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HomeMy WebLinkAbout020-1149-00-000 % 0 to § r R K § o � \ @ � (D / �] k \ /j§% � E» D ] 2�\ o 0 0 .2c k�= m a ) f ° o § 5 $/.0 a LL q a #f & '0 kkak8 » # � i j \ § m z R § $ i a m S B z :!t 2 \ • 0 z ) § . I- = ± E 2 I © -� (D ) ) § _ , g � Q zm z } � & .. k � ƒ f 2 CD La CD ~ 39x2 4 � E 2 ' 2 0 0 a = ' j : E 0 0 0 k o a a a CL § o B �f ° � U) J Q CO - z % § w 2 I . ] o o = \ § : 0 2 @ a / $ J ƒ / o to 2 a / \ � � o = Erg Q © C) CO 7 c f 8 £_ E o ¥ \ o c ClJ § r z § 0) f ) % \ a § a § 2 \ ) c o - g k } } [ 0 z / / z \ � ■ � °CL » E § $ } § a 2 J a 0 2 o Parcel #: 020-1149-00-000 03/21/2006 04:14 PM PAGE 1 OF 1 Alt. Parcel#: 33.29.19.798 020-TOWN OF HUDSON Current jXI ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner MATTHEW H &SANDRA L BRUCHU O-BRUCHU, MATTHEW H&SANDRA L 573 TWIN OAKS CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *573 TWIN OAKS CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.600 Plat: 0215-COUNTRYSIDE VILLAGE SEC 33 T29N R19W COUNTRYSIDE VILLAGES Block/Condo Bldg: LOT 12 LOT 12 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1151/234 WD 07/23/1997 826/394 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 92666 264,400 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.600 77,400 192,300 269,700 NO 05 Totals for 2005: General Property 2.600 77,400 192,300 269,700 Woodland 0.000 0 0 Totals for 2004: General Property 2.600 33,000 140,500 173,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 124 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 �4j 715 - 962 - 3121 800 -962 - 5227 ST, C:ROIX ZONING REPORT NO.' 17143/01 PAGE 1 ST, CROIX COUNTY REPORT DATES 1/27/92 COURTHOUSE DATE RECEIVED' 1/23/92 HUDSON, WI 54015 ATTN' THOMAS C. NELSON 3 OWNER' John Ro Knutson �- LOCATION** 573 Twin Oaks ircle, Hudson COLLECTOR' M. Jenkins DATE COLLECTED' 1-22-92 TIME COLLECTED' 1'45pm SOURCE OF SAMPLE' Outside faucet DATE ANALYZED'1-23-92 TIME ANALYZED'2'00pe COLIFORMt 0 /100 ml INTERPRETATION' Bacteriologically SAFE NITRATE-NS 5 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100-m1 Nitrate-Nitrogen, mg/L 9 10 >>, LAB TECHNICIAN' Pam Gane tD 'yc F.\NDFVENpE O�� WI Approved Lab No. 19 Means "LESS THAN" Detectable Level Approved by' 4 ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ,L ST. CROIX COUNTY ZONING OFFICE fa 911 4th Street Hudson, WI 54016 \ / Telephone - (715)386-4680 The St. Croix.� x Co. Zoning Office offers the service of septic and water inspection to Lending Institution, Realty Firms , and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. _....._....._,___ h,-'/ WATER TESTING------------------------------- EE:$ 25.00 For nitrates and coliform bacteria) - ---- WATER TESTING--------------------------------FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION---------------------FEE:$ 25.00 r° PROPERTY OWNERS NAME: ` PROPERTY OWNERS ADDRESS: ?j �A)i v1 i 'CITYsr�y r' � 14t4 Legal Des yip tion 1/4 , 1/4 , Sec. 33_, T �.C) N-R 17 W, Town of_ ,Lot No. Subdivision �' r FIRE NO. '� /3 LOCK BOX NO. o�o ! l,(q-0-0T/ -71 Color of house Realty sign? ) _Firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e. ,,, COPY OF PLAT, BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services:_ ��( lkoyc)I1 f(. A F,,d-e,ra Telephone No. REPORT TO BE SENT O: CLOSING DATE- Signature: AS BUILT SANITARY SYSTEM REPORT QW i.:i:-- "'ter " - J - ---- TOWNSHIP j SEC . 3 f9 To N-R W AllDRl ST. CROIX COUNTY, WISCONSIN. -e t)0 r I 0 r—)i SUBDIVISION ,a{ �__ �+ LOT / LOT SIZE PLAN VIEW Distances and dimensions' to meet requirements of H63 sHow EVERYTHING WITHIN 190 FEET OF SYSTEM TT f _ _ oI,� S Q s — —� I di a e No th Arrow -EE 7 SCALE : , C �-,i; .