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HomeMy WebLinkAbout040-1011-20-100 \ z, \ 0 2 � � A � § � A ; � G � � \ � � & 2 ) 22 LL 7 \ 3 k \ � ) § ce) � � / I � o § r § $ IL m \ B $ 2 \q . ■ � _ $ k 2 � @ ® � \ L j ® } k c $ \ } ) \ } @ .. k E R § ; m 2 / £ c CL k \ \ 2 k 2 E E \ Z $ � « k k k o 60 0 0 k k o a a a _ _ 2 j 0 ® 7 '4 !� > § { § a § E ca t = n G & m R © , a 2 0 § ■ a \ $ / \ @ § � k � 1 ° � 2 ) f ° k k \ q , = w � C) - \ o Cq/ / / o } / / 2 / cl E « k ( a CL .2 » E e c c a § / 3 a 2 0 & 2 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse ( \ 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private .individuals. Comnjet;on of this form is essential so that the oroRerty can be located. please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------- ---------------FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) ---FEE: $25.00 SEPTIC SYSTEM INSPECTION---------- ---^ (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's ad ss Dloq Legal Description 1/4 of the F 1/4 of Section �_, T_$_N-R q Town of TYOV Lot Number Subdivision Name- FIRE NUMBER LC () � LQ= BOX N== 'I Color of house Qa&uml Realty sign by house? NO If so, list firm: PLEABB 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: �Ktc✓ , c7!r!t �rha1A Telephone Number QA'd REPORT TO BE SENT TO: N yD) closing date Signature COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NOA 03044/01 PAGE 1 ST, CROIX COUNTY REPORT DATE: 3/23/90 COURTHOUSE DATE RECEIVEM 3/21/90 HUDSON, WI 54016 ATTNS THOMAS Co NELSON! Et OWNERS Rick LOCATION: 689 Tower Rd,, Hudson COLLECTOR: Rick Singerhouse SOURCE OF SAMPLE'# Kitchen tap COLIFORMS 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-NS < 1 ppm Under 10 ppm is safe for human consumption, Con form Bacteria/100 al Nitrate-Nitrogen, mg/L I LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 �.\NOEVENOEHl V Means "LESS THAN" Detectable Level Approved by! �T 4� ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r\ ! J � fA %' !Pl NV1d57R 1�,u3�L"if��('3;4a%,^t:;> ki.ninnn �► �i t? �' a O€1 z SOdd 8 SWnIOA ----------- � J3A I I IZL'E09Z 311851LZo00N 13S aq4 3o auil 3sea to I ` — — — — — —CO c� O `v d LT'9E , £8 •8LZ U - n `(1 3AI80 OOOM8330 o `� o b 1 Z .0 a) N I M•.. �•' L o ( I � W t- 0 O 4- O •.+ O C 4- I O U V U °u I M + W v O b N N x I % •� 41 O UI L I I 11 U m ro v L c I • v I O I U r-I 0 c - w 1 IO a%1 U ,yi O tv a C NI O O O x d O• c. :3 co aLi i I m Im p ^W Y I O Q 0 1 I • • N Ln 'C 1 L .0 I I 4-I tH C I C ..+ I I -cc 1 1 3 1 4 d I °I �—! • O -I I a) C • 3 1 I IS U1 N y 1 C F_ 1 _ 3sl � bI O LL) •n c 1 I O I P O M U � U 'D I d' ni N f0 [1 L o_ rbi I E-1 I00 00 0 I ►nN _ .. d +,, rn ,� dl rn ° - c A i I I00 ri I:r ,--! r4 w N N 0 1••1 Q 4- C I 1 to x C1 7 I uj c I z C.M 00 W N J o 4) x E-I v c O >~ I I O .rl j-P .5 't z;,`„�► o� ° . I Eh'9E , LS '8LZ ��' `a �•� �°' . 00 -ST£ M„8S . LZOOOS C1 � � CCo p O MAY r '� W �^p ' {n A .N -------------------------------- N �y� 0 » ja34eTd �tq pauMo spueT pa};eTdun o W Q Z Z ao I o -,o N om'''/ v��, O N d 41 O 4 0 41 C• ^7 V) 41 O 3 a, w L L� 44 ,v w m x L O O N o W a ° o O LL s N w N yr L ° m LO U) z o d O W v, d y L J) A W cn r N -.a N W N 3 y > t .0•i � O C O W -0 O C/1 i s v, W v u o L v LL- c d c 0 0 ++ W �4 N ,•---, L Of d C 0 CD pl r1 L t 1� (.1 W N A d N Q O b d •• L C y Q W,i w ..