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HomeMy WebLinkAbout038-1169-20-000 M 0 e°a d 00 ~ ~o ~ I N C~ ~ N c d I L x I o I Y c w m 3 O Y z CO o Li c y 3 00 U a°~ I Cl) z y V , C M ~ a co c (9 O Z c a N O = CL O U) (D 0 o C) • ~ a t N U) ~ N I Q jr- O O N z m z Z Z C) N 3 ~ ~ I z C) o 0 a .n Y 3 N~ U N d ~ 6000 o a a a a U M M O N U) J U rn rn Z N N Q ~ N Op N (D 0) Q ml o. L 0 O O) O -6 _d Q } O O N ~j y O 3 N f~ll c 0 0 :3 0) C) O Ly N O ` d y d Q a' O rfi co O N Q N C O O c d f~ M V 7 _N 40. ~ M d C c a+ H H 0 0 CDP 42 -=5 -=i 2 E L c c 3 o ~a 3 3 o ~ 1 A 0 a 0 V1 0 } ST. CROIX COUNT i WISCONSIN PLANNING & DEVELOPMENT PLANNING SOLID WASTE REAL PROPERTY ZONING 715-386-4674 715-386-4623 715-386-4677 715-386-4680 September 29, 1993 To Whom it May Concern: An inspection of the septic system for the Allen Lunde property, located in the SW; of the SW', of Section 13, T31N-R18W, Town of Star Prairie, was conducted on September 27, 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. Sincerely, James Thompson Assistant Zoning Administrator mij C(D?l ST. CROIX COUNTY GOVERNMENT CENTER • 1 101 CARMICHAEL ROAD • HUDSON, WI 54016 I1=1043rtm'WIeRQVIIr~dls,1,y31.18,SW,ghjY I-t gE~AVErSYSItM'COUNTRY oun y: Labfiand Human Relations INSPECTION REPORT Safety and Buildings Division Sanitary Permit No.: ST- CROIX GENERAL-INFORMATION (ATTACH TO PERMIT) 193472 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: I v.: Insp. BM Elev.: BM Description: Parcel Tax No.: 6 "-'o 2y 038-1169-20 -000 TANK INFORMATION ELEVATION DATA A9300134 ?/~q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,~t OA Benchmark p ~S &c,l Dosing _/~/y, Aeration Bldg. Sewer 5 2? Inlet Holding St/ Ift TANK SETBACK INFORMATION St/ Outlet Vent to TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic loC~ ' NA Dt Bottom Dosing- - NA Header /tae: Aeration Dist. Pipe Holding - Bot. System D / PUMP/ SIPHON INFORMATION Final Grade Mapufacturex- Demand 7- G, (o 3. ~,j Model Number GPM TDH Lift Friction em TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTE BED/TRENCH Width i Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -z DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O /Ja---,) CHAMBER o um er: System: g© OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s) x He Size x Hole Spacing Vent To Air Intake Length Dia 7 Length _~Ky Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System Depth Over Depth Over c'F xx Depth Of eeded / Sodded xx Mulched Bed / T+ermh Center 3d- r Bed / Tfe Edges 3q - Topsoil ❑ Yes ❑ No ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.13.31.18,SW,SW,210TH AVE., LOT COUNTRY MEADOWS Z. - cS 6o, lG Y✓. - _ Plan revision required? ❑ Yes [ZNo Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: {~,ILHR SANITARY PERMIT APPLICATION COUNTY Ll In accord with ILHR 83.05, Wis. Adm. Code - STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / 731-19 1Z 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 OWNER PROPERTY LOCATION A C A.) ~l NO/2. ITra1'/a S 1 T N, R 0 ~ (or) W PROPEERTTY/OWNER'S MAIL IN ADDRESS . LOT # BLOCK # A) wAd' .'AV / Usv '5 . C.6u .~T/. rw CITY, STATE Z CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE :lD~ /w ❑ Public M 1 or 2 Fam. Dwelling- # of bedrooms 3 PARCEL T NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 0 3&P l / C~ 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. New 2.0 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 Other 11 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 7 72 0 d X~c' ?p~ r l s.