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HomeMy WebLinkAbout020-1015-40-000 St., Croix County Zoning Detail Sanitary Information Computer 020-1015-40-000 Sub/Plat: metes & bounds Section: 12 Parcel 12.29.19.698 Lot: TN/RNG: T29N R19W Municipality: Hudson, Town of CSM: 1/4 1/4: E 1/2 SE 1/4 Owner: Flaherty, Patrick 1021 Arctic Trail Hudson, WI 54016 State Permit: 119499 Issued: 06/07/1989 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 11/21/1989 POWTS Detail: Trench (seepage) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Not Tom Nelson Yes Schumaker, William The inspectior Signed Off: No of system and paperwork. TI along Arctic Ti Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 6/7/2005 6/7/2008 Friday, January 14, 2005 at 12:06:52 PM Page I of 1 es Money Owed i report wasn't filled out, but a sketch $0.00 elevations was attached to its house is now part of another CSM ,ail Parcel 020-1015-40-000 01/14/2005 11:54 AM ' PAGE 1 OF 1 Alt. Parcel M 12.29.19.69B 020 - TOWN OF HUDSON Current jX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * FLAHERTY, PATRICK H & SANDRA PATRICK H & SANDRA FLAHERTY PO BOX 45 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1021 ARCTIC TRL SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 23.000 Plat: N/A-NOT AVAILABLE SEC 12 T29N R19W PT E 1/2 OF SE1/4 COM Block/Condo Bldg: SE COR-N 1312.44'TO POB S89DEG W 759' N 1325' TO N LN SE1/4-E 759'-S 1325' TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB 12-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 47677 Use Value Assessment Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 21,600 105,900 127,500 NO AGRICULTURAL G4 6.000 500 0 500 NO UNDEVELOPED G5 14.000 14,300 0 14,300 NO Totals for 2004: General Property 23.000 36,400 105,900 142,300 Woodland 0.000 0 0 Totals for 2003: General Property 23.000 117,000 105,900 222,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 106 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 p f~6C~fldt~ C%j Nov - o, FILED 2 ST. CROIX COUNTY SURVEYOR'S RECORD KATHLEEN H. W&M 3 g CERTIFIED SURVEY MAP cs OCATED IN PART ❑F THE NE1/4 ❑F THE SE1/4 AND IN PART ❑F THE SE1/4 ❑F THE SE1/4 ❑F SECTION 12, T29N, R19W, TOWN OF HUDSON, ST, CR❑IX COUNTY, WISCONSIN. OWNERS MATCH LINE OF W1SL., RICHARD & SUSAN HJELMGREN SEE SHEET 2 O,y P.O. BOX 1112 HUDSON, WI 54016 1 vj DOUGLAS J. ~Z 0° ' QI * ZAHLER ' S-2145 ~2 89*57'29" E HUDSON, F o o~ ~I I ~I Wis. U N Q 1 ccVO - 0I ~ 1 Wool ~1 OI O N CD 1 p O; ~I ~j loo I Z L' CD 2 00 N M I.JI ~OI ~I L~I IOYI J Q m In M w g Q I ~I 1~rI' W US ~o o @; w 6 LOT 4 _o C'; g; ~I 5)'~ v u ~4! 6.114 ACRES oo al Qni aN°w I I O 266,319 SQ. FT. o ' l~1 OI o 0 1 M l 1 0 Z ^ (n ~jq I N LLI D (llr WQN I 9 , ; 8 N89°38'11 "E MW_ t j Cl ° i Q°; 8 231.22 - - - - - - - - - - EL13 =fl O I I Z HARAGE O; G dl ~ 9° co Lwl I Qo v HE SE EXI TING 1 DRIVE o 1 °R I J LD I ~I I ~I §31 Q; APPROVED 6, I N ~I ~]1 1@ 1 Lwll (ol, i ST. CROIX COUNTY p I o ~MI I ~1 arming Zoning and Parks Committee SEP 14 2000 01 10 3 \ 78*341 OR I I 0° ; by _459.13, ~If not recorded within 30 days of ♦ 22772' 320,24. approval date approval shall be IST/N~ d i ° I <ull and void ♦ S78o 4"E 5 2976' DRIVE 1 9a, ♦ ♦ LCIT2 U2 3.643 ACRES - - - - - \ `c 158,681 SQ. FT. ~,O 1J' 2 Should Lot 2 access from the T- / existing access for Lot 3,the M p p~ l /access would be required to p , / ° be upgraded to County road co no 1 1 I / / Standards. 1DD~oJ S84 1 o I Q l c7 I Q PROPgSED 233.97 01 7"E518.77' DRIVI`_ 284.80' 1 I / ( ♦ UI ~ I ; 1 gig W / I 111 Q ♦ ♦ o; ~I o0 1 O1 U In CC Cl) <1 L tT 1 L° JI i ~I oo r Ilf,~ O I 00 0 3/4" REBAR FOUND N -i 3.643 ACRES Ili a Q; 91 9 a; S86t2'06"W, 7.85- .85' 158,707 SQ. FT. aI ° I } FROM SET CORNER. ( ROPOS D 3'33'1 1 M! M W DRIVE w 1" IRON PIPE FOUND I o S16°26'05"E, 10.39' 9 905 51.26 FROM SET CORNER. YS C~o~ofi~o_~10do_1 Z~, _f141Z W I Z Z - Lno SCALE IN FEET 1" = 200' NER 200 0 200 400 SHEET 1 OF 2 SHEETS Vol. 14 Paqe 3949 Forts - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Gt SEC. TN-RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I?LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l ~4 4L 't- 