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HomeMy WebLinkAbout036-1091-60-100 oa I M C C � O O cL h rn I y 7 N O O C c i ; O h x @ E C N f6 O C p Z O N 7 (D Y C c (6 o a o cu c 3 _ :? c LO T E Q �$ 3 U (0 N n LLI E LO i+ O z a m M F Z O C O z O (0 Z O co H O (u N N 7 I D1 N c •My d V) L O cu o 0CD a ° z m z o N c z c 000 't E c �' � c d L N I LO d Z r E F O li 3 3 3 ° o i;p O O O z •w�rl 3 a a a o U) t- r- J U j, 'o O O Z _ I O O N i T N N U M m CO N N 0 cll m 0 C: g o ° Cp � � o Sao 7 ~ O N N m N ° 40. O n O W co V7 Z "O i�l ( M c E _ .c N • �, M u 0 04 O y O O M U y, O M U) O z — 1- Z U) Aj o E I `/ ✓� d m a a ` • m .e m m � `�1 A v IL 0 U) i Parcel #: 036-1091-60-300 02/22/2007 10:32 AM PAGE 1 OF 1 Alt. Parcel#: 35.31.17.558A-30 036-TOWN OF STANTON Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 09/30/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner HARVY B TR CHRISTENSEN O-CHRISTENSEN, HARVY B TR 1492 CTY RD K NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): `=Primary Type Dist# Description * 1833 CTY RD T SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 10.060 Plat: 4850-CSM 19-4850 036-04 SEC 35 T31 N R1 7W S 1/2 NW SE CSM 19-4850 Block/Condo Bldg: OUTLOT 1 OUTLOT 1 (10.06 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 35-31N-17W NW SE Notes: Parcel History: Date Doc# Vol/Page Type 03/01/2005 788504 2756/628 QC 09/30/2004 775798 19/4850 CSM 09/30/2004 775798 19/4850 CSM 01/05/2004 750691 2485/041 TD more... 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/28/2005 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 5.000 2,500 0 2,500 NO PRODUCTIVE FORST LANDS G6 5.060 12,500 0 12,500 NO Totals for 2007: General Property 10.060 15,000 0 15,000 Woodland 0.000 0 0 Totals for 2006: General Property 10.060 15,000 0 15,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 036-1091-60-200 02/22/2007 10:33 AM PAGE 1 OF 1 Alt. Parcel M 35.31.17.558A-20 036-TOWN OF STANTON Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 09/30/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-CHRISTENSEN, HARVY B TR HARVY B TR CHRISTENSEN 1492 CTY RD K NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): `=Primary Type Dist# Description * 1825 CTY RD T SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.030 Plat: 4850-CSM 19-4850 036-04 SEC 35 T31 N R1 7W S 1/2 NW SE CSM 19-4850 Block/Condo Bldg: LOT 2 LOT 2(4.03 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-31N-17W NW SE Notes: Parcel History: Date Doc# Vol/Page Type 03/01/2005 788504 2756/628 QC 09/30/2004 775798 19/4850 CSM 09/30/2004 775798 19/4850 CSM 01/05/2004 750691 2485/041 TD more 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/03/2005 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 4.030 10,000 0 10,000 NO Totals for 2007: General Property 4.030 10,000 0 10,000 Woodland 0.000 0 0 Totals for 2006: General Property 4.030 10,000 0 10,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 \yUlYaurr/Nl/Ililj/! ' III it ji, ; a E ? Ty f, r• UaDG[ MAY 13 20055 a 248'� 7 7 5 7 9 8 IiL 3 CLEAN LR KEOft � 8-?3-o¢ VOL 19 PAGE 4850 -�° �IN4 E�/ `1- z�-o 9L KATAI.IM H. w-ALS �- f)� CotZ 6Y \\\ REGISTER OF DEEDS F ^r r,ZSPFe.GRD ST. cROIx co. MI ��1 z,2 v ^ RECEIVED FOR kECORD 2 '9� ^V - _ c� 09/30/2004 03:95P12 X O x o ° a u° ° o N - /°s Ej fS mo oz rr CERTIFIED SURVEY MAP x Z n a o ° ° 3 m o m v v v cn m REC FEE: 13.00 o x 3 ?n 3 ' o :?°_ z COPY FEE: 3.00 �v .S t�� o W ,' a <z 0 0 0_ _7 i f�*1 PAGES: 2 rr rn m �2w a o m x n o x w 131 3 n df CIO p 37 O O =D c . r- ° u ° CL— II f�l ZO rt j w a 3 o 2; UNPLATTED LANDS — — -=N01-25'53"W 665.60' — — - -� 404.05'- r__261.55'__._ �01'25'53'W CENTERLINE 404.06' �^' /c� r 61.57 C 1331.20. � —/ N 133'54"W 665.63-N m a o Q g 4 \9 O a �a ZAm .............�.��7......�r-...