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HomeMy WebLinkAbout020-1056-80-110 Q o I 3 0 N O v v N � N p a O N � I C ! 'C3 � I I I � I v z° m LL c O 3 Q i Cl) 3 I a, w E � � E a m o z v ° c lq z t' N c � I N N 7 CL N N � • N O N Q III I O Z [0 Z N co c CD d a A a w C) N d s n G O t z ° c Imo- H d Z N 0 0 0 a ° c -j co n a to J U I c rn rn } v �i Co N N O O O O O N N ,I'II W m N r N N y d Q (n f0 0 O O m C '05) y Q1 > O O M 4 N � w C c U a V N N N O In c (/J O Z a.+ '° p to Z Vl COY) N N t=x,1 H N N 7 a — j O N m O c6 U •�'�i O N S O O Z O I— V] d R a ` a rr�� E 2 C G a+ 02/1612007 04:41 PM PAGE 1 OF 1 Parcel #: 020-1056-80-110 020-TOWN OF HUDSON Alt. Parcel#: 21.29.19.212C ST. CROIX COUNTY,WISCONSIN Current X Sales Area Application# Permit# Permit Type Creation Date Historical Date Ma #00 0 Towner(s): O=Current Owner, C=Current Co-Owner Tax Address: FORESTER,ARTHUR G &CHERYL A ARTHUR G&CHERYL A FORESTER 807 LARSEN LA HUDSON WI 54016 Property Address(es): •=Primary Districts: SC= School SP= Special *807 LARSEN LA Type Dist# Description SC 2611 HUDSON SP 1700 WITC Acres: 2.730 Plat: 1768-CSM 06/1768 LOT 2 SEC 21 T29N Legal Description: Block/Condo Bldg: 6/1768 EXC CTRY WY PROJ 1031 582M Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 21-29N-19W 17Date istory: Type Notes: Doc# Vol/Page WD 98 576669 83122092 97 799/315 07/23/199 7 Bill#` Fair Market Value: 2007 SUMMARY Assessed with: 0 Last Changed: 10/25/2005 Valuations: Land Improve Total State Reason Class Acres 288,100 NO Description 2 392 76,600 211,500 RESIDENTIAL G1 0 0 0 NO COUNTY X3 0.338 Totals for 2007: 76,600 211,500 288,100 General Property 2.392 0 0 Woodland 0.000 Totals for 2006: 76,600 211,500 288,100 General Property 2.392 0 0 Woodland 0.000 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 113 Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Cha O 00 Total 0.00 0.00 PUMP CHAMBER Manufacturer: �V 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). SOIL ABSORPTION SYSTEM Bed: t)a„t; ,,j / Trench: Width: /g' Length: 3 Number of Lines: --:3r Area Built:l -T' Fill depth to top of pipe: d/z Number of feet from nearest property line: Front, O Side, Rear, Pt , _ Number of feet from well: Number of feet from building: 5 (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: k Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: OC License Number: jr 3/84:mj Ad Form - S T C - 104 • - AS BUILT SANITARY SYSTEM REPORT �� N-R / W OWNER �� //7i �` TOWNSHIP SEC.-2, /'� T ADDRESS �•� � 2$ Z" ST. CROIX COUNTY, WISCONSIN ��li d 5 0.► Lc/� S�/o��, SUBDIVISION 1467�S -� �uvla5 LOT LOT SIZE #Z PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �i: �•� w�., y Gaid9cL �o C h zYhSo 0 &d t/ N 51 r po. Q� P;p � INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4,1 lob'L,a- Elevation of vertical reference point: /e,,70 -o7 Proposed slope at site: �•�� S���h 'ANK: Manufacturer: Liquid Capacity: ,er of rings used: �_ Tank manhole cover elevation: let Elevation: `��-/ Tank Outlet Elevation: %471. S f zf from nearest Road: Front Side,K R' O gd, feet de t`�' �o4U f,operty line , Front,OSide,®Rear,O 7o feet of feet from: well (p0 r building: �3 ��b'°'S��and✓ information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 421:22' CERTIFIED SURVEY MAP Located in the SW 1/4 of the SE 1/4 of Section 21 , T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin Owner and Subdivider: N Verlyn & Catherine Benoy UNP�ATTED LANDS_ — m Rt. 1 Meadow Drive S 00-51#49"E = Hudson, Wi. 54016 EAST LINE OF THE . 