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HomeMy WebLinkAbout038-1138-40-000 \ � 2 $ � a ¥ © \ 0 CL ® ;aa §$ @2 ƒ �k� / 2 Kz%� k (�0 c 0 E k 2�a & e 0) $ a)w*0 ZCj _ - 0 co � IqX » 1!� cc \ )§\ )) ; f \ � n , « \ � B 2 { J � ) a. $ § % .. . � \ z 2 z 2 ■ e 7 2 D m ; \ ) 7 } - ! A / \ $ , g z CD z .. LO 'a / § 2222 v ; a o a .0 / ■ » ƒ I - m z 2 2 2 \ \ § \ \ k k ° \ \ \ g \ { § \ \ 2 0 o g o t I e ) k If 2 © ® � � 2 $ % ( / k o § :3 C, LO \ § d §ƒ § § k ) & ) / z z 2 ] 2 § § . £ 2 2 \ z z « a a § \ § S o ® g ' g -� o n n z m o z £ / e ■ m # 7 � m IL , \ .%.: (L 2 E J ' @ a § o J a \ 3 1 J , Parcel #: 038-1138-40-000 03/11/2009 10:39 AM PAGE 1 OF 1 Alt. Parcel M 34.31.18.566 038-TOWN OF STAR PRAIRIE Current X. ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner GLENN A&MARY S TR NEWBY O-NEWBY, GLENN A&MARY S TR 1847 110TH ST NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description ` 1847 110TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 34 T31 N R1 8W SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 34-31N-18W Notes: Parcel History: Date Doc# Vol/Page Type 11/19/2008 884483 QC 07/23/1997 436/497 2009 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 39.000 97,500 0 97,500 NO OTHER G7 1.000 20,000 123,600 143,600 NO Totals for 2009: General Property 40.000 117,500 123,600 241,100 Woodland 0.000 0 0 Totals for 2008: General Property 40.000 117,500 123,600 241,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 114 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER t 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: ��/ Lenith: Number of Lines:_ Area Built: Fill depth to top of pipe: �8 Number of feet from nearest property line: Front, 0 Side, O Rear,O Ft .� 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, 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• .J �� 5�� License Number: 3/84:mj Form - S T C - 104 J f t AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP , 1( �� SEC. 3 T �N-R�_W ADDRESS � � ST. CROIX COUNTY, WISCONSIN 3 7 3/ ��• sw/N�j �6 d QOa2bV sy6� SUBDIVISION LOT LOT SIZE i� PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM U' Ge V"� az 14 ll = �Sc'he,�" TE NORrH ARROW BENCHMARK: Describe the vertical reference point used 1 - ,/ Elevation of vertical reference point: 40't_ Proposed sl pe at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side, Rear, O feet From nearest property line Front,0 Side,®Rear,0 feet Number of feet from: well buildingj (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS P.O.BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MatG11SON,W 1 53707 BUREAU OF PLUMBING SE�4,NEk,933,T31N—R18W UCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number : 1, ❑Holding (If assigned) Town of Star Prairie g Tank ❑ In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE7: Glenn Newby Route 5, Box 46, New Richmond, WI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St.Croix 99067 SEPTIC TANK/HOLDING TANK: MANUFACTURER: TL UID CAPACITY: TANK INLET ELE V,. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER Of ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET,FROM LINE: AIR INLET: ❑YES ONO ❑YES NO NEAREST` DOSING CHAMBER: MANUFACTURER- BNG: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑NO El YES ONO I ❑YES ONO 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) EYES ONO 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: BEDITRENC.'H WIDTH TRENCHES DISTR.PIPE SPACING. COVER INSIUE DIA. #PITS. LIQUID /�� TRENCHES. MATERIAL: PIT DEPTH. I31MENSIONS v GRAVEL DEPTH FILL DEPTH IDISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL NO.DISTR ':NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER: ELEV.INL 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS. DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED. t CENTER. EDGES. ❑YES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: SA LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: . IT�tE(�GH TRENCHES RENCHES MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: £LEi(ATION A-�Ii� [ 1RIUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED �Ai��1U��MTI�N PLANS. ❑YES NO YES —]NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FRM LINE: I ❑YES ❑NO DYES 1:1 NO INEARE ST� 2, fo. 55, 10- 8I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION T , 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, usuall'j 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 owners 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; Vl. 