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HomeMy WebLinkAbout020-1113-10-000 o am3 °o, I rn c I 4 0 I � I ° I N o I II y I � I C I I a3 ID I 0 ° Z c I ti o Q M I Z N O uJ E r z a m I c c t7 o z v I Y, y Z E v I (V I •� L C O O mz z N z d N I CD _ Z I 06 i a�i m C7 c I p a` a cd g I E CL E 0 33 aN o 0 00 R � aaa Z a = ; r- -'10 rn of O h IV ', rnrn Z I �l M N N I I I! ° m ¢ min , I a y o I ►mil C, O I `� V O 4C.0 w O Q ~ = E _O E� C1.1 v<° � l M C N y y N C Z Z E E c ' o 2 ! = p z' _ H F to d oaf _c L rrww _1 A vat ', ONV Parcel #: 020-1113-10-000 02/09/2007 08:31 AM PAGE 1 OF 1 Alt. Parcel#: 12.29.20.458G 020-TOWN OF HUDSON Current X 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 JAMES R&MARY A JOHNSON O-JOHNSON,JAMES R&MARY A 1032 HWY 35 N HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): •=Primary Type Dist# Description * 1032 HWY 35 N SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 12 T29N R20W PT NW SE DESC AS FROM Block/Condo Bldg: SW COR GO E 332.7 FT TO HWY 35 R/W&POB TH N30 DEG W 100 FT,TH N 59 DEG W 452.4 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT TOWLNS280.2FTTHS87 DEG E 205.29 FT S 74 DEG E 133 FT TO POB 12-29N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 765/114 07/23/1997 692/272 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 46,000 137,700 183,700 NO Totals for 2007: General Property 1.000 46,000 137,700 183,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.000 46,000 137,700 183,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 220 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_JA-AC5 J©/fN 5 oiy TOWNSHIP if yQ S o,v SEC. ,R T ?9' N-R o�O W ADDRESS _/cp32 �,L,,y .3SN- ST. CROIX COUNTY, WISCONSIN �U/J Sock GJi a e. 5rlC�/� SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IMR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM n s , R A./ � r .� CoR fR dF SYVDO/� 3 a , EiF<uf,uT ILI' t- ' VE Af sr nR�Ptx Orywt&� .' J�x,S 711tl8. ` rt , fx>STnitJ� �fl �lhCsC �R�vES/ /mDo 00 3 t �us�,t /"RvPE�IY�/tif INDICATE NORTH ARROW 100 BENCHMARK: Describe the vertical reference point used /Y- � R ESP of ` /mp of 1�TovP Elevation of vertical reference point: /Oa Proposed slope at site: SEPTIC TANK: Manufacturer: 4e1sTiy Liquid Capacity: /Odp Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Sideo Rear, O feet From nearest- property line Front,0 Side 10 Rear,0 feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) k PUMP CHAMBER Manufacturer: y 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: 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: Number of pits: w�� Diameter: Liquid depth: S Bottom of seepage pit elevation: Area Built: a. Ez ,((,Xa7� Has either a drop box O or distribution box(D1'een 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: c7 Inspector: Dated: oc Plumber on job: License Number: ��S .=7. O o 3/84:mj DEPAR;rMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: 71 NW14-,SE%,S12,T29N-R2OW CONVENTIONAL ❑ ALTERATIVE (If assigned) TII U H on ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 9 NAME OF PERM IT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Jamez Johnson 1032 Highway 35N, Hub n, DUI 54016 rah 36 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: G any Zappa 3300 St. cuix 119407 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.:EWARNING L LOCKING COVER PROVIDED: ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST---* DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY: I 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 O±DIAMETER:PERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM E: AIR INLET: PUMP ON AND OFF ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: 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: WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH 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_ � 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 I 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: N0.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: Zoning AdminniStAa Wt SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COU chi � IfILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PE MIT# /q dr —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 5�NO PROP RTY OWNER PROPERTY LOCATION /,Sz- %, S T , N, R A0 E(Or nW PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE ZIP CODE PHONE NUMBER 71 CITY NEAREST ROAD,LAKE OR LANDMARK S tiro 11 _31 N VILLAGE: .l0 r.� N TOWN OR II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. 1:1 New New b.19 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. 9 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. §9 See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): P. y 33[� 0 s-o Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xis Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank v 00 v ❑ ❑ Lift Pum 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) 4#W/MPRSW No.: Business Phone Number: Z p p /S 6-o2 U-0 umber' Address( et,City,State,Zip Code T-.