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HomeMy WebLinkAbout032-1066-30-001 o N O 0 fA O '! z d e d �1 o m m m CD CD ° 0 W o N 0 W W O W m 0 O O W O A W `C �• a ? 3 O ,`1. A 3 O c tC Ln W (O 6. (aD W (Q O. y @ o N Z O M C O 7 fD 7 CD O co 7 N (D (0 O O m a N m N 0 o W U) 0 w 9 zi O Cl 0 O _ �• p = fD n O W° O co OD A 3 co a o W .r c m ` CD o m ro ° o v D •�. W a t� -< D A � F a n a v m u 0 A ° W W 0 0 0 = cC _ 0 = N 3 O 4 ` fp 6 0 z CO O T' (o c. O CD Ln O CCD 0 0 c O A? W 0 C cn a_ c o O cn Z o O O O m O O O CD �• 03 ^! < z a c N N N f c N N o D °O O .0 fD .N+ y y N I w fll U7 , Ui cn 7 m c o n m m o d - N W CD - N CC N 3 7 A N A z N o z o y co o -o D Z O 3 3 hi 0) 0 O O CD CD a N m N v m _ CD w M W N 0 N S n. D' fD a o m m 3 -Wo m c ! O N O CL CD n. x CL CL z p 7 o 0 M v Z A o C co C _ Z 0 0 3 0 3 A 3 3 3 � y W y UI N N A zt A N W N D 3 o D ° m W a 0 W 3 3 v_ c o a 0 o a a CD N 3 u CD CD a � o' 3 2 En CD H I II O 0 N O O I A O� p A =3 =1 b CD m w rn O O w O i O a - `' F — r , VVisconsin Department of Corxnerce PRIVATE I EWAGE SYSTEM oust y: Safety arid Buildings Division INSPE ION REPORT St. Croix GENERAL INFORMATION (ATTA H TO PERMIT) Sanitary Permit No.: Personal information you pmvfoe may be used for secondary (Privacy Law. x.15.04 (1)(m)). 384293 Permit Holder's Name: 0 City Villaxe ❑ Town of: State Plan ID No.: Ba lar eon Wayne I Somerset Townshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: a 2- 1066 -30 -001 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAP CITY STATION BS HI FS ELEV. Septic P Benchmark r Dosing 2 Alt. BM ation - -- Bldg. Sewer Holding / St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Oue Ping WELL BLDG. Ventto ROAD Air Intake - 3 - L NA IS Dad It� 41eu) > a i /�( NA Header /Man. 7 4 9Z, `T A Dist. Pipe Bot. System t yy O. 3 O PUMP/ SIPHON INFORMATION Final Grade , d 3, 70 ____ - -- mand t over �w Model Number / GPM TDH Li Friction System TD 4Te� ead Loss Fo main Length Dia. H Dist. Towel SOIL AB PT[ON SYSTEM 30 4 BED / EN Width Len h No.O PIT No.Of Pits Inside Dia. Liquid Depth I E 1 3 S DIMN I N SETBAC K SYSTEM TO P / L BLD WELL LAKE/STREAM LEACHING Mau attu INFORMATION Type o Moe u er: System: J Z/r } 7 f ® IT S� DISTRIBUTION SYSTEM Header / manilo Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r• A � Length �l _ Dia. _� Length Q3•� � pia. Spacing ,V SOIL COVER x Pressure System Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Ot xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, per�ons present ll43y3�pction #1: '� I t j /Dj Inspection #2: / Location: 2045 Highway 35, Somerset, WI 5 025 (NW 1/4 SW 1/4 24 T31 N R19W) - 243119328D -Lot 1 1.) Alt BM Description = y -) Pmo I �,o L d er ekr�r 2.) Bldg sewer length = r - amount of cover = ( C (9b {ai`� / u� It a� cL6o vc ,� / aw►.o( f'oo 3 -� D. Serdc4t0" ve ll I/S — %!v ifil a� evis M equl Yes ❑ No Use other side for additional information. SBD -6710 (R.W97) Date Inspector's Signature Cert No i Sanitary Perm't Application Safety & Buildings Division In accord with Comm 8 .21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ��sC®nson Personal information you provide ay be used for secondary purposes Madison, WI 53707 -7302 Department of commerce (Submit completed form to county if not (Privacy Law, . 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper no han 8 -1/2 x 11 inches in size. County State Sanita ermit Number ❑ Check if revision to prerv�ous App l* alio� fate Plan I. D. Number - Coo (y 38 �93 r-- I. Application I - Please Print all Information �• `; oc ion: Property Owner Name PiVoe Location / '7 % �tl� � !/ G� / Lr `'� i. C' • ~ 4 4414, SUZ T ,N, a( Property Owner's MaKn Address „ } Lot •u`m er Block Number s r City, State Zip Code Phone Nu boy MVG so. v' ion Name or CSM Number II. Type of Building: (check one) =' / ! fn City 1 or 2 Family Dwelling - No. of Bedrooms: ° 4- -.. ❑Village Public /Commercial (describe use):_ 15t4own of ❑ State -Owned .• a,� ..�� \ Nearest Road J 44 - �/ /,� --- 2� 11 — M Parcel Tax u r(s� III. Type of Permit: (Chet only one box on line A. Check bo on line B if applicable) T ! a A) 1. )ew 2. eplacement 3. ❑ Replacement of 4. 5. 6. El Addition to System System Tank Only Existing System B) Permit N mber Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) P'Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland E) Pressurized In- ground ❑ Holding T ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Tri tment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. S it Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required_ Proposed Rat (Gals. /day /sq. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted 1 Tanks Tanks r I1 ❑ ❑ ❑ ❑ Mee VIII. Responsibility Statement I, the undersigned, assu responsibility for installation of the P O TS shown on the attached plans. Plumbe Name (print) / Plumbers- gnature (no stamps): MP/MPRS No. Business Phone Number Plum ss A ddress (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee Includes Groundwater Date Issued ssu' g Agent Si lure (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee} _ Determination 1 2 X. Conditions of L Approval /Reasons for Di sa proval• 4- s �'^^'^^ `'" `� � - - of Pe, CmAklxt , t3. - Z5 Ac -Ca,� ia.-t ` stn 0 u SBD -6398 (R. 07/00) 1 I PLOT PL I N PROJECT Wavne Bailaraeon ADDRESS 2045 Hvwav 35 Somerset Wi.54025 NW 1/4 SW 1/4S 24 /T 31 N/R 19 TOWN N. Somerset COUNTY ST. CROIX _ 6 -29 -01 BEDROOM 4 MFRS Byron Bird Jr. 2205 DATE CONVENTIONAL XXX A,>i Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 260 &1000 gal L FT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 BSORPTION AREA 500 # of chambers 30 BENCHMARK Y.R.P base of window #aItBM radeath US g ASSUME ELEVATION 100 ❑ BOREHOLE O WELL sH.R.p. same as BM A601 Vent SYSTEM ELEVATION T 1 =90.2 Sidewinder High Of Capacity Leaching Chamber with 17.2 t ^2 per chamber Grade it Systpm Long � _ ReMatiau Dri veway i 8 B1 r well above.? � 8 grade � pool t� 30 ' lbed ouse garage 30, 30' Ott PL 20' i Ex. ai ield'� 93.7 I PLOT PLAN PROJECT Wavne Bailaraeon ADDRESS Hvwav 35 Somerset Wi.54025 NW 1/4 SW 1 /4s 24 /T 31 N/R 19 W TOWN N. Somerset COUNTY ST. CROIX MPRS Byron Bird Jr. 2205 DATE 6 -29 -01 BEDROOM 4 CONVENTIONAL XXX Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 260 &1000 gal L FT TANK SIZE DOSE TANK SIZE TE HOLDING TANK SIZE 0 LOAD RA 1.2 :BSORPTION AREA 500 30 # of chambers BENCHMARK V .R.P. base of window #altWgradeath�US ASSUME ELEVATION 100 , ❑ BOREHOLE O WELL *H.R.P. same as BM Vent SYSTEM ELEVATION T - =90.2 > 12" Sidewinder High Of Cove Capacity Leaching Chamber with 17.2 6 t ^2 per chamber Long 34" E�pvatinn I I i Driveway j 8 BI j well 8 above c 93.7 98' grade pool 30' 4 bed house garage 30' 30' st st B .�- PL 20' 1 w gainfi Id 93.7 i i I _B3 i i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County G y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r include, but not limited to: vertical and horizontal reference point (BM) direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. a sewed by Date I I—r Personal information you provide may be used for secondary purposes (Privac Law, s. 15.04 (1) (m)). 2,I Property Owners ,c Property Location " �C 4!! //-- Govt. Lot 1/4 &/1/4 S; T 3/ N R E (o Property Owner's Mailfng Address Lot # I Block # S Name or CS # City State Zip Cod Phone Number ❑ city E] Village ]Mown Nearest Road e ,-- SP �/ 3 New Construction Use Residential / Number of bedrooms Code derived design flow rate t'v m 0 GPD ❑ Replacement ❑ Public or commercial - Describe: I Parent material Flood Plain elevation if applicable General comments and recommendations: _ i 5/1 Boring Boring # �� c� pit Ground surface elev. ft. i 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 s f /1 qD .2a' Boring Boring # ❑ j 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 y/ I z * 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 Nam Please Print) S gnal ure CST Number Add re Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) 1 le Property Owner / w G u� %�c r ���/� Parcel ID # Page of M Boring # El ' Boring IC —�` Pit Ground surface elev. � C ��n. , 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 ❑ Boring # ❑ Boring ❑ 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 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit 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 I i * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L ent of Commerce is an equal opportunity service you need assistance to access services or provider and employer. er. If The Departm q pp ty p p y y need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) ' I Soil Test Plot Plan Project Name Wayne Bailergeon Byron Bird Jr. Address 2045 Hy 35 -in ° - - Somerset Wi. 54025 CSTM #220527 Lot Subdivision --- Date 6/29 N W 1/4 SW 1/4S T 31 N /R W j Township N. Somerset F1 Boring Q Well PL Property Line County S T. CROIX I ,BM or VRP Assume Elevation 100 ft.base of window #alt BM grade at house99.4 System Elevation T. -1 =90.2 H.R.P. Same as BM i Drivew y 8' B1 I I i well 93.7 i .