__....m. W Z 3 O O y C CO.r V'••� j c 0 :2-1 An m�0 02 ewe CL y 0cnO -45 acn n°°`d w N to.--i-1:-I-N ccl N o c ° c I`' cn �� w � ro n vi r NS ° W j f0 W X OI V O AE :7 'r O C NO V V j C Z m O I'. n Q2 O. e0 n- tr W V p1 D D _• I `-'�� & -4: N m ;U;V AvM3M1Rl0-1/� W�(q_(Wjl 7 '� Y ° OHO 1 D 4 I pl mm q rt m C p j �D ❑O Vl(n 7 0 A s w � m v - m o I - �n Q 7pra =33'13 I Z? c ° n-i --i Ir v C7 0�p N w '\"-- ---------- -- - ZIP - - m g ,y D ---------- - /0 ;Z1 rt rn o0 -fin._.... J ! D C7'O 2 Sao D � Q.4D i. m �, .7/N BIXINDARY / IO ° v g Y= %z ° c ° o / -4 o CO, F- ' ° o 1% c, N 1 w 406.37 z co zm a o z 63.16' - — — RIVER n �ry u — — MLLOW of�m w 3c 2 m °c =1 w \ � �w= � rn�° =o C p C 7 O m a p q I Z ' ONE OD.i n n o g o ' o `I y I- O cZ O a 0 S$ =r m-2 > 0,0 rt T oz. � Z TOE p O m� �p -�.�o00PU04 BrwK I j C T vn v 3 W 5. ° 'm C 1 --'-----III'_-�IQP� 60/M0_A_RY cc0 cn q V Ce —0 O O O 3 m v o P m CD O cn a o a ° n 5 En 03,<c 3 p} �` Of 2 \O N N N in 0 O '!7 C A O OD O�+ z w n ° 3 ° s: O tO r�. rn °O aAi 5'0 0 w ° ?e«0 rq "7 cn .ZI — ° O y O = CL n y a o �� i EAST L/NE Q� 7NE NIYf/t Q� 7HE SEl/4 \ / w x'o` '< SOO'40'14`E 665.15 UNPLATTED LANDS OWNED BY OTHERS S - - -- - - - - - - - - - - Sheet 1 of 2 f Vol 19 Page 4850 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). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len$th: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 It Number of feet from well: Number of feet from building: (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: j j ALarm Manufacturer: Inspector: Dated: �/�- �1)-� � Plumber on job: t,Al leJr. s License Number: 3/84:m3 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT TOWNSHIP 1 SEC. T Z� N-R�W OWNER �i��r�',�/�;/X' ,fir �;�� 22�C_ ADDRESS J� ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT 41 �_ LOT SIZE �j� PLAN VIEW Distances and dimensions to meet requirements of II- HR 83 s SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 -?T Ift' Q /c, INDICATE NCRTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 14�2,v j Proposed slope at site: ? 4 / SEETIC TANK: Manufacturer: 1,r.8-�«,�ti � /4Liquid Capacity: f Number of rings used: ` Tank manhole cover elevation: ^� Tank Inlet Elevation: -22 Tank Outlet Elevation: 9T, 75- Number of feet from nearest Road: Front 10 Side,©Rear, O s-Ili _ feet From nearest property line Front 10Side,�Rear,0 / /1C2__ feet Number of feet from: well building: 3/ (I1clude this information of the above plot plan)( 2 reference dimensions to s+ otic tank) SEE nrVERSE SIDS: DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS I LABOR&H DIVISON UMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 NWT, SE4, S35,T31N-R17W XR1 CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: Town of Stanton ❑Holding Tank ❑In-Ground Pressure ❑Mound I CITY Road T NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Elton Mohr Route 3 New Richmond W1 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumber JMPIMPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. St, Croix 102783 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED OYES ONO DYES ONO BEDDING VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LINE JAIR TO DYES ONO 1:1 YES —]NO NEAREST DOSING CHAMBER: MANUFACTURER JBIEDDING JLIOUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL ILOCKINGCOVER PROVIDED: PROVIDED: DYES ONO IDYES ONO ❑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 LENGTH DIAMETER MATERIAL 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: —j- WIDTH: LENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END: PIPES. FEET FROM LINE AIR INLET NEAREST--► 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ONO SOIL COVER ITEXTURE PERMANENT MARKERS JOBS111VATION WE 11S DYES ❑NO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL ISODDFD S"E""U MULCHED CENTER. EDGES DYES El IDYES ONO El YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING Ci RAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&M HKIN(, ELEV. ELEV.. CIA. ELEV.. PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS LIFT CORRESPONDS TO APPROVED OYES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE. DYES 1:1 NO 1DYES 1:1 r, INEAREST- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. Zoning Administrator iI DILHR SBD 6710(R.01/82) f 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 included the creation of surcharges (fees) for a number of regulated practices which Wisco Ch. can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that burled TeaSUCB', a is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. o 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) {�, DILHR SANITARY PERMIT APPLICATION COUNTY L 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 nd NO PROPERTY OWNER PROPERTY LOCATION N, R J,7 It(or PROPfERTY OWNER'S MAILING ADDRESS LOT NU BER I BLOCK UMBER SUBDIVIS N NAME 3 CITY,STAT ZIP CODE PHONE NUMBER CITY NEAREST ROA AKE(�R LANDMARK I El VILLAGE : 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family / L OR ❑ Public(Specify): 41/0 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. X 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. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 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 O IcaSO Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation a private sewage system shown on the attached plans. Plum er' Name(P ' t): PI ber's Sign ure:( S mps) MP/MPRSW No.: Business Phone Number: J � ; Id Plum er's Address(Street,Ctty, ate,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certifi d S it Tester(C )Name CST## 9 secs CST' ADDRESS( reet,City, te,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary' Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) rcharge Fee Approved ❑ Owner Given Initial ^�.� Adverse Determination Ol ,V 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 • � • Y . .. � _ .. 4 "� i • -, _ _.S'ti a. i �..' n .. • C � . ` • 1:� � s n ':_:' ".. • �. , . _ ... ;� � � � '.. ... • Yy V Y � t - i \ .. �. v. � r. a. �_ t '', �.� • ' '..' ` ` ._ iY % �.:� v � .. �� ; 4 � $ i� �� Y u M t � s., e \ __ e ' e �'nir � • ' � .. •.. � t ` � �. '. • ..- r 1 i 1 "., y. � � Y � �. ' � 1 ' ' i �. � 1 -� . �v H� � � " y i r• .,� ,�• .. - � � �, � m r. - .. 1 a s �. �., f� ' � �. � n y� �'� . 4 - y W �.) � ti �a9.tr. +, ��. ,. - .. A ,. .,+ .. ' 4 _ .. "R;: +• �. .. .y . . � .. ,_� _.. ..:: ..Y, •. .. „ _. .. �: Yy APPLICATION FOR SANITARY PERMIT STC - 100 his 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 bet" M d �r, .3 Location of Property A) 1% _�F_-_fit, Section 3.- , T�N-R _ZZ W Township Mailing Address R R 3 Address of Site Subdivision lime J/14 i. Lot Number Previous Owner of Property _ 1GL'e. h'1 . ,h r• �..�,� Total Size of Parcel f2� Date Parcel was Created _ ��, .} of (0_Z_ Are all corners and lot lines identifiable? j( Yes No Is this property being developed for resale (spec house) ? Yes _�� No Volume �7` and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed hick 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 (10e) cvLU6y that afe Atatement�s on thus 601EM ane tAue to the best o6 my (oun) hnowtedge; that I (we) am (ah.e) .the ownekk) o6 the phopehty de�sc i.bed in th.ia .in6oimaLion 6onm, by viAtue o6 a waA.anty deed neeonded in the 06 ice o6 the Cotmtyy Reg,usten. o6 Ueed�s d6 Document No. ; and that I ice pnmentty avn I phopoaed zite 6oh the 6ewage cUApos bys em (on I (we) have obtained an ea.aement, to nun with the above de cA bed pnopehty, bon the eon,6tAucti.on o6 eaid eyd.tun, and the name has been duty necohded to the 066.ice o6 the County Reg•i.a.teh o6 Deedb, ae Voc meet No. ) . SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 2701 UB'n«a—common Form ,b 0 L. taaa r, ^ o ,. I 8r 136.16,W Y.statute& F 'N&1 r bUmbed y as Mks O.t a D"NOW Ok !I t This Indenture, lade this- l s t. day of August ,A.P.,It 2 i between Mae M. Uhrley . l part y of the first part,and 4! 