~ f~/ Feet ! d d Feet VII. TANK CAPACITY Site ans Total # of Prefab. Fiber- Exper. inllo INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App I Tanks Tanks structed Septic Tank or Holdin Tank CU Aw Lift Pump Tank/Si hon Chamber F] F1 n 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 Na a (Print : J Plu er' Sign re: ( Stamps (AP/MPRSW No.: Business Phone Number: 1V,4 r~ ~2rt~~Ti~~ft 4/' y7d Plumber's A ress Street, City, State, Zip Code): u(-, /l IX. COUNTY/DEPARTMENT USE ONLY ry Permit Fee (Includes Groundwater Date Issued Issuing A nt Sig ature (No m harge Fee) Surc ❑ Disapproved 4"Vl 4?Approved El Owner Given Initial Adverse Determination X. CONDITIONS OF APP OV /R AS S FOR DIS_APPR;"AL: GC~/u~l SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s 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 p,oduct 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 81/2 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; distributio,ri 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 SURCHAR'GE 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) j STC - 104 AS BUILT SANITARY SYSTEM REPORT 1320 2AV. OWNER ,(7~6 ADDRESS /0,RS' j~; .vu T'c>XJ SUBDIVISION / CSM# ~a w J LOT # t2Z SECTION T N-R_1ej4, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 ~a ~o u.S e INDICATE °NOfZ`Pi# ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. • t BENCHMARK: ALTERNATE BM: Al te 0o y- Ne. r 0 ~ Ah t.c r E,. SEPTIC TANK / PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: S~~ v`! ~►ea ~ Liquid Capacity: / D 6 0 Setback from: Well +50 ~ House ~ J Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length p Number of trenches g f Distance & Direction to nearest prop. line:` Setback from: well: f.~U House Other ELEVATIONS Building Sewer `i . 2'7 ST Inlet.- ~dc ST outlets • PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: I l PLUMBER ON JOB: j(JJc~vf Q- 4j-/re •vL LICENSE NUMBER: INSPECTOR: 3/93:jt ' r ) 1 43 ` d In J ~ Q r Q ~ d I O lz~k, ~C 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 ~n delays of the pormit issuance. , Should this development be intended for resale by owner/contractor (s ec house), then Ia 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 `/e AI u N of - Location of property! t 1/4 1/4, Section T 3 N-R W Township 7`a r ,4Q, . Mailing address f o (o txJ )o`-'a w a Address of site / Subdivision name v 7` , w Lot no. Other homes on property? yes No Previous owner of property Total size of parcel < 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 and. Page Number J'~3 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 n the office of the County Register of Deeds as Document No. , and that I own the proposed site for the sewage disposal system) orreI (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of county Register of deeds as Document No. signature f applicant Co-applicant D~ of Signature Date of Signature DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: J" x/45 '/4 13 /T3/ N/R~~E (or) W a iII COUNTY: MAILING ADDRESS: V85- 9L(o,r v USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: ER ATION TESTS: .07 y / ZResidence 3 _ 4 New ❑Replace (9(2'.t RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:( ptional) r I I I zS ❑U C$S ❑U OS [_]U ❑S ®U EIS 23U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. I L H R 83.09(5)(b), indicate: ` Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 