--_ above 98' 8 grade pool 10' 30' 4 bed house gage 30' I 30' B2 St PL 20, i i Ex. ainfield 93.7 8' i I 10) I PL 250' I I I POWTS OWNER'S MANUAL at MANAGEMENT PLAN Pa of — FILE INFORMATION SYSTEM SPECIFICATIONS 13 NA Owner a Septic Tank Capacity gal Permit # Septic Tank Manufacturer ` "' ` ` ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 13 NA Number of Bedrooms 41 0 NA, Effluent Fllter,Modei ,/ / ❑ NA 11 — Number of Commercial Units 13 NA Pump Tank Capacity gal ❑ NA Estimated flow (average) .6�pL7 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated X 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate /.. ,Z I /day /ftz Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil at Grease (FOG) 530 m L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 g/L ❑Mechanical Aeration ❑Wetland ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) 5150 rr g/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 m L n- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 m&1L 0 At -grade ❑ Mound Fecal Coliform (geometric mean) 510 c /100m1 10 Drip-line ❑ Other. j Maximum Effluent Particle Size 1i inch di ameter * Values typical for domestic (non - commercial) wastewater and septic j tank effluent. j * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 0 months ` Lyear(s) (Maximunil yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume Inspect dispersal cell(s) At least lone every 0 months _Myear(s) (Maxlmugl —) Clean effluent filter At least lonce every ❑ months d year(s) , Inspect pump, pump controls at:alarm At least once every ❑ months years) 0 NA Flush laterals and pressure test At least once every . 0 months ❑ year(s) 0 NA Other At least once every ❑ months ❑ year(s) 0 NA Other: At least once every 0 months ❑ year(s) 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by a i individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insp ctor; POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for ai y back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent lev Is in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the groun surface may Indicate a failing condition and requires the immediate nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (Ya) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servi ng Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent fllters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND - OPERATION For new construction, prior to use of the POWTS check atment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage a dispersal cell(s). If high concentrations are detected have the contents Page of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks. may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; Daintina oroducts: pesticides: sanitary napkins: tampons: and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated'and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to'establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area Is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMpnewUR1.F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Phone v. Phone �?y _ - SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ; '� n 21 t Name /' y . Agency �". � �- * ST CROIX COUNTY . - - I • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer &4 Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number i2 _32 - 10 LEGAL DESCRIPTION Property Location 1 14, Z' / a, Sec. , T_4/_N -R�W, Town of Subdivision . Lot Certified Survey Map # 3 ! / � . Volume . Page # Warranty Deed # f i� . Volume Page # Spec house O yes no Lot lines identifiable yes El no SYSTEM 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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. '0� 11 / § ,G - NATLJRE OF APPLIC 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG ATURE OF APPLI DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.***** ** Include with 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 _ DOCUMENT NO, STATE BAR OF WISCONSIN FORM 3-190 -.4 g PACt 111448XV1110 ION ascoleolMO DATA QUIT CLAIM DEED 40M.77 VAL PAGE 2 Dennis M. Neumann Co., WiL ............................................................................................................... Rec'd frriacord fms 12th ................................... ....................... ..................................................... ................................................................................................................. day of March A.D. 19_15 quit-claims to Jcayn. --- A ........... of 8:30 A —0 M. Baill . - s�b ............. A.. 4n4..".d_Wi.fe ................... ...•.......•.......... ........................................................ ............. .......................................... C41% V . meompw ........................................................................... ..................................... I h -- e -- - follo w ing -- described --- re I - e - s - t - a - in .......... A ..... 9 State of Wisconsin: 01c -URN TO Tax Parcel No: .............................. ji Lot f the Certified Survey Map filed in the St. Croix County Register of Deeds office in Volume 5 of Certified Survey Maps on Page 1404 -as Docume t No. U)11138, being a part of the Northwest Quarter of the 'ff& Quarter (W14 of SW4) of Section Twenty- four (24), Township Thirty-one (31) North, Range Nineteen (19) West, St. Cro-- - -ounty, Wisconsin. The actual consideration for this deed is less than $100.00 This AA-.AlPt ............ homestead property. (is) (is not) --------- .... ......... day of .......... --- ----- Dated this ............ . . .. ................... t ............ ... . ✓.. . a Dennis Neum ann ----- ................. .... ---------------- ---- - ---------- --------- .............. ­ ....... uan . ................ ........... -------------------------------------- ....... ... --------_-------------- ---------------- ....... ...... (SEAL) .... .......... ......................... .. . .. .....................(SEAL) --------------------------------------------------- -------------- • . ..... .. ......•........ ----------- - - •--- -.... -- ......... AUTHENTICATION ACKNOWLEDGMENT Signature(s) ......•...•..•.............••..•...........•••.............. STATE OF WISCONSIN ................................................................................ t .5.t ... ..... County. .'X ......... authenticated this ........ day of .......................... 19 -_ - -_• P-rzon- epme before me ev ...._ 41t.day of .......... 19 8__. the above named . . ............................................................................. ­- De umann ................................................................................ ------------------------------ * ----------------------------------------------- ........................ ..................................................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not ----_-------------------- ................................ ................................ ------ ...................... ............... authorized by § 706.06, Wis. State.) to me known to be the person ..... ...... who executed the foregoing . strument, and, acknowledge the same. THIS INSTRUMENT WAS DRAFTED 13Y . DOAR & SKOW, .. ........ -------- . ......... ...... r -- - --------------------------------- .... ...................... ...... ............ Cherrijl Hirst .............................. ............ --- New Richmond, WI 54017 OA' .....•..... ....................................... I ...... .................. Notary Public ---- ...County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanen ---- if __n'o'i, state expiration 6 are not necessary.) date: .......... ...... ........ ........• �J '�,'Iscon�in *Kamm or persons sicniar in an cap .city should be t or printed below their signattres. STATF BAR 0.' WISCONSIN FORM Ns. 3-1992 Stock No. 13003 r , 391638. C ERTIFIED SURVEY MAP LOCATED IN THE NW1 /4 OF THE SW1 /4 OF SECTION 24, T31N, R19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. � I I Nl l U n • p t a t t e d l a n d s 21 c1 - :1 - 60' 115' ( E1 /4 CORNER ci M i *EAST TURTLE LAKE ROAD SECTION 24 -- = , Centerline of existing town road North line oFtfiie – – Cen terline 200 _ _ c; W_1 /4 - r� W1 /4 CORNER S87 0 57 1 05 11 ` E 355.06' p— SECTION 24 % -- – � S 87 383.03' T31N, R19W ♦♦♦ 1y�0lyyo 39.38' South right -of -way line Ln ♦ I° N LOT 1 - c 3.99 acres including town c I z = road right -of -way , a+ 3.74 acres .'excluding town M c: ` W 85 , ; road right -of -way 4- ri W o III In Ln _ ° L > �o f o ai •- M N 0 C N L N M "' w Z � cn 0 cn �IUI >I j70 1 v M ' o �o S87 ° 49'44 "E Z�' LM 25.00' I +r I 'on - N87 °57'05 "W - -- _ –� �N •70.92' 490.00' - - - -_ I S87° '05 'E I Point of Beginning I I Unplatted Lands I SCALE IN FEET .U, 60' 60' I I I 100 200 300' M l c l — I MI U JI I CORNER z Cl 1 SECTION 24 0 R =I T31N, R19W a w m LEGEND F ' LRtib 0 COUNTY SECTION CORNER y A" o w MONUMENT, FOUND. N 1 "x24" IRON PIPE, WEIGHING �, O 1.68 # /LINEAL FOOT, SET. • EXISTING 1 IRON PIPE, Drafted by Walter J. Gregory '' APPROVED MAR 7 1984 S C:tOiX COUNTY Volume 5 Page 11404 CO3 AP'E;iENSJVE PARKS PLAN"G P AMD ZOt4mro COMM IM Form- ST C- 104 AS BUILT SANITARY SYSTE RE PORT OWNER R 41j z &A j ;' TOWNSHIP - SEC. TI N -RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �� ( fie 1 � � � • � ' i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used , ',,,,�4 �E Elevatiop of vertical reference point: Proposed slope at site: SEPTIC TANK: MaAufacturer: L171. -Ar. Liquid Capacity: o L _ Number of rings used: _ Tank manhole cover elevation: �Z ,7 Tank:nlet Elevation: Tank Outlet Elevation: Numbe;�' of fe t from nearest Road: r ide, Rear, Q feet rFrom nearest property line Front,O Side, aRear, / feet Numbe`- of feet from: well si k JI._ building: 1 2 S (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I 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, Q Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: ; Trench: Width -,I r Length: Number of Lines: Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, © Rear, © Ft.