- Name of Designer: III. SOIL TEST INFORMATION Certified Soil Tester(CST) me CST# C f - e ST's ADDRE (Street,City,State,Zip Code) Phone Number: p/o t U^ ^ D^r ��� -rV — C�a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater late 1 ing Agent Signature(No Stamps) �pproved ❑ Owner Given Initial Srg`e F/e�e Q�!!!!!! Adverse Determination (2 o vv V �`� k4', M 'L LAI,I X. COMMENTS/REASONS FOR DISAPPROVAL: f SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber r INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT f APPLICATION 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 maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact 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: I. 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 information 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 8'/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; 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 result of over 2 years of steady negotiation and public debate. The groundwater bill Ground .afar included the creation of surcharges (fees) for a number of regulated practices which Wisco iri' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea$ure. is used in your building is returned to the groundwater through your soil absorption 0 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) r 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. -------------------------------------------------------------- - ------------------ ---------------o---------------------------4h&l------J--0--`- soi-A------ rt V�'h�e5 N arm Owner of grope uh y Location of property 1/4 J 1/9, Section �_, T.2(� N-Ro2 O W Township Mailing address Aloa&614-7 Address of site Subdivision name Lot number / Previous owner of property 04 c,c b V VcA H r 4hh ®N f' Total size of parcel / Ac- h e Date parcel was created /I — �/ 7 Are all corners and lot lines identifiable? es No Is this property being developed for resale (spec house)? Yes No Volume 6 9^and Page Number o2 7o:� 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, wpuld 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. t ------------------------------------------------------------------------------- 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 warrant E;:Zo deed �jecorded in the Office of the County Register of Deeds as Document No. 7 �7 ; and that I (We) presently o� wn the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the cons ruction of said s em, and the same has been duly recorded in the Office of a County is f Deeds, as DocumenttNo. ) • /y[ i of Ow r Signat a of Co-0 r (If Applicable) Date of Signature Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FO M 2--1982 . 165PAGE'llf,.. RW*fts oFrice Jacob John Mohr and Georgianna Mae Mohr, his *fe ­---­--- ........ ..1­---------­­1------- . ............. ................. ------------- ST. CROIX 00., WIS. - ----------------------------------------------------------------------- ....•........ --------- ---- I ROecL for Record ft- I .....................................­........---._.._.._....._.....-----.__••........ JIS I day of Dec. 1.76 A.D6 19 - ...............__................. . .............. ........ ...... ........................... conveys and warrants to -Aamea..K.-Johnson..and..Mary-Ann............... t 2.2A --...Johnson,.-husband-.and-wif e-.as..joint.-tenants....................... .----•-----------------•-•----------.....----------•------- •---• ........................................ .... .................•...... ...•.......•........................................... ........ ..•......• .. . ........I.................................. ........... .................................................. ............................. ................. ........................................ RETURN TO ------------- ---------------------------------------------------------------------- ............S ---- -, '-------------------------- - the following described real estate in ............ t C e 01 x........................County, State of Wisconsin: Tax Parcel No: .............................. Part of the Northwest one-fourth of the Southeast one-fourth (NWiSED of Section 12, Township 29 North; Range 20 West, described as follows: From the SW corner of said NWi of SEJ go E along S line of said W of SO 332.7 feet to Wly right of way line of State Tr8nk Highway "35", the place of beginning of this gescription; thence N30 48'E on said Wly line 100.0 feet; thence N59 12'W 452.4 feet to W line of said NWI of SE's; thence S 0 on said W line 280.2 feet; thence S87 42'E 205.29 feet; thence S74 23'E 133 feet to Place of Beginning. EXCEPT a parcel described as follows: Commencing at SW corner of said NW41 of SEi; thence E on S line of said NWi of SO 332.7 feet to Wly right of way line of S.T.H. "35"; thenc6 N74 0 23'W 133 feet; thence N 87 42'W 205.29 feet to W line of said NWi of SO; thence S on• said W line to Place of Beginning. This deed is executed in fulfillment of that certain Land Contract between the parties hereto dated July 9, 1984, recorded July 11 , 1984 in Volume "692", Page 272, Document Number 394761 . is IRANSF-M This ............................(is)' is not) homestead property. sis Exception to warranties: Easements and restrictions of record, if any. FEE Dated this -------------­17th- - - ---­-----­- ----------- day of ...................._J.u_l.y----- ............ ------_----_-- 19..86.. ---- --- -------- ----------- --------------- ---------------(SEAL) -A&t AL) J c-c c _bD John Mohr ............... ------------------------------------------- ................................ ------ .......... ................ (SEAL) --- --- (SEAL) Georgia ia na Mae Mohr eorgia7n, .......... -------- -­--------------------­----- ...... ....... AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN ss. -------------------------------------------------------------------------------- St. Croix ...........I------------ County. 17+h Wly line 100.0 feet; thence N59 12'W 452.4 feet to W lane of said NWi of SEJ; thence S on said W line 280.2 feet; thence S87 42'E 205.29 , feet; thence S74 0 23'E 133 feet to Place of Beginning. EXCEPT a parcel described as follows: Commenng at SW corner of said NWi of SEA; thence E on S line of said NWi og $Ej 332.7 feet to Wly right of way line of S.T.H. "35"; thence N74 23'W 133 feet; thence N 87 42'W 205.29 feet to W line of said NWT of, SU; thence S on said W line to Place of Beginning. This deed is executed in fulfillment of that gertain Land Contract between the parties hereto dated July 9, 1984, recorded July 11 , 1984 in Volume "692", Page 272, Document Number 394761 . is This .. ......................_. homestead property. (is) (is not) Exception to warranties: Easements and restrictions of record, if any. FEE Datedthis -- --------------17th------------•--•----------- --- day of --------------------.JU1 ---------------------------------------0 19..86 _ D (SEAL) AL) J c.0 b John Mohr ..(SEAL) . ... ....-- -(,,a�??14/.�.. �L/(SEAL) * t Georgia na Mae Mohr AUTHENTICATION ACKNOWLEDGMENT Signature(s) --------- STATE OF WISCONSIN se. ------------•............................................•--•-------••._...----- St. Croix ..................................... County. authenticated this .-------day of........................... 19...... Personally came before me this .._ 4k----day of ------------------------•--..........------.:.........................-----..... -----•--......�U Y...----•--•••--...... 19_._86. the above named ___ ________ *------ ---------•------------------------------------------------------------- ---MOhr--.----- --- ---------- •------ TITLE: MEMBER STATE BAR OF WISCONSIN' (If not. ......... .............................. L =---•-----------------•••••----•----•......••-------•------•-•-• •-••--••... authorized by § 706.06, Wis. State.) S•� � T'V1 .• •,,..•s••�ti !il► �, to me known to be the person .5--------- who executed t f g Instrumen an owledge the same. THIS INSTRUMENT WAS DRAFTED BT': William J. Radosevich, Atto.�n : s . _......--•---------•- _ ... ................................................... •.. William J. R osevi ch . .._+ 502 Second Street, Hudson, � •----------------•-----------5i.............................................. I �' St. Croix ----------•----•- _ — ........................... : ' - , Notary Public ----- -------------------..County, Wis. (Signatures may be authenticated or acki 4*1 $p��t"i My Commission is permanent.(If not, state expiration are not necessary.) . date- -------------•--•--------------•-----------••-----------• 19......... r *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. FORM No. 2— 1882 hlilwaukee. Wis. \ I 1 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 'P 7e_ ^j'd !- Mqkl A7 A1 J041 ROUTE/BOX NUMBER Q3 Yi FIRE NO. le CITY/STATE �/�f ZIP PROPERTY LOCATION: )YW 1/4 �1/4, Section / , Tot / N, R 00 L W, Town of �!R r'd , St. Croix County, Subdivision , 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 0 fice within 30 days of the three year expiration date. SIGNE c� 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 . '1't tr�..tiV'YM%&K . • ...•,I_�M-S,RiI+'.•:. • ... - .-r Yv n .. ....... .. INDUSTRY OF REPORT ON SOIL 114GS AND SAFETY& BUILDINGS INDUSTRY, '�+ C DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H83.09(1)d Chapter 145.045) LOCATION:5 SE TOWNSHIP/�: OT NO. LK NO,: SUBDIVISION NAME: N 11 c /Z %TZ9 N/R zo#(o f,/u a o COUNTY: WNER' MAILING 5T Ceolk 1/4 JON o /a3Z /-� 3S u�soN �V' 54U/6 USE DATES OBSERVATIONS MADE NO.B .: COMMERCIAL T O : L IZ- Flesidence ❑ Re l/t N K New place J 4'q /b 19-6 9 T J A,4 �1LS v Pwc49 -66TIgAM RATING:S-Site suitable for system U-Sit*urawitable for system((� n j _S_a MOUND: jG1JS ❑ IN T �� /iG1JS []®L SG Y : EC VEpjTIl>IVAL �DptiogD)�.Y If Percolation Tests are NOT required DESIGN RATE: ' If any portion of the tested area is in the under s.H63.09(5)(b),indicate: `LEAS Floodplain,indicate Floodplain elevation: NA t- C-T PROFILE DESCRIPTIONS BORING TOTAL Ut D116TE54 NCH A ACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH tit. ELEVATION BSE V TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- ( /S•oa 95 33 nI /S f2"iBc_c,s �FS 25 PS! S/'ZI" MS 13�QLLTS W&L /6'190=5 Zt-.R ->j FS B- Z i lZ 96,42 /�©N� �6. ''rt ��, / e Ms B- 3 3 95,7 I�aN� > S, ~&LCT's ?S' $c=s ZC'k NS 121" IMS B- B- B- DtC-T-T PERCOLATION TESTS TEST DEPTH I WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I111i.rt�si5 AFTERS ELLING INTERVAL-MIN. PER INCH 5.3 g / / f3,9 P I 11. 0 1J 9 D P. - 1'2.90 0 ]b TT- ' Z 6.7 P- illo NowhE 9-E, /' 171 174- D P- VAr QN a Pic- 0 s...�_..St•'RCS.. _w��_Z+1 iL LN!Al_� N G S_Qh(—C�.V$' � AG'�. 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 '8 3.So I�ASi LIN N61trI4 rFACIL 00F NOLKtt' p V , l f rC�►1t�Aq 3 14 ousg`� g 3 a�-� ► pENCHNIA�K—ioP Nee TN eattNe�o t^ sT�P ScAL� = ioo oa ELf-VOki-l0>,1 1 20 1,the undersigned,hereby certify that the soil teats reported on this form 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. 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