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HomeMy WebLinkAbout030-2072-95-000 G 0' C 2 3 p A A 7 N A O R ' A7 A 0 m CD p y o ° I o y o ° i ° C w ° f c • J <, Ci C �'+` O 3 3 C 9 Oo C .I L W Q j j N C "' p m N N O I Z Z N O y ° r� A O C\ Cn N CA U) rCT O o 1a fpD C n c�D', A O p H N N I p to N L ° En S1 G G N I O `ry In < D a l (n D A a N c`, o CD N I-c-� -' o m CD N c a CD c 3 o m CD N O O O CL O t t0 N O CO ID CA --� (� W N jv � � CD O O C y OD Co �. N r CO) N I v V= 1 3 w Q lr 0 n� 000 � 000 o 0 � o C -0 �+ nDi ro � < Z c D to cn to v c to to to N o G 0 Q C G + o .l7 y N O) (D CD .► A •= �p (D lY Q ,N•' N N .di O fD O) d co a I o D o o I D CD o O -• T o I I � � N y I CD C/) N !r• CD N N C 0) CD .•. p. N N �f CD CD (D a CL a A Z o cn - I w a a� Z o f I o FF cn No N y Z m v I `D a f D CL 3 c CD m D a I CL a m o N N m c o a I -4C y' o a ..m CD 0 CD m N C) � y. I d CD - � N CL FD fD S O m I o c T F N x N (47 I I O O (D I CD c x '0 0 O CL I O C - ) (n 0 C -0 0 7 r ra i / A � � � ) � cp F Z 0 0 m e. c— ca (D oo w z z C (D (D CD co 00 i;3 R) 0 0 :-4 0 \ ^ \ IA (4) to CL OD CD e (D CL CD \ E: CL 3 0 (D to 0 G) cc CD co @ 00 00 0 c ■ 4 -4 w tr E ; CL M z 0 0 0 9 0 :* < T / cr 0 C/) m 1 3 m -0 M m m CD N) 00 z 0� z � � \ \ z 03 z � � > m CL U) c (D 1 0 M. CD w I Cl. 3 CD z m cl k z 0 G) :3 C/) - 4 C4 � ■ � � CA) c :> §± 0 0 0 (D 0 CD cn » C CD co 0) CL X 0 0 k-4 Cb m ¢ t-j 4A 0 p G ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner r� /A/� i f �iI! s(!�t/ STif�4�! .S • syd 3 Addres 2-5 Z Tie City /State U/�IO.y kJ /. Syo /fi Legal Description: Lot Block SM # •3 Z Sec.3 , T, N -R W, Town of S/ • PIN # 034 • ZO 71. • S SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: - L - rtVks /"v Yee f 7s asoa • > y Tank manufacturer �u!t�J�c Size ST/PC / Setback from: House S' " Well P/L S U Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM �✓i ��fi ?4;r Ce / /sue Type of system: Width Length X3 Number of Trenches Setback from: House - 5 ' 2.' Well �5o P/L 2 ' Ven to fresh air intake > 2 S ' ELEVATIONS ( I `/- 36 / ) %OP OF -iewo �i�c.l� �S y'� C 2 - /� • v Description of benchmark V- -i'� ��siJ� "1 7� Cr Elevation ' Description of alternate benchmark Elevation y 44 Exrsr���- �x,•si��vc,- Building Sewer A ST/HT Inlet 4 ST Outlet G 'ys PC Inlet PC Bottom / Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) () ( ) Bottom of System( Final Grade ( )� 0 of • a-oo � 3 9 �ypf �_ Date of installation / / Permit number State plan number •! 2 1lr 3 7 /0 3d • °� Plumber's signature / License number / Date -- ^tor ?�Jyla U/` /� � A01?5 Complete plot plan syS7e /,� �!/ vrFl� -e — C/v S`S'T • o,v "��f ��TT� -- . l Vg!�s 7 /,-o A f 3a' P s s O;o osa � � l f� vsa S ,o� ` j .� TUB �f o y r 113' �I it P/57. Wl T 30 �r of jiff �°p O F Sffd /S 9� 7 3 1 � p o t , id o o 7�t ys. L y2 SC 5 2 NeX ev// U•¢ /v all _ W r Zz Cl,v�/l e �S 5 �i 6- , o'er -5,7. Gvi Ste' ciates N&W L UGrei� fir" Vlbricht &Ass a Consultan 11 prtivate gQ wag eO 1U- 655 p�'yalw gd' 5400 f� Hudson, / V Sf * - T° of �-- 0 • f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399405 , GENEFfAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal inform&0on you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). �— Permit Holder's Name: City Village X Township Parcel Tax No: Strom, Blaine St. Joseph Township 030 - 2072 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: (4 OD .D t c, = CST — evM 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Se tic Benchmark Alt. BM Aeration Bldg. Sewer 9� Holding St/Ht Inlet t L TANK SETBACK INFORMATION SVHtOutlet qb• �s' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD et r 5,-#2 '�' b• s� as �s Z > > So ZS 45 .33' Begin IH�mder/IV16n. Aeration !— I � 5 ` t� ° l2 -Ye Holding Bot.Syst It 8D) �•8f r 6 PUMP /SIPHON INFORMATION Final Grade rrn Manufa urer Demand St Cover ro�oQQ GPM Model Numbe lh p I G. 3(. t� • Z� TDH Li Fri n Loss System Head TD Ft D T Forcemain Length Di Dist. to well SOIL BSORPTION SYSTEM (3) 3`x -k I fi (2) V x (.2.