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HomeMy WebLinkAbout020-1080-21-000 M C N ti 0 C N O N i C cD 7 tj 0 C c o. M �O N O L-0 3 E v w N O y C p O C Z 0 t 7 m LL G @ 0 3 Q �> M N 3 w Z 0 rn Z = Z € N IN- z a m 0 o Z 1 C L co N r O 0 Z E - ' M N N 0) 7 C cc N •^i d = 00 O O N Q w N zmz o �1 @ Z LO V III m E O N m •- ° Cb CF F.G.. (L E co Q O co s S p 0 Z Z M ro > "= a 6 a o •N aa CL v) ao o co J U p oi W } co Y 0 ai O p E o r 7 :3 _ m w c EL d Q } (n c6 ►„ ° o a U H c O O h C C N N O V a 0 M E O O o p OD y o Z y n O N a; c °' ►'w 7 O N E N L Cc IL 2. V G v 0 d rrww E E 3 w 7 _1 A ciao Ovid Parcel #: 020-1080-21-000 02/07/2005 01:27 PM PAGE 1 OF 1 Alt.Parcel#: 29.29.19.327C 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): *=Current Owner * DANIEL W&JULIE A KOCH KOCH, DANIEL W&JULIE A 465 CTY RD UU HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *465 CTY RD UU SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.120 Plat: N/A-NOT AVAILABLE SEC 29 T29N R19W NW NE 3.120 AC LOT 3 Block/Condo Bldg: CSM 7/1957 ALSO ADJ LAND DESC AS; COM N1/4 COR OF SAID SEC 29;TH S 62'TO THE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) STHLY R/O/W OF C.T.H. UU TH N 89 DEG E 29-29N-19W ALG SAID R/O/W 595.88'TO POB;TH N 89 DEG E 70'TO THE NW COR OF LOT 3 OF more Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1139/208 WD 07/23/1997 945/625 07/23/1997 838/12 07/23/1997 836/75 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 48269 292,000 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total Staite Reason RESIDENTIAL G1 3.120 46,700 179,200 225,900 NO Totals for 2004: General Property 3.120 46,700 179,200 225,900 Woodland 0.000 0 0 Totals for 2003: General Property 3.120 46,700 179,200 225,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 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 j yD&, 70 •�-.z r�r- "-�-�-y1`�-�'- .; � ��,lr ;L' �9 8 9 �,:�.OJ• �c,��o -� �' ., 9- a? 9 9 fe. -7 '7 r/ass-, i9 Te -�7 D a7 �4- CERTIFIED SURVEY MAP LOCATED IN PART OF THE NWJ OF THE NE{ OF SECTION 29, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. $ 9 q D OWNER Sam Miller LAND CONTRACT FILED P.O. Box 282 Forrest E. Rossing and Ruby Daily Hudson, Wi. 54016 to Sam E. Mi I ler APR 2 2 w JAMES CONNELL O' Of Deeds St Cr*Co.,Wf � 1 S Z (r C.T.H. "UU" N8901512211E 120 .711 north line of he NE} c N8901512211E 5 1.68' NE CORNER Nrner ---270.00' -' 271.68'""" Section 29 Section 29 z T29N, R19W T29N, R19W O o i c I O F O N I r I N � O G N N I N N 44 �h m N 1rr is o rn is 0 OD c o 107,995 sq. ft. 108,639 sq. ft. °° N 0 o I a' u, o .o ;'" ° 2.48 acres 2.49 acres o o Cn N - 1 £ 0 N = S a. Im Ico m '..'; i`` 270.001 271.541 rt - S8901512211W. 541.54' APPROVED to Irt c 0 33 0 o. o..ico . unplatted lands-owned-by-platter iy ---------- APR 2 2 190 rr ST.CROUC COUW AMMUft SCALE IN FEET c cc��i o. s_. 200 100 0 200 LEGEND No Monument found. Recorded ties to corner were found. Contact County Surveyor. o . 111 x 2411 Iron Pipe weighing 1.68 pounds per linear foot, set. — --- — 101 wide utility easement parallel with and adjacent to lot line. •—+I - - — Existing fence line ALLEi NYHA A S-140 LtL 7 _a l-lid'h0 i y VOLUME 7 PAGE 1957 u!F�t�f�u'v r� Ca j�rsF. this instrument was drafted by Douglas Zahler job no. 87-52 . .u.1 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S� .-y,. t I ¢�' TOWNSHIP ku SEC. a '�'t T 2 e / W ADDRESS ( 7�o X7t 24:� ST. CROIX COUNTY, WISCONSIN. SUBDIVISION (� `� ,�,OT �? r oS�,'a.�. Cc>u , �a� r ;.in/ S,,b LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1, HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6+y H - - ff i ct I I e s 0 two- N INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used / /of P to NW Co✓itaJ' Elevation of vertical reference point: 1p0,0 Proposed slope at site: / 2-/, SEPTIC TANK: Manufacturer: (Jp (s r Liquid Capacity: __L_060 ,7a I IF Number of rings used: �_ Tank manhole cover elevation: U Tank Inlet Elevation:_A'7•0`j Tank Outlet Elevation: � '�r Number of feet from nearest Road: Front,Side Rear, C(S feet From nearest property line Ftont,OSide,�Rear,O �S feet Number of feet from: well O buildin �{ �o �lOyL� �� CerHn✓o� E(o.r3rL (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE f PUMP CHAMBER Manufacturer: i`(/ � 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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 