(;IIMARK: (Permanent refere e Point) Describe : ! , v,t 1.ion of vertical reference point :_ ,i Slope at site . Liquid La acit C' TANK: Manufacturer :2—r i`c C,y q P y : n�_-. l of rings on cover ---_Tank manhole cover elevatio : _ 1 — Tank Inlet Elevation:_ �7, Z, Tank Outlet Elevation__ t:i IAMBER ."lilitL acturer : 4ime( je-,�' Number of gallons l,Li,jber of gal . pump set f6r a cycle Q 0 (7, gallons ; total pacit distribution lines gallon: size of pump head; l,c.itlon per minute horsepower ra d ame of pump : ud model number SD 5 ('Q /b R � , Type of warning device OW.DING TANK: Manufacturer Number of gallons r. IevaLion of manhole cover 1w of warning device_ c ��� l. N11' SIZE: _.--1Tum6er o pits feet diameter t Liquid depth seepage pit in et pipe-elevation oftom of seepage pit elevation feet . i,,�G BED SIZE: number of lines width length file depth l';AGE TRENCH: width--,..- ., length _ �'01,A'IION RATE A$EA REQUIRED AREA AS BUILT INSPECTOR _ PLUMBER ON JOB LICENSE NUMBER Y . sot's DIMENSIONS SPD50HISPD100H 14.34" ILM 6.00" 2.72" 12.78" PERFORMANCE SPD50H/SPD100H—MAX.SOLIDS 3/4"SPHERE-3450 RPM 60 50 ti TOTAL - HEAD IN FEET a � 20 _. ._._. .-—— —,— _..... �. _ _� ._.. �_._- -- 10 ._—.. -.-- . - .-.___._4 .___ __.. _ __—_a-_ .-_-: __._ 0 20 40 60 80 100 120 140 U.S. GALLONS PER MINUTE "$u;lcun HW-106 — _.___ �1ew 10186(Replaces Bulletin 110-5) 'U� NYDROMATIC PUMPS Printed in U.S.A. 1840 Baney Road•Ashland,OH 44805•419/289-3042 �HYDROMATIC PUMPS Bulletin HW-106 APPLICATION SUBMERSIBLE HIGH 'HEAD • Septic tank effluent • Industrial sump service EFFLUENT PUMPS FEATURES ✓ Cor.-rple ely ubl'.�ersiblR:. I ica;,y d,, ;y,oil-filled motors wit;r bat; bea in .design in pu e di, octric insulating;oil �� for cooly r rur ruin,;,permanent tubr. ation and long life. Moors,tre 1;'21``P(SPD50H)or 11 i'(SPD100H). Single pha se n-;otor°s, 11"s volt or 230'olt, 30 RPM,feature start cal aciter's,50lid state ;tart swi ches and automatic reset thermal overload protection. ''hree phase motors 200 volt,230 volt or 460 volt,require magnetic starter with overload protection located in the accessory control panel. ✓ Dual mechanical shaft seals are standard. Seals are long ' life,carbon and ceramic faced. Seal failure(S.F.)sensor capability(for connection to a meal failure alarm device) 4 _ available as an option on single phase units,standard on three phase units. ✓ Water level(automatic models)controlled by wide-angle float switch with piggyback style plug. N" ✓ Non-clogging,two-vane,cast iron semi-open impellers., SPD50H=3-7/8 diameter impeller;SPD100H=4-1/16" diameter impeller. Impellers threaded to stainless steel shafts. No inlet screen to become clogged. Capable ofr handling 3/4"spherical solids. p ✓ Pump:case and motor housing are heavy cast iron for corrosion resistance. All exposed parts are high grade bronze,cast iron,steel and stainless steel. ✓ Field serviceable. CAPABILITIES Capacities to: 140 GPM Shutoff Head: 50 Feet 63 Feet Solids Handling: 3/4" 3/4" Discharge: 2"(3"optional) 2"(3"optional) Horsepower: 1/2 1 Electrical: Io,60 Hz,3450 RPM,230V,9.5 FLA 230V,7.0 FLA 3o,200V,4.5 FLA;230V,4.0 FLA;460V,1.65 FLA Controls: Automatic or Manual Automatic or Manual Power Cord: 14/3,SJTW-A,lo,115V=10'std.(20'opt.) 16/3,STW-A,10,230V=20'std. *14/4,STW-A,1 o,115V=10'std.(20'opt.) *16/4,STW-A,lo,230V=20'std. 16/3,STW-A,le,230V,=20'std. *18/5,STW-A,3e,200V,230V or 460V'=20'std. *16/4,STW-A,10,230V=20'std. *Models with seal failure sensor wire. PAGE OF <1 CrUSS Jec � lon o � cl� en-) r Fry$h Air Inlet$ And ObtarV0llon Pipe 1 Approved Vent Cop Minimum 12"Above Final Grade 20 42"Above Pipe _4"Cost Iron To Final Grads Vent PIP$ Marsh Hoy Or Synthetic Covering Min 2"Aggregate Over Pipe DIs1rlDutlon pipe 0 0 0 0 0 '—Too Be Aggregate Perforated Pipe Below B$n$olh Plp$ ° P o —Coupling Terminating At Bottom Of System �IeJ•.