%6 4rtm o - (�- -` ta� S• Width Lengt \ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 i 1 /� 1 r�,G1Q5� SETBACK SYSTEM TO P //L BL / DG WELL LAKE /STREAM LEACHING M ufactur INFORMATION CHAMBEROR TP A—W .5 Type Of System: -32 t S2 I UNIT Model Number: �- • Sa _ DISTRIBUTION SYSTEM f- Ven Header /Maniftl _ ,p Distribution x Hole Size x Hole Spacing t to Air Intake p Id Pipe(s) /_ ? t Length t Dia Length Dia Spacing C7 J SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [ Yes rn� No I [] Yes [W No COMMENTS (include code discrepancies, persons present, etc.) Inspection #1: 0 / a `J D ` Inspection #2: TT Location: 252 Red Pi a Trail Hudson, WI 54016 ((SW 1/4 SE 1/4 36 T30N R20W) NA Lot 1 `�`op3 Parcel No: 36.30.20.624B l y 1.) Alt BM Description Ct u dst" � J �• 0(0 ((• Z7 N•) 2.) Bldg sewer length =,� �d[ .) - amount of cover = 3) ,,e.r �clo. 4. 146 c..tW 4b ,} .+ . Plan revise �ui er d7 L es X No 3' �' Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) i - - � � `'�� o i r i �5 � -_ --� Safety and Buildings Division Qqunty 201 W. Washington Ave., P.O. Box 7162 I S�Ons�� Madison, WI '53707 - 7162 Site Address De artment of Commerce Sanitary Permit App ' I / j ?; Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, pers •,t �p+mgtion y9tr provide * may be used for secondary ses Pri ❑Check if Revision v 1 5 1)(rfi� I. Application Information - please Print All Informdtltn,' State Plan I.D. Number �/V A - Property Owner's Name „ Parcel Number �jGf}iN� AN 5 d,30 72 • �l S Property Owner's Mailing Address V Pro lion � perry iRt be t �a d Z 2 /�-� /�i itl.� � p 2 S u> GG Co •' S 'f 7 C� i�:S� T� N,R � City, State Zip Code Pholi, Number Lot Number Block Number - / 7 S ff'MDSa-0 C 0A J WI&o' 5y ��03 to CSM Number 3 211672, G'v /. , GT H. Type of Building (check all that apply) %I or 2 Family Dwelling - Number of Bedrooms ❑City ❑ ❑Village Public /Commercial - Describe Use 1 �<wnship ❑ State Owned Nearest Road R ,a M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. LS ystem New 2 IA Replacement System 3 ❑ Replacement of 6 ❑ Addition to For Cotmty use Tani 1 Existin, System �. B. El Check if Sanitary Permit Previously Issued '"lit Number Date Issued IV. Type of Permit: (Check all that ai ;.ly)(numbering scheme is for internal use) /h w btu �r. aerJ 44)�Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line so c 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other d 3 3• V. Dis ersa 1/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade /^ Required Proposed Rate(Gals. /Da IS Ft.) (Min./inch) 9z • Elevati G O ' W. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Ifil"t SA Septic or Holding Tank � 0VV 1156 Z Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si nature 14P/MPRS Number Business Phone Number ' R•2l/ /� %(�1i z�-Co V75� 7 1S• 3 - 0 04S Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artm Us e M pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) - ❑ Owner Given Initial Adverse . 2�5 `r Tl * f o' Determination v ( IX. Conditions of ApprovaldReasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. I ' I 2. All setbacks to system and residential structure must meet applicable code requirements. 3. Per conservation with Robert Ulbricht on 9- 19 -01. It is Mr. Ulbricht professional opinion that the deep silts at boring 2 are an inclusion. He is very confident the system elevation for the lower trench of 91.50' will work. However, Mr. Ulbricht indicated, if needed, the system elevation c e a e p otmty only) for the system on paper not leaf than 81/2 s 11 !aches in she SM-6398 (R. 05101) JUL BRICI & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 neg..neslgners of Fnglneering Sy stems 715 -3aG -a 1 a5 f'rivele Sewage Consullenls • PROJECT INDEX PLAN ID # DATE OWNER 3/*,,VE SIN Yv,v, 577 PHONE `���' ���✓ A U DR E s s 25.2 iP-eet A;44C 7 ffUDSa_ 6 /y. 5_ y6/6 LE DESCRIPTION GOB ,{ CS 3 2 V6 2- ee 5 Gv 5 3Co, 7' 3 o .v, /' its Gv /- 0 30 • zo 72- - 9S TOWN OF < 5 -/• COUNTY LOCAL AuviORITY/ SUPERVISION d - 1' �d /,x_ C�� �N�•�G— P ROJEC T UESCRIP'IION: de S S ys /• v�Gv,� . 9 � I q� Ulbrich & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 Pg.l INFILTRATOR SIZING WORKSHEET , �� O� Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 if it ff it Pg.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG•7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." Version 2.0 SBD- 1075 -P NO1 O1. o p , N- N cn �, -- M w Wiz � T o M vi 1311 Y1 - 2 T Ex l T ,.j,SOUE OUTLET SW1,11 0 9G , �y , - To 13 E P EMO�Go s, 7 D � S r• � DR °� f3E i ti�w (g v // U ,4 1pe � rs� � �y"' I I 2.b I II �j ' II II i� II I I II 38 r II(� II 70 \ jl�b. I 1 � � ( • I I � 'D 01 q 1,50 q CrFI�uthTED � i 5 -f4Nu. f o1^ "f 5 - U P f ��a I/ fl �9PPiPa /0 r r -. p er c o.v 4" IlAek&tP 7 NS U ,v 10iv. 2 , 1 ff Iii .. N NI eve< y o S S EC T 1,1 1 0 CR S S � 6 7e,4 �• C c � � '' ��Ew N �� D � G �� " t ov P � y flPf �h T /d ' ow iNSAEc T/o 0 0 /," 1/l Vii / -- ^�.. ��iv,'s QED � � • � . 