Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
040-1063-10-000
,Wisconsin 'Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515010 0 GENERAL INFORMATION State Plan ID No: Personal information 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: Johnson, Michael N. I Troy, Town of 040 - 1063 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: d ffa ,.�_ Section/rown /Range /Map No: C ( 15.28.19.239D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I ' Benchmark 13eeing `,• •IS Alt. BM �. I K J -tv f!.) Bldg. Sewer Holding St/Ht Inlet ' St/Ht Outlet TANK SETBACK INFORMATION 5' 3 �S • �' TANK TO L P/L WELL BLDG. Vent to Air Intake ROAD td J6J�'�.. 5.J0 9'S• 3 Septic Dt Bottom j `� 13 Zy 5.72 y'5. Dosing ` Z4 Header /Man. 7 - ,`V 43• C Aeration Dist. Pipe 7. 5 13- X15 -,. Holding Bot. System $ •5 z , ��•, •�Z D�J PUMP /SIPHON INFORMATION Final Grade � �o Manufacturer GP M St Cover I J Z 14 l i r 4 /5 Model Number - - - TDH Lift Friction Loss System Hea,, DH Ft Forcemain Length Dia: Dist. to Well - SOIL ABSORPTION SYSTEM BED /TRENCH Width Length > No. Of Tr enche s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 A Z T o e r , ,\ �— SETBACK SYSTEM TO w P/L BLDG WE LAKE /STREAM LEACHING Manufacturer: ,! f INFORMATION CHAMBER OR Z Type Of System: ` l.� UNIT i 1 5 rj Model Number '\, G � DISTRIBUTION SYSTEM Sa �T -7� ZS+Z 5 = SQ V Header /Manifold Distribution ` I x Hole Size I x Hole Spacing Vent to Air I aloe Length , Dia _ Length \ Dia Spacing ` ` St , - - SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed /Trench Center ? C, 7 Bed/Trench Edges To ` 'N—yes D No Yes 0 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 318 Hwy 35 N River Falls, WI 54022 (SE 1/4 SE 1/4 15 T28N R19W) metes & bounds Lot Parcel No: 15.28.19.239D 1.) Alt BM Description= ` `� p J e ` - C}, �I M, O 2.) Bldg sewer length amount of cover = �X t 5' ' f✓c 'r-S - �,.0 a `^ L l.0 J {'�' f Plan revision Required? Yes No /3 q ❑ � I I � ( D Use other side for additional information. V Sinature SBD -6710 (R.3/97) Date Insepctor' Cert. No. It commeree.wi,gdv Safety and Buildings Division County 1 iepartmerdolCommerce a 201 W. Washington Ave., i sco n s i n Madison, W I 53707 -7162 Sanitary Permit Number (to be filled in by Co.) • Sanitary PP Permit Application State Transaction Number Number In accordance with S. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different th mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary , t `� es in accordance with the Privacy Law, s. 15.04(l m), Stats. c�/� I. Application Information - Please Print All Inform o6. 6ECF-i t: Prope Own 's Name ( �: Parcel # box b� Qo- a�310 X Property Owners Mailing Add Property Location 3S COUNTY Govt. mot City, �atep � � � Zip Code q IMF F i C -- V ., 3 6- ,)1 t r� �C� �/., Section .� , j II. Type of Building (check all that a 1 Lot # T � (circle one N; R E PP y) ❑ I or 2 Family Dwelling - Number of Bedrooms ! Subdivision Name ,l ❑ Public /Commercial - Describe Use %�j +'� rte f: "\ Block # ❑ City of ❑ State Owned - Describe Use CSM Number. ❑ Village of ¢ 1 Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System y 1R Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) Li it u ber ed B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑ Permit Transfer to New A � Jr � C y� � .y � _l �_ S ' Before Expiration Own . �j 3 / 9 ! b � f� IV. Type of POWTS System/Component/Device: Check all that a 1 r% 1 E Non- Pressurized In- Ground ❑ Pressurized In -Ground ❑ At -Grade '❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate( pdsl) Dispersal Area equ'red (sty