'Avrtle A. Pederson I; part y of the second part. j 6ftntOOOD: That the said part y of the first part, for and in consideration of the sum of s) One Lollar and other valuable consideration' to her, in hand paid by the said pan Y of the second part, the receipt whereof is hereby confessed and acknowledged,ha a given,granted,bargained, sold, remised, released, aliened, conveyed jand confirmed, and by these presents do es give, grant, bargain, sell, remise,release, alien, convey and !, confirm unto the said party of the second part, herself, her heirs and assigns i forever,the following described real estate,situated in the County of St. G ro i x i j' and State of Wisconsin,to-wit': South, half, of the Northwest quarter of the Southeast ouarter *(S1NWSEg) of --ection Thirty-five fj Township Thirty One i+orth (T31I') of ksnge Seventeen (� �j W s t '(A17 w) Phis d°ced is ivPn for the purpose of cor•rectii, the . I iescri_,,tior in tnat certain det_d dated Au6ust 1, 1962 and recorded Ii, the Office of the eFister cf Dee.ds for St. kroix u county, visuonsin, on August 2, 1962,. in ";Olume 31,7 Cf I' Hvuord.s on pages 366 and 367. This ,being a correction deed and a co.,,sideration than Cne hundred tollars 0100.00j , no - evenue Stamp is requ`- red. e 1 I � fI I, i II . Ogtt�tt with all and singular the hereditaments and appurtenances thereinto belonging or in anywise appertaining; and all the estate,right, title, interest,claim,or demand whatsoever,of the said part f of the first part,either in law or equity,either In•possession or expectancy of,in and to the above bargained premises and their hereditaments and appurtenances. Co i`jr abt anb to iloCb,the said premises as above described with the hereditaments and appurtenances, unto the said part y of the second part,and to her heirs and assigns FOREVER. ' i Uhrle RitiD tit %si0 Mae. M.. y 'f for herself, 'her heirs,executors and administrators,do es covenant,grant,bargain and it agree to and with the said part y of the second part, her heirs and assigns,that at the time of the ensealing and delivery of these presents she Is , well seized of the premises above described, I� as of a good, sure, perfect,'absolute and indefeasible estate of Inheritance in the law,in fee simple, and I' that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part y of the I V) - second part, her heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, she will forever WARRANT and DEFEND. ]n alltntoo Mbtuot► the said part Y of the first part has hereunto set her hand �"d seal this lot* day of August. .A.D.,1962 Signed and Sealed JA Presence of M /Seal) osap�. Hu�.7h . 1 ` '. i.� —(Sea!) Watt at Wioconoin, ty.1 ss. �. day of A' ust ,A.D.,1962 Personally came before me,this 1 at. Y , the above named Mae M. Uhrley to me known to be the person who executed the f egoi instruMent and acknow\\ledg d t • 0 Notary Public,_Lj_ ;rni x _ County, Wifjo.gh _ My"corr+myssioir ezpire� J aria 9 ` .A.D..19 Drafted by IN' B—Zh.bf Wis.State.prerldee that all Wtrasegto to be reeorM/9ha11 herw plainly printed or typenrttten ther.en the namw.1 the grantors. grant*.