+ L M d) U c C LA d N L 1-- •C C O N LLJ cc 1•• 1 CO N 1' L O C 7 Z O N ° 7 O ..-1 .ni 0• h—) -P W O L 3 N r• —Id d d C C uj U L L O C O N 40 2 J W LM V o ./�{ 8 .j W N z000s�7 ,M U) t � Form S T C 104 AS BUILT SANITARY SYSTEM REPORT OWNER R'�C I-\gK_O� 5•aN2g4(3 u5tTOWNSHIP TtZON SEC. -3 T $N-R I W ADDRESS (P-S9 fow e p, 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 b ��� Ct) yob° ry, O D l i S� 6- J INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used I Step- pipe - Elevation of vertical reference point: ��Q_� Proposed slope at site: SEPTIC TANK: Manufacturer: W2�kS Liquid Capacity: 1000 qAl Number of rings used: Tank manhole cover elevation: 10T Tank Inlet Elevation:�S.S9 Tank Outlet Elevation: 10,5. 3U ` Number of feet from nearest Road.: Front,O Side,®Rear, O 130 feet - From nearest property line ' Front,O Side,O Rear,O 83 feet Number of feet from: well 5 0� , building: o� (Include this information of the above plot plan)( 2 refere dimensions to septic tank) SEE REVERSE SIDE i 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,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan) Shd �3-dy 100 00 SOIL ABSORPTION SYSTEM ;k- )0 io�.33 Bed: Trench: Width: Ids Lenith: Number of Lines:�o . Area Built: 1pa 1 Fill depth to top of pipe: Number of feet from nearest property line: (Front, O Side, ® Rear,O Ft .�, Number of feet from well: Iu�va� Number of feet from building: 11 , (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: ' Dated: NOV. W Plumber on job: � 2!!=gg;k� License Number: 3 I 0 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING .LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION D153AN a(VI'L�, 19W State Plan I.D.Number: S-2 �.jj L 7 X44 CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Troy Tower Road ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:- Richard Sin erhouse 654 Tower Rd Hudson, WI j/(0`SW71 o��© BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV: Nam of P ber: MP/MPRSW No.: County: Sanitary Permit Number: Jim Boumeester 3404 St. Croix 128623 SEPTIC TANK/HOLDING TANK: MANUFACTURE : LIQUID CAPACITY: TANK INLET ELE`(1)V.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: �j - - /000 0 ED YES ED No ❑YES ❑NO BEDDING: VENT IA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH { " ALARM: FEET FROM O AIR INLET: ❑YES NO ❑YES NO NEAREST—� I O t7�� DOSING HAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P 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) ❑YES ❑NO NEAREST--* 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: LE GTH: NO.OF DISTFj PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID /\ ^ TRENCI,j-ES: / VT RI L: PIT j DEPTH: DIMENSIONS /' (� � GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE D R. IP IAL: NO. R. NUMBER OF PROPERTY TEL BUILDING: VENT TO FRESH BELOW IVES: ABOVE O R: ELEV.INLET: ELEV. N PIPE LINE: AIR INLET: `9 �} FEET FROM ,1 f 1 tT NEAREST—I► ' 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: NO.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 I NEAREST—♦ Sketch System on Retain in county file for au it. Reverse Side. SIGN e rl E: s!