391 ,331 SWI/4- SEI/4 479.26 _ $ 445.9:1 N og z L "� U U F� �� W W LL W N O � JAN l7J 190 z cr Z F N O y d OMB ►- �A��� < U.°C a a W R1 co poMM". ���tltplpjp� Ia- z o o ° ? . of �rrri 'fir th Soo w.Sa�y, ul O �v. F- (�z Q y z N o_ Q o 3�1 ,Y O. , z .�� ° QOM n;OM z�° Cr) m o p a6 . CD JAF1� F- O U v N "—'w'i.P2R VQ pl RUSCH cv ear J �$r 1'36'09g.13g I 01 353.26'Hudson 33 sf- wis �� N � 320 y00' --- co ��♦t© W LL 1 W I W O � U LL ',..Z � Q •`� WOQ W�aO Q rp.�nURM o crN m� o O1 # APPROVED ° �oa ti-4 CO -� I O U. z O W O Z p cu =O JAN 0 81997 y; S 02' 10'27"E rn V z, 548.94' 33 .23 4t 515.71 ST. ::-10A C'SU':i Y U1. 1 If7 IA �I COMP. HE1131VE P,,kXS PIANINIiNG i LL N "'I p o ANo Zoi4ING COIA0311EE O 1 1 ICU yl 111 N m v4 =1 N LEGEND a: ZU U.0: h ¢I�1 SECTION COR. MONUMENT N_a ~ a a ao Z a J' c� O I I Za vee O NzC NZM O - n) I w101 Q' _ -� U1>1 0' ��, - �7N N?N M W 0 111 IRON PIPE FOUND l .0 094 WX4 ao40> z S Oe QXC aD Z; W J 211 IRON PIPE FOUND W3 W I W O PA 24' ROUND IRON PIPE WEIGHING v ~ a z I 1.68 LOS . /LIN, FT. SET t0 N t0 p w r U O _ Q rn Z In !b0 .900 450 Sao soo so o ru 50. 6 0— _l�1RS�EN O• o M \ \ z ID L2ME_ SCALE'IN FEET j' (v 6p.08 iO W Bearings referenced to the South nine of l the 0 SEI/4 of Section 21, assumed S89 23 51 E. ., a a ao o 6 W 3 °° ffj Z 3 LL C~ m n J O O N _ W to ON ~ N - 1- 0 o� rno I -Z(r 0 0 O N J M J 1f1 J N - V' ti U ,�U - c 7 U m \o N-SI/4 SECTION px _? OWN — w LINE — W Z yrnt z 4645.721 550.00' 33 N 00'51'27-M 583.01' volwae 6 Pate 1768 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS DIVISION i±ABQ.Q'% HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BN969 OX tuber: MADISON WI 53 707 State Plan I.D.Nu SW1,4,SE�,S21,T29N-R19W Yin CONVENTIONAL ❑ALTERNATIVE (lfassigned) Town'of Hudson ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 2 County HWY "UU" INSPECTION DATE: NAME OF PERMIT HOLDER JADDRESS OF PERMIT HOLDER: Sam Miller Route 1, Box 282, Hudson, WI 54016 gyp, s�l(o° $ 1 J "'30 REF.PT.ELEV.: CST REF.PT.ELEV.. BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: MPIMPRSW No-. County Sanitary Permit Number: . Name of Plumber: 99098 Douglas Strohbeen MP5432 St. Croix 77 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ROVIDEDLABEL PROVIDED:COVER YES ❑NO ❑YES Q140 O $ R O ROAD: PROPERTY WELL BUILDING: VENT TO FRESH BEDDING: VENT DIA.: VENT MAT L.: TER LINE AIR INLET, FEET FROM eai0 "ID �O OYES �hIO O NEAREST: DOS ING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER. PROVIDED:LABEL PROVIDED COVER El YES ❑NO ❑YES ONO DYES ONO I`UM P AND CONTROLS OPERATIONAL NUMBER OF LROE ERTY WELL. BUILDING: VVERN N O FRESH GALLONS PER CYCLE: FEET FROM (DIFFERENCE BETWEEN ❑YES ❑NO NEAREST PUMP ON AND OFF) LENGTH. DIAMETER. MATERIAL AND MARKING SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE CIA: #PITS La QUID WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING. MATERIAL: DEPTH: RENCFt TREE Es �� PIT ClI AENSI'l S' PROPERTY WELL: BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO EST TR NUMBER OF LINE AIR INLET: BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END. FEET FROM �` �j �1 -�- 4, 5 a1 3 NEAREST CJJ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO PERMANENT MARKERS OBSERVATION WELLS SOIL COVER TEXTURE DYES ❑NO El YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED. CENTER ❑ F-1 YES ❑NO ❑YES El NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER: WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: . "+ TRENCHES: DIMENSI�INS I MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: pip DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.: �'ei('A 'ION AND [TiST{�toutlou COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. PLANS. INFRMATIQhk DYES ONO ❑YES NO NUMBER QF PROPERTY WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: FEET FRCHNI LINE: 3.01 ❑YES 0 N YES NO NEAREST �0 in Sketch System on Retain in county file for audit. Reverse Side. nrLE. NATURE-. Zoning Administrator DILHR SBD 6710 (R.01/82) 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 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 included the creation of surcharges (fees) for a number of regulated practices which Ground # can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that W�sCO !ri is used in our building buried rat�re; Y g is returned to the groundwater through your soil absorption 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 water, groundwater contamination investigations and establishment of standards. Groundwater, t it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION C v/ TOIL- HR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# v —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 FOR VARIANCE ❑YES NO 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. PROPERTY LOCATION PROPERTY OWNER �� /�%�/c�, :54111, .5,67 '/4, S Z TES, N, R / E or PROPEL OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME �p Z E E5 QVe4/1a f / &O 2� CITY NEAREST ROAD,LAKE OR LANDMARK CITY,STATE ZIP CODE PHONE NUMBER Cl VILLAGE: g4 74, TOWN nF' II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family _S OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an 1. a. New b.❑ Replacement c• an Existing System Existing System System System Septic Tank Only g y 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued 3. ED An Existing System has been inspected and soil conditions meet minimum requirements. 4. El 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. El Experimental 2. a. ❑System- b. El Holding c.❑ Pit Privy d.❑ Vault Privy e. El Mound f. ❑ IGP FPERCOLATION n-Fill Tank ION SYSTEM INFORMATION: (Check one) Seepage e Bed b. ❑seepage Trench c. ❑Seepage Pit RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELE NATION 6. WATER SUPPLY: s per inch): REQUIRED(Square Feet): PROPOSED(Square�et): 9s SD Feet Private ❑Joint ❑ Public Z (HISS 7r (o`/$ s VI. TAN K CAPACITY Prefab. Con- Stee l Fiber- Plastic Exper. in allons Total #of Manufacturer's Name Concrete glass App. INFORMATION New xi sting Gallons Tanks structed Tanks Tanks Septic Tank or Holding Tank 000 / C.t�a-f S r ❑ ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Phone Number: Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: o �Psy 3 z Zv7 32 D'o �QS Stro h 6 Q-a- Name of Designer: Plumbers Address(Street,City,State,Zip Code): T%1017 D c S O `Al et- � � ..v 9 �ch ,�►� on4� G�JZ Vlll. SOIL TEST INFORMATION CST# Certified Soil Tester(CST)Name S I)a,d , S C h r s-T- 02 h 4-/ s¢r► Phone Number: CST's ADDRESS(Street,City,State,zip Code) L4 u C d,) V4- 4e .30 6v x . S IX. COUNTYIDEPARTMENT USE ONLY Issuin Agent Signature(No Stamps) ❑ Disapproved S tary Permit Fee Groundwater ate urcharge Fee Approved ❑ Owner Given Initial /f1 �� `� ^` /v Adverse Determination QI 0� X. COMMENTS/REASONS FOR DISAPPROVAL: 0-j-, N)pz ap C) cLAt J.,J'.e kA SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 • i AZ Location of Property S 4U 1% S �6, Section TownshipCcOSOi� Nailing Address �/C AW40 jj Address of Site .40roc-0 T A' Subdivision Name I/ET,6E . Lot Number ' Z Previous Owner of Property ����j//1 ���`l V/'i Total Size of Parcel Z • 3 O 14 Q✓ Date Parcel was Created �Q 7 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? X Yes No Volume and Page Number Jz_�S_ 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 (We) eeA,ti.6y that a t atatementA on thin 6oiun cute t1Cue to the best o6 my (oun) knowledge; that 1 (we) am (a&e) the owneA(a) o6 the pnopeAty deA cA i.bed in this in6o"ati.on 6o4m, by vi'Ltue o6 a waAAanty deed neeonded in the 066ice o6 the Count yy RegiAteh o6 Ueed6as Document No. Z ; and that I (We) pneben,tey own the pnopoaed site bon the sewage di6poAat system (on I (we) have obtained an easement, to nun with the above dedcA bed picopenty, bon the eonstAucti.on o6 said s ys.tem, and the name has been duty %eco&ded in the 0iS6ice 06 the County Reg.e.ateA o6 Veede, ae Document No. -�-y Z/ ) SIGNATURE Op M6R SIGNATURE OF -OWNER (IF APPLICABLE) .41 con q— 19- DATE SIGNED DATE SIGNED n`BAR OF oocuMENT�`1 STATE PERSONAL REPRESENTATIVE'S DEED a THIS SPACE RESERVED FOR RECORDING DATA PERS 4V4.-- t -5 _, __ - ofriCE Harry J. Stewart ?!?! CO., wa ................ .............., as Personal R_ es en-t-a- tiv e of th e estate of _e;-r- March 1 s o. , 7� John_A�dfo_Myren_- a_John__A�dro__Larsen a�k�a_Aldro Larsen ------•---- 9:45 A La ._..__. .. .. . . ..-•---------------------------__......._..........._._-•--•- („Decedent"), •-- i ----------------------------------------------------------- Verl n_ for a valuable consideration conveys, without warranty, to .._.._.._-Y_. •E,__Benoy i and Catherine-A._Benoy_s__as__husband__and__wife_as marital_ progerty__with_right_ of_-survivorship_____--_-_-- _-_--_--- -- _ ....................................... --•-•. • •_.... ._...•• -•--•_. . -----------------Grantee, "ETU TO ` St. Croix _ ___________________ County, ' the following described real estate in ............... ....... State of Wisconsin (hereinafter called the"Property"): West Half of the South East Quarter of Section 21, Tax Parcel No- ------------------------------ Township 29, Range 19. I i I I i, I I Personal Represents tive by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the II Personal Representative has since acquired. Dated this ------.28 1~�1---------------------------- y I I �� �JV�6LS,\,!-•_...__.(SEAL) ..............(SEAL) ,-°=�-�... .. ............ . H1rxy- J.t,... >r.mart---- ... •r` �------ --------------------- - •,.