*.4.Itneseee and nets►y./ CIjro (Tl ryl C rV11 ` C1 Cj t/9 di N w Aj b A F' ) 't A 2z - K+ wy 73 VOL H rn H a r ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a H OWNER/BUYER����,�! Cl7 ROUTE/BOX NUMB R Fire Number CITY/STATE ZIP PROPERTY LOCATION : 1�, _14, Section,]1' , T . N , RZ 2 _W, Town of �. �. , St . Croix County, Subdivision , Lot number 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. Ho E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth , herein, as set by the Wisconsin Depart- ro ment 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 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 . INSTRUCTIONS FOR COMPLETING FORM 115 - SR® - 6395 + To be a complete and accurate sail test,your report must include, 1. Complete lcgiAl description; 2. The use section must clearly indicate whether this is a residence or commercial project: 3, MAXIMUM number of bedrooms or commrarcial use planned; 4. Is this a nevv or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; b� PLEASE use the abbreviat.ions shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Dr-awing to scale is preferred, A separate shr.et may tae used if desired; 8, Mai<e sure yeaur benchmark and vertical elevation reference point are clearly shown,and are permanent; L'. C_arnt late all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 15, If the, information (such as flood plain, elevation)does not apply,place Wk in the appropriate box; 11. Skin the form and place your current address and your certification number, 12, :slake legible copi€a and distribute as requirecL ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols — Stone (saver 10") BR — Bedrock, cols -- Cobble (3- 10-I SS — Sandstone td, Gravel (under 3"I LS Lirnestonr s - S I-rd HGW High C;,t>un dwater. s — Coarse Sand Pen, .. Ferct:flation Cate me d s -- Medium Sand 'ul — Vv 1 C3 ...... G E3;e Sand Bld-J Btdl ding is — Loarny Sand Greater Than m si -- Sandy Loarn < --- Mess Than Loam? Fora Rrovvn Silt Lo Rl __ Rinck ci --- Clay Loam y Ye'4,rvv scl Sandy Clay Loam R Red sifsi __ Silty Clay f..ea<;rn raaot ... i€'ott es=, - sc -- sandy Clay vv with sir.: — Silty Clay ;ff -- few, fine, fain+ Clay c;€ — tacaraarta€:e . coarse pt -- Feat ntrn — Many, rnediurn ,a -- Muck, d — distinct to — prominent I-I'VilL — [-nigh water level; Six general soil textaares surface water for liquid waste disposal BNil - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county orthe Department may request verification of this sail tesi, in the field prior to permit issuance. A complete set of glans for the private sewage system and a perinit application must be suk:tnaitted tea the appropriate local au�tlaority in order to o ,vain a permit. The sanitary perrrait must be obtained and postr;d prior to the start of any construction, DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& B DI VI ON INDUSTRY; ' C LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/M "" ""'. SUBDIV ION NAME:61.p TY: LOT O.:BLK. OUNTY: OWNER'S BUYER'S NAME: MAILING ADORES . � r USE DATES OBSERVATIONS MADE CO Residence BEDRMS.:JCOMMER7AL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: yarResidence ❑New Replace I /� it RATING:S=Site suitable for system U=Site unsuitable for system /1 S CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: YSTEM-IN-FILCH LDINGTANK: RECOMMENDED ST M:(optonal) MS ❑U NS ❑U ]S ❑U ISM Zu ❑S ED 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: I Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING -TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH1T4, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWEL ING INTERVAL-MIN. PERIOD 1 PERIOD2 PERI PER PER INCH P- P- P- 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 r_ tN E 3 i 3 f j € � 1 t 1 t I ! l .4.. {. .�.......,._ ...._.� I I 1 a i m I,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 WERE COMPLETED ON: ADD SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): �.,/ _ CST ATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) OVER — V • T •. -30� ,���cfo G✓/!arty /1�!/.�%r rt �1 l ol mss.,