Dispersal A roposed ( ystem Elevation IV e VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ° New Tanks Existing Tanks ! r a A / r F , ! r, • ' t Septic or Holding Tank 1 y 1 U� (N W;1 p s y Dosing Chamber C/ /� t C VII. Responsibility Statement- 1, the undersigned, ass a responsibility for installation of the POWTS show a attac ed plans. Re Plus Name (Print) Plu Signature M a Business Phone $ Number 0- " 3 X Plumber's Address (Street City, State, ip C � D � e) VIII. Coun /De artment Use Onl roved Permit Fee Date I�sued Issuir gent Signa } I I Q O Given Reason forDeaial ! v / f IX. Condit1&ly$TE4%*V$"Measons for Disapproval 1. Septic tank, effluent filter alld - h - a rw s b 1 .. dispersal cen must a;i be servlcesitntainttai 1 as per management plant provided byplumr.pr, 2 AN sebwk requirements must be rn* taineo all code / o dkWIM. Attach to complete plans for the system and submit to the County only an paper not less than a tax 11 inches iu size SBD -6398 (R. 01/07) Valid thru 01/09 a M tQ AA Zt Cb CL y� U �; � 'l• o 0 3 s � c � � S 0 4*3 t, c u s . C EC 0 P� M r l A RA y M u \ Lr) �o fn o r �. Dc i E. S 3 , s �oto zz o (} M i ce kA J V � � 3 f1 0 i t1 RECEIVED Wisconsin Department of Corn erce SOI EVALUATION Page ! of 3 Division of Safety and Buildings QG� ► 200a a ante with 85, Wis. Adm. Cod County Attach complete site plan on p 'ern f(f3 Q7>?1Q inche in size. Plan must include, but not limited to: verti I an ®fie M), direction and Parcel I.D. percent slope, scale or dimensi ocation aqq distance to nearest road.. b 4 O - O 63 / O - 00 Please print all information. Revie*k by Date r Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Gwk-- et SF 1/4 1/4 S �� T N R a4ara Property Owner's Mailing Address Lot # I Block # Subd. Name or CSW City State Zip Code Phone Number ❑ City ❑ Village a Town Nearest Road R: rea /= j1s I WT 1 5 40 ( 715 i 42s,5�86 4 3.S ❑ New Construction User Residential / Number of bedrooms _ _ Code derived design flow rate 6 n GPD Replacement ❑ Public or commercial - Describe: /VA Parent material /6 o rs 6. Q(ac ; •f-; /j Flood Plain elevation tf applicable IV A ft. General comments Q =,.. / and recommendations: /l ec o �i, eft C. 1. x � ""-t fa`! df',r "." 11 /e e�c -6j, yr Ch? "W 'de L Ole J -? fio ' `�J- t f e or. .h! / 1 Zw � use 4- Z f"I a/° f ' � t on H ante dt�' C?• F-1 I Boring # E] Boring JZ Pit Ground surface elev. IS - 6 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh: / 'Efr#1 I 'Eff#2 j 0 -/o lot�P3ld - : r / I rk 3, d / 0 -9 !a -aQ lo / 1,f 313 s'' 2 H, a 6K s Lc s �- 0. ,6 445 s 2 rr. 4 Lk �s `r s l f' p.� / /'U Fa-1 Boring # ❑ Boring pit Ground surface elev. ¢ ft. Depth to limiting factor in, Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz_ Sh_ •Eff#1 'Effft to -1 e lo m 1,3 'aK cf r 4 cc S f' 07 p_ C'? .2 -5 D m 61 a, a d r 4 q x / - 4 , 4 XS - PR s-fs _ s -- cs - 7 7 -` Effluent #1 = BOD > 30 220 mg/L and TSb >30 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L. CST Name (Please Print) lgnature C N umber . . 2-.2- & � ck We �t C� ®1�� Address Date Evaluation Conducted Telephone Number N3- /S 7 7� -14 sr. �� /s.vp,f�� �+rS4o /,� falkX ff 7!s -z7-? 