'L' L' c' -s" a'V& INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used e; a.5- /I j-- Elevation of vertical reference point: Proposed slope at site: :S SEPTIC TANK: Manufacturer: Liquid Capacity: /t.3a Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Side,Q Rear, O dd feet From nearest-property line . ' Frontlo Side 10 Rear, 0 feet Number of feet from: well .lJ~7L }ruilding: (Include this information of the above plot plan)(2 reference dimensions to septic tank) - ITT AT}11n 1H1+ /TT11~ PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: r Width: Lendth: ~ Number of Lines:_ _ Area Built: Cj Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O Pt. Number of feet from well:'' Number of feet from building:'': 4,-'3 " (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number : Q 3/84:mj Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ '0 r, . 00 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,© Side Rear, O feet From nearest-property line 'Front 10 Side, 0Rear, 0 f, Number of feet from: well , builditto* (Include this information of the above plot plic,- Qns it7i-mam PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon P Manufacturer. Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 It Number of feet from well: Number of feet from building:'., (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage"'pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector: Dated: Plumber on job: License Number: 3/84:mj 7 ~I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LAEOR4 HUMAN RELATIONS DIVISION ` P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4j SE f, S12, T29N1 -R19W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound F PETU= H ADDRESS OF PERMIT HOLDER: INS Patrick Ylaherty Box 296, Lakeland, MN 55049 - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. T. ELEV.: CST REF. PT. ELEV.: Name of Plumber MP/MPRSW No.: County: Sanitary Permit Number: William Schmaker 6382 St. Croix 119499 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-11111- DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) I El YES ❑ NO NEAREST -111111- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: TRNO.OF ENCHES: DISTR.. PIPE SPACING: MCOVER ATERIAL: PIT INSIDE DIA.: # PITS: DEPTID DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: N T FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06188) Zoning Administrator Ca1LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMI # -Attach complete plans (to the county copy only) for the system, on paper not less than l! qy 9 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 f . je a, 71-,. % ,4,- S l2 T_Qjr, N, R / E (or PRO RTY OWNER'S MAILING ADDRESS LOT # BLOCK # keno j1d411;111_1(_ I CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ill. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE' ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms P AR ELTAX . UM ER( J III. BUILDING USE: (If building type is public, check all that apply) q 10-0 - (3 03 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. ❑ Replacement 3.E1 Replacement of 4.E1 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 12. 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) o ELEVATION Feet? 5 Gl Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank •~G' / Lift Pump Tank/Si hon Chamber El 1 1-1 F] I El I Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) WMPRSW No.: Business Phone Number: . o l Plumber's Address (Street, City, State, Zip Code): r.z-. Al c IX. COUNTY/DEPARTMENT USE ONLY Stam ) ❑ Disapproved X14(5-, ary Permit Fee (Includes Groundwater re Issued Issuing Agent Signature No Surcharge Fee) IP Approved El Owner Given Initial A verse Det rminati n v c) o X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I 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 -orthe 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. Vlll. 