ U is S ❑ U us ❑ U ❑ S M ❑ S 1911
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouni:13y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
1 1 0-7 10 r2/2 none sl. 2rt r mvfr cs 2f .5 .6
2.2' 10yr44 none sit. 2mshl- Mfr gM'7 If .5 .6
Ground 3 22-34 10yr5/4 none co.s. n sg MI na na .7 .8
elev.
103-10.
Depth to
limiting
factor
>84Remarks:
Boring #
1 0-7 10yr212 none ST. 2 m gr mvfr cs 2f .5 .6
2
2. 7-13 10yr4/4 none sl. ?/m/s;hlc nfr n/w 1/f. .5 .6
3 13-27 10yr4/4 none i_s. 01sg nl g/w 1/f .7 LF)
Ground
elev. 4 27-88 10yr5/4 none co.s. 0/sg ral n/a /a. .7 S
103.4()L
Depth to
limiting
factor
- LT
Remarks:
CST Name:-Please Print
Gary L. Steel 175 P-"=620n
Address:
1554 2,A tli. A9 xa Ric-pond, 1II. 54017
Signature: Date: CST N m er:
~u- 8-3-03 cstn Z
PARCEL I.D. # Ray Quinn Page 2 of
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture
Qu. Sz. Cont. Color Structure Consistence GPD/ft
1 0-10 10 2 2 Gr. Sz. Sh. Bo~Y Roots Bed Trench
none sl. 2
2 10-1 10yr4/4 none ~f
Is. 0/sp ml J-/f .7 .8
Ground 3 18-tin 10yr5/4 none
elev. co.s. 0/sg ml na/ /a .7 .8
ln~ .1h5
Depth to
limiting
ffa8co r
Remarks:
Boring #
1 0-8 10yr2/? non
t 2 8-19 sl. 2/m/gr mvfr c/s 2/f .5 '.6
10yr4/4 none Is. /sg rnl a/w 1/f .7 .3
Ground 3 19-80 1(~,r5/4 none co.s.
elev. 0/sg ml n/a n/a .7 .3
99.85 ft
Depth to
limiting
factor
>Rn"
Remarks:
Boring #
1
0-7 10yr2/2 none
5 sl. 2/m/fir mvfr c/s 2/f .5. =.6
2 7-1.8 10yr4/4 none
Is. o/sg ml g•w 1/f
.7
=.3
J
1P 8n 10yr
5
4
Ground none co.s. 0/s
~el
ev.
MI na/ n/a .7
.8
lime
factor
Remarks:
Boring #
Ground
elev.
ft. ;9
Depth to
limiting
factor
Remarks:
iBD-8330(R.05/92)
STEEL'S SOIL SERVICE 1454 ?()C)tb. Ave.
Gary L. Steel
C.S.T. 2298 Raymond J. (Minn New Richmond, WI 54017
MPRSW-3254 SE%,SE-'; S32-T30X-R!-9W (715) 246-6200
town of St. Joseph
VIP of "..IQ 61, 1
1v
l~~ ~o r aye
~ (rmr9vl~~ ~o ~,e~
~z \~-5 ~b ra7
30 ~
s~
i
i
Gary L. Steel-
8-3-q3
i
~L U KY-7 ~3Li2
CROSS SECTION OF A BED OR TRENCH SYSTEM
(DELETE OUT IDE LATERAL FOR''A TRENCH SYSTEM)
i
f I r +i
'60fL' ►ILL
o1sTRlatmou Fin ,
APPROVED SIWTHETIC COVER
~''~~)AATERIAL OR V OF STRAW
>Zr OF A&SKEGATE 3 t t f 31 Ci , OR MARSH NA`S
4:04-ItC AD6REGATC
ELEV.:).F.~ZFEET
DISTRIDUTIOU V4FE TO BC AT LEAST IUCAEB' BELOW ORIGIWAL GRADE
1 AMD AT LEASTtO IAI NES BUT u0 MORE TRAM yZ ILICHES DELOW FILIAL GRADE
t
cr
MAXIMUM DEPTH OF' EXCAVATIOIJ FROM ORIGIMA.L GRADE WILL BE IAICHES
MINIMUM DEPTH OF EXCAVATIOAI FROM ORIGIIJAL GRADE WILL. BE INCHES
SIGUED:
LICENSE .UUMDER:
DATE: hz 4
(JAMES ILED '5
1319930- 4
50'719' O'CONW
ster of Deeds
roix Co., Wi S
AREA LOT 5 -v
O 4.15 Acres Inc. R/W
180,985 Sq. Ft. Inc. R/W Bearings are referenced to the ~-i -t-,
south line of the SW} of Section 33, CD 0
4.02 Acres Exc. R/W 0 n
rn assumed to bear N8904814811E. O H w
3 z 175,081 Sq. Ft. Exc. R/W a w 0
n z - IU1
M o o IN i C (D Z a
N ~m~ I z I CIi N.
