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Home My WebLink About020-1313-10-000 0 & lu % ° � . « K 0 Ic 2 ® % :c & \/ ¢ 77 § \ LO ƒ \§ f % ƒ 0c ) J \ b E p« 8 2 / § � 0 V5 � ) 0 c -0 co 722 §0 n � « § a z E q § 7 m § k z k c \ 4 z 7 2 { k E � \ (L> ; \ [ } m � .� § I ƒ § � ¥ , O \ } ) ) ° 2 ) o c � \ � . & , @ 3 CS a 2 a . (L k k FL N } -pk� k 2 a a ) \ k \\ ° z o ° � § o % , b = \ E � 7 7 2 ® 6 � k k ) I % . % ) \ § : / CO 2 V) 3 3 s a g , o a ! = c o § § k k / z T / z \ � ® � z ) � : § I (L E � ' L; (L ƒ 0 a 2 0 2 J . Parcel #: 020-1313-10-000 02/27/2006 09:19 AM PAGE 1 OF 1 Alt. Parcel#: 22.29.19.1580 020-TOWN OF HUDSON Current FX 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 KEVIN A&CATHERINE L HENDERSON O- HENDERSON, KEVIN A&CATHERINE L 655HWY12E HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *655 HWY 12 SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.070 Plat: 2301-PHEASANT RUN SEC 22 T29N R19W PT SW NE LOT 1 PHEASANT Block/Condo Bldg: LOT 1 RUN 4.07 AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 02/16/2000 618383 1490/311 07/23/1997 1136/481 WD 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 93398 284,800 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.070 83,300 207,200 290,500 NO 05 Totals for 2005: General Property 4.070 83,300 207,200 290,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.070 40,400 170,200 210,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 130 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 l FILED 3 D AUG 1 6 1995 P- , ;- 6 1995 WHLEM H.WALSH 1 Register of Deals SL Croix Co.,M 532606 sr.cROrix ,� r CERTIFIED SURVEY MAP Located in part of the SW1/4 of the NE1/4 and the NW1/4 of the SE1/4, all in Section 22, T29N, R19W, Town of Hudson, St. CroiR County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume N 7, Page 1817 at the St. Croix County Register of Deeds Office. C z N d A fi 3• L l7 T I L OT I n> C c , C. M. VO1. g PG. 2490 .0 1 S89 042'26"W -4 ° et i'0 I 44.59, is � -1, S00 017123"E �= Ln d z a U. H. ��12'� North line of the SWk of the NEk, –_– _ 14 . 26 0o 0 509. 6v ' m 9°42 ' 26"W-4-5 7 .67 ' � e S85916 W °o DEDICATED THE PURL I;C o-h cr '�cn° t —�-S89°5 '16"W -- 719 - f 90 .34' S8 59'16"W a 0 O a tn It o " � ti- l � 1 �• •I-I V 3 ° go oo°i I t z zl W v+ SEPTIC i fs •M w " 0j ' 4 3 3 3HOUSE o CD m WELL a i s 3LOT 2 f Iz 'o m GARAGE Ik K 12.67 Acres �ww rn icy) w H 1 v m SHED O 1 552,064 . �t. ;^IN c N I s o °°I 'fin• I rn w r. - �. - v j et= I (< • IU }L/ .i� ,�/,' U v o1 -&_ to a (�_ rn w Sgt°41'49"W ,•.•',' I i �7 I I Cr, 00 Ct a w b .S. i w v1. rri Fn It- Icy L+ ve Pt a is j 1 817,Coc:iPcehens r 9„ Toning and 5 - W F�arf:s Comrttitie m y , ( . : Pool ' r o i{ not recordo o - - I o° LOT 5 ° , (�� z wi;hin 30 da f tO rn `O L �•w o / w 2.33 Acres N HOUSE N aorwova o 101,582 Sq. Ft. - WINOMI2 'aRrn _ - a Ko C S89-50-11711w,,' I I S89°50'17"W SHED SO o t ,; . m ar ,� 2.4't- 10' I. SEPTIC s D� �'y � I Irr ^^f9�2y34 1 N89°50 ' 17"E 215 . 931 K a� LOT 3°� �_ LOT 4 N o LEGEND o+'coe g,� 10_ v o 9 Aluminum County Section t7 0 2.00 Acres I m 8.11 Acres v' ° Monument Found 87,166 Sq. F 353,063 Sq. Ft. CO N „ �y _ • 1 Iron Pipe Found � 11 tl �+ 292.51 ' 6fi0 292.50' - ��, ° 1 x 24 Iron Pipe Set, 0.2' weighing 1.68 lbs. per N89°50 ' 17"E 651 . 