343 I - Property Owner M o4 a e/ /`la T A Asa» Parcel ID # page '� of Boring # El Boring 121 q UI Pit Ground surface elev. Q6• ft. Depth to limiting factor >- ` `� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F in. Munsell / ']] Qu. Sz. Cont. Color Gr. Sz. Sh. ' / *Efr#2 CL dry ❑ 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Efl#2 E Gro Boring # Pit P limiting Boring und surface elev. ft. De th to limiti factor in. O Sal Application Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Efr#2 I Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS -< 30 mglL The Department of Commerce is an equal opportunity service provider and 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.07/00) M c z ZZ G° flu, It o , 4 1 � b 0 v 'u y u n na SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer k ;4 � 4k' - J - � 6414 Mailin g Address //� 4 Property Address & A (Verification required from Planning & Zoning Department for new cons ? City /State % Ait..e- Parcel Identification Number �XD ` f 11 cl)x LEGAL DESCRIPTION Property Location '/4 , '/a , Sec. , T ,;� S A N R 1� W, Town of Subdivision , Lot # Cerfigep Survey Map # , Volume , Page # k1t COKti &ai `i'° *a_f # 'S �w /` .� `�f , Volume 1 _`i 3 , Page # Spec house yes SO Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms 9 1G TiAE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to ger tify that I have inspected the septic tank presently serving the d 14%0n 4 6 c aK residence located at: :F 1 /4, E 1 /4, Section � , Town N Range /9 W, Town of , St. Croix County Wisconsin. Upon inspection, I certity that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 10 1316 �l Did flow back occur from absorption system? Yes AS NoX_ (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ;b Construction: Prefab Concrete Steel Other Manufacturer (if known): 1114 1b46i, Age of Tank (if known): (Licensed Plumber Si ature) (Print Name) Pf � 0 � (Title) (License Number) MV64PRS f�d (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) o li - o. a U W C �\ C1 c r V) 1+ 0 y. \ \ ►� o ..� t' j�� \ • a • . :. ' .. o (n I 1 O 11 cam, o f vo 4) n 4) > o c U w r 1 ti o CL N- 4 - Al y .-._••� system Management Plan ' Pursuant to Comm 83.54, Nis.Adm. Code Sectic Tank The septic tank Shan tie maintained by an Via! cer3fied to service $eptk tanks under s. 281.48. Slats. The OnWft of the outlet ftw still tx of in � "M NR 113. Wis. Adm. Code. The operd& q of the at W se0c t N* id ensure proper OWN= The tBOe °"� '� 3 yem by inspection. The puttee fitter s; be deaned as necessar, to smY 3k"* off ft ltitefwhm removed front � yid not be removed unless provisins are =de to retain solids in the tank that the ahem b endrsrua. 8 the fitter is eq dpped wb an Bart. the MW sW be serviced if saptk tank Shan have &s contents *- alarms may irtdkate surge Bows or an tg s atarrrt. The removed when the vottmte of not t s f a W and srrm� std � the tank tf the patents of the tank are errtpv,d # the erne of a 1rl�nial fhe"owner of when the next servica nee& b be p u b med b less tt�t atetri<ttttd� si»tra and sbdge acumulatlor► in Sad a ctie,ricaf addtlhes b se* tank Pew is 9enerzpy trot raga ;red, Own. eer snap be approved for septic tank use by the i)e Of CcatntUM ,gay and The PUMP tom) taNc 3W be 1113POded at least once eve y 3 years. AN s Afts, abnM �d ! * Proper mat. !f an etiluent War bstaied 111,n the hank It shat be PXPs Ad be tesbd to bspeded and s rA=d as nec s my, At - ade Comooneut and Pressure Distribution system o.trees ....... or be s ru s s on e g ante or a ove to grow on the component. Plantings may made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost than for vegetative maintenance) on the component is not ost ostp netrati n.Traffic (other atio require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 ag /L TSS and 30 mgJL FOG. Influent flow may not exceed the ■animism design floe specified is the permit for this installation. The leered b VAh a kahk D POW d #* end of each �. and n b soft s at bast p hmW