� Number of feet from well: Number of feet from building: 7_� (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box 0 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 j ob: License Number: 3/84:mj Wisconsin Department of fndustry, PLB -1 * INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing Name of remises Date Plan I.D. No. 1 1 s =eet.. oun t Sanitary Permi t , w M ast er Pl umb er & F irm Name Address Journeyman Plumber Address Owner Address Ar r 1 }fv J 4 � a , co �, J/ - }. M � ! "� / -... J .'�.• .17 .Y. •..! , -T a�.1� .Rl� .3' . d � , . ` y { Ft Discussed with Si gna ( )See Attached. DILHR - SBD - 6192 (R.10/82) Signature — of is um ng x4 p. O ire ecia is Inspector Local Inspector Plumber or Responsible a�ty__, - __ Owner DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &kiUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 C ONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number: (If assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wayne Ba.? oAgeon R. R. , Someu et, wI _.? 1:340 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV. ICST REF, PT. ELEV.: NW SW, Section 24, T31N -R19W, Town o6 Somerset Narne of Plumber: MP /MPRSW No. County Sanitary Permit Number: Cat Powe/u 1563 St. Cnoix 49459 SEPTIC TANK /HOLDING TANK: MANUFACTURER: J ILIOUID CAPAcTY, TANK INLET ELEV.. TANK OUTLET ((LFyV - WARNING LABEL LOCKING COVER -"/� ( P OV D D. : PROVIDE ^J 7 L 1 G _ YES ONO ❑YES 0 N BEDDING: VENT A.: VENT MATL HIGH WATER NUMB ,ROAD: PROPER WE BU+�DI NG: VENT TO FRESH ALARM: FEET FROM � LIN A /] IAIR INLE,�- DYES NO ❑ E NEAREST d ♦ ♦ V� [ �� I �� DOSING CH MBER: MANUFACTURER: [ 7(N E G , LIQUID CAPACITY PUMP MODEL. P P /SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑NO DYES ONO DYES ONO GALLONS PER CYCLE: PUMPANoCONTR SOP ATIO L NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR 1 "LET: PUMP ON AND OFF) ❑Y S O NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth ofpiowingv 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 NO. OF DISTR. PIPS SPA / � TRENCHES / MI R AL: PIT C / l` GRAVEL DEPTH FILL ER DEPTH UISTR. PIPF I D ST PIP LIN DISTR. PIPE MATERIAL: NO. TR NUMBER OF "PROP WE BU DI VENT TO FRESH BELOW PIPES ABV E,COV ELEV. INLET ELE E 2 PIPE E �/ 1 , `i' FEET FROM 7;2 [Y 1 ) 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- F-1 YES 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DYES ONO DYES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED. CENTER EDGES. [:]YES ONO DYES ONO I O YES ONO PRESSURIZED DISTRIBUTION SYSTEM: Cc y .WIDTH: LENGTH NO OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: �8� TRENCHES: �l1�+1Ei�ils,`ION$ ` s MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPE &. DIA.: HOLE SIZE HOLE SPACING DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED w�R PLANS. ❑YES ONO ❑YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: ER PROPERTY WELL BUILDING: FEET F#�tJM LINE: ❑YES ❑NO DYES ONO iIIEARET" �L? 4 Sketch System on R file for audit. Reverse Side. SIGNATUR � TIT DILHR SBD 6710 (R. 01/82) Wisco APPLICATION FOR SANITARY PERMIT , � ` DILHR C OUNTY � OEGRRTRIEnT OG (��� ��� UNIFORM SANITARY PERMIT # InOUSTMY LRBOR 6 MUrriRn RELRTIons — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPS TY OWNER MAIL N ADDR SS Lea- PROP Le PROP'ER7F4 LOCATION etTy: P 1/4, S._' , T1, N, R/ (Or TOWN OF: t �" IL T N BER BLOCK MBER I SUBDIVISI NAME NEAREST ROAD, LAKE OR LANDMARK STATE 7P;N I.D. NUMBER Z4 i TYPE OF BUILDING OR USE SERVED _ 0--c� ER 1 or 2 Family Number of Bedrooms: Public (Specify): � 7j") THIS PERMIT IS FOR A: 4 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. 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 Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity F t PumpjSiphon Chamber nufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per •rich): REQUIRED (Square Feet): PROPOSED (Square Feet): / ® Private ❑ Joint El Public I, the undersigned, hereby assume responsibility for installatio the private sewage system shown on the attached plans. Name Plumber (P in Sign u e MP /MPRSW No.: Phone N P b 's Address: Name o Designer: b j Z' L COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ' 3 � / ` �j Owner Given Initial ((�(dd (� � El y (Y 7 Approved 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 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. I I 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, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 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 ay Q C \\'I a go XN , �\\ ""`� Location of Property �W � S W �4, Section � , T 3/ N - R L W c .. Township Jdrn-2 r S ¢T Mailing Address Subdivision Name A) l /7 Lot Number Previous Owner of Property l) e n :w Total Size of Parcel Date Parcel was Created 