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. SBD-6398 (8.11/88) 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 fla H r -a7W Location of property .i*tt LIE- 1/9, Section T~N-R_ Township LL r-'6 I& Mailing address '6 k ~67L('_ C D /14 1 I~l V(C S ©~q ~~~~a y3 Address of site Al'i Subdivision name /yo Lot number A/O O h -e, Previous owner of property H n-Q ~`N r Total size of parcel y Ar R S Date parcel was created / 77 Are all corners and lot lines identifiable? k Yes No Is this property being developed for resale ll//(spec house)? Yes o Volume d Page Numbe as ie~o~ded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: Y A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and he 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. 9-X 16 9% ; 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. Signature of Owner / Signature of Co-Owner (If Applicab elel ) .-Date of Signature Date of Sign ture DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 381699 Vo►- 666 u,^i 548 Roy Hopkins and Edna his D ed, m4d betwe e}~ Hok„ PT ins is wl e and In Tler own-----.-- rl fit - .F 17th - - ' -Grantor, ~v r Dec w? 82 - r atrick H. Flahert i 1. 1 ~ and P- - y and •-:S--a-- -n--dra L. i 12:05 P j.-~, Flaherty, husband and wife as point tenants°._ - - - - Grantee Witnesseth, That the said rantor, for a valuable consideration---___ - 14 000.00 conveys to Grantee the following described real estate in _St C rO _ i X RETURN TO County, State of Wisconsin: A parcel of land located in Section 12, Township 29 North, Range 19 West, in the Town of Hudson, St. Croix County, Wisconsin, more fully described as follows: Tax Parcel No- Commencing at the SE corner of said Section 12; thence North along the East section line a distance of 1312.44 ft. to the POINT OF BEGINNING: thence S890411W a distance of 759 ft.; thence North parallel with the East section line 1325 ft., more or less, to the North line of the SE4 of said section 12; thence East along said 4 line 759 ft., more or less, to the East section line; thence South along said East section line 1325 ft., more or less, to the POINT OF BEGINNING; said parcel containing 23 acres, more or less. Together with a non-exclusive easement for an access road and for installation of utilities, all utility lines to be so located as to not interfere with the use of said area as a road, over and across a strip of land 66 ft. in width lying North of the Town Road, the East line of said easement being described as follows: Commencing at the SE corner of said Section 12, thence S890S8 IW, 462. 00 ft . ; thence N 110 .59 ft more or less, to the center of the Town Road and the POINT OF BEGINNING: thence North 1199.56 ft., more or less, to the Southerly boundary of the parcel above described. This deed is in performance of a Land Contract between the parties dated December 14, 1977 recorded on December 16, 1977 in the Office of the Register of Deeds for St. Croix County in Vol. 566, Page 442-443, Doc. 345433. .,Y is not c• ; r•,!til This _ homestead property. ` N70. 1 01)7. L Together with all and sin ular the hereditaments and appurtenances thereunto belonging; And. _~?oy_HopCins and Edna Hopkins, his wife and in her own right warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except existing utility easements of record if any, and to liens and encumbrances if any, created by the above named Grantees. and will warrant and defend the same. Dated this day of D ec_emb_er------•.- : 19... .2_. l/- ~._--(SEAL) --------------------------------------------------------------------(SEAL) _ - - ~r P.0Y H0PKINS I----------------------------- (SEAL)< - (SEAL) * * EDNA._11OP_K-I.NS------------------ AUTHENTICATION ACKNOWLEDGMENT Signature(s) __k0y__I-!opkinS__and___Edna_________ STATE OF WISCONSIN Hopkins, his wife and in her own right ss, County. 82 authenticat this I~-_day of_.__~ 2C 2mb er___, 19.----- Personally came before me this day of L.,sv / L7/L 19-------- the above named * JQ ij~T D-. HEYWOOD TITLE: MEMBER STATE BAR OF WISCONSIN (If not- - - - - - authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY HEYWOOD, CAR I & MURRAY PO Box 229 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: , 19_____-_-.) 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 1 - 1982 Milwaukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER E- ROUTE/BOX NUMBER I/, FIRE N0. CITY/STATE A G /t!- 6t ® /V / -N rI ZIP J J~ d / Jff PROPERTY LOCATION: -:2 aiiEk S L-. 