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 �� - commoniy 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��ter = .. included the creation of surcharges (fees) for a number of regulated practices which Wisco in can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ieaSui.re 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. a The monies collected through these surcharges are credited to the groundwater fund adrninis- 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. saD-f398 i19t.03/36) SANITARY PERMIT APPLICATION COUNTY ST 7DILHR In accord with ILHR 83.05,Wis.Adm. Code 0,R0 STATF_SANITARY PERMtT# 7 -A�tach 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 NO PROPERTY OWNE PROPERTY LOCATION '/4 %4, S 3 T , N, R Ig E (or)V PROPERTY OWNER'S MA ICING ADDRESS LOT NOER BLOC NUMBER SUBDIVISI N NAME CITY,STA ZIP CO PHONE NUMBER CITY NEA EST AD,L E OR LANDMARK O VILLAGE 11. TYPE OF BUILDING OR USE SERVED: - D —�o�CS-�O Number of Bedrooms if 1 or 2 Family 3 OR 1:1 Public(Specify) 3� 3 III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. =New b.0 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. XConventional 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. 9 seepage Bed b. ❑seepage Trench c. ❑seepacie 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): Feet 19 Private ❑Joint ❑ Public VI. TANK CAPACITY Prefab Site in allons Total Manufacturer's Name Con- Steel Plastic Exper. INFORMATION ##of . Fiber-New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank — 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' Name(Print): Plumbe 's Signature (No S mps) MP/MPRSW No.: Business Phone Number: P um is Ad res (Street,1 2y,State,Zip Code): Name of Designe . VII . SOIL TEST INFORMATION Certif' d S I Tester( S Name CST# CST's DR SS Ptreet,City, te,Zip Code) Phone Number: f� IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved El Owner Given Initial / Surcharge Fee Q Adverse Determination 1 vY�5.C)0 � -87 01,,Ij 0M X. COMMENTS/REASONS FOR DISAPPROVAL: Ciroi.oc, b� �-t�.��,c.� e - hj.-e is do SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INSTRUCTIONS NS FOR COMPLETING FORM 115 - SIT - 6395 To be a complete and accurate shit test,your repot°t rust include. , 1. Complete legal description; 2. The use section must clearly indicate vvhether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement systern; 5. Complete the suitability rating boxes.A SITE IS SUITABLE FOR A }BOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; S. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; ?. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sel'ante sheet may be used if desired; S. Male Sara your benchmark and vertical elevation reference point are clearly shown.and are permanent; 9, Complete all appropriate boxes as to dates, dames,addresses, flood plain data, percolwicin test exemp- tion, it appropriate; 10, if t;-re information (such as flood plain,elevation)does not apply, placer N.A. in the appropriate box; 11, Sues the form and place Your current address and your certification number; 12. Make legible copies and distribute as required. 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 ;over 10") BR — Bedrock cols -- Cobble (3- 10") SS -- Sandstone gr — Gravel (under 3") LS — Limestone s — Sand H G W — High Gioundwater c,s - coarse Sand Perc Pewolation Rate Hared s IMediurn Sarrd W - kAvo11 f -- Fine Sand Bldg — Building, is Loamy Sand } — Greater Than Is! Sandy Loarn Less Than 'I Loan) Bn Brov�n srl .... Silt Loarra Bl ._- Black Silt, G ...._ c_iray 16 Clay Loam Y yei1G-%v set Sandy Clay Loans R R,r di Sic! - Silly Clay Loam mot - motiles J sc _ Saa dy Clay wr vv ttr sic — Silt~} Clay fff -- few, line" faint: IC Clay cc —� �,orrrm.sr:, coarse" pt: - Peat nicer Mary, rnediurn r [Track d — distinct p — prorninen't H`JVL - High vvater level, Six gerteral soil textures surface water for liquid vaaste disposal BM — Bench Mark VRP -- Vertical Deference Point T O THE OWNER: This sail test report is the first step in securincl a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sevvacge system and a permit application must: be submitted to the appropriate local authority in order to obtain a perrnit,The sanitary perrxtit Must. F.ae obtained and posted prior to the start of any construction. INDUS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDING INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.°. BOX 7969 HUMAN RELATIONS \ / MADISON,WI 53707 (H63.090)& Chapter 145.045) LOCATION: T SECTION: TOWNSHIP/M Y: LOT NO.:BLK.?O.: SUBDIVISION NAME: i - 1/ / N/R E (or n f , COUNTY: OWNER'S BU EFTS NA E: LNG ADDRESS: ZWW� USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER L DESCRIPTION: Ml ESCRIPTIONS: ER O ATI N TESTS: Residence [:]New WReplace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL:IMOUND: IN-GFtOUND-PRESSUR_ -. S STECM-IN-F�I JLL HOL &GTA* NK:IR,t EC OM NDED SYSTEM:(optional) ES DU ZS �� QS ❑U ❑S Y � Y J If Percolation Tests are NOT re uir DESIGN RATE: Q I lf any portion of the tested area is in the / under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER IDEPTH W4. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Ad Zi bnll� B-,4? -�( > Q,s 7 J B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 1 S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOU2 PEP4 PER INCH P_ 1 :�7 q - AIW(Z 36 P- 7 Y 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. � I SYSTEM ELEVATION 8 _T 77 Id. > > I � I aw % tN Ai E , i I E ; ) 3 E i a � f v F I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m thods 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 1v1,r,ipr1V1 : j TESTS WERE COMPLETED ON: ADD SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): n__ �.1. CST NAT RE: L STRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. LHR-SBD-6395 (R.02/82) —OVER — 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 4t /Ll,4ley Location of Property S167- k 14, Section 3 , T 3 I N-R 623 W Township S'r— 2 ej -sew Id Hailing Address /Q S Ao,*-4e S*O! 7 Address of Site Subdivision Name _ . Lot Number Previous Owner of Property Total Size of Parcel AG! Ps Date Parcel was Created ,7 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes �_ No Volume 3 _ and Page Numbers as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrantq 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) cvtti.6y that att statements on thin olcm ane true to the best o6 my (om) hnowt.edge; that 1 (we) am (ake) the ownen.(b� o6 the phopenty de�schi.bed in thin in6o4mati.on 6oAm, by vixtue o6 a waAAant de d heconded in the 066ice o6 the Count RepAten o6 Deeds as Vocument No. ; and that I (We) pneden,tey own the pnopoded 4 to bon the sewage dyes em (on I (we) have obtained an eaAement, to kun with the above de CAX'b p opehty, bon the con6tAucti.on o6 natal dyetem, and the dame ha.e b y necotded ice 06 the County Reg"teA o6 needs, ab Vocament No. ) a E71 SIGNATURE 01 OWNER SIGNATURE eF CO-OWNER (IF APPLI ABLE) DATE SIGNED DATE SIGNED r ST C - 105 a ' t H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a A' H OWNER/BUYERr7LFN Z6 ,V A d ' -/ZSi s- /���waY ROUTE/BOX NUMBER /Q7-3- '4F&'Kq 6 Fire Number CITY/STATE iU�'7.v %C�t NsK a N —ZIP Fy 617 SuJ /V 3V TY LOCATION : =�, INr 14, Section 33 , T 31 PROPER $t+- Town of si?>%�2 / /�If�ea.,a 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 , if needed , by a licensed septic tank pumper . What you put into !I 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 H three year expiration . o I/WE, the undersigned,, have read the above requirements and agree L, to maintain the private sewage disposal system in accordance with H the standards set forth , herein , as set by the Wisconsin Depart- 'b 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 4�r St . Croix County Zoning Office P .O. Box 98 Hammond, WI 54015 7.15-796-2239 or 715-425-8363 Sign , date and return to above address . r,DCUMENT NO. W4PPART) DEED -ON --I ,P.%l STATI Of %, ,'�,I\ THIS SFACL RLSLVN*U) 1`01: UATA CZ I L 1% THIS INDENTURE, Made this ------ day of...... A. D., 19....67., bctween__.,_J_nh_n---- re. Gex.maifi, ST. CROIX CO.• V. husbandan(I wife.......--_-----------------------------------_---------------------------------------------_--------------- ----------------------___1--------------- Rec'd for Record this-- ........................................------- ---_-------------------- ------------------ ------------------------------------------------- day of Sertember __­ ­-------------------------- ---------------------------------------------------------------------- A.1).19' ------------------------------- at M• ------•----•-------•--••-------------------Usafk-----­------part--?:-"-.of the first part and 1�ewby husband ane. wi.fe ----e---n...n------A---------I------- ....g�pd... ......­1..........------------------------------------------- -­----------------------_•---------­ ......... --------------------------------------------------------------------------------------------- ------------------------------------------ ------­--------------_ Reg star o e e -----------------­part--- _e _of the second part, RETURN TO W I t n e is s e t h, That the said part.i__e_s__..of the first part, for and in consideration of the sum of--..T -e hundred an(?_qq r.t.e-e-n -----------------------t1�ousan_d----f-i-y------------------ .... .......... -------no/l0C --------- Aolla-r-s-------------------------------------------------------------------------------------------------------------------------------------------- ......