�-' ____________________ -- Personal Representative ti I Personal Representative , I • 4: J ACHNOWLEDCITO d`.Y -» AUTHENTICATION ;Gi •, QJ `� STATE OF WISCONSIN Signature(s) ------------------------------------------------------------ � �0 41 _�1.. --• . . ........... 19.._.. ---------•---...-••--•--------•-----•• ._..�1;...�);(2�.X...__••••-•-•--.County. authenticated this --------day of........................... Personally came before me this __-..2Uh...day of kraSC .--••--------•--- 19. x?__. the above named .._..---••-- Hi3X1'X_.>Jx..Sel4xa.-as_.Peo2� _.RePeentative * _..._. __fRx..lih�--pB>i >i�_.3 _.,Iohl}.Aldro Myen__Lasen, ------•-•-_..__..._. -•- ........................ John A1dro Larsen a k a Aldro TITLE: MEMBER STATE BAR OF WISCONSIN I_.Li3....................................�.-._�..I._._..._....•._._.-- (If not- ------------------------------------------------------------ ---- --• ------•------•----------- a authorized by $ 706.06, Wis. Stats.) to me k own to be the person ............ who executed the fore instrume t and ack wledge the same. THIS INSTRUMENT WAS DRAFTED BY ................... Lois A. Murray of HEYWOOD, CARI & MURRAY "'^ ................ G rl �s �1,J.-_ --•-• (ll ( 1� HIL.54QLh _______.. ....._.. County, is. -----__----- Notary Public __St __Croi_x j'••A••--�x'-�9'�"�'�•''�� My Commission is permanent.(If not, st to expiration (Signatures may be authenticated or acknowledged. Both c5 �?' are not necessary.) date: kn _ – --- -- - — --_-. *Names of persons signing in any rapacity should be typed or printed below their signatures. r H z H r STC - 105 r 9 H H SEPTIC TANK MAINTENANCE AGREEMENT z St . Croix County 9 H C+7 OWNER BUYER—'---,*-- �n � �OXZgZ Fire Number ROUTE/BOX NUMBER (� ZIP sy'9Arn CITY/STATE O-SaH PROPERTY LOCATION : !'54V 14, S� �, Section a / T N , R PF W Town of St . Croix County , �ut�.SOh Subdivision M, Lot number Z . I Improper use and maintenance of your septic system could result con_in maintenance I Proper its premature failure to handle wastes . p ears or sooner , I sists of pumping out the septic tank every thrWhat you put into` if needed , by a licensed septic tank pumper . the system can affect the functionn o of temhe septic tank as a treat- ment stage in the waste disposal y 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, to July 1 , 1978 . St . Croix County which was in operation prior . of 1980, with the requirement that accepted this program in August owners of all new systems agree to keep their systems properly maintained . bmit to St . Croix County Zoning a The property owner agrees to suba master plumber , certification form, signed by the owner and by journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper ion and (2) after inspection and pumping (if nec- operating condit less than essary) , the septic 'tank is oximatelyl30fdaysdpriordtocum. Certification form will be sent app H 0 three year expiration . I/WE, the undersigned , have read the above requirements and agree z disposal system in accordance with to maintain the private sewage disp y .d Wisconsin the standards set forth , herein, as set by the Depart- ted m ment of Natural Resources . Certification form mutwithin30edays and returned to the St . Croix County Zoning office 