4,4, Trench Width: Lenth• s Z Number, of Lines: Area Built: �T Fill depth to top of pipe: �/Z Number of feet from nearest property line: Front, O Side, O Rear,®Ft .L______ Number of feet from well: J l� Number of feet from building: S 7 (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 /J/j� Manufacturer: . '!1 �7� 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: Plumber on job: License Number: 1411 P, — J ! Z 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P-0.BTX 1969 BUREAU OF PLUMBING MADISON,WI 53707 N.V%4) F%4) )N S29 T29N-R19W CONVENTIONAL ED ALTERNATIVE State Plan I.D.Number: pt assigned) Town of Hudkon ❑Holding Tank ❑ In-Ground Pressure 1:1 Mound Lod Aols.6in Is Counttc w-ew NAME Or JRMbT�1�EiT ADDRESS OF PERMIT HOLDER: INSPECTION DATE Sam rrM-i..�,25` etc Route 1, Box 282, Hudson, wI 54016 BENCH MARK(Permanent reference oomt))DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV. CST REF.PT.ELEV.. Name of Plumber: TFTF��N o.. Co�my. Samtary Permit NumberDougtas StAohbeen 32 St. Gcoix 112780 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. T OUTLET ELEV.. WARNING LABEL LOCKING COVER PRO IDED: PROVIDED�11 A/ YES LINO OYES �MNO BEDDING: VENT DIA. I VENT MAT I HIGH WATER NUMBER OF ROAD. ILINO ROPERTY . BUILDING: VENT TO FRESH 1 / ALARM i'2o � AIR INLET. DYES 94NO ✓ ❑YES��No NEARESTOM r�o DOSING CHAMBER: MANUFACTURER. BE)DING. 11-1011111 CAPACITY PUMP MODEL 111IMP,SIPHON MANUF nCiUR EH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑ S O —]YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF HO LL PERT ILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES E:1 NO INIEAAEST__�l S OIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I Nt,T 1111AN11 TEFL ATF ND AHKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE I ll the soil is dry enough to continue.) MAIN" CONVENTIONAL SYSTEM: WIDTH LENGTH IND OF DISTR PIPE SPACINI; COVER JINIIDE DIA =PITS LIQUID BED/TRENCH -. DIMENSIONS THENCHFS MA7 IAL PIT DEPTH 47— f- GRAVELDE H FILL DEPTH UIST H.PIPF DISTR PIPE DI R.PIPE MATERIAL NO ,.TH NUM BE(I QF PROPERTY WELL BUILDING: VENTTO FRESH BELOW PIPES ` ABOVE CO R EI FV. NIL t ELEV.LNU PIPF- FEET.FROM LINE / AIR/(INLET. I� ,, 02 7 �/ 1 NEAREST-, Js- MOUND SYSTEM: - Mound site plowed pe endicular to slope eck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upsl mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PEHNIANENTMARKERS :TSIFIVATIONINILIS ❑YES ❑NO _DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL SOUOFO S U MULCHED CENTER EDGES ❑YES. ❑NO ONO DYES 1:1 NO PRESSURIZED+ DISTRIBUTION SYSTEM: BED/TRENCH.. WIDTH LENGTH TR EONCH ES. LATERAL SPACING: (:NAVEL DEPTH BELOW PIPE- FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV. DIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING L'RILLEU CORRECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS O DYES ❑NO DYES ❑NO v COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER PROPERTY WELL: BUILDING: FEET FROLINE ❑YES ❑NO ❑YES ❑NO INEAAESTF�� 1 S3 1o'i U ' 111.1 q� ;3 . 53 075 k03 7 �. �Dq Sketch System on C R county the or audit. Reverse Side. SIGNATURE TITLE. Zoning Admc:ni6ttcatotc. DILHR SBD 6710 (R.01/82) I =--­a=LHR SANITARY PERMIT APPLICATION COUN�� �x 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 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 K NO PROPERTY OWNER PROPERTY LOCATION <Z4_11t All Ta , N, R / E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK 9UMBER SUBDIVISION NAME # B ox =t Z g z 3 CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST R AD,LAKE 6R LANDMARK s O/ 3 b (o VILLAGE: ccd`3 L t W 11. TYPE OF BUILDING OR USE SERVED: R Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. V%j New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Dd seepage Bed b. ❑Seepage Trench c. ❑ 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): e 3 c /S W Z'/ �o•S� Feet Private ❑Joint F-1 Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks 1 Tanks Septic Tank or Holding Tank D wr j sr r El Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,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) MP/MPRSW No.: Business Phone Number: Do li 14 ( Plumber's Address(Street,City,State,Zip Code): Name of Designer: N04,Lol C .