+ SBD-6710(R.06/88) On 1 DILHR SANITARY PERMIT APPLICATION COUN In accord with ILHR 83.05,Wis.Adm.Code C OI STATE SANI0 PE -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ d;,:—,_,_),frev`_Ws__on o8%X 11 inches in size. t application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPER OWN R C, PROPERTY LOCATION N"a4Q2 %aS %, S To� �N, R 9, E(or W PROPERTY OWNER'S MAILING DRE�S LOT# BLOC # /(0 O R NA CI SATE � ZIP CODE PHO NUMBER SUBDIVISION NAME OR C MBER k� 013 f'Cr II. TYPE OF BUILDIN (Check one) CITY NEARS ROAD State Owned ❑ VILLAGE: goAn ❑ Public . 1 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX NU ER( III. BUILDING USE: (If building type is public,check all that apply) ,e-15 I­_� ,Or) ) 1 El Apt/Condo — _10( 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) 1.0 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 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE RE IRED(sq.ft.) PROPOSED(sq.ft.) (Gals/ � (Min./inch) ELEVATION is, .1/C 33eet W. G3Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber Vlll. 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: you Q trims o3 ,G '7/s- Me— c)U Plumber's!ddr�ss(street,City,State,Zip Code: i - n VV 011, S 1 U (s V IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved ary Per it Fee(Includes Groundwater e s� Iss ng gent SignatureiNo S ps) Approved ❑ Owner Given Initial surc rge Fee) Adverse Det rmin ti n. . CONDITIONS OF APPROVAL/REASONS FOR DIS PROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s)-must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite-sewage system, contact your local code administrator or the State of Wisconsin, Safety 4 Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owper'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) . . P- B. L. 67 PLOT AND CROSS SECTION PROJECT PLUMBER N AN E SIB NAME Tires LOCATION L I C ENS E 3 a A T E PLOT MAP 6m--SW lot Cort),P, Sf'alve (r-r o>: I"Steel P;fR �N 9PO ELF►oU.0 X=Pefz l,u les raw►Sb 'ots, Wr I Is P2 cp �oti ►, ISO FI �r�oM SQ���c S� r�ern Well ) s �R>z kv_ S ern `T S f l Fe-or- -A �^ 3 Bmpoorr, ry> U O /000 as 9Y -r I�-Y 3)D 0 0 as' N IBS U FRESH AIR INLETS AND OBSERVATION PIPE CROSS SECTION Approved Vent Cap Minimum 12" Above Final Grade 4– 4" Cast Iron Above Pipe Vent Pipe To Final Grad Marsh Hay Or Synthetic Coveri g Min. 2" Aggreg Over Pipe Distributio�n� — Tee Pipe Aggregate Perforated Pipe Below Beneath Pipe 4— Coupling Terminating At (OQ 33 Bottom of System Qu�p M �b 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, ,. DIVISION LABOR AND PERCOLATION TESTS (1151 P.°. BOX 7969 Ht1MAN RELATIONS \ / . _MADISON,WI 5370) (H63.09(1)& Chapter 145.045) y ; LOC,A�t,/��/ SEGO%������ .r^ ( TOWNSHIP/MtjlY: OT O.:BLK.NO.: SU�IV ION NAME: V ff ) COUNTY: OWNER S BU ER'S AME: MAI LING ADDRESS: Jj- C 1 l Lis:rr s,j� X h ah : /UkIL' t,L h c+� (r✓- -�7i"�k USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMFR AL DESCRIPTION: I O 75,- _� Residence J!./ fVew ❑Replace �i� Cf (J'f+ �_ /V O Q ,i•, 'it RATING:S=Site suitable for system U=Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND-PRESSURE:PRESSURE: SYSTEM-IILLHO�LDING.TAJVK:RECOMMENEYSTEM:(op I �s ou ®s au J(ChS ,(��JU S U S MU 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: < 3 Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH LEVATION OBSERVED EST.HIGHEST TR BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) S8 /06" .� cr e B-L 9', j� �o� d 9 �3 , /,o e/%A os��^s� /.9z ;� s��� S, 3 3'/'., 7 . 7 s / B- 7, s /C • f ' , 1. S8' , o hx g.