1/4, Section TIN N, R W, Town of St. Croix County, Subdivision ~&D Lot No. 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 $3000 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 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Offic wi hin 30 days of the three year expiration date. SIGNED o`- DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTME14T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDI.YiTRY, DIVISION P.O. BOX 769 LABOR-AND PERCOLATION TESTS (115) MADISON W153707 'HUMAN RELATIONS ' (H63.09(1) & Chapter 145.0451 1 TOW14U NSHtP/~: l OT NO.: r LK. NOr SUBDIVISIONrNAME: N & 1/4 * I/ /T z9 N/R 19 ~Ior & O A/ _ ...r cc~ NTY• E NAME: IV A ADDRESS: S~CiR~lx A-TkieGC F'L.A ME-Q Y ~ 29 LAyF.LA*V4 M ')-~'S a4~ DATES OBSERVATIONS MADE DESCRIPTION: t TESTS: Residence XNew ❑ Replace M AV I I iq 7 M 4 Y 13 I T ~o;t cs ~ S t RATING: S• Site sultable for system U- Ske unsuitable for system ~1 501 LS - V &'K NMR. tt,, - N-FILL OLDING TTAryN'K: RECOMMENDED SYSTEM: (optional) Y ❑Y ffS ~U TO ❑U ❑s Co VE4Tf,►fvt4L i OL e-N 0s If any portion of the tested area is in the If Percolation Tests are NOT requ{red OE~y RATE: ! 11 under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: •r1y PROFILE DESCRIPTIONS ELEVATION AT R-INCHE CHARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) t'~•S~ 9p 16LLTS Z& ~ *.I'SrL l J~BQN`~ 53'$R M5 at S& $6.9? Na N I, s- 11-60 1.6g II ,oo 11 L #--M src o $RP4 MS 9nSQ0N 14'6Q'j S- C:- B- 3 $.S$ 4~ .94 1J0-,OL > $.S8 ji "&LI 33"84N 1'-,L I'Itg 7Z 1., &Aic S t!i R 8.9Z g4.ZZ a 92 ~O" c~ I NStL 2c~'$ S Sc ~4"LT M cs S. B- 6.47 8 33 Alo„g ? 8.0 12 "$c.LTS /d, 5L 76" cT L1?,qN ria S Qa~T PERCOLATION TESTS TEST WATER N 0 H HOLE TEST TIME LEVEL-INCHES RATE MINUTES NUMBER I m's ELLIN INTERVAL-MIN. PER INCH P- t 3.60 o>vf, & &7.00 3 > 2 < 3 p. Z T40 o>VY 111, ~ z >2 > < 3 - 3 p o >E S.4 >Z >2 ~3 P t lore nz PLAC- P P- PL.OT IPLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- I and vortical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of lend slope. SYSTEM ELEVATION $ 3 ~q ,ice t ; , t i -7 J t ` ~ , P be Ex,Sz IN4 TN t la,A? r~lo^t" ~,pf.Lr I i - J 1., 7 'k i ...i r 1. ! 04MA? Ir - NW col N I R I. . i. i.. _ ~ dF' coNCIRe'rec P~b~,t..TA C. - ~L~vW i roh., /00, C_W 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods slxmcilied in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME pr nt ; TESTS WERE COMPLETED ON: )0 44N so w c~SC J ?Y i~4 M d y 13 19 0 AWNS- CERTIFI ATION NUMBER: PHONE NUn~ER(optiunal): ' ~cc~a A ~V 4Sv rti W I Soo) G 34 'A 'L ?E ~ - C UST RE** OllffR19UTWN: Original and one copy to total Authority, Property Owner and Soil Tester. J X < 7l , L' 1. 71 141 1 C e111 /,.7 r 1y I7 Form - STC - 104 .w AS BUILT SANITARY SYSTEM REPORT OWNER L/Y~y27. TOWNSHIP C~L/D.PDn/ SEC. T` N-R O W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~1oq~ Pry°PER I--' N E ZA ~ ~ ~ ~ ~RvOE~PTy L_:XZS7_L,JG C~S7~E.vGE ~y s, I o, pR~ oERrr ~o s' L ~,uE • INDICATE NORTH ARROW NO SCAL4" BENCHMARK: Describe the vertical reference point used A)A,L ZN OAC - RE6 Elevation of vertical reference point: /00 / Proposed slope at site: SEPTIC TANK: Manufacturer: t')/'C5 ZK Liquid Capacity: /0000 Number of rings used: Tank manhole cover elevation: 91p . S3Tank Inlet Elevation: Tank Outlet Elevation: CEO. $S Number of feet from nearest Road: Front,O Side Rear, O feet From nearest-property line °Front.0 Side,O Rear, SS feet Number of feet from: well building: /log (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER a,. Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size. Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, 0 Pt Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: /300 &P41. Number of pits: 3 Diameter: '/O Liquid depth: Bottom of seepage pit elevation: V!5' 33 Area Built: Has either a drop box O or distribution box (E~Ieen used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: I Inspector: Dated: Plumber on job: License Number : D 3/84:mj DEPARTMEjNT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS DIVISION LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SW4, SEk, S12,T29N-R20W 'CONVENTIONAL ❑ALTERNATIVE StatePlan o Number: (11 assigned) Town of Hudson El Holding Tank ❑ In-Ground Pressure El Mound Hw)r 35 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E: Larry & Doris Hart Route 2, HUdson, WI 54016 .162 -ff r JCi G►(v~ BENCH MARK (Permanent reference volno DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. Name of Plumber MP/MPRSW No. County: Sanitary Permit Number: Gary Zappa I3300 St. Croix 102821 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ,i6jzcz, /l1lT , ~S YES ❑NO ❑YES NO BEDDING: VENT DIA.. VENT MAT_ HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING. VIN TO FRESH / C J ALARM FEET FROM /t LIN:rJ AIR NLEr ❑YES NO ❑YES NO NEAREST OC S DOSING CHAMBER: MANUFACTURER JBEDDING'. JLIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCK:.ED ER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO [-]YES ❑NO PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH GALLONS PER CYCLE: LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM DIAMETER ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH TER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE CIA sPITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT /C7 l DEPTH DIMENSIONS 1 :5 -5 ~2 GRAVEL DEPTH FILL DEPTH JDIITR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH 1 1 PIPES FEET FROM LINE/ Alf~l►l T BELOW PIPES ABOVE COVER ELEV. INLET ELEV. Ell NEAREST T J( p\/p'(J MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MAHKEHS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS D~STR PIPE MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATE HIAL & MARKING . S ELEVATION AND ELEV ELEV DIA ELEV PIPE DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PL ANS ❑YES ❑NO ❑YES ❑NO COMMENTS: p PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPER TV WELL: RUILDING. f4 t FEET FROM LI"E: + ❑YES ❑NO ❑YES ❑NO NEAREST 10-63 P1 4f r t ~ .4 Sketch System on l/ e kv augiL Reverse Side. SIGNATURE. TITLE. Zoning Administrator DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNTY =U11L. In accord with ILHR 83.05, Wis. Adm. Code STATES SANITARY PERMIT # V -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES J&J NO ji PROPERTY OWNER PROPERTY LOCATION 1, '/4 SE '/4, S T , N, R E (or W PROPERTY NER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME /1/, CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ❑ VILLAGE : r VJOrv ~Wic W1. 700 ' CEO - 0/lam ~0-c II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family. OR ❑ Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ® New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ® Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑ seepage Trench c. Seepage it 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): f J3o " d. JnJdd -3-,.1? Feet ®Private ❑Joint ❑Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. Manufacturer's Name Con- Steel Plastic i INFORMATION New xisting Gallons Tanks Concrete glass App. structed Tanks Tanks Septic Tank or Holding Tank ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name Print : Plumber's Signature: (No Stamps) iMP/MPRSW No.: Business Phone Number: Plumber' Address ( r , City, State, Zip Code): Name of Designer: 1:01r 111-~ ,77o- T VIII. SOIL TEST INFORMATION C;~Zwl%'Ev d Soil Tester (CST) N me CST # n..co>✓ 7 c 1 CST's ADDR S (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee Groundwater Date ISSU Agent Signature (No Stamps) yA Approved ❑ Owner Given Initial ap S rge Fee 1 Adverse Determination I N. d AL& " z X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION L a TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly rnaintainecC The septic tank(s) should be pumped by a licensed pumpQF whenever necessary, usually every 2 to 3'years; 6. If you have questions concerning your private sewage system, contaet your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all informatfon requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y2 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; dosing or pumping chambers; 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. - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the f result of over 2 years of steady negotiation and public.debate. The groundwater bill Ground#ater included the creation of surcharges (fees) for a number of regulated practices which Wiscori,-in's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) 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 / 411-y ate/ dm-Alf /7 -/Q~ 7 Location of Property `"_W S C Section T a 9 N-R ;Z,19 W Township ad se/L Nailing Address 5`Y'19 Address of Site RR J~-/- z 4 4.0 j~ scv~sl~c 51 101 G Subdivision Name .Lot Number Previous Owner of Property e 5 gH.