�4 st.e> ti bCa1�, VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# 0�• A S�e har Sa / 477 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: A✓,L- �l��.To ct/is ,S yd/rr 7/S 'SSG— s IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Is ing Agent Signature(No Sta ) Approved ❑ Owner Given Initial `�6� rcharge Fee Lp Adverse Determination I `� +� 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 / I 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; Ill. 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% 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 s<tBT included the creation of surcharges (fees) for a number of regulated practices which Wisco fF3'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried8stif8 is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used'by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Location of property &/J,)1/4 V& 1/4, Section _, T_�N-R / W Township Au �'&81A' Mailing address Address of site C-{' �i� U U a '�r� t /a-s Subdivision name 4�5S :�( q /',, �,�'ii/ �/i�.t✓ Lot number .3 Previous owner of property az's ti o Total size of cad arcel z. yS p 4 5 Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No �0 Number -5-2 Volume � and Page 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 recorded in the Office of the County Register of Deeds as Document No. 3 G S / ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner / Signature of Co-Owner (If Applicable) 9 , 1 -2. -�9 Date of Signature Date of Signature I ew 524 `I DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 1' THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 4 __ REGISTER'S OFFICE II This Deed, made between -. . .- - ST. C ROIX CO., W1 -_� �------- Rec d for R�card -.-Ruby--- (I �I 1 ------------------ ------------------------------- ................................................... APR �5 1988 ------------------------------------------------------------------- Grantor, I and__.Sln_ ,•_Miller I -_a_single_man 1 at 8:30 A M I I •-••------------ I ----------------------------- ' ....................................................... -------------------------------------------------- --•---- --••-•------ -----------------•--•----- . • ••--- •• . . -------- Grantee, I Regisfer of Deeds Witnesseth, That the said Grantor, for a valuable consideration-__-_- I iI ---------------------------------------------- -- --- -- I conveys to Grantee the following described real estate in __St. Croix RETURN TO —I County, State of Wisconsin: I Two parcels of land in the NWT of the SEk of Section 29 C/ l ..---- i--- T29N -- -- - ---- ,R19W described as Lots 1 and 2 of the Certified Survey Map filed in the office of the Register of Deeds for Tax Parcel No: ------------------ St. Croix County, Wisconsin on April 22, 1988 in Vol. 7 of C.S.M. , Page 1956, Document 4436486. Also anon.-exclusive easement to use as the 66 foot strip of land I� ii shown on said map as "Proposed Town Road" for an access road and for the installation of utility lines so located as not to interfere with use of said road by others having similar rights, it Two parcels of land located in the NWT of the NE% of Sec. 29, T29N, R19W described as .I Lots 3 and 4 of the Certified Survey.Map filed in the office of the Register of Deeds for!j St. Croix County on April 22, 1988, in Volume 7 of C.S.M. , Page 1957, Document 44436487. This deed is given in partial fulfillment of: the land contract between the parties l recorded in the office of the Register of Deeds for St. Croix County on November 17, 1987" in Volume 797, Page 49, Document #432230, 4 Ef- PA/P EXEMPT Ii is not I This ............................ homestead property. iWjk (is not) i j Together with all and singular the hereditaments and appurtenances thereunto belonging; And_.Forrest__E_!