1 . «1fe rir&vex,-� OVER: See Reverse Side for Vent/ Observation Pipe Details. PAGE 6 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS 5 -r- Aoily * Governmental authority/ inspectors: ID- 3 86 • yG �o *.Licensed installer, responsible for providing an operation/ maintenance "Users" manual: 7 s y * Licensed service / inspection agent other than installer: Cyy * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. i 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the 1 e cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'T'EM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualiOied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. POWr 71t v s veo Gy , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings iJ in accordance twjth Corhm 85 Vi/is Code L' Attach complete site plan on paper no County I less than 8 xA I inches i ize Pl�►k nu include, but not limited to: vertical and horizontal r (ere poil� irection Parcel I.D. p 3p . 20 7; • / s percent slope, scale or dimensions, north arrow, nd stance nea st ad. Please print all in o at /on. �.Q r- Re 'ewed y ` Date Personal information you provide may be used for se pure oVIri a ' s. 1 .04 1 Property Owner r G cop cation t U1/�f/t SUN $ ® G L 51V 1/4 1/4 s36 T 3 6 N R E ( W Z Property Owner's Mailing Address -� L i Block # Subd. Name or CSM# S Z f� D Pi,t�F JAN L. � ` � � C'514 PA ylo 7 2 (/o /• // Pg City State Zip Code Phone Number HUD,SDA) (,(� , .S O /(� 7� S s � ❑City E] Village own Nearest Road / y ( S y9 y 3 ST JOSE Gv &,P Pr ve- Tfe ❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate & & GPD Replacement ❑ Public or commercial - Describe: Parent material �d�D Y ovT LlJl4k41 Flood Plain elevation if applicable ft. General comments D 1 and recommendations: 4 Cf,Rf P • .S 401, ,AJ / y 1 f0 6 — �� ( 7 v �� X3G 3 C 9 ) HOST 1-?/ coD-G $5/s1='49 A&Q_ a Boring # ❑ Boring 99• y , C,Q ® Pit Ground surface elev. ft. Depth to limiting factor / V in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eff#2 0 - 9 /o yR 3/3 — L 2fSkir 1w - FR CS 2 f- .5 . . 2- • / s /o YR G5' /,' M cl e cs — .7 !. L DT �xrSTi' S si • i'S i;v o� �- l,• .vi �S o./ �,� •2.1 VIA 13 oll U.�vje . ❑ Boring c B ❑ Pit Ground surface elev. l -70 ft. Depth to limiting facto /Cm in. Soil Application Rate 0 on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color G r. Sz. Sh. •Eff#1 •Eff#2 o •io /o YR 3/3 spar � K 2. it •s io Y,e S IL / s K • Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number � oQEfP7 — Zll6��'c 2 z Ce 3 '7 s Address Date Evaluation Conducted Telephone Number 3 z 7/S•38co •8 /8S Utbricht & Associates private Sewage Consultants 655 O'Neil Rd. ' 1 Hudson, Wis. 54016 N �G Qu- "vlc w -,ARYK w/ 3 0 6 v 1 by1Z ' 6K it t l 6 {„ of -IA �� �cv1 `Nn•. ' 44 I +S • �. G�.t,t. C--11 ; 7U Srr � e vn •.G(wtroVftyh e% a 1 •S b I W1 tl wirt k f L 61Medt e.� YKf , I) 1 6i, "n - i cl intov,,- Ufa A,. obi �- Sz t 6 2 . M _ Property Owner ✓� / ' Parcel ID # 03 140 7 d- - fJ 2 l Page of F-3 Boring # ❑ Boring 0 > Q Pit Ground surface eiev. y ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o •,o /t) xe 3 /3 - Sic /fsbK I A - f • Z . 3 1- •3l0 /0 --- Z A" ,C cs .7 !- Z Boring # ❑ Boring D D y / 9 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 /o 31 4 z 9" Y2- YR Y � �� �fs�� '4 „ f Q s ��- y� • •� s s o, S5 F] Boring # ❑ Boring Ground ❑ Pit surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider qnd employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.6100) ' _• • ; 1. .. I - � ----------- N T-5 / / T OV7 �l g ► � �,fsr o 5,7 ,O" >1 �D�E gRfl OUT4e7- - TD 13 E PE x 4 g 3 � t fJE n sy51 2, e4f i r l 1 r I I 7 1 X31 � 6A O 8 �0 o o, � r loo 93, � f 3 — i ST CROIX COUNTY • SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Uwner /13er ��i'�l�E ? �N SvN J`T/PD/�J Marling Address S- � eOX T ' Property Address (Verification required from Planning Department for new construction} City /State Parcel Identification Number 0 - LEGAL DESCRIPTION Property Location . 