~ *'d r of 7 Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? r/ Yes No Is this property being developed for resale (spec house) ? Yes 14 No Volume _ and Page Number I Q 12 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (we) ceh.Li..6y that att statement6 on thih onm ahe .tAue to the best 06 my (ouh) hnowtedge; that I (we) am (she) the owneh(sf o6 the pnopehty descA bed in this in6o"at.,i..on 6oAm, by vi tue 06 a waAnanty ed necokded in the 066ice 06 the Countyy Regi,6teA o6 Deeds cps Document No. i9r . and that I (We) pnesentty own -the pnoposed bite bon the sewage diApos sys em (on I (we) have obtained an eahtment, to nun with the above de cAibed pnopenty, bon the eonstnuction 06 said eyatem, and the same has b. ~ hecoaded in the 066ice o6 the County Reg.csten o6 Uetdb, as Document No. V ) . SIGMA 01f OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) /Vg v 8, DATE SIGNED DATE SIGNED 1 DOCUMENT NO. STATE BAR QF.WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA 3~.91Q WARRANTY DEED trot..796PAGe REGISTER'S OFFICE This Deed, made between 'WIE41 #eoI 4 11g&,tr1 E JL,?11y ST. CROIXCO, W1 Reed for Reoond NOVEMBER 6;,, 1987 Grantor, and ~a~Mtr D Doa;s /~o.T 11:00 A M bow of 0" Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN conveys to Grantee the following described real estate in tl County, State of Wisconsin: PEA T Ae S W //y ® f 7/e e Tax Parcel No: S E Y q m~ ) d r - W .5rv a,, 12 Tic/ t1,/ R l o w T,1 &f t4 IC 46410 1. r T cky, x edr W; 4<, ff This tZ, 7: homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this _ o day of 19 (SEAL) -Z (SEAL) 7 4 • H ahh4 A E Hu, t (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN County. S3. s T c Roy authenticated this day of 19 so I a be~ a me thi day of 19 th a ov nam iie r- r, r .411)p I MA, r. TITLE: MEMBER STATE BAR OF WISCONSIN' (If not, rw. " v tb, •rn , known 'to be the person-who excuted the authorized by § 706.06, Wis. Stats:) - foroi instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Y7 : . y _ _L rt aT a A7 Iy X ..S i vote ""Notary ublic County, Wis. (Signatures may be authenticated or ac rroirole gec4 Both Arty Comm'ssion 's permanen . (If not, state expiration are not necessary.) . ror,.,+•' 4 date:___ / 36 -19 ) Names of persons signing in any capacity should be typed or printed below their signatures. NF 3573 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms, P.O. Box 10208, Green Bay, WI 54307-0208 FORM No. 1-1982 s RED NOW 51987 0 AM a amt 43186'9 « ~I CERTIFIED SURVEY MAP Located in the SW 1/4 of the SE1/4 of Section 12, T29N,R20W, Town of Hurlso.t, St. Croix County, Wisconsin. N /4 CORNER Surveyed For: Larry Hart Hwy. 35N Hudson, Wi. Pz _ 4, . West Hart o4 00 Al 40 o Hwy 35N. c10 WV 05 Hudson, Wi. A) a ~g• / v C0 h ro 3P ~ w, 3P h Q WWWOMW M ACS ft**IM ? OJ 0 ~O Q / AND ZONING Cf WWM 0 ~P ra/ ~Q CO 00, s1~° JSa / 11 LEGEND CULVERT ' SECTION CORNER' MONUMENT/ • I" IRON PIPE FOUND W .r N ~'4-7- -NATURAL 3 ti DRAINAGE o I "X 24" ROUND IRON PIPE W - _ . . ~ SWALE WEIGHING 1.68LBS./LIN. FT. SET. N O Cq t0 d °y zI M LOT I ua d E- h 79276 SO. FT. SCALE IN FEET 111:1001 W O In (1.82 ACA N Di I Z W O 25' 50' 100' 2001 W N W WI z 3 W= vi F-1 J W M N ~W; 0.I _ of W - WI W z o ZI ~ m z ~I 3 O N N 00 O O z~ Z - 00 N 'I ~ h 4D ap C; 0 • N N ,r1~11tttH!!!!