__Rossin and Rub Daile warrants that the title is food, indefeasible in fee simple and free and clear of encumbrances except Easements of record, if any, and liens or encumbrances, if any created by the act or Ii default of the grantee. I and will warrant and defend the same. it Dated this ------------------------------------------------ day of ---April............... ----------- AL) (SEAL) I� -- - --0 ) I * •.For r_e s t._Z.._Roaaing-----•-------------_----- * __.9uby_Da ].ey-------------------------- (SEAL) •-----(SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signature(s) ..af..Fazr-p-at--F,--.Roasin g_.ansi:_____._ STATE OF WISCONSIN {I JJKUY_1 1411?y---------------------------------------------------------- ss. ' --------------------------------------Coun ty. j; authenticated this --2..day of..:.Ap>~i.] ------------- 19.8$. Personally came before me this _ day of I d' ------------------------------------------- 19-------- the above named ---------------- --- --------------- ------- --------- ---- ---- -- ----- ----- *-.Jphn._D:._Heywood ------------------------------------------------------------ I TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not- ------------------------------------ -- I --------------------- � 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 I okl�l_D,..Iieywood;_Het�T,i{,�Tood Cari & MurraV�7 ------------------------------------------------- ------------------------------ P.O. Box 229 Hudson WI 54016 *------------------------------------------------ ----------------------------- 1I ---- --------- Notary Public ------------------------------------------County Wis. 1 (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration I are not necessary.) c date- --------------------------------------------------------- 19--------'} i *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. f STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER vrr �il'1�G✓ ROUTE/BOX NUMBER ' �� I �OX' Z-�'Z— FIRE NO. CITY/STATE ZV�/G ZIP PROPERTY LOCATION: lVk�1 14 /4, Section *_-7 T 0-9 N, R W Town ofaicJ'Svn , St. Croix County, Subdivision �cc�'Nf"� �/i�uJ , 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 Office within 30 days of the three year expiration date. SIG an� DATE q - 12- St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 1 Sign, Date, and Return to above address I"DUS TMErvT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ' W1lDUSTRY, DIVISION P-ABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON,W1 53707 (H63.090)& Chapter 145.045) OWNSHIPIV: OT NO.:BLK.NO.: SUBDIVISf M1�NA E: W '/415,'/ o2 /Ta q N/R/y i'(or r 3 ht. ►r s - �.r.�l. Or AUNTY: OWNER'S/BUYER'S NAME: MAI LING ADDRESS: E DATES OBSERVATI NS MADE NO. kC.. C M . t"F31I5TI _._.... .�_ ._ .._ ppp NS:IFERCOLATRIN TESTS! Residence ew �n lRe,place IPA TLL•"6it'RIF'Tlal � 9X RATING:S-SIto sult+Nfla for system tl-Site unsuitable for system 6+[? ��(3uY / I .fi! ONVE I N MOUNp: IN-G GROUND- ORE: S -IN-FILL OLDING TANK;RECOMMENDEDSYSTEM:(optional) as-0i CS IU tS DU CAS ClSU .�. �_; ,��,��,� �y'xs1 If Percolation Tests are NOT required N F DESIGN RATE: If any portion of the tested area is in the under s,1­163.09(5)(b),indicate: Flood lain indicate Flood lain elevation: /(f�/T 1 p p P F1 E DESCRIPTIONS BORING ..AL H T R UN WAT R HARA T R OT SOIL WITH THICKNIEM,COLOR, TEXTURE,AND DEPTH NUMBER DEPTH- , ELEVATION pgSERVED I G TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK;) o' o, 7 ` fr fv,ue _7 49 d' • 9 B/1 / o I A 2 010, r s ! �/.2 ,.s 7 a ii,-v /S.5 fn �� �. O S gY �d r ] , d' $..t ae S/� , •r,B h p./C S.,4 e_- d s g. >Q• , /uvirc e i8/1� , S�.r. % .r�.I n raj /, o A w f e-s '66 wow e � r V t /.� d/�.1 �O o�+�� o�.0 vh G�1• .���Sp D N�k �C s. B- PERCOLATION TESTS TEST DEPTHI WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RA MINUTES NUMBER 4N6e+E''3 AFTER SWELLING INTERVAL-MIN. PERIOD 1 ERI 0D 2 PERIOD 3 PER INCH P_ h 3' 6 2 4 r. e- 3 P •� Nq Z_ -3 P- P �, r P- JAI PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil arms. Indicate scale di S. be what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the"urface eledai9oRt fs an `l1 direction and percent of land slope. . ern,4.. SYSTEM ELEVATION tS�6 `r CSeg% /°` ,.�, ' 1 `. • . lfeF At , ow► - e 8l, ,R ,>�o� 1 l fer 2-IS-7o ;f1F /f lo7�; �.y►wi/ tut/h`v. 2- 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, NA E(print,): TESTS WERE COMPLETED ON: f� ADDA9 S S CERTIFICATION NUMBER: GONE-NUM B E R(optional): : CST SfGNATUR I ; DISTRiBUTION'. Original ands necopy to local Authority,fropr'r'ty Owner and Soil T,-swi. DII-HR,SIiD 63 951R.d12/821 OVER �Lrykwy 'UCH -. io 7 �3 5 A 41 4,1 W Let or1 ---� �/ (La ', A+ -rha. Ab w. i�t tom.�t� ✓ CI �3a � C cj&C k kCV) L e.le e r �r /xf �► 8 I Z 4 V-, tj To::lVN J DO v s , 1- a o s '0 0, ►, :. M � O s In �Y ` V, II I �I I} i II I I I k I I ti i � it CL a , 1 � � I y � � If- ' S i3O,1 a ; e r hi