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 . CERTIFIED SURVEY MAP Located in the SW 1/4 of the SE 1/4 of Section 21, T29N, R 19W O Town of Hudson, St. Croix County, Wisconsin Owner and Subdivider: Verlyri & Catherine Benoy ' Rt. 1 Meadow Drive s Hudson, Wi. 54016 41 sEa4TNt = 00051.49pE 2 01*361008m Of iR v e� �fw iii+ X � 41 4d .4d Z y o a s oo•�0•07•� J sale* wj VI 5115.71 s « WI LEGEND - � SECTION CON. NONI►MENT a C • � �M, 0 1" IRON PIPE FOUND 0 t" 140N PIP# IrOYNO •�� ■ ■ �!! O All'e ROuNOIRON rope WEIGHING N. M • 1 LisL�s./LIN. IT. SIT r10 t p N • s0 ." Bearings referenced to the South line of the SE1/4 of Section 21, assumed S890 23151"E. X s 06 �� 1 i�r 1 N mom o" �11v��1 N-S I/4 SECTION >r N LINE 4 y, r I ONO !lIQI.Oi' i � • � ��� SAFETY&BUILDiN REPORT 4N SQtL IJOX 7 -MENT OF P.O.SOX I t ANq PERCOLATION TESTS (115) MADISON,WI 53707 AN RELATIONS 0M.090)&Ch"thr 146.046) / SHI UNI<CIIP,A/LiTY: M S $t�taa 4s 4 2► Z9N/R�rtlo+' C LINTY: R-T N1EAd04v ki* i� �UASmIN 1n/, 5o �T TE:oBURVAT Iii aR ust oNew ❑Replica 4cT Z-7 /9%o QCl -2-7 /g rC Residence U-j 5o►�s $up,KN+4 W Iztea aetwfbiMal—" �. COfrA Np D 8 E t ttal) RATING:S■�sukaWe for sY ► D L. S $ �s C0 tom If Percolation Teas are NOT required DE N RA If any portion of the tested area Is in the N� CLAMS Z Floodplain,Indicate Ftoodplein elevation: /�j under s.H63.0%5I(b),indicate: _ PROFILE DESCRIPTIONS ,AND EPTH b VE EE ABBRV.ON BACK. BO A ELEVATION T E F iBANMS 24"'k d$RNMS*E6Q B- / &Sa ill NON L `j g f 3'BL L•i'S z7"gR+.t S r L �c,R 45 QRry MS >/0.00 3SR� q-7-73 nlon/t I t�►.S+L 31" lS+�11�1 S tEt4 R 3s 3'4 3 s B-3 .33 94• IfoN 3 Ith8ltni t3•�ialtT� t®"Bk�tS,l, MGR s Z�" S �R > 9.4Z B.4 q.4z. 9�•3g n�nf,t s e-5 q.az /Orto r >9.4Z eN c B- PERCOLATION TESTS WKITUIll aEG Cr'f -PER INCH ORO D PTH . W IN LE �r R S AFTERS ELLIN INTERVAL-MIN. P. z 3•$ C 94,35 > P- P• P- P and the dimensions of suitable evil . Indicate scale or distances�� and percent are the hori- PLOT PLAN: Show locations of percolation tests, $oil borings Show the rfaca elevation at all borittps :ontal and vertical elevation reference points and show their location on the plot plan. of land slope• IMdRY �S•SO , , t� ��rE o f�T■ q 3.s� __ _._ _ , 4 pr S YSTE � ELEIAT 1 _ . g,-4 lc��Ktio ' ._c��I. �!� .. � _ ._ _ , { � � ,Y, �►�, 'mow �� TNI � ' Ttb�ll t+ it i i 1 i ' j. j 1 �x 1 tied In the Wisconsin i,the undersigned,hereby certify that the soil teats reported on this form were made by line in accord with the procedures and methods sped Administrative Code,and that the data recorded and the location of the tests are correct to the best of mV knowledge artd ttf)lief: T C LETOED ON: NAM print : \ GJc'T' -n / 7� AAkil JONnISOf1) CERTIF CATION NUMBER. PHONE NUMBER optional): ADDR �: — ,,l1 1_r 3 %+ �tS6-4C�gC> 40-1 SEConif� -S Nl)A'Slan► �+ i ��/�• S I URE: a;4�" :lni►'1l ?N tl,ir;�;csl anti(,,,�r)p.• r,, I:neal Authority,Prot-16l Owner and Soil Tester. —OVFR SAM ►NII LLER Nl�r�s Bou/V AS L E&E N D • (3 M V"-t d- z Ra i�o;it o W a-5 t lot V v%a. ra P of a Y' 0� F-\V = IDo•1?7" 80ra-S Pd.r c s 11dst 3o ffo Eli �AI-fdr�at� A�u E I Y. 93. SCa��n. i/y��= ID� �EXGc�D1' aro��a.w• V r`�-2 f a � � ,� 6�• s Aral � 5 p I t r 1, 1 � L o s o a A a j- Ci � r 4 � � a s •.,, + -- NO 0 i