1 9 Yn cc r c, g Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes Volume S and Page Number IYO Y as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 'A Warranty Deed, - 2 Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPER OWNER CERTIFICATION I (We) eeAti.by that aU 5tatemen-t6 on thiss bonm ane tAue to the beat ob my (oun) knowledge; that I (we) am (case) tie awn �Athe phope&ty de�snibed in this inbonmati.on bonm, by vZ tue ob a wa�vca ty deed neeonded in the Obb.tce ob the County Regi6t,?A ob Deeds ais Document N , and that I (we) p4m entty own the pAo pas ed site ban .t a as e p a s y�s tem ( on 1 (we) have obtained an eiL6ement, to &un with the above - deaen,ibed pupeAty, bon the corotAucti.on ,)b .aaid sy ,6 tem, and the sam has been duty neeonded i tike OA jice ob the County Regtis.ten ob Deeda, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE / S GNED DATE SIGNED n c Ff1HM NU, 9115 A CERTIFIED SURVEY MAP Jn�latted_ I Land � 100' ! 115' i U n � l a t t_e d land E1 /4 Corner Section 24 _4 I i Centerline of existing town road North line of the r �� NW -S M c o M CENTERLINE _._ -- ? - - -.__ _ _ - -- E S87 ° 57'05 "E 355.06' K, F ; —A W1/4 M W1 /4 Corner — - - -- -- `" - -~ Section 24 0� AN S 87° 22' 42 "E 383.03' T 31 N , R 1 9W �' '�� 3 9. 38' h 00 �o South right -of -way line � 1 1 NW-S t CI � 3.99 acres including town road right- ° of- -way 0 3.74 acres excluding town road right I - -- 85' 00 - p w of way 'Y I _ C Lr) Ln 41 1 ° ^ a) ,� M I N N I M Z w I I V lf) J 0 Q - I 4-- ^'- S87 °49'44 "E N CI I 31 >r 170 a) M ° M g 25.00 ° C Driveway , - _ I Z B ee detail Y s easement A N87 °57'05 "W G -p j j u) , 490. 00' 70. 92 I _ 1 S87 7 05 "E r point of beginning I I U n M a t t e d I a n d I - I I 60' 60' I SCALE IN FEET , fl..l C I 100' 200' 300' SW Corner TABE OF INTERIOR Section 24 A=89 E =135 ° 35 s# B =90 F =89 ° 52'39" T31N, R19W ASSUMED C =270° G =90 1 07'21" BEARING D =134 °46'29" LEGEND COUNTY SECTION CORNER MONUMENT, FOUND. O 1 "x24" IRON PIPE, WEIGHING DRIVEWAY EASEMENT 1.68# /LINEAL FOOT, SET DETA I L $ • EXISTING 1" IRON PIPE SCALE I"=40 s8r49' 44 "E 25' 3 EXISTING DRIVEWAY w iD S 87 0 57'05 "E r- 0 ". c.0 50' — — `I 0 ° N N N EASEME N T 0 POINT OF BEGINNING - Z N87 ° 57 05 "W N N LOT LINE EAST RIGHT -OF -WAY LINE 50' I w — — -- -3 a EASEMENT Cm 0 S 87'57 - 05 E N j 0 Drafted by Wade Hartensstein. 0 50' o y N Z f/ t D_E I p'T I O N `rce,l 'oC land loc.itcd in the NW1,.1 0; (he 4, 1'31N, R19W, a1 pa Town Somerset St. Croix County, Wisconsin, described as follows: Commencing at the W1 /4 corner of said Section 24; t hence S1 °53 "W (assumed bearing) 385.05' along the West line of said SWIM thence S87 ° 57 1 05 "E 70.02' to the point of beginning; thence NO 10'16 "1;.36.75' along the East right -of -way line of State Trunk Highway "35"; thence S87 °49'41 "E 25.00' along said East right - of -way line; thence N2'10 16 F 239.Sl along, said East right -of -way line; thence N47 ° 23 1 47 "E 151.88' along said East right -of -way line; thence S8707 (35S.06' along; the North line of said SWI /4; thence S2 °10'16 "W 385.05'; thence N87 0 57 1 05 "W 490.00' to the point of beginning. Also a driveway easement describ C as follows: beginning at the above described point of beginning; thence S2 0 10'16 "W 20.00' :.along said last right - of - way line; thence S87 °57;05 "E 50.00'; thence N2 0 10'16 "E 20.00'; thence N87 °57'05 "W 50.00' to the point of beginning. Subject to a driveway easement described as follows: beginning at the above described point of beginning; thence N2"10'16 "l: 20.00' along said East right -oi way line; thence S87 ° 57'05 "E 0.00'; thence S2 ° "W 20.00'; thence N87 0 57'05 "W 50.00' to the point of beginning. Also subject to an easement for i existi -ng town road right -of -way on the Nort 31.5', more or less, of said parcel. Contains 3.99 acres including torn road right- of -way and 3.74 acres excluding town road right -of -way. I certify that the above description and map arc correct and that I have fully complied with the provisions of Sec. 236.34 of the Wisconsin Statutes and I Section S.4.2 of the St. Croix County zoning Ordinance. Date: October 19, 1978. "6 h`oltcr .''-"- eg�i S 44 .l 2ob No. 78 -1081 Ogden Engineering Co. Q �?° 123 U. Elm Street River Falls, Wisconsin 54022 S Y � &1� t I hereby certi that this map has been approved by the 'Town Board. Data' 7 7 SURVEYED FOR: William F. Ba i l l a r9cun R. R. H1 Somerset, Wisconsin SMS DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 --1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED Vol, -- R5tG],57 S OFFICE This Deed made between _...._W1 -- E. _ ______ ___ _____ ____________ Sf C;';olx CO.,' ; Bai b llargeon and Lucille M. Baillargeon,ys'd, for r? cart! Mils 26th h>�sand_ wife,____ - - - - -- - - - -- - -- ---- - - - - -- � ®� March A. D. 19 84 t --- - --•- - - -- -- - --- -- --- -- -- --- --- - --- -- - "� Granto r, C� - and ----- Wayne --- 0-•--- Bai. ---- - - - - -- ---------- - - - - -- ----------------- - - - - -- - t 8: 30 A M. .