m
CAD U NN ID A I I L G a F m
rn _ 33'133' 2 ro
-4 U
-4 , I_ANQS) Z I() 0 `
I~
I~~ ~_CO C -i -0 1 1 t F' rt
I N (NORTH 628.97') z x
o I IF 0OO
~I II- rn V S00°03'09°W 628.88' ; DOD 4
IC~ , o
O I ~ICI11`~ 595.86' 33.02' o (n I~ `J 0 ~r
" (D
SEC 32 W U1 m I'd
110859'5872"W III I t-~ ~ CO
IG~1`'I_-I o SEC 33 ~ S8 7
t CJ f Oj - /I G~ D rt ,t
0 0 cl x W m A
0~1 T N o
1 C) 0 W T D N D ' N W t7, I z C4 O
01 -j 0
_ N mlp rr,
I 1 C7l
U1
< CD O ao Woo I O I >y "0
j C)
I-~ rt (u
v.0v9 0a s
If-
6
L
IF CD rt, En
r ) 4v9g x `25 . 0 1 f`J vo t+i
I (Irl K .
I (J~ I -1 m 00 \ (D rt oar
IG:3 U) y 1 I-- \ TRF n °0 W ,
1 1~ C/) N O (n
I~ n d n H- (D C--)
101 z 0 0 M
00.
=
N n FJ -I
Q0 I C _
N z I L G
OD OD I U n:~
E DD C" O° 11 G N d
cn O _I> p .
0• m N rn N w rn N I -I rt C/)
1 co o i -1 :z IL C
o CO r o I OD 00 8 1 r~l F' z
o CD - _ F 0 r n ip I C7 ((D 0 a M
= 0 mo RI Lo Oro
m " -3 N- t~ N N -n ,`Di+ op F-'• ,`3 A)
K3 0 CD 't L" p En U) h ::c
w = n H x = ' N ft p• rt D
C, b (D -0
d o O N o _ 1-( 0
M o C 0-) N N ~1f rh
Cn T X M O E cO -1> O Cr
CD 'D O `G g I G, rh (D rt
rt r• c o
l
C/5
w W d 0
X- Cn a rt I` c G' 1 C i (D W
r fi o I J T (D In
= arm
U) 0
s s
t
M 0 o Ii> 16 ft
O B
O j ht1 ,P 1••11
LO CD rt,
O m I r~ „ n hh
c v o N N
N CT O C
44-- (D Un
M rt o rt >t
O N O
O I _L7 -3 Cn O O N CU N•
0 7 (D C rt
O
ro I L n p F I-h
a w N c t2i
(D
N00°14'45°W 610.04'
a ~ m
w w (SO0°14 45"E 614.24') bn N 3 W 0
= n w rt a 0 rt
m 3 x 1( r,
0 o co lylrrl~I r-f LANDS
~ m = C O
00 (D Z
O W _ N Q
r cn c
aD w
to ti F to _ w
co ri-• co
rn = 01
n = - ro
(r C-) m
o C J
to
w W
VOLUME 9 PAGE 2700
This instrument drafted by Ed Flanum Job No. 93-39
r-~
z
. cn
H
` y
ST C- 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
9
OWNER/BUYER pAVI C 0V-eVA I
ROUTE/BOX NUMBER ~a J'hl Fire Number
CITY/STATE 1-Ic.ds~v~ 5 ZIP
PROPERTY LOCATION:S,-J ~4, SLJ 1, Section 3- Ted N, R_L2_W,
Town of S}, j j2Ce_)-)h St. Croix County,
Subdivisions Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists 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 treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
o
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ru
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED (y
DATE 1 " l c~ G~
St. Croix County Zoning Office
P.O. Box 98.-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
APPLICATION FOR SANITARY PERMIT
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), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property J'E l=' C O U °e vqJ 1'e-
Location of property LaLl 1/9, Section 3 S , T 3 N-R_LZ_W
Township S JO e-1 _