67 o >F7 D- 611, 17-11,'1O7,_~'4 t5h.y,, 16-20a0-32,. > LZ- 32 . s, 644 S -7R-' v ` rrC' 2 - / S - X18"' B- 8LP bl/ U`6~ •S&,/81/7s im- "Ll, -2 6 An C, B-5 8$ gs. 6- , 1e 3°.s. IB- I PERCOLATIOTESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- AD 3, P- Z_ P- 3 a / Pli_ 1-7 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 8Y.9 F T -77 I # t Z . e E _ TN a~ { i ow- A? E E E t; E I, the undersigned, l~Vv certify that the, spi ` sts reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, an at the,dotA, recb` d and the location of the tests are correct to the best of my knowledge and belief. NAME (print) TESTS WERE COMPLETED ON: a 0 (!,t ? 5- / Z- ADDRESS: CERTIFICATION NUMBER: PHON NUMBER(optional): IL 15- Q V. ,C c X35 3 0037 0 q 7/ ~ 11-2 z - $ CST SIGNATURE: Z Z9 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water ' Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. INDUSTRY, RCrUM I V11 bUIL V b H U - I I a 0 DIVISION LABOR AND PERCOLATION TESTS (115) P.O. MADISON, WI BOX 53707 RELATIONS ` 7969 iUMAN , 3707 (ILHR 83.09(1) & Chapter 145) TOWNSHIP/MUNICIPALITY: T NO.: BLK. NO.: SUBDIVISION A : 30 1/4 3W 1/4 i3 /T3/ N/Ri8 E (or) W COUNT . vBs - 9tt:,7~ DATES OBSERVATIONS MADE JOE NO. t:HV.IAL DESCRIPTIO 'PROFILE DESCRIPTIONS. PERCOCATION TESTS: ZReddence 1,3=3 ❑ Replace gr N / L RATING: S- Site suitable for system Um Site unsuitable for system , 1^.O NV4b~TAT MOUND: tt,, ,(FiO~UNc - N-FILL OLDING TANK: RECOMMENDED SYSTEM. (optional) r" [Z lL1JS ❑u ®S ❑Y L!:JJ ❑u ❑S U ❑S [ZU If Percolation Tests are NOT required-DESIGN ~AT~E: If any portion of the tested area is in the under s. ILHR 83.08(5)(b), Indicate: C!!W4!4 0 # Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TAL ELEVATIGN P H T R UNDWff. INCHES HARACTER SOIL WI H THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DFPTH IN, BS RV TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) _Vk .9,4o - 10 n S C - .S B- Z 90 9y O-~''4 /317 J,'/, /Y-LG"n~.k B- 3 Sb 93. Ss' pb ° ' ? _ , - z z'~ b~ J, . , as - ~z ~~J B- y 9y. 3 g i~ ° - ~ z i 641 IV w CS - e (,t r e'S B- S 8~ 9y. 3 M z - ~y-~~ c ass B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER HE RA MINUTES NUMBER INCHES AFTERSWELLIN INTERVAL•MIN. PERIOD T PERIQ[32~~--- 1013_3_1 PER INCH P. 1 24) a / 3- P- /a 2 P P- P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hort- ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent ,f land slope, i ;YSTEM ELEVATION P9 9 P ~a - - _ a o o y ' of T N t I -J th ..i the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and mezhods specified in the Wisconsin Xdministrative Code, aril that the data recorded and the location of the tests are correct to the best of my knowledge and belief. VAME print : TESTS WERE COMPLETED ON: 0-DRESS: n-~ of S i99z• CERTIFICATION NUMBER: PHONE NUMBER(optional): 00 205 1- Z- y CST SI NATURE: `RIBUTION: Original and one copy to Local Authority, Property Owner and Soil 'Tester. IR-SBDS395 (R. 10/83) - OVER - UNPLATTED LANDS BY OWNER I N.M°44X00'N! 456.90 -----------/52_30--------- --------~5230~ _ • ~I ~0 1 • ~I N~ tc) a (Z) I LOT I LOT 2 LOT 3 ; a vi ,I 68,217 SO. FT r~ 68,217 SO.FT. 68,217 SO. FT. c p N o o a 1.57 AC. 1.57 AC. 1.57 AC. N ~I 0 (p I J 2 ~ o VI O ~ O 2 3 w id JO/NT ACCESS EASEMENT TO L07S / 8 2 FOR i 1-0 DRIVEWAY PURPOSES. 2 /50.99' - io' /50.99 N ------%5099'- R/w ' W S.88044'O/ "E. 452.97 " se.9s" i r°' 116' M 2/0 th Avenue P S. 88 0.34'10'k-. 