- _-- _ -... -, Grantee, RoObloe of Dodo Witnesseth That the said Grantor, for a valuable consideration.. -___ RETURN TO conveys to Grantee the following described real estate in ---- st..__.. ro.IvX -------- County, State of Wisconsin: Lot One (1) of the Certified Survey Map Tax Parcel No:____ ____ __ ______ ______ ________ _ _ _ __ filed in the St. Croix County Register of Deeds office in Volume 5 of Certified Survey Maps on Page 1404 as Document No. 391838, being a part of the Northwest quarter of the Southwest quarter (NW, of SW,) of Section Twenty -four (24), Township Thirty -one (31) North, Range Nineteen (19) West. T is not This ---------------------------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And - - - -- - - - - -- ----------- --------- ------ --- ----- -- - - -- ---- -- --- -- - - - -- -- - ------- ----- ---- _- --- --- ---- -- - --- -- ---------------------------- ........ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this - -- -- - - -- - --- -_ 1 3_6-t�c = day of - ---- -- -- ---- -- Mar- ch - - - -- ------ •- ------ -- --- -- -- -- - --- -- 19_ -84. - / y - ✓��- - -I ---- �- �- �'/.a '- /---- �i_iX�Z_ -- • :"2-- (SEAL) ---•-- L- "--- "-- •- -- -•-- -CGZ�• --'L- William Baillarge� Lucille A1. Baillargeon ----- -- - - -- ------------- (SEAL) --------------------------------------------- - ------- -•---- -- -. .... (SEAL) * « AUTHENTICATION ACKNOWLEDGMENT Signature(s) of William E. Baillargeon STATE OF WISCONSIN ---- ---- •--- ----------- --- - -- -- -- -- and Lucille M. Baillargeon ss• - - -- --- - - - - -- ----•------------------------------------------------------------ -------------------------------------- County. authenticated, this�_' � < &ay of ... March -•__, QQ4 Personally came day of ____•_ _ 19'_.___ befre me this _ - - - - -, 19- • - ..... the above named G. E. Norman - ------------------------------------------------------ - - - - -- --- - - - - -- - - - - -- ---------------------------------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN ' (ifTlSt' - - -- - - - - -- authoxiaed -b3� § 79f"Of'rW4s- Statrs.4 to me known to be the person --------- --- who executed the foregoing instrument and acknowledge the same. j THIS INSTRUMENT WAS DRAFTED BY ------ D-O.Aa DRILL. _SKOW - - -S _..C--------------- New Richmond Wisconsin 54017 * - - - -- - - - - -- -------------- - - - - -- - - - - -- - - - - -- ----- _- - - - - -- -------------- - -- - ------------------ ------------------------- -------- ---- --- ------- -- - - - --- Notary Public ---------------- -- -- ------- -- -- ---- -- - - -- County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: -- - - - - -- 19 ...... *Names of persons signing in any capacity should be typed or printed below their signatures. m n ll" i VTV nrrT) STATE. BAR OF WTSCONSTN V,'i :r. in T.eval Rlnnk Co. Inc. Vp rj S C— 105 SEPTIC TANK MAINTENANCE AGREEMENT (D SL Croix Count y OWNER /BUYER Y\L R / B O X N U M B E R Fire Number CITY/STATE' PROPERTY LOCATION: , 114, Sect. ion 1' 31 N, R / 9 - W Town of 50r� SL. Croix County, Subdivis Lon Improper use and maintenance of your :;optic :system could result in iLs premature failure to handle WasLes. Proper maintenance eon - Mists of pumping uuL the septic La"k every three years or sooner- if needed, by a licensed supjic cank pumper. What you put into the system can affect. the f the :optic tank an a treat - ment stage in the waste disposal System. St, Croix County residents way be eLlribiv Lo receive a grant- Iol a maximum of 60% of the cost- of replaccme"L of a failing system, w h i c h I was in uperallion prior to July 1, 19 / 8 . Sc. Croix County aCeepCud LhiU program in AuguSL Ut 1980, with the requirement: that uwnurs ut all new yySqem;, agree to keep their systems properly maintaineu:_ The property owner agrees LO submit to SL. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, rest-rieLed plumber or a licensed pumper veri- fying LhaL (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspeccion and pumping (if nec- essary), the sepLiC LUUk is less Lhan L/3 full of sludge and scum. CurLifiCaLion form will be sent approximaLeLy 30 days prior to three year expiration. 