®j 163.41 a® v V ~'r S I /4 CORNER SE CORNER HARVEY G. SECTION 12 SECTION 12 JOHNSON ~ T29N,R20W 5-1899 SOUTH LINE OF THE SE 1/4 ? HUDSON a UNPLATTED _ LANDS L~ W IS r,►11 ~r ~ S U RJ ~~°10ot~et ~ VOLUME 7 PAGE 1912 This instrument drafted by: H.G. Johnson 487=1255 r. Z t 6T SOW L HWfilOA 311a1O ' auxoH 'el!U T a4v(j 1 Z43 ~ •uospnH to unno I, agI ;o pi-eog unnoy agl Aq panoadd-e Agaaag st thew stay M~tfs~l~ryy~ , M ~bf1S OlvbP 00 . L861 jsn~n~r Q A'r -b ~ elm i~P 9I0-VS uisuoosT& 'uospnH NOSof1H IaaalS Pu03aS L0-V OS 669L-S r►OS •ouI 2uiAananS gosng ~ •p ABAUVH 6681`9 uos ~SanxVH yl~~IfgNM~N~~ •aoueutpxO uoistntpgnS uospnH;o annoy agI pine aou-eutpaO uotstntpgng AlunoO xtoa0 - IS aql IsalnjielS utsuoostM agl ;o :V£ • 9£Z uotloaS ;o suotsinoad aqI g4lm patlduloo Aljn3 an-eq I Iugl pine :palCanans pu-el aql;o satx-epunoq aotxalxa aqj ;o uotjleluasaxdax joaxaoo pine anal E st Iuld Bans I'egl IA4aadoad paglaosap aao.qu agl padd'ew pine pa.Canans anuq I I-eqI `;atlaq pine 2utpu,ejsxapun 'aOpajnnoux l-euotssajoxd ALu jo Isaq agI of f%Itjxao Agaaall ' xoAanxnS pine^I utsuooSIM paaalsi&aa 'uosugor - J Cana-eH `I •paoaaa ;o slu-euanoo pine suotlotalsaa 'sluauaaslea aaglo IjE of Ioafgns $uiaq pine 'ssal ao axouI (saaoie Z8 • I) jaaj aaenbs 9LZ' 6L $uturejuoo ' $utuut2aq Io Iutod aql of autl glnog pies 2uol-e 11l,r£91 M„L0,8Io68N aouagl :l,/las pies 30 ~~oLSS au.1 glnoS aql oI V r9£fiV M,,££jSZ,OS aouagl °,8i'SLI all9Zj aouagl :autl A-enn-jo-Ig$tx Plus Suolu lZI:::gZ (al8toKN su papxooax) a.,6£aZS.S£N aouagl Alenng2TH al'eIS }o autl ATOM-jo-jgBtx Ajxa4s-ea -gjnos agl of fi/jaS aql;o autl IsaM ptVs $uolu 10£'LOS (:K„MSZoON pauznswe ' 1,/IaS aql;o autl IsaM aql of paouaaajaa sOutaleaq) a,,££,SZ,ON aouagl !Zj uoilaaS Io aauaoo -v/jS aqI lu $utuut2ag :snnollo; s-e pagtxosap 'utsuoostM `f,,lunoO xioa0 -IS 'uospnH Io unno,I, ' MOZ2l 'N6ZZ ' ZI UotloaS 3o V/ I aS aql ;o :P/ I MS aql ut palvooj puul Io laoxled y NOIZdIllOSaQ H z H ' a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z t7 a H OWNER/BUYER -T ROUTE/BOX NUMBER fi?mY 40 Fire Number CITY/STATE /~ua/4a4 ZIP 5-41,P PROPERTY LOCATION: ~~i 3L, X14, Sections, T 2q N, R ?p W, Town of t4ads;e4 , St. Croix County, Subdivision 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. yo 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- ro 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 DATE -.v 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. INOUS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS fIV'F3USTR DIVISION LABOR AND P.O. BOX 7969 PERCOLATION TESTS (115) MADISON WI 537 HfdMAN RELATIONS 07 (1-163,0911) & Chapter 145.045) f .-5 SECTION: TOWNSHIP MUNICIPALITY: OT =NO.:. : SUB (VISION NAME: .5 J44 4 /Z 29M/R'zoE (o► vA ~ OPaSF 4 S COUN Y: 15 R'S A : MAILING . JT(-PtI S +4t(T WY 3~ N . /Yu-)N Soq W ~ . USE DATE$ OBSERVATIONS MADE DESCRIPTION: Residence New ❑ Replace 'Sa+i-s SolLs ~aoL - oT aM RATING. Sw Wee tarftabio far sA*m Uw fibs uawitybI fer st►atern Pal C- , L Ajj F I j L h r O.NVENTIONAL, JMWID. VMM-INTIL HOLDING A ECOMMENDED SYSTEM:loptional) S ou us 09 lRd S ou S u aS ~y at~s If Percolation Tests we NOT raQuired SIGN RATE: 71 FF'loodplain, any portion of the tested area is in the under s.H63.09(5)(b,, indicate: cL.Ik,'`-~s indicate Floodplain elevation: NA PROFILE DESCRIPTIONS BORING A HARACTER OF IC WITH THICKNESS, COLOR, TEXTURE, AND DEPTH ELEVATION TO BEDROCK IF OBSERVED fSEQE ACBBRVV. ON BACK.) /ts"LTU~/V~7L 22" &Q, 2N :3, J i4e t, CLL 19"*cT96, J >I, s 97, >II.~S pF-r--s zC`t 1R Csfcft Z"FS,S Y 36"eR estc /4'I9Rr4 t- :a its" Rk lRk v r L_ /'Z". War +~'+v tCa~z e- Il.0 S,z$ f4ar-,/ > J/ 17 qty' 6RN Cs -f&k 29FSrt6e ,S' F 2A S~FSrL B- ~ ~15a X6.41 > J/, 5a '2 ~~~'~'u "s *~5 ~ fe 8Rry FS 7"Pak C,fr 74" 9PN S C'k ig' &FS bEgsc 8- l1.5 ' 3 > li.Sa /$.1 1r,Igy RIB i° rt-FS "BRA s~ t,t~ _ l2'"$e.sLTS, 17 ~'Y~K ~t~tF~ t'~'"DK ~RN'r ~~~Q 37 is Q'~/ 13 1 MS .,1, PERCOLATION TESTS TEST DEPTH WATER )E TEST TIFR DROP IN WATER LEVEL-INEPES R AT E 'M -N-TE§- NUMBER 111111161111111 AFTER SWELL( INTERVAL-MIN. PERIOD I" PER PERIOD 3 PER INCH P. .3Q 9 ` > 2 > < P. Z ,qU OWE 46.20 a ~z < P- -7.A,7 I CIS -7.7 '?2 > L P- Q :d= C-LE aw AT P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil area. Indicate scale or distances. Describe what are the hori- tontal 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. GULV k'~ i SYSTEM ELEVAT - )'tk6N AtAti /titNRKCIa WITH t --ai 'DEL ~ANCt ~'dST ~e 96.9 +v; ~ ~ Ian / ~'n Q5 /0% gez. L I gEW-44 A~k - >Pt Kl `X r4 L L- 9 Lowt++ W Y ' ' IN CAC I kEA N OR, 4 ~L~.1►~`~>~ ti *oK zTy L►N r x'65 ~C+eaM AT NGftV-T cogrAR E LCVAi IbN /00, 00 AL-r&kIiJA-rL V, `°K LINE to _ 'off ` 1, the undarsiprred,i wreby certify that the soil tests reported on this fornn were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. [NAME print : TESTS WERE COMPLETED ON: oN Sts ~usc.