01 ' linear foot 80` RADIUS CUL-DE-SAC(TEMPORARY) ••••• ••••••••50' Roadway Setback Line f .� Js o i Ia 1 I - _A 1 — 12' wide utility easement l --- -- --- - --- --�-Exi sti ng Fencel i ne Previously Recorded SCALE IN'FEET 1" 200' Dimension 100 50 0 100 200 300 It SHEET 1 of 2 SHEETS Vol. 11 Page 2975 `� CU O` Z, FILED D 110 d L AUG 1 6 1995 ► 3 WHI.1114 K WALSH `..; 16 1995 RegIsier of Deeds Qy St Croix Co.,WI $T CROIX 532606 tS` y l CERTIFIED SURVEY MAP Located in part of the SW1/4 of the NE1/4 and the NW1/4 of the SE1/4 , all in Section 22 , T29N, R19W, Town of Hudson, St. CroiR County, Wisconsin; including Lot 1 of Certified Survey Map recorded in Volume 7 , Page 1817 at the St. Croix Count Register of Deeds Office. (A z Y g N � m 0 N d N _ = O LO I !OI_ I 'N N -•= n N to C. M. V01 9, PG. 2490 W o C.S.-PA VOL. 3, PG. 621 - - - --- - -- ---- a o S89°42126 11W v ° 1644.591 tn ° sA S00°17 ' 23"E =' CT m m U. H. ��I�� 1 1 North line of the SWk of the NEB "' 14 . 26 -S89°42 ' 26"W-457 .67 ' — S89°59 ' 16"W 509. 66 ' °°o o HIGHWAY DEDICATED T O1 THE PURL I:C Ct S89°5 '16"W -- 19.34' , I 589°59'16"W v,o w m ° S m °° o , o It Ycn ' I—I w ° e g ° OSEPTIC 1 °c� o?a�33, 3 a Ln V HOUSE o m V` I� .m O HOUSE ° LOT I z o ro m GARAGE j N -' Z °v I�l cr 12.67 Acres w w Hi '�' I�� i F r ° 552,064 *t. v+N v'N IS m m m (Y DSHED _ _.ice r. a N t0 t0 cf n Ir (+ N a O1 w C—:�y 581°41'49"W - '�,. ,' �7T I � �� i -a 6 W 5 -'7 • ' �. %v1.. °0_ I-7t N o• ICJ � m ,'„•..--c•- i I G� N "'a LROIX C ouF i Y °° I I Ca PG: I8I 10 I(I :�prehensive Pia it •' • - 18!::t 81°41'49"E j Zoning and / N n 5 9 Park's COm tte N• � , � 1" Z• r^ � POOL 0 .� LOT 5 CT I not recordo ° = I o o wi;isftt 38 d f `$ M w � 2.33 Acres o HousE Ah • 800rovai oo w 101,582 Sq. Ft. - WINDMILL ^ �� a F�Ov S890.501171% 1 I S89050 17 SEPTIC SE TIC SHED i 10 CA 21 24_ .c, 22' 10' I 292.34' N89°50 ' 17"E ° I I if I 215. 931 CO -4.,n�a� LOT 3°° �_ LOT 4 N o LEGEND o Aluminum Count Section °i�"td'o - 2.00 Acres I C2 8.11 Acres ° Q ,Monument Found y 87,166 Sq. F 353,063 Sq. Ft. F~., 1" Iron Pipe Found v •° '+ 292.51 66,0 292.50' _ ►�-� o 1" x 24" Iron Pipe Set, ' 0.2- _ — weighing 1.68 lbs. per N89°50 ' 17"E 651 . 01 ' linear foot } L 80' RADIUS CUL-DE-SAC(TEMPORARY) ••••• ••••••••50' Roadway Setback Line 1� UNPLATT , ^ .. — --—12' wide utility easement LED- - ---- - --- -W— m-Existing Fencel i ne `'.. ( ) Previously Recorded SCALE INFEET 1" 200' Dimension 100 50 0 100 200 300 C SHEET 1 of 2 SHEETS Vol. 11 Page 2975 `� 1 Form - STC - 10 AS BUILT SANITARY SYSTEM REPORT OWNER F. ' L am TOWNSHIP ar�.,� SEC. T �JN-R W ADDRESS �jj� rtiT�s Lit, ST. CROIX COUNTY, WISCONSIN L/• SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 .FEET OF SYSTEM �S Hwy is M F --i-o i i � I O �- 9y' -- - — o 31. I a 'V2 D I q INDICATE NORTH ARROW No S C AL4- BENCHMARK: Describe the vertical reference point used )J4,L /,V P0,.,6,( Ave Elevation of vertical reference point: X00 ' Proposed slope at site: o/ SEPTIC TANK: Manufacturer: (.j"e SEA Liquid Capacity: .10W (9X4 Number of rings used: /� Tank manhole cover elevation: ' 7� Tank Inlet Elevation: JO'y' Tank