4t) ' /,, ` e ' /,, Sec. 3 , T �� N -R 2 W, Town of Subdivision , Lot # la d Certified Survey Map # 3 21/1171- ,Volume l ,Page # SSA/ �f Warranty Deed # ,Volume 120 ,Page # Spec house ❑ yes K no Lot lines identifiable x yes ❑ no SYS'T'EM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se =APPLICANT tic sstem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of th three ONATU DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the described above, b virtue of a warranty deed recorded in Register of Deeds Office. 11 / SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include 1001 this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed �� 0 RIGIN STATE BAR OF WISCONSIN FORK' 2 - 1982 551642 WARRANTY DEED , DOCUMENT NO. • j F GISTEA 3 C; ri C David J. Defenbaugh and Mary E. Defenbaugh, ST. CRCiXCo..V4 husband and wife, �j R�dtaRtoad 'NOV, 4. 1 _. conveys and wart ats to Blaine W. Strom and Un Sun Strom, 1t 8:45 A. M husband and wife, as survivorship marital property, jl I THIS SPACE RESERVED FOR RECORDING DATA -- NAME AND RETURN ADDRESS the following described real estate in St. Croi County, State of Wisconsin: Ii i 030- 2072 -95 PARCEL. IDENTIFICATION NUMBER Part of SW 1/4 of SE 1/4 of Section 36, Township 30 North, Range 20 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed Novemher 12, 1974 in Volume "i ", Page 68, as Document Number 324672. This is homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this 3 0 day of October A.D., 19 (SEAL) _ (SEAL) I I' ' ••�� DAVID � J. DEFE AUG _ I (SEAL) O y' (SEAL) U (j MARY E. DEFENBAUGH AUTHENTICATION ACKNOWLEDGMENT Signatures) State of Wisconsin, ss. II _ St. Croix County. ►h authenticated this day of , 19 Persona came before the this day of_ October 19 -2fi-, the above name'' David J. Defgnbaugh and ' -- Mar-, E. Defenbaugh. hnsthand A f TITLE: MEMBER STATE BAR OF WISCONSIN I wife - I lf not authorized by 970(t.06, Wis. Stars.) to TO-Q- to be the person s who executed the foregoing rument d ackncwkd t sarru z � I THIS INSTRUMENT WAS DRAFTED BY V STEPHEN J. DUNLAP _ `1Q Hudson Wiscons fe � n ota - , St. Croix County Wis. (Signatures may be authenticated or acknowledged. Both are not commission is permanent. (If not, state expiration due: trecessary.) .5- q , 19_2_.) �� • Noma of persons signing to any apaiey should by typed or primed below diet start., es. JANE TERKELSE N WAttlAtM DEED sun a" OF WtSCON V Notimy public 1pW 8rr k Ca. kr li Fees Ne. 2 - 1911 � 01 Vsconsin •' 324672 f 1� 11 CERTIFIED SURVEY MAP c, FILE D PART OF SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER OF im 121974 `' SECTION 3'6', T 30 N, R 20 W. St. CROIX COUNTY r . d/&E6 O' CONNELL WISCONSIN 1*y4br of Do*& I\) sr , mi County, N. E. corner of S W!", of ni w SE ��y of Sac. 36, T30 N, R ,2 W, Sf Croix Co., Wis. ,. 5 88 °5 1225.00 _ — — - — — — C4 325.00 5 500.00 '0 10 � �r 0 o b Lof / o b kd Lof 2 •W Lof 3 0 0 & • > 0 3z'r 89 CO ti � Q 126-.00 0 Easement for All corners travel over ex- o isting road to rn arkad by iron S .T.H. 35 is pipe 1 "x30" granted to all I N L o f " h Lots. weighing /./3 /bs I o . S. 00,2 pe /irk. r74 � O • I kh o JC AV 77.8 ° .. • C ;c1 W /V 88°//' W I N M of be9ir�r� o "'r r r ( a ,4 - fh Vq corner Scq /e: / ,200' c. 36 -30- �' Z Surveyed for Leslie Lindstrom 7a 89 ° 2 /E Nov. 1974 Description: That certain parcel of Land or tract of real estate'located'in the southwest quarter of the southeast quarter'of Section 36, T 30 N, R 19 W, Town of St. Joseph, St. Croix County, Wis., more fully described as fol- lows: from the south quarter corner of said Sec. 36 go S 89 21' E along the south line of said Sec. 36 a distance of 1311.0 feet to the east line of said quarter - quarter; thence N 1 00' E with said east Linea dis- tanec of 438.03 feet to point of beginning for parcel herein described; thence N 88 11' W a distance of 477.84 feet; thence along the east and north side of a road as follows: N 7° 35' W a distance of 275.00 feet; thence along a curve, concave southwest whose chord bears N 25 15' W a distance of 125.00 feet; thence along a curve, concave southwest whose chord. bears N 64u 15' W a distance of 358.85 feet; thnec S 83 23' W a distance of 327.89 feet; thence leaving said road N 1 00' E a dis- tance of 339 .53 feet to the north Line of said quarter - quarter; thence with said north line S 88 54' E a distance of 1225.00 feet to the north- east corner of said quarter - quarter; thence with