- B- ,r PERCOLATION TESTS TEST DEPTH j WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD RI PER INCH P. z j;f.3' ,� G 3 P- J P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Z 3 3 o I 3 �� Pi. � 03 ____ . ass: , Ad 01f .. . _L 1,the undersigned,hereby certify that the soil tests 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. NAME(print): / TESTS WE E O LETED ON: ADDRESS ICERTIFICATIQIN NUMBER: PHONE NUMBER(optionaq: D/ -11 S/ /—If.11%d 0 I o d U��y7 JAI; CST SIGNAT RE, DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR•SBD-6395 (R.02/82) -OVER- it - _ n M- x rn N v S 1 t✓ 4.- r• N o r N r— N {n O O -1 (D (D 0 rn = O 7 - Z 0 ill N = (D (D 4-I- e'1' m QJ r (D -3 t'1' 7 C G+f /� (* �1 O N C 2 C = O -3 W (D W m ) Cn o = o w (o = = m Q+ –1 CD N (D m r 1p= 3 '7 N 0_ O_ a-• N m ---h to CD 1•-• r• N (D 1, m co v 0 ° T ' O m o c a o o. � 0 C Ffi ct 0- r•r -o r. < CD m �° N m � CDW m N r• a _ M N fi O N ~• .�N m .7..i = m 0 m o -3 C7 rij w o W rt N A a c T ABC' c) (* O (D O o w. v x rn Cn (D I"h -3 m X C-) B N to E p tt (n (D Cr It CD N ♦ ��I (D ID z a a g r� unplatted lands owned by platter d O F— A; o`C N ________________ _ �_ 0"' cn C f.. 0 o ► hfi S00°27 ' 58"W 315. 00 ' ' °• F cn 278. 57 ' 36.43 I ``it, ��. 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I 11 1•C N (D F(t Z y g- OJ o O N 1 I (° s m ct n -, > DEERWOOD—DRIVE N' C1 C 278. 83 ' 36.17 D = N ' o east line of the SE} N0002715811E 2603.721 N' r ' I C a ID small tract 3 _ -----------. o• rr m o_ w v v -- (o w N s �t S, «' QN� 44 0 • •� Ob Bil •OMPS 6uTddpw pup 6uTAanans uT xToao •qS jo Ajunoo aql ;o 90UPUTp30 UOTSTnTpgns pupa aqq pup sagngpqs uTs -uoosiM aq4 Jo V£•gEZ 39qdpg0 3o SUOTSTnoad quaaano aqq ggTM paTTdwoo ATTn3 anpq I 4pg4 :pagTaosap pup paAanans Aappunoq aoTaagxa aql ;o aTpos 04 uoTgpquasaadaa joaaaoo p sT dpW AananS paT;Tgaao sTgl gpgq A;Tgaaa osTp I •paOOaa jo squawaspa aaggo TTp pup dvw stgq uo uMogs sp ppog uMOy agq ao; Avm-3o-gg5T3 oq goaCgnS •6uTuuT6aq ;o quTod aqq oq °zs pTps 3o auTT -4spa aqq 6UOTp '4993 00-GTE S AGI LZOOON aOuagl :4993 00'065 ZSKS 9Ou9g4 � qaa3 00'STE M,,8S , LZo00S aouaqq !auiT aagapnb-auo gsaM pup gspa aqq 6uOTp•gaa3 00'069 SSSM 90uag4 !uoTjdTaosap ST44 30 6uTuuT6aq 3o juTod aqq buTaq osTp aauaoO pTps £ UOT,4OaS pips 3o aaUaoO kS agJ qp 6uTOUOWWOZ) :sMOT -TO; sp pagTaosap 3agg3n3 IUTSUOOSTM Aqunoo xTOJ0 •qS IAoay 30 uMOy 'M611i 'N8ZS 'E uoTloaS 3o ASS aqq 30 'ESN 9q4 3o javd UT paIPOOT pupT 30 Taoapd K asMoTTo3 sp pagTao -sap sT paddpm pup paAanans Taoapd pupT aqq 3o Aappunoq aoTaa4xa aq4 4pg4 !dpW AananS paT3Tgaa0 sTg4 Aq paquasaada.z sT goigM Taoapd puvl aqq paddpm pup pagTaosop 'paAanans anpq I asnogaa6uTs gaagTaa 30 uoTloaaTp aqq Aq qpgq A3Tgaao Aqaaaq op 130Aanans pupZ uTsuoosTM p93agsT693 ,ua6pgAN •0 uaTTK ' I SS'd0I3IS2is0 s ��oxsn�ns STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /C S'�1G,0/ &9 LIS e ROUTE/BOX NUMBER . ' FIRE NO. CITY/STATE_ai26(-(911 C-0/1 4 ZIP S-401 6 PROPERTY LOCATION: 1/41/4, Section 3 , T 28 N, R / 7 W, Town of Trcg4 , St. Croix County, Subdivision nd/C , Lot No. &g.," 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. SIGNED IZ�Yt / �+ DATE / D 7 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 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 94v S 1 he 0Se Location of property ,�_1/4 /4, Section 3 , T�N-R—Lq—W Township T� y Mailing address fsq ToLje✓ Address of site `G Cr Aawj ITcd--o S C011SI� Subdivision name rim�t Lot number `l�n�� Previous owner of property • el ber l Sl/l Q/h0USe- Total size of parcel 4. 