Outlet Elevation: i Number of feet from nearest Road: Front,O Side,O Rear, feet From nearest property line Front 10 Side,0ear,0 q� feet Number of feet from: well G 3 , , building: /iq , (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, OSide, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: C<<✓- 95! ga Trench: Width: /g Length: 3 Co Number of Lines: Area Built: t/o wT4p• Fill depth to top of pipe: 3 6 y Number of feet from nearest property line: Front, , O Side, (2y%ear,O Pt .TS- Number of feet from well: 110? Number of feet from building: 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, 0Ft. Number of feet from well: �.J Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 1 �� Plumber on job: License Number: 3/84:mj DEPORTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.d.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SW4jNE�,S22,T29N—R19W ENCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: D'S"of Hudson (If assigned) T Holding Tank ❑ In-Ground Pressure El U.S. HWY 12 NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Edward Alberg & Carol Luber 1 708 Riverside Drive North, Hudson, WI 5016 //—/a `/,� BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW Nu.. Cnunry Sanitary Permit Number Gary Zappa I3300 St. Croix 106058 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. DYES ONO I DYES ONO BEDDING: VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING'. VENT TO FRESH ALARM FEET.FROM LINE LAIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING- LIQUID CAPA(:ITV P11M1 M111 JPIIMP SIPHON MANUE AC IUHE4t WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO : YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP A NO CONTROLS OPERATIONAL NUMBER OF ,PROPERTY WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES ❑NO NEAREST till SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I f NGTTI DIAMF T II JIIATI HIAL 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. JLINGTH NO OF UI$TR PIPE SPACINI, COVER INSIDE AIA -PITS LIQUID BED/TRENCH TRENCHES MAT EHIAL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTH PIPF UISTH PIPE DISTR.PIPE MATERIAL NO DIST Ii NUMBER QF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV.INLF 1 ELEV END PIPS FEE LINE AIR INLET: T FROM N€AREST- -—ir MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑ meets the criteria for medium sand. TIONS MEASURED. NO SOIL COVER TEXTURE PFHMANI NT MARKERS oHSEHVATION WELLS _ El YES ONO _❑YES 11 NO DEPTH OVER TRENCH BED DEPTH OVFR TRENCH HEU DEPTH 11 TOPSAIL S(l AI1F I) SEFUFO MULCHED CENTER EDGES =E S, 1:1 NO ❑YES ONO ❑YES El NO PRESSURIZED DISTRIBUTION SYSTEM: _ BED/TRENCH WIDTH LENGTH NOOF LATERAL SPACING (HAVE L DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MAN IFOLU MATE HIAL NO "IS"' DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV_ ELEV.' CIA ELEV. PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECI LV COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES El NO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF "PROPERTY WELL: BUILDING: FEET FROM LINE. ❑YES 1:1 NO 1DYES 0 N NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE: Zoning Administrator DILHR SBD 6710 (R.01/82) ' I DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code 1 9: / �._.:.M,..A...w ....o� STATE SANITARY PERMIT# /v 666-,-G, —Mach 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 I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES rPSI NO PROPERTY OWNER PROPERTY LOCATION .PW '/a /Vt '/a, S �1� T o1 N, R E (or PROPERTY OWNER'S MAILING A DRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY, ZIP CODE I PHONE NUMBER 77 CIT~Y- NEAREST ROAD,LAKE OR LANDMARK ❑ VILLAGE II. TYPE 6F BUILDING OR USE SERVED: �s7 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. ® 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. :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. ❑ seepage 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): 0 Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 6,00 X ❑ ❑ El I Lift Pump Tank/Siphon Chamber El ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached p lans. Plumber's Name(Print): Plumber's Signature:(No Stamps) #P/MPRSW No.: Business Phone Number: ,k 3ov 3,�2 o -Fifumbe^AddressjSfreet,City,State,Zip Cod Name of Designer: s T r. s- a VIII. SOIL TEST INFORMATION Certified Soil Tester(22w",rov Name CST## v nv V CST's ADDR S(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) ®Approved I F-1 owner Given Initial S .%h�arrgge Fee Adverse Determination ��a ela '� 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 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 Biz 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 AtBf included the creation of surcharges (fees) for a number of regulated practices which Wisco ICI' can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r+6iSt3f a 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. n ... 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 f 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 1 1.41 -' Location of Property&] % � � ection 2v , T z!rtip N-R /� W Township �r,�� Mailing Address Address of Sit A ObL04.1 4 W115 f Subdivision Base _ VA , Lot !lumber � 4 Previous Amer of Property yNi'9l Total Size of Parcel Date Parcel was Created l[�e- • �� Are all corners and lot lines identifiable? >Z Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number f,�AD / 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 Iwe) cv_A_ ,6y that aU statements on this onm CAP- Zlcue to the best o6 my (ouh) hncwCedge; that 1 (we) am (ahe) tJie owneh( o6 the pnopenty d"cAi.bed in this .i"Wmati.on 60", by viAtue 06 a waAAant eed neconded in the 066ice 06 the Count RegiAten o6 Deeds ah Document No. and that i (We) pheaentty sun I pRoposed bite- bon the sewage di�spos ys em (oh 1 (we) have obtained an easement, to tun with the above dehcAi.bed pnopehty, Koh the eonsthucti.on o6 said sys.ten+, and the sane has been dut neconded to the 066tee od the County Re9iAten. o6 Deeds, as Doemo t No. ) SIGNATURE Op OWNER SIGN TURE OF CO-� (IF 'APPLICABLE) t I DAIS SIGNED DATE SIGNED f � � r x� an 3ATW_' PA $ tJD CIl�t��"� a " ` .:.... t"l�+ebaaie"«�hetbsr oars or aaro)• ;� . , `�Ilill/>• ws. rlM tot PtasDi►t and full per- " , sr„tM Mewing p iperty,together wftb the appeleaast laterdls(aU called the"Prepate). ? 