It*A that each OMPWW b ft bftl hat When tare sa batansd t 1 +e 8 a pie bads pe itsltottid be Mpired b and hb," t s the do99b9 has oc�trred and 1 orilpce dearbrtg is Observation pipes within the dispersal cell shall be* checked for effluent ponding. Ponding levels should be reported to the owner and any levels above k inches considered' as an impending hydraulic failure requiring additional, note frequent monitoring in accordance with'Camm 83.52 General T ?stem shall be operated in accordance with Camm'82 -84 Vis.Adm.Code and shall be . maintained in accordance with it!s component manual SBD 10570-P- (R.6/99) and state rules pertaining to system maintenance and maintenance reporting.. No one strouid eW - - PUM tm* WMWODMW SW be POWTS oomp b Comm 83.33. Wb Ad . the tames &v bW � as ._ °P � brsec ��•s and covers shoWd be inspected for rrdbC tigts and soundness. Access . a b shd be sealed wabertl9ht the pmpldpn Of 'a7 oP�in9 downed be by an bddng device b r' ar ss osWnings t et 1= 84nCh s b dWWW sW Pee t a=WenW or urmdntted ot*y bb a tuk or component latltorarg d� cop4pooa bi�e detadhe are tank or be -' ,�.. _ - � Peoperoperadrig uot�iat, reP�ed or b ft d P .Psnp cort6de, alarm orwlaied widrg bewnas def clw tier d*cM =*Grad shat be ' ��- NO2ced v t a cpmpon" of Ste sums ar egtd pertomtar�ce. the the 8xo�tad e�pie t- fa3ls to pt srastawiter: orri'el3as� sc di rue wastewiter to sur � be necessary to Install stn amble pro-treatmant omit or dpdiaona �ponent• A&Htio4a]. site atnd- soil• evaluations my mead to be done. and Sate and D ss�s may- tined to be prepared and apppoved by the Department of Commarce,- _ tT uildiags Division. , Questioas'.ibont� the operation or iisiateaance of this system shou]tl'be directed to:� l -. The Couaty� zoaiag Office at =" Z�$'_ = The system installer at LS _ 6► �` ' �)� - The Lsnit menniracturer at &OQ- 3 ?5 - 8�15 yVt�s.'S1 The effluent filter' manufacturer at - ZZl - S1u Z ZtK@t A 6 30- .8z0 -qp Goers • DOCUMENT NO. _STATE BAR OF WISCONSIN FORM 15 -1982 ASSIGNMENT OF LAND CONTRACT J iZ2..: Assignor, whether one or more, for a valuable consideration, assigns and conveys to _ -_ Michael " - " "Johnson and Nancy . -- "C. Johnson, !' AUG � N915 - - -- - - -- _Husbxnd.- and__Glife� -" holding Suryiy�rship "_r'iarital ProperCy E -, 2:30 P. - --- -- -- i 1 1 -- ------ - ----- --------------------- --- - -• ---- ( "Assignee" ---- _ce i whether one or more) the ( ancWicr Purchaser'a) interest in a Land Contract dated the ----------- 2Qth --------- day oi -------- May ------------ •----., 19---93., executed by Ae i e _.Res an........ ------------------ ------- -- - -- - --------- - - - -- - -- -- --- -- ------ - -- - -- ---- ----- - -- --- --------- - ----- -- - _ -- _= ------ ----------- alk%a.Joseph. Ernest - Rhodes --------------------------- •------- as Vendor to Joseph- E_.. Rho des . - and- - Harriet..IL. Rhodes.,.. Hal band- and- Se}.i£e.,__.a Survivorship .. Marital- .Property,_.said__Harriet__H. _- Rhodes- __._.__- l l a /k/ �_ -?nazi iQt__i�e�eal_.7313s?de;z�__ky._ 7QS��b _sxLe�_t____5isct[lxxax Rhodes, her -In act I� or_ lands in __ ____________ ________ __ __5 t._QKQ1X..