—_--------­-------------—----------------- to---------R S_---------in hand paid by the said partkf�---of the second part, the receipt whereof is hereby . confessed and acknowledged,ha_:Ke...given,granted,bargained,sold,remised.released,aliened,conveyed and confirmed, and by these presents do_...------give, grant, bargain, sell,remise,release,alien,convey and confirm unto the said part__i.e-§.of the second partb�e.i_Xeirs and assigns St. forever, the following described real estate situated in the County of--.-----_--------------Cr _91 0.......------and State of Wisconsin, to-wit: The Southwest ouarter of horthwest of ctiOC3:4�-) South- east o Sec ii 33 all in east aw-irter oil .'.ortheast quarter S'� ;'4 4 1 7.0 r 0 Townshi-P 31 'Yorth Rpnre 1F, West, 8 es r.,ore r e o r lessi St. Croix County oiscollsin X- (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;and all the estate right,title,interest,claim or demand whatsoever,of the said part.-i-e-Sof the first part,either in law or equity,either in possession or expe ctanc%, of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said part.3-f!.Sof the second part, and to---the.iX!.heirs and assigns FOREVER. Ana the said. John D. Germain and Berencere Ge mai.n,. husband and wife.1.....................................................................................................T............ ....................................I-------------_-- --------­---------------- ........... ------------ ........................ ....................................................­---------------------------------- ........ for.. . V A)-c-ir----------------heirs, executors and administrators, do------------_-covenant, grant, bargain, and agree to and with the said part.....__of the second part.........th e.i-r.........heirs and assigns,that at the time of the ensealing and delivery of these presents .th e,y...aXe . .........well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple,and that the same are free and clear from all incumbrances whatever................................................................ . ................ ..................­.............I........... I.... .... ... ......... .. . ..............................................................................__.......... ...........I........... ..•. ........-----•----.___...._..--- ................­1...... ...... ­ ...............................­...........I................... ... ..... and that the above bargained premises in the quiet and peaceable possession of the said part__1_e_.%f the second partVI.Q.iWeirs and as,igrls. against all and every person or persons lawfully claiming the whole or any pact thereof,__'t.h.eY------will forever WARRANT AND DEFEND In Witness Whereof, the said part-i-e-Sof the first part ha_Y_L'__.hereunto set----thedXband._5L__.and seaL__8__.this-----2 o:th_ day of... ....... A. D., 19 I ISEAL; SIGNED 7,D SE LED,11PRESENCE OF John D. Germain ­............... ----------------- 1 1 1 - I_(SFAL) 14'. Ward il4ererqere Germain ..........-------...................................... -----------------.................... (SEAL: ............ ... .­­--------------- ........ `iune ........... (SEAL -----••----- STATE OF WISCONSIN, St. Croix County.1 Personally cam-c before me, _day ---------------------_-------- A- D., 19.�_-- theabovenamed_John D. Germain and Berenpere Germain , husband and wife to me known to be the person-------who executed the foregoing instrument and acknowledged the same. Wm. W. 'Ward NOTARY SIEAL This instrument drafted by Notary Public__—------ .•..... Wis ----------_-------...... NI N Commission MiN" (I ii).... I e r ma n en t (Section".31(1)of the Wisconsin Statutes provides that an Instruments to be recorded&hall have plainly printed or typewritten thereon the names of the grantors,grantees,witnesses and notary). DEEI)—STATE OF WISCONSIN, FORM Isi 0. 1 43b 49*i C ­19.cc'. .—I kA) c �Jr = 9- 19-S-7 y� ,Slav EwA:) l y; A 5 t—oylj Heusi J,rdK r PAGE OF Fresh Air Inlets And Observation Pipe C Approved Vent Cop Minimum 12"Above "//NIIYY//�JO UI(I�i �ONd � final Grad. 20-42"Above Pipe _4"Cost Iron To Final Grods Vent Pipe Marsh Hoy Or Synihetk Covering win 2"Aggregate Over Pipe DISnIDullon —Tee ' Pipe 0 0 0 0 0 6"Aggregale ILI P erforated Pipe Below enealh Plpe —Coupling Terminating At Bolcom Of System SOIL FILL DISTRIBUTIOf.I PIPE APPROVED S4NTH ETIC COVER �'.• e o ° '" -pl ATEP'J A . OR 9" OF ST. RAW Its OF hGGRIEGAIE ' MARSH HAy e � 4o'OF12-21/2 AGGREGATE �R tLEV. OF� FEET, ..�\� %I D15'T'RIA1JTIOIJ PIPE TO BE AT LEAST y�`i INCHES BELOW ORIGIAJAL GRADE A►JU AT LEAST20 INCHES BUT AIO MORE THAI) H1 IMCRES BELOW FINAL GRADE MAXIMUM Mrvi OF EXCAVAT100 FK011 0KI&INAL WK. WILL BE INCHES MINIMUM! 9F-Pro OF EACAVATIOM fP\01A It> 161VJINL GRAPE WILL 8E INCHES SIGHED: LIGEUSE DUMBER: i� DAT E : =L`�� ,� 1 110 JJi