0 �71 L14 I/WE, the undersigned, have read the above requirements and agree to maintain. the private sewage disposaL system in accordance with the standards set turLh, herein, as SeL by the Wisconsin Deparc ment of Natural Resources. Certification form must be completed and returned Lo the St. Croix County Zoning Office within 30 days of Lhe three year expiral-ion. date. S I C N J." I) DATE 5 t ;ruix County Zoning 01 tic'-! P.O. Box 98 Hamm ind, WL 54015 71.5 or 715 Sign, date and return LU above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, cc DIVISION HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707 (H63.090) & Chapter 145.045) I LO ATIQN: SECTI N: T2 / p TOWNSHIP /MliP1+EtPxYt?TY: OT O.: BLK. N .: SUBDI VI ON NAME: CO UNTY: 0 W E 'S BUYER'S NA E: MAILING ADDRESS: +: it - USE DATES OBSE VATIONS MADE NO.BEDRMS.: COMMERCA DESCRIPTION: PROFILE DESCRIPTIONS: PE TESTS: Residence ®New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTE (optional) ❑U ©S ❑U IS ❑U ❑ S ©U S QU JJ,4- T.A�1 �. If Percolation Tests are NOT require DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Fl in Floodplain elevation: / Z_ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HI HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- B- L PERCOLATION TESTS TEST 'DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD PERIOD — PE RIOD 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. r i SYSTEM ELEVATION / �._ _ ----- j ._ .�I / rJ' t j t p E } E s pC6 fvG I 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. 1 N ME A4NAME�int : TESTS WERE COMPLETED ON: AD CERTIFICATION UMBER: PHONE NUMBER (optional): C T E: L��_ UTION: Original and one copy to Local Authority, Proue+,y Owner and Soil Tester. / tr;. 02/821 — OV EP — / ^'/ ^ � INSTRUCTIONS FOR COMPLETING FORM 115 ' SB[} ' 6395 To be complete and aooumte Soil test you, report mmt indudo� ^ � 1. Complete legal description; Z The use section mwt clearly indicate whmho,this is residence or mrmmcrcia| project; 3, MAXIMUM number of bedrooms orcomm*/ria| use planned; � 4. |s this a new urmp|auomant system; 5� Complete the suitability rating boxes, A SITE \S SUITABLE FOR A HOLDING TANK ONLY |FALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL C0ND\T|0NS� . � 0, PLEASE use the abbreviations shown here fot wviting profile desci iptio 1-ind completing tile plot plan; 7, MAKE & LEGIBLE diagram accurately locating your test locations, Drm,v\ng to scale is meh+,red. A � sepavate s may be used if desired; � 8, Make ourayour h*nuhnmrh and vertical elevation reference point are claur|v shown, and are permanent; 9, cumr\av all appropriate boxes as to dates, names, addresses, flood plain data, poum|ohon test oxcnop' tion 10, Mthe i"io^mx ion (such as flood plain, e|evn ion)duos riot apply, NA.in the appropriate box; 11, Sign the form and place Your current address and your certification nvmbe,� 12. Nbko legible copies and dbnibotn as ,oquirod. ALL SOIL TESTS 1%-)ST BE FILED WITH THE LOCAL AUTHORITY WITHIN JO DAYS OFCONPLET[ON. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols g — Stone <ovor 70''> 13 — Bedrock nob — Cob Ne (3 lO'') SS — S*ndmono g, — Gwve| (Linder 3'') LS — Limestone Sund HGVV — HighG,oum� Vato, m — CoonmSond Pco — P�mo|^dn"�^m meU o & — Fine�mnd O|dg — BuUd\n8 |� — �mmySand ) — Gua�erTha'` ^s| — sandy Loam ( — LmoThan ° Rn — n,mwn 5D|v G — Gray °d — Quy;,-omm Y — YeUum ��i — �mdyQuy Loam R — 8ed Sandv�|; t m — K8"ok d — d/minc} P — nmmin*nc HVVL— Highmmt"/|ovo| � - Six gonam| ooi| |axn/nm su/�nevmm*, fo!'|iquidw:studi;pnsa| RM — Bonch K4a,k VRP — vcmca| Rofu'ennr Poin� � � � � � � � 'TO TfIE OWNER: is|hoKatmepinomourinQosanivarypmrnoi-, The countyo.vhoDeuanmemmaytequnm `ol of nhis s"U msl in fhe Yi�W prio/ to permit A comp|nte »a/ of p|uns for tho private J"'lidTI km and m pa,miz "op|imdon muo/ bwmbmir�d io/heanprun/iae a| autho/�y in order to mi�� Tho s»ni�nry nunni/ must br oWainod ond pou'o6 p,iol chW mx ofo^v con�,mr/k,n, N 115 , WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ` DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 • REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: ' ' /4,_!i - Section, TZLN, R d E (or& Township or Municipality a "�Z454r � Lot No. ,Block No. `y � Subdivision Name County ' al Owner's Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms S Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE :: SOIL BORINGS �� _7j PERCOLATION TESTS /.I L8 SOIL MAP SHEET SOIL TYPE Auvi - LA 1 0 Zd11 4MD PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 f P R SOIL BORING TESTS F: TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHE OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) O Ic fjzs _ _ 96 _ c, f 1 If' PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Z, /-. 4 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. A A' I t wa N 1 t 9 i ° v 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 ministrative,Code, and that the data recorded and location of test holes are correct to the best of my knowledge and beli �' -t %' Certification No. ��nt) staller if known CST Signature" / LOCAL AUTHORITY 1 i JA I NV I �,rr r f- i i Ll