�' lore ���/�� / � '��\opO SOIL FILL DISTkIBUTIC PIPE APPROVED S4?J MF-TIC COVER OR 9" OF STRAW 2"oFAGGREWE OR MARSH HAy n ° LLEV. OF FED T--► e 1o'OF J2 -212 AGGRE T E GA -• r DISTRIg,TIfDM PIPE TO BE AT LEAST INCHES BELOW ORIGIMAL GRADE AQU AT LEAST20 INCHES BUT AIO MORE THAI) 42. IMCHES BELOW FIAIAL GRADE /'MAXIMUM WN OF F-XCRVAT100 FKOM bWINAL 6KADF- WILL BE IMC-HES NIIIJIMUM ®FP" of EXCAVATION FROM O�141WONL GR49E WILL BE INCHES SIGHED: LICEWSE DUMBER: DATE : 122 _ 110 J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOIL 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION SE,Mni 011 T'l 521� 19W State Plan LD.Number: Town of 14fsdson E9'CONVENTIONAL ❑ ALTERATIVE (If assigned) Lot 12 Countryside Vi.11ag Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT DATE; John Knutson 2421 4th Ave. N Ifenomonie, WI 54751 CX/ BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST FMF.PT.ELEV: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number.: Wayne Lorenz 934 St. Croix 119524 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: BEDDING: VENT DIA.: VENT MATL.: HIGH WATER ❑YES ❑NO 10YES ❑NO ALARM: NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ❑YES ❑NO FEET FROM LINE: AIR INLET: ❑YES ❑NO NEAREST—� DOSING CHAMBER: MANUFACTURER: J BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO 1:1 YES ❑No ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF IPROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAREST—► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST­-110- 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 I 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: DIMENSIONS TRENCHES: MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV: PIPES: DIA.: 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.06/88) Zoning AdTI 1n 1S trator Thomas C. Nelson SANITARY PERMIT APPLICATION 4 DILHR couNTY , 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 84 x 11 inches in size. ❑ Check if revision to previous application -See reverse side for,instructions for completing this application. STATE PLAN D.NUMBER 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. /(f PROPERTY OWN R PROPERTY LOCATION p %4 j %4, S T_,�<' , N, R l e7 E(or) PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# U-C &AI CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑State Owned ❑ NEA EST ROAD ❑ Public L'P 1 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) q Q rI 1 ❑ Apt/Condo / / u 2 El 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. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 El SeepageTrench 22 El 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.A A 4. LOADING RATE 5. P RC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(s .ft.) (Gals/day/sq.ft.) ( in./inch) ELEVATION 460, 4 r6l V 0 Feet 014 Feet CAPACITY VII. TANK in oallons Total #of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks anufacturer's a Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank I /^ —p, lQ001 I Ea Lift Pump Tank/Siphon Chamber 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 Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: P mb is Address(Street City,State,Zip Code): , , IX. COUNTY/DEPARTME USE ONLY ❑ Disapproved Sagitary Permit Fee(Includes Groundwater ate Issued Issui Agent Signature(No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determin do 0 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 locaf-.code'administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit appNcation must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the-county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.