Mailing address ~3 J~ 6v~~f0
'P- PA O /y 4 s-.-a;!
Address of site Py~.~a h
Subdivision name
Lot number 10
Previous owner of property ~►A a v 10
Total size of parcel % i9YC s
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? t/ es No
Volume and Page Number;~-719 y as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No.D ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of Deeds, as Document No. -~z
Signature of Owner Signature of Co-Owner (If Applicable)
la~~a~g3 ta~ia~ 93
Date of Signature Date of Signature
• • DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2-1982
Raymond J. Quinn and Maxine A. Quinn, husband
and
conveys and warrants to . Jeffrjt A. Coverdal6 and
Pamela J. Coyerdale~••husband••and-wife. as, survivorship ,
marital-.property-••--•
RETURN TO
_ the following described real estate in `St• CrCiX ....County,
State of Wisconsin:
Tax Parcel No
Part of SW 1/4 of SW 1/4 of Section 33, Township 30 North, Range 19 West,
St. Croix County, Wisconsin described as follows: Lot 6 of Certified Survey
map filed October 13, 1993 in Vol. 9, page 2700, Doc. No. 507197.
Together with an easement for ingress and egress over the Easterly 50 feet
of Lot 5, Certified Survey Map in Vol. 9, page 2700, Doc. No. 507197,
60 feet in length from the NE corner of said Lot 5.
The grantor and grantee agree to share the cost of maintenance of the
shared ingress and egress.
This is not homestead property.
(is) (is not)
Exception to warranties:
Dated this 0 day of .ember....... 19.93....
..................(SEAL) LQUIM
- - - {
_~......................(SEAL)
RA J.
(SEAL)
* MAXI E A. QUINN
AUTHENTICATION ACKNOWLEDGMENT
Signature (a) $TATE OF WISCONSIN
St. Croix ss.
~y - ......................................County.
authenticated t is -.....day of Q.[Pxln.bftr, 193.3 Personal) came before me this .day of
~e > 1 93 . tha above named MID 9.......
t~ .--RAY!(!4)?a..!I.:_..QUAI n.and._M0. 41M..Ar..Quinn----
• _
TITLE: MEMMBER STATE BAR OF WISCO SIN
If not .
authorized by 4 708.06. Wis. Stats.) to me known to be the erson who executed the
p a
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
STEPHEN J. DUNLAP
°r
Hudson, Wisconsin
Notary Public t.__ CC'OiX........... -----County, Wis.
(Signatures may be authenticated or acknowledged. Both My.. Commission is permanent. (If not, state expiration
are. not necessary.)
dater 19.........)
-
•Names of Verso" signing In any capacity should be typed or printed below their signaturm.
WARRANTY DEED STATE DAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
'01,11 No. I- 11082 Milwaukee. Wisconsin