the east line of same S 1 00' W a distance of 835.00 feet to point of beginning. I hereby certify that I have surveyed, divided and mapped the Lands described above; that the above description is a true description of the exterior boundaries of said lands and the above map is a true and correct representation of said lands; that I have fully complied with the provisions of Wis. Statute 236 in surveying, mapping and dividing said lands 324572 , ;�? St. Croix County Certified Maps James R. - Grubb "folume l Dage 68 is. Registered Land Survey t 324672 9 W r 171), "`T'TiTF) ' �\,7py "JAP 4� PAPIT Oil' ST. C X COUNTY Q) FILED T r i D rpl - - () T T j rn 14 , ITT ; -1 , - T V1 1 _a SCTTMT,jT -AST AR J., I fT T I T. 2 o w St.CRO CO".j11 NOV 12 1974 0 N TX 3AMES 01 COMMUL i- i A" T (1 1 0' 3 T T" kb Count /Vf C orn e- r o - F S W f of Sec. 36, T JTON, 2 0 W, '5 - A C)-O/* X Co., Wis . 3.26 00, 0. 500.0 opt )0 'Z o 50"'o 0 k4 07 Lo 'A to 'A 0 2. 369 N, S sti 327 89 2 7 15 000 0 a NZ501.5 X06 1 Q) Easement for All corners over ex ,�' �� h g istin road to mc7rked by . ro r2 C; S.T.H 35 is pipe S44kas 1"X30" N () to all 'n Z o f Lots. we/ 7/ _q 13 16:5 p er '17. rf /V (58 0 W ' 41 of b /)7 t7 e y Q� C0rP7P- 01" 4- Sc a /e 200' Sec 30-zo Sur. vey(­d for Les Lie Lin(9strorm 79 A 9 ° 2 / !'Tov. 1974 Description: That certain parcel of land or tract of real estate 'located 'in the southiqRst quarter of the southeast qfaarter'of Section 36, T 30 N, R 10 W, Toi,\Tn of St. Joseph, St. Croix County, Wis., more fully described as fol- lows: from the south quarter corner of said Sec. '36 go 3 39 21 'P, along thn south line of said Sec. 3 a distance of 1 feet to the east line of calid quarter-quarter; thence N l 00 F', i�.Tith said east Line �Ii­ tanec of 438.03 feet to point of beginning for parcel herein described; C� - ,,T 9 8 0 11 W distance o f 4 77-8 4 fee; t thence aion the he east an , ' tthence �' a _, t-, north side of a road as follows: N 7 35' W a distance of 275-00 feet; thence along a curve, concave south"Niest W'nos(' ch ord bears '1 2 5 0 15' W a distance of 125-00 feet; thence alonF, a curve, concave southwest iihosp chord bears N 64 15' W a d-istance of 358.85 feet; thnec S 3 3 0 23' W a distance of 3 feet; thence ieavin() said road id `1 0 0' T` a dis- tance of 339.53 feet to the north line of said quarter-quarter; thence With said north Line S 88 54 '-E �-,. distance of 1225-00 feet to the nort a s t cor­2-=r of said quarter-quarter; thence IATitl ti east Line Of sc S 10 0 eD 00 vi a distance of " 35. 00 fO to Point of beginning. I hereby certify that 1 In eve surveyed, dividt d .'and. r ppe(l. th�(.-. described above; that the above description is -a true description of the exterior boundaries of said. lands and the above map is a true and. correct representation of said Lands; that T have fully complied with the provisions of Wis. Statute 236 in surveying, mapping and dividing said Lancls. 324672 St. Croix County Certified Maps JemeG R - Grubb o L um' g pae . 68 6 I i �' s�ered Land Surveyor S-72� 0 Parcel #: 030-2072 -95 -000 04/1212005 12:24 PM PAGE 1 OF 1 Alt. Parcel M 36.30.20.624B 030 - TOWN OF SAINT JOSEPH Current x1i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner ELAINE W & UN SUN STROM STROM, BLAINE W & UN SUN 252 RED PINE TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 252 RED PINE TR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.369 Plat: N/A -NOT AVAILABLE SEC 36 T30N R20W SW SE LOT 1 OF CSM 1/68 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1206/608 WD 07/23/1997 1086/268 WD 07/23/1997 774/163 07/23/1997 702/181 2004 SUMMARY Bill M Fair Market Value: Assessed with: 6328 268,300 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.370 67,800 196,200 264,000 NO Totals for 2004: General Property 2.370 67,800 196,200 264,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.370 39,700 154,000 193,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER jt u'ti 9 CA TOWNSHIP s� j p�say SEC. �� T 3 O Nit bW ADDRESS 90>e G S ST. CROIX COUNTY, WISCONSIN SUBDIVISION J� Hrz. 7x Z OT „Z LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM E �IMIa ne No Gv,E G G o s ;T,e Asa' 104.4 e4 s � INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used P -16itE Elevation of vertical reference point: U C! ' Proposed slope at site: SEPTIC TANK: Manufacturer: %', S R S Liquid Capacity • / U CJ G G�— lQ 6 , Number of rings used: 3 Tank manhole cover elevation: 8 z Tank Inlet Elevation: 9�Z. 6O Tank Outlet Elevation: . 