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. --------------------------------n----------------------------------------------- Owner of property To fiQ 4 kCSE KNUr%0t,1 Location of property _SE 1/4 SE 1/4, Section 3 3 , T ZC? N-R iq CW7 Township Ui) oN [eUOOT) Mailing address 7-4ZI 04 2 IU 1J3 I L CAC nor S I E6 Vk g 2 51415) x 9101(0 Address of site Subdivision name COVn4yZ5iJe- UtIlage, Lot number 2 Previous owner of property FgAmc6 0 Erb F-/V &yelvgee Total size of parcel Z. (0CY�S Date parcel was created ©clks '` ZI 1 l -1 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume W and Page Number 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, 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 record�in the Office of the County Register of Deeds as Document No. �1Z(P • 39 ; 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 ount Regis er of Deeds, as Document No. 8?(o - 3`lq ) . ign Lure o e Owner Signature of Co-Owner (If Applicable) (4z/1/22 "Si4nature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER JOHf4 kfJL)TSO/y ROUTE/BOX NUMBER ' FIRE NO. CITY/STATE—..--- T ono/\l ZIP PROPERTY LOCATION: 5'F- 1/4 1/4, Section -33 , T_ZI_N, R�_ W Town of 7l , St. Croix County, Subdivision l .UUhySldQ, Ud�CIQG' , Lot No. (Z 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 Office within 30 days of the three year expiration date. ILI 4— SIGNED r y DATE f CJ 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 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1—1982 THIS SPACE RESERVED FOR RECORDING DATA 42`793 WARRANTY DEED REGISTERS OFFICE - � ST. CROIX CO., WI Francis H 0 den Recd for Record This Deed, made between ---- Francis --•----g --------- ......... NO11 :d 21986 ------- ---- a 2 8 M - - - ------------------------------------------------------------- Grantor, -------------------------- ---- John-Knutson and_Rose_Knut_---9R -- -band._al�s .. 7£e.______ Rephter of Oeede" survivorship, marit ail l--property--------------------------------------------- ._. ------------------ ----------------------------------------- - ----------•-------------• Grantee, Witnesseth, That the said Grantor, for a valuable consideration._--__ ------------- ---------------------------------------- RETURN To - conveys to Grantee the following described real estate in ---S_t___C_r_Q.ix,_____________ County, State of Wisconsin: Lot 12, Countryside Village in the Town of Hudson, Tax Parcel No_ ___________________________________ St. Croix County, Wisconsin. 0 T I This --------i.5..rlAt-------- homestead property. (1;;) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And____grantors,--John Knutson and Rose Knutson ................. ............ - - -- --- ------ --------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record, if any, and will warrant and defend the same. October 88 Dated this ------------4'L--.� ------------------ -------- day of -------- --------- --- --, 19------ — (SEAL) _./1,�f — (SEAL) * Francis H. gden ---------------------------(SEAL) ----- -----------------------.(SEAL) * * ------------------------------------------ AUTHENTICATION ACKNOWLEDGMENT Signatures) -----Francis_1i.__.OgAen----------------------- STATE OF WISCONSIN ss. ---------------------------------------------------------- --------------------- --------------•-----------------------County. authenticated this _�7-fday of-----October_----, 1988-_ Personally came before me this ________________day of I' ----------------------------------------- 19-------- the above named ------------- ------ *----- Jahn--H•---Heywnod-------------------------------------- -------------------------------------------------------------------------------- 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, CARI & MURRAY -------------------------------------------------------------------------------- -- ------- - - -.-------------------------------------- by- --Sa- mue R. Cari -------------------- -- --------PTO-.--Box--229-,-.Hudson.,---W-I------ ,40-146---_-__- 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. _ GRPPHICS DEPARTMEr,'T Or REPORT ON SOIL BORINGS AND OWSION _71 TTW L TT kill NA 0 v' ;11,),Bn S-1 ]b s &'or fred Zn s(grarl SYSTEM SCALE CIRCLF OVER r� i 1 / Y