1 a c rtS Date parcel was created Xok / !G Act Are all corners and lot lines identifiable? �./Y es _-_�!o Is this property being developed for resale (spec house)? Yes .�. No Volume _and Page Number col 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 warrant deed recorded in the Office of the County Register of Deeds as Document No. SCXJ©A ; 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 ,Count egist r of Deeds, as Document No. 4$DOOa`� ) . Signature of Ow er Signature of Co-Owner (If Applicable) Date 6f Signature Date of Signature ---- i DOCUMENT No. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED 450084 '��� PAGE _ REGISTER'S OFFICE ST. CROIX CO., WI Delbert L. Sin erhouse and Bernie H , - -- - �---- --- Recd for Record Singerhouse, husband and wife, as point -•-•• tenants, Grantors► JUL 2 7.1989 uit-claims to --Rick Singerhouse and Heidi Singerhouse a 2:20 P•M lusband and wife, as survivorship marital Ii ----- --- ---------- property,_- Grantees �. --------_---_----------- ---- - •••--- - ----- --- St Croix the following described real estate in ...._-.-.�..... ........... ........... County, i! Tom Dahle State of Wisconsin: RETURN To 713 Riverside Drive N. I Tax Parcel No: ................... ---------- i Part of the NE4 of the SE4 of Section 3, T28N, R19W, described as Lot 1 of the Certified Survey Map recorded July 25, 1989 in Volume 8 , Page 2130, document #450002 in the office of the Register of Deeds, St. Croix County, Wisconsin. i �i i i r - F i I i i i is not This ............................ homestead property. i! (is) (is not) I' Dated this 25th.----------•--_------ day of .July---------- ---------•---••----....------•-------------- 198.9..-. Y -----(SEAL) C1 ..�.o.X.Jy. - . ....--(SEAL) • _Delbert--L._..Singerhouse............ ----------- --------- ......................... ......(SEAL) --.!D'I.. - fiC 4 .......(SEAL) ii Bernie. H. Singerhouse --------- ------------------------------------------------- ---- i AUTHENTICATION ACKNOWLEDGMENT i it Signature(a) Delbert-_L. SingerhQu_ee--•¢�.-__ STATE OF WISCONSIN Bernie H. Singerhouse ag I: ------------------------------------------------------------------------------- .._...---•-••-••-•••• Count Y. authenticated this 25t}day of_.JUly............... 19...x_9 Personally came before me this ................day of I r-; • 19-------- the above named ._• ' ---- ----------------- .................... .................... ............... •. Thomas A. D------------------------------------------------hle i TITLE: MEMBER STATE BAR OF WISCONSI (I£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 _----.. Thomas A Dahle..... .......................... * II Hudson, WT ----------------- ............... -••••-•••----•-••---••-•............---- -- - – - ------------------- Notary Public --- ---_--••--_--- ------------•--- ..._County, Wis. it ---__- --------------- (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration j are not necessary.) date; 19--------- ) j i I Names of Persons signing in any capacity should be typed or panted below their signatures. i) .. STATF. BAR OF WISCONSIN Stock No. 13003 yFiClYlillat FORM No. 3—1982