~t t~Y~v~~ri', ~NZ- S~ ~rv`~3c>~ /4 19v67 ERTIFICATI NUMBER: P NUMBER (optional): 4o-7 '&~COrv l4, 'ST ISO N Sqo t 34 %qf NATURE: i DISTRIBUTION: Oripirial and one copy to Local Authority. Profterly Owner and d Soil Tesler. DILHR•SB"395 (RL 021" OVER - • I'll q, SSr~ -18b ~ " ~ NOS(3n ON *Or 0 aitC M IMP 0-0-1 00 dP A! emu' _ M• WWI- alllbldin 3$ 3H1 Ao 3N1'1 m.Lnos riOj1 acv IM oa v •N631 al Nolloss 31 N011035 w3usoo as asNvoo r/ 1 s M L0,91 >a N , li''S91 N N N es • ssaaSa pu-e a a ssaaSut aoJ za-eH ':a gEuu7zH pue zx'eH ISOM Aq O o pasn aq o1 `Ii£Z6Z $ zuouxnooQ '{,I£ aSled 1 e N 'M, '10A ut papaooaa 9v zuauzasiea N a I~ or- f" (zoo} Z/ 191) poa Quo :a.LON o a W to 14 1A _ w It -4 ' q 01 III f0 1'• w s * Z p ,gyp', ,003 .001 .02 ,9: o z ! OR 1 O ~1 . 1. „I 1731 41 31yos to ,i 'ld 'OS 9tZ6t r -4 a ' 1 10-1 w N C N so 13S 't' ae m o1 'ld 'NI'1/',tA'1 09'1 8NiH913M _ m 3dld.NOIi1 CINnoa OF? X..1 0 6 ONnOd 3d Id NOMI ,I \ 1N3NInNOM1 WANaOD N011*3S \ aN303'1 rift PALS • 100 r~ ~r s y + ry ? a ti a Z u • 4r' N'~ tv° MSC /ImH o h 1x.eH zs a M •cM 'uospnH Y MS£ ' AmH n,y j eH A-12-e-I : toA pa,ioxanS V3Na00 bJ N •u-tsuooscM 'Azunoo xtoao 'zS 'i ospnl-1 3o unAol ' MOZ2i'rM6Zl `ZI uotWaS 30 i 3S au1 JO f'/1 MS a41 ul Pal 0-1 ddw k3Asns 031.411830 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B LDINGS DIVISION IIVDll~TFiY Y, , P.O. BOX BOB ND~.ATiONS PERCOLATION TESTS (115) MADISON WI 53 69 HUMAN (H63.0911i & Chapter 145.045) '.S SECTION: TOWNSHtP MUNICIPALITY: 0 N0.• LK. NO.: SUB IVISIO NA E: 5u 4 JZ 29M/Rz6 Elor vb COUNTY: l / ~ -Q'►X s ~I~t'T` wy 3~ N , E DATES OBSERVATIONS MADE KRa,dance New ❑Repface -SEOT l'1 l 7 'i / S C PT 4- / 9 yr So lLs k ~4~'t A Sa 1 LS 6 0 G- oT14 w M RATING: Go Site lwit" tsar syttnettt Um IlifturAsh"fear aystom P07 C - L ATN F 1 ~ w h L G TANK:IRECOMMENDED SYSTEM: (optional) ros I! S [IV S 09 oS u o S y kc<-s If Percolation Tests are NOT required ATE: If any portion of the tested area is in the under s,H63.09(5)(b), itadlcete: Floodplain, indicate Floodplain elevation: /'JA PROFILE DESCRIPTIONS BORING TOTAL DEPTH nuffe -1 HgS CHARACTER OF IL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH MaMRM ELEVATION OBS F;5 . HIGHEST T ELD2ROCK IF OBSERVED (SEE ABBRV. ON BACK.) B' / !~'LrI~P.iv~J~ ZZ"BQnt1~Q ~,S~taQ /g" Q ~f!..Z ~"C7$~E1~a 97. S' 1E > /J. 75 N F- Ms gas hlge cwm 2' F S, S y X/ae -lip ~4 "6a„t r S 2k" Ro, ban/ C_ /2''. b✓fr,- ~c'rv ~C,yz 8- Z 5,Z$ ~/bnl I1. J'j 8G' 9RN CS 46-. e- /1, So q6.4 i > 1/. 5O /2" S, s tGe 29"FSrt6e /S' F Q~ S ~fS~ l 26" uT 'i:'s '56 &r,4 _ I" Bar, FS 7" 8,eN asQ Z4" 90q S 5'c>k *"Fs t~,ise ~C 1/156 -13, 1> 18,41 04T Pb, 8Q th - FS ` gR ( t a!) it g. /z L'SLTS f-7 bK AewFS f7~DKf acv d6 32 A e►,( s- rL ;-7 PERCOLATION TESTS DEPTH TWEEENST NUMBER ttlt~AAFTERSWELLI INTERVAL-MIN. AATT PER INCH P- P. Z l czo P- 7 > 2 P- (ZL &&4AMAL -A -Tr P- PLOT PLAN: Show locations of percolation testa, soil borings and the dimensions of suitable soil area. 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. w Nat`TIC SYSTEM ELEVATION cu,Lo-k _ , _ r_ - ! ~iRbV A,Pti M,tkKC4 w►rly io 4.10 1"H /O gtZ . ~z zo'~ ~NM~2k- SA Y.t: Sc .car F'Li5WL1"1 'l A)N I± , Y - _ . 9 ' 1N CyAK t ~Ee GAR $-4 AP-~ -Y Litir x'65 ~V-poM Ai Noft Y toil r` - 7U CoRAP, -41-61AaT IbN 100, 00 ALTA,Q iATc •16 1, the undersignad,•hereby certify that the soil tests reported on this form were made by me in accord wit the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. A print : TESTIS WERE COMPLETED ON: ` 01-1 So ~f)SC i ~ ' LEy/ -~CLIIS+.►~_ JCr ~11'Iq`~,1~ 14 /9'~7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 7 SIE7CON & S-7 J~sa h W( Sg01 34i4 z~'-AN NAZ NATURE: 1 ISTRIBUTION: Oijilmal and one cot,y to Local Authority, f'rntmrty Owner raid Soil Testes. 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