4 .......... Cenaty. states of WIN niwr -- i# Oisee attached legal description** Ilk -t is tot Exempt from filing transfer tax ;fit k ..w... .... bomestead property. #3. '110 sat)> t6garebase the Property and to pap to Vendor at __F213c:E, P,. djar in the follow, manner: (a) _._ .n_,.__ sE tlatis aentraett and.(b) the balance of 5..2 0_s t5�U.0 0 ,together with iMi1lM9R 9:75 IN1111Msadlag from time to time at the rate of..... .. .. ................... pat ta” fief $ebruar 1988 and on the 1st i•,i of eae.fi and41W. ng. ,- y �s s Y 4 tbereAfter, equal monthly installments of principal and rest in tfie amount of $185.37. ao+ 0*swam de entire outstanding balance shall be paid in full on nr before the...... lst........ tallr�t� #$ ......».. :..., 199.3... (the maturity date). ww default in payment, interest shall aver ue nt the rate of per annum s,the sfrtlsa x� rij k shall include, without limitation, delinquent interest and, up,n acceleration or amAnsilr, aailm excused by Vendor,agrees to pay monthly to Vendor ann,unts sufficient to par rsassnatlly� ` " " tMtsy Special asspsmatts,fire and required ins urance premiums when due.To the e3dent seesiwi by a&OIS'is apply payments to these obligations when due. Such amounts received by the Vaodw fiw l�laewnwNs mad insurance will be deposited into an escrow fund or trustee account. but tlhall sat iasr u by law. '« x 40 be appWd first to interest on the unpaid balance at the rule specified and tbw be �31 y" s pmgp" trkheat premium or fee upon prinzipal nt any time x9(#XXXX.XXXXXJ=XIMI 1, M Wk1A XXYrf ')C r: bt tbs oMeat of say prepayment. this contract shall noot be treated n° in .L f:urtt with reapeet is MI►wsM tiltlptlad beleaft of priaelpal.and interest (and in such cane accruing inter, :t from month to snobtb,•ahw4o pali.•b.ltss than the amount that said indc'tcdncss would ha.e ) cn had the aaatbly papas ; " above; provided that monthly payrnenta shall be continu, 1 'n the event of essdk st condemnation, the condemned premises being thereafter caclu,1 •1 herefrum, stabs that Purchaser is satisfied with the tale n% shown by fl- title evidence �,�LNt stapit: , ±easements, restriction: and right..^-Df-way of Te( any. M atom to pay the cost of future title evidence. If title evidence is in tlM,yfallR II w Y9aier V"AW fud 'purchase price Is paid, �Ill�!b�lilr4nntitied to t** f ' pailsession of the Property on:...........J8rit1dLlf..�. „... a u.S. /✓y / NOATW /oRopEtiTY LINE '3M .rs -f&)<e i� /04"-ra Pur 11010T /V.,-.a Cno�rs PnvPvJEO EL t✓. = /bo,oo' S)_cT.zor✓ /24 rvs X76 SLo�E VftT 17ACK p3� /8' l j ✓OLT. o J) CT 39 s,03 J7TE e0 L13 E2 G 6' s' .5"SU 'to ti�orr Prlo,�tzrr �irvC --� /L,�w .rt'.fTE'r�'1 y"Pvc. F-FFLuE,-T LiaE TDwN 01= /YUGLf[�ri/ .1,T. Coo=x Cou,TY O /000 GAL S-rpmc T,orvk N A A(),*oleo l s, W E PoAcH n�Sroe,vc E 1 � � LAvP01Eo kALL--0y A10 --�-C4L25 \ lU&o`ZI, Tv Sou rN /rtopc2Tr L�NF FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MA k IM JK4 12" ABOVE FINAL GRADE 4" CAST IRON PENT PIPE MAXIMUM OF 42" ABOVE PIPE TO FINAL GRADE SIGNED: / WRSH HAY OR SYNTHETIC COYERINia LICENSE: /JJ/✓�/�?,.1' . 