3 Number of feet from nearest Road: Front „� Side,O Rear, f r 6 - feet From nearest property line Front ,O Side ,0Rear,O ! rdz feet Number of feet from: well , building: / O ' (Include this information of e a ve plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: i 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: x Trench: Width: 8 Lenjth: Q Number of Lines: _ Area Built: 0 /4r Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, pt. � Number of feet from well: �& O_{ Number of feet from building: 3 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, QFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: I C LV k ` Dated: - Q ' Plumber on job: rr 4h g q License Number: l 6 y 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LIBOR & AUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 * - BUREAU OF PLUMBING MADISON, WI 53707 SWk,SE W CONVENTIONAL El ALTERNATIVE State l I.D. Number: Town of St. Josep ❑Holding Tank ❑In- Ground Pressure ❑Mound Lot 1, Pine Tree Meadows NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Lorran J. Church Route 2 Box 105A Hudson WI 5401 e/- ;I, 9' g7 va 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: Stephen L. Aaby I MP5184 I St. Croix 92486 SEPTIC TANK /HOLDING TANK: MANUFACTURER: _ LIQUID CAPACITY: TA 'I /f /J,ET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER d� r •�J P V DE PROVIDED: YE ❑NO DYES 0 BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: P L BUILDING. VENT TO FRESH ALARM: LINE: AIR INLE FEET FROM ❑ YES NO G ❑ YES ❑ NO NEAREST DOSING CH MBER: MANUFACTURER: BEDDING: - LIQUID CAPACITY. PUMP MODEL: PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: 7M PA L: NUMBER OF PROPERTY J WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR INLET PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I 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: WIDTH. LENGTH NO. OF DISTR PI E SPA NG: COVER J INSIDE DIA. SPITS LIQUID BED /TRENCH /�� TRE D(HFS P TERI PIT DEPTH DIMENSIONS v` L RAVEL DEPTH FILL DEPTH DISTR. IPF DISTR. PIPE DISTR. PIPE MATERIAL: N nAL' NUMBER OF PROPERTY WELL BUILLDING: V NT TR BELOW PIPE BOVE OVff ELE V.If�L T- ELEV .EN `"`% �� PIPNEAREST- --► LIN Ey') .( AIR1{JL,. MOUND SYSTEM: (( (�y` (/ (f 1✓ V l� Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OESYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO OIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS D YES 1:1 NO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES: DYES ONO DYES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR, PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.: DIA.: ELEV.: PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ONO I DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FEIDM I LI NE: ' r,�,, ,q ❑YES ❑NO DYES El NO N ST x,,40,, �. 7. (� 3 2 �� � � • 1 � S f r MA� etch System on — & is-0 in in County file for audit. , erse Side. SIG TITLE -. 3 SBD 6710 (R. 01182) �� Zoning Administrator r I consln APPLICATION FOR SANITARY PERMIT DILHR (PLB67) J7 • �� /) I 2Ci C OUNTY Fuji UNIIFORM SANITARY PERMIT U STRV, , LR80R 6 MUMRn RELRTIOnS 9 /) — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS K T C X ;t ) g o >e / o S u Sept GcJ ; PROPERTY LOCATION 6*M: sw1/4.S/E1/4, S 19 , T J, N, R V (or )o TO .S7 To S h LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 2 Yoh r, NAME �ti Ro%4.f pol I' Trt A; 4 /q TYPE OF BUILDING OR USE SERVED e) I 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. N Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Oo a Lift Pump Tank /Siphon Chamber Holding Tank capacity IF Manufacturer: &A V R IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete I Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): �. 