452.68' s.88034'1301.37 RIW SOUT/r SEC. /3, UNPLATTED LANDS S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O NER/BUYER "Al U A,,' ADDRESS / ~Rd 9 -X 10 FIRE NUMBER CITY/STATE c~T' ~/rPa Jk ~AfIS `-U I -zip- PROPERTY LOCATION :56J 1/4,S_ W 1/4, SECTION TOWN OF d 7`~'~ ~l•,v.`~-j' , St. Croix County, SUBDIVISION 1 a C .,jea4~rW~, 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. 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/tqe, 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 da . SIGNED: v~ DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 fi WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA DOCUMENT NO. STATE_BARQOFnnWISCONSIN FORM 2-IM8 491209 nl 9~t7rAoE RVISTE1t~S~+OFFiCE STa CROIX CO., WI Dennis---•A,.-'Ib?'~?io_and- Nancy. C. 2brnjo, husband .and..... Reed for RitMd .-.wife.......... a NOV O 91992 8:30 A. conveys and warrants to .....A~.~,et1 Lunde-• -Vary Br~anclik, s t is in ormlon d b/ a 'rlou7esteacT.Developme.. , ~ r TO } the following described real estate in S1A.... - County, State of Wisconsin: Tax Parcel No: Part of the South one-half Of the Southwest Quarter (31/2 of SWIM of the Southwest Section 13, T31N, R18W, described as follows: Commencing at thence North corner of said Section 13, alF being the point of beginning; 00'13'37" West along the West line of the Southwest Quarter (SWIA) of said Section 13, 1289.05 feet; thence South 88'51`11" East along the North line of the said Southwest Quarter of Southwest Quarter (SW'k of SWk) and Southeast 2227.26 feet; thence South 00'16127" Quarter of Southwest Quarter (SEk of SWk), West, 1299.80 feet; thence North 88'34110" West rlong the South line of the Southwest Quarter (SW-Y.) of said Section 13, 2215.18 feet to the point of „ n beginning; EXCEPT Certified Survey Mafiled September 1979 in olume 3Page , Page 795; and EXCEPT Certified Survey Map 863; and EXCEPT Certified Survey Map filed September 20, 1989, in olumee7"8~ 2029; and EXCEPT Certified Survey Map filed filed March 26, 3"}92 page. 2174; and FXCEPT46 ,Lots all~irl St fCroixCertified CountyS,~Wi.sct~in. in Volume "9", Page *Grantees agree not to place a driveway closer than 135 feet from p the westerly boun- dary of the above described property and'~rantors agree not to 467, closer than 65 driveway on Lot 4 of Certified Survey Map, Vol. 9, pie feet from the easterly boundary of said Lot 4. *their heirs, successors and assigns. This S g homestead property. (is) (is not) ~F, easements, restrictions and rights-of way of record, Exception to warranties: if any. w±- . . 16 92..... Da this O9~'CbCi' -NO T day of (SEAL) ..............(SEAL) A. Tb - O Nanc C. Tornio s _ (SEAL) ........(SEAL) AUTHENTICATION ACKNOWLEDGMENT I Signature (a) .Ilenili8-_A_-.TQrniQ,..................... STATE OF WISCONSIN ss. Nancy C. Tornio ---County. bb authenticated this =lt..-day of-------- 19- 9 Personally came before me this day of 19 the above named 1G©Ovl.+s_------------------------------------------- Kristina ogl.and TITLE: MEMBER STATE BAR OF WISCONSIN au (If not, •••ed authoriz by 706.06, Wia. States) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY na Ogland Kt,5 Atttorney at"•Law Notary Public ---------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration are not necessary) date: . 19--------•) 'Names of persons signing in any capacity should be typed or printed below their signatures. Wisconsin Legal Blank Co.. Inc. WISCONSIN WARRANTY DEED STATIC FORM BAR No. OF 2 WI- 1982 Milwaukee. Wisconsin