7?DO MININUM 2" AGGREGATE GATE: OVER PIPE �y/Poi DISTRIBUTION IBUTION PIPE TEE � SOIL TESTING BY: ./Y/0/L✓�f'v V �S/nr Dni ELEVATION BEE) 6" AGGREGATE • BOTTOM PER SOIL, BENEATH PIPE PERFORATED PIPE BELOW TEST IS I C�,UPLING TERMINATING IF -�%.00 FT. AT BOTTOM OF SYSTEM IM)US T OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IN'UUSTR Y, C DIVISION LABOR REDATIONS PERCOLATION TESTS (115) MADISON WBOX I 3969 (H63.090)&Chapter 145.046) LOCATION: SECTION: alll H MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: COUNTY: WNE AM : MAI I AD . USE DATES OBSERVATIONS MADE NO.BEDR : COMMERCIAL DESCRIPTION: F� Residence NNK RINew ❑Replace �'7 ,9 )Sec /t /9T t Lt_c,r O RA►AqTTIyI��INGGQ:S-Site suitable for system U-Site unsuitable for system - A r1, �JJT❑� IMOUNE ❑� INGItdIS ❑� S ❑�L ❑SG ANK:RECOMEIOIJALSYSTEM:1op8C.y If Percolation Tests are NOT required DESnIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: l.LfLSS I Floodplain,indicate Floodplain elevation: f4 A PROFILE DESCRIPTIONS BORING TOTAL P R )UNDjERWWjJ CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER OEPTH49. ELEVATION_OBSERVEP T TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- ( 8.ob 99.E p C_ >'S.w /6'9L'LTS 1Z"90 S,L $RN MS j 4 b � f3"gcL�S ,5'$ftr�S.� 20 SaNMS /1'?�$Rn Shit co1� B- c0z 99•?4- r4oNL > .9Z "BeN,rv►s�s$e►.le lC.R'�b�o�Rss.ba�cs 36"Beti Fc, p f 1"6,LL TS /&"IR �IStL 41 "&,1 MS 2"'864 6k /Z'! et M S B- 9.17 �,9� 0 7 1.17 ftMe.T Am IN'TE?7A.4 ZZ•'8QNCb 74-9- B- 4 IS"k1.Ly-% ass"BQNs,l /I"Be•,i Ms #I' aN c S Ycr i+►► f� S� S� p $•S 6 6"$Q�CS•4 s-ItA'.I.& /7"8 r c-�►,3i �c,rL B- < C1'0 % .34 �, > 9.0g ►z•.BL4-r-s r� BRK St 5� z� BRr4 CS B- PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DRZ5P IN WATER LEVEL-INCHFES RATER (INCH ES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P_ I 3$3 r40 9%.63 t '�_-*k- >1 < P_ 2 3.91 ko SSs. 2 3 y 7z %> Z c 3 P- 3 3• I •.lo $ 51 >Z >Z < 3 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 :ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 1-6usr. NORTu o.r rr1 Z fS vIRt: Numaik GS2 E SYSTEM ELEVATION I.. � Lraf {�16NuAY 1 2" t Ga�►T 5 It fPI Ke � �ICNM+aR CoT/�• •W, E O I $,4 wQP A�tf <*7s 16 $4 om ELEl )00.00 XX l 1, t Q I _., a-Z _ 5 UPC Q { i i l 2 KELLY I,the and igned 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 WERE COMPLETED ON: l-�QeJC'/ JCy4NS01� 1ruScN C 5(ti1 Ct AD RESS: CERTIFICATION NUMBER: JPJ�ONE NyM BER(optional):7 ccS {,�uDS'n/ 3�� 6- 9pg 0 CST SIG I RE: DISTRIBUTION:Original and one copy to Local Aulhority,Property Owner rind Soil Tester. —• nvcn H z N tA F r STC - 105 a SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z c7 9 C �L -e.A.�"ck.�i OWNER/BUYER / y� ROUTE/BOX NUMBER✓ ZO g /�i�lt CL ��1�e. � Fire Number CITY/STATE c C�► CcJ� Z I P V X55/y/ LOCATION 1 V �, Section , T f=l N , R PROPERTY LOC Z, Town of St . Croix County , Subdivision Lot number I 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 , I 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. H 0 E z I/WE, the undersigned , have read the above requirements and agree En to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- 'd ment of Natural Resources . Certification form must be completed and returned to the St . Croix County 'honing Office within 30 days of the three year expiration date . SIGNED DATE ' ` 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 .