33 1?9 Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for Installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signat re: MP /MPRSW No.: Phone Number: s K L 4 Psip (M) A&07 Plumber's Address: Cl Name of Designer: i rn S l u�oaol vc L G Gv ' ,� Govt t,14 g COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: � F / eee: ' / "� Date: y� El Disapproved F' /C)C) `� �n ,✓� Approved El Owner Given Initial 7A cdnaq 0, AJA4j� {r� i •v� Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber l I I INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DI LHR, State of Wisconsin. f 'ASCCWM&n SANITARY PERMIT ®' � � � County ' �, � ii1 ,� GROUNDWATER SURCHARGE � 0, r6� x Sanitary Permit No. 9') Sl g On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building 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 ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground sco S gnature of 1 u i ng A ent: G undwater Fee: Date: buried DILHR SOD -7289 (N. 05184)' a, 1. 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 Z4J 1 % SE 1 %, Section ,..'s G , T -1 N -R a2 O W Township e,o y Nailing Address �>' .,2 ,U.� �C /0,C - /t � 0 A"VS 1 ,4e 9 i L Address of Site Subdivision Name /IAlc /� "90 "C",j .Lot Number Previous Owner of Property 49-J CC-7 .Vs - - C Total Size of Parcel. Date Parcel was Created Z N'm Are all corners and lot lines identifiable? V --' Yes No Is this property being developed for resale (spec house) ? Yes V No Volume and Page Number as recorded with the Register of Deeds. i 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 CERTIFICATIO I (we) een,ti,6y that att statements on thin 6onm ane tAue to the but o6 my (oun) hnow.tedge; that I (we) am (ah.e) the own en(,$) o6 the pnopeAty duni.bed in thZ6 in onmattion onm b viA to o e a w 6 6 anlcant d n y 6 y deed eeonded in the 066.cce 06 the County Re9iAten o6 Deed6 Document No. ; and that I (We) pnesentCy own the pnopoded site bon the sewage diAp_Fs 4ys em (on I (we) have obtained an eaA meat, to nun with the above deb ch i.bed pnopen ty, bon the conathucti.on o6 ea.id aydtem, and the came hae been duty neconded in the 066.ice 06 the County Re9iAten o6 Vee ctb Vocument No. ) . SIGN A OED SIGNATURE OF CO -OWNER (IF APPLICABLE) tZ DATE SIGNED DATE SIGNED HY MillerCaop" • �DOCUMENT NO. STATE BAR OF WISCONSIN — FORM 2 BOOK 774 rAL A .63 WARRANTY DEED �y 00! pt► J THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE Bradley R. Dahlman and Gary R. Johnson, ST. CROIX CO., WIS. d /b /a Brad Dahlman Construction Company Recd. for R;&cord this 3rd day of April A.D. 19_87 conveys and warrants to Lorran J. Church and Doris A. At 11:50 A IM Church, husband and wife, survivorship Jame O'Conneh marital property, brldM IN 0 RETURN To d eputy the following described real estate in St. Croix County, State of Wisconsin: Lot 1 of Certified Survey Map recorded November 12, 1974, in Vol. "i ", page 68, Document #324672 of Certified Survey Maps. Tax Key No. WSL Aama This is no t homestead property. (is) (is not) Exception to warranties: Dated this �� day of March ,19 87 (SEAL) �C (SEAL) .BRADLE R. DAHLMAN (SEAL) (SEAL) • • GAR JR. J HNSON AUTHENTICATION. ACKNOWLEDGEMENT Signatures authenticated this day of STATE OF WISCONSIN County. Personally came before me, this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, the above named authorized by § 706.06, Wis. Stats.) This instrument was drafted by Mark J. Gherty Hudson, Wisconsin 540 16 to me known to be the person _ who executed the foregoing in- strument and acknowledged the same. I (Signatures may be authenticated or acknowledged. Both are not necessary. 'Names of persons signing In any capacity must be typed or printed below their signatures. Notary Public County, Wis. My Commission is permanent. (if not, state expiration date: WARRANTY DEED - STATE BAROF VvISCONSI�, FRbld'N0. 2 fi97T '" ` °` " ` °'" "' _ '._ _ _. ._ . � Stock No. 13002 - _ -� I - - z ra 9 S T C - 105 r A SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER /BUYER Ole 'Co ' ROUTE /BOX NUMBER A Z 4oX /OJ � Fire Number CITY /STATE ,44' -0 0 ZIP PROPERTY LOCATION: .. 54J Sect / ion -3 T 30 N, R ..t) - W, Town of .ST �/oSCi St. Croix County, i v T C Alkr do u/S 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 the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix. County residents m be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o E I /WE, the undersigned, have read the above requirements and agree Cn 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. SICNE D ATE 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AWD CC P.O. BOX 7969 HUMAN R�LATIONS PERCOLATION TESTS C��J) MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION:,e SECTION: TOWNSHIP1*W4WkRAW -ZY: OT NO.:BLK. NO.:j SUBDIVISION NAME: SW 1/ V4 367 IT3 N /R /q E (o W sr Josh #- i ;ve E.�r��oows COUNTY: OWNER'S NAME: MAILING ADDRESS: S T 0 R0 %X 1302) P01, M/f / 'T &t Teti /, v�lov �v %s Tai USE DATES OBSERVATIONS MADE NO. BEDR : COMMERC AL DESCRIPTION: D SC IP ONS: PER A I N TESTS: Residence New ❑Replace I�� �� /�►�� / '�� � s RATING: S= Site suitable for system U= Site unsuitable for system - 5; - - -V �� � 4s ' ' y ©'�*�1; sdAs I CONVENTIONAL KIS : MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM :(optional) ❑U DS ❑U C SDU ❑SQU DS DU P!! r. r/ iZ "xsi' ©< If Percolation Tests are NOT re w iflE SIGN RATE: 71 4 ` If any portion of the tested area is in the under s.H63.09(5) (b), indicate: G! ,S- S -j^ Floodplain, indicat F l oodp lain elevation: ' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) � - ate. � � Y�• � • v, s . , . t 9 3 . S ' Z1 It f 7 ' . 7 L /3.v .t c ou s-k- B_ Z /o. o A io 0 15 s v 11AAe cs , , 5 ' �� �' �� 13A, yr, si, i �3 ' M; . 4 � a• 15�, -ma s% , . s� • W 13.0 1.5 .e. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IN' AFTERSWELLING INTERVAL -MIN. PERIOD 1 — PERIOD 2 PER10133 PER INCH P. f %.t/ P- s S s P- 2,- Z < P -_ I d I & P- 3 v d Eta— 7/; .1"r— 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. f SYSTEM LEVATION �?lo�, of = 2 f _ - F : ���$ _._ _..___ } p F 1 5 � i f JA _ R i V l i �-r �7 h ; �; 1 Q 24 . o� J/ _.._ i I . �_. _ �...� _._. _. � I �p Vi _ _ i:s 7b ' cE'tiT v to i < ... . _ (._. - F t - IV E 1 i 3 E , I, the undersigned, hereby certify that the soil tests reported on this for a by n rd with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the s e corrgct�he b my knowledge and belief. NAME (print): STS WERE COMPLETED ON: HOMESITE SEPTIC PLUIN✓?I �+�� I i� %L- f f/ G p G ADDRESS: BOSON, WIS 09 RTIFICATION NUMBER: PHONE NU ER(optional): MS. MASURRWAIRPR FP ROBERT ULBRICHT �6' i t Oi o�L �I hilt. INSTALLER & DESIGNER IIC. N0. 1ti cs IGNATU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) -OVER - iL ^. . � INSTRUCTIONS FOR COMPLETING FORM 115 - SBD 6395 � � � To bca complete and accurate Soil test, your report must include: � 1. Comp|etr legal description; � 2� Tha use section must clearly indicate whmhrrthis is residence or commercial project; 1 K8AX|W1UK8 number of bedrooms or uommvroia| use planned; 4� |sthioe new or replacement system; 5� Complete the mhabOhy rating boxes. A3/TE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS A RULED OUT BASED DN SOIL COND|T0NS: 6. PLEASE use ,haabbreviationsshown here for writing profile dnoniotion�ond completing the plot plan; 7� MAKE A LEGIBLE diagram accurately locating Your �r locations. Dra�ing to scale is preferred. A ' separate sheet \nay beuwd ifdoi/od; 8� Make sure your henohmmrk and ,ouioa| elevation ,vh,nnne point are c|ear|v shown, and ate permanent; 9, Complete all mppropn�.it* boxes as to dates, namos.addmems plain data, percolation test. exemp- tion, ifapp,opriaze� 10, |f the information (such -is 8uod plain, elevation) domoozavr|y'p|aooN+4�intheappropriatebox; ll, Sign the fnrm and p|uru you, cur-rent address and your certification nunmbm,, 12� Make /egib|e nzp/ao and distribute as requited. ALL SOIL. TESTS0U8T BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates audToxmms Other Symbols st — Stone (over 10^> BR — Bedrock cob — Cobble (3 10^) SS — Sundouune g, — Gravel (under 3") LS — Limpstmnn °, — Sand HGVV — Hi0hG,nundwau:r o\ — Coa P*,c — Pnno|ubonRutm meds — Medium Sand VV Sand 8)dg — Budding Is — LoumySand — BrrotorThon ~d — Sandy Loam ( — Lo�,-,Than °| — Loam 8n — Bmwn °sit — Sill: Loam 8| — Black �i — Sill Gy — (;ray °d — Clay Lowm Y — YnUmw m| — SannyC|ay Loam R — Rod oir/ — Silty Clay Lown mot — Mo/flem s o — 3nndyC|ay wf — vvitb sic — Silty Clay fff — fn"'v finu ° — Clay co — non mon p/ — Peat mm — Manv, mudium m — Mud' d — distinct p — prominent HVVL — High oveL ° Sixgooe.,u| soi(uyxtu,00 uurfl­cewmcer tot liquid waste disposal 8K4 — Bench KXo,k VRP — Varriva} Rmfemnr* Point ' � � TO THE OWNER: � � Th�z sod test report b the hnst slop insex/inyamnim`rxpe,mic The noun�vo,the Department movrovu�,t � myrifirar)on of rhis »oii rns-;_ in rho fic|d p,iol tn iouanvo, A comp|o/e o^i of plans for the private � yewmga oymom "and ^ pe.mu a��ivabon mum bo oubmk�od �o �ho «pp,omia�o |oom} mud`o,ity in o^1e' to � o�uem a pn.mi� The d and posted p,o/to tho ,tart ofany conurummo, � � �� v S .s � P � 3 �d- S 1 S 0 p as v � J o .J ti h ct