___ -____- ___County, State of Wisconsin, together with ( the indebtedness therein referred to and) all the interest of the Assignor in the Land Contract and the lands described therein, which Land Con - � f tract was recorded in the Office of the Register of Deeds of said County, on ;i i� May__ 24 ---- --- ---- --- ----------- - - ---- 19•_ as Document Number_ - 4-99-543..... in �I ! ( gRll} (Records) Umatge) FEB (Vol.) Vol - 11 ,101-1 ....... - ------ of O on (Page) 5.2- -- -- •-- ---- - 1 The Assignor covenants that there is now owing and unpaid on said Land Contract, the sum of t•:_ghry - Svvpn Thousand and no /100 - -- - - - - -- - _Dollars. '! ----- ----- --- --- --------------•----•----------•------------ i--• it and also interest at ------- 8_5% per cent per annum from --- -- -- --- -- --------- - --- ----__ - -- • -< -- 1995 _.., ' that Assignor is the owner of the above described interest in the Lana Contract and has good right to assign the same, and that the condition of the title of Assignor's interest is the same as at the time of recording *,he Land Contract t PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMENT OF PURCHASER'S INTEREST: (Strike either 1. or 2.) By acceptirg and recording this assignment, the Assignee agrees: 1. That Assignee assumes and agrees to pay the obligation secured by the Land Contract, to comply wit all f I 4 , terms and conditions of the Land Contract, and to hold harmless and indemnify Assignor as to the performance. of all I{ fi obligations, terms and conditions of the Land Contract. QCK919 8cx$ YaxBCl�xi�sx, 7sffiscitacgta1g5K7[ a5& C2fdiDAlf�XIItlfi' K1fo. E7�dt�yS�tlaLis3c4tI` 1. ss�i} aaat� 'ii;gila®e•�so..� NS1: :,A",.� -"- �� Aji17CA�, �10X�7C7@ QXIiXdC] OX7 Q�H_} tPCiC7A717�] tiL7�3f�1S�31t51Xi11DE} CXi�7S�¢. �iIL�: 7C�FC1C�8{L 3�7fsf $if743�LX1KOfd�Lii§2t]�i�L}FfiFx XkAC�igic4cXdCat�7e8p[ aa1F.) c�YC�ticat} �3�7��atre�' �aS3E�RLCt�11Fc2t�iS? F9�x�li 'idt�`h�ig'14 #F1z�ilbxlEct+� } � �ergee' S' ��x �7ISX$ZRtir@C7:C➢E 11D2�[ iGiK: 6. cIi3Cr3Ex1��FiKxKSiElt} SA�S1�X�` E7f��h�i� 'eK��FigX4�s'tt�d4�s`��f�Fe'E� s1�rs33ci4xea�exs�cxsti +Plc4i�e1¢!c Xnrr4i•Xg�ge. PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMENT OF VENDOR'S INTEREST: (Strike either 1. or 2.) 1. This is a complete assignment of the Vendor's interests in the above described Land Contract. The Purchaser under the Land Contract is instructed to make all further payments to Assignee upon receipt of a copy of this docu- ment. kXM) 2. Ti4it§ xi�gliistxtl€ KI�1 iiGi��Fr1F} Gacniaac�eudaaccstadudZ6cisxfiorxs�aicRaugso�exYae a�C xltavre�x xctcxsi 7 1 �1E> X14 s'tl `i' i6x 5 3bK3fa�7f lE1 4iFr3t 36I4i =xPf1 6F#'i* i iax) aYOOSameaaII�c�;$ ac�ax�c3i�arcxocl4xE�f' xCAx�# 1Ei�) f�YetliKSit7t �'t�x��c;�ks'Y�6F+i5 x�x�a�n�s��axxixm�c�s�x�x�' �txx' �sax�ax�x�tna�x�ax�ax�c ,��s�x,>�x��cab�l��€�}s This ...... ls .. .. .. ...... ...... homestead property. �I (is) (is not) � Dated this - ----- -- ----- ---------31st_..... ....... _ day of _J41Y. .. .............., ------ (SEA !` i (?/ "' �8 ..._... (SEAL) - - I� os .. Joseph r.Itsest Rhodes ....- - - --- --------------- - -- ---- --- - -- - ...... (SEAL) ... Fr'xf . 0 4 L` '... (SEAL) ,.. arriet K. Rhodes C/ by Joseph Earrnest Rhodes, her Attorney- AUTHENTICATION in- Fac kOKNOtVLEDGIMENT Signature(s) ------------ ____ .-------------------- ----------- ------ -- -- STATE OF WISCONSIN } ---------- ---- ---- -- ----- -- - -- - -- ----- - •------ ------- -- ---- ------- ---- _ST,_CROIX --- - -- - -- - - - -- County. !; authenticated this ___ -_. -day of_ --------------------- _ 19 - - - - -- Personally came before me this ---- 3lfst- -.day of -___ - Jt •- --- -- - - - - -, 19__ 9.5__ the above named -------- --- I -------------- --' --'-- { -- - -- - -- . JasQRh__ F.._._ RhQSIe�_. 1�nd __Hazx.l.eS__ ._ IS IN Harriet._ Ilei. en __Rhodes__1zX_- �?ez---- ----- -- - X 111 I T1TLE: MEMBER STATE BAR OF W - 1 Attorney - In -F'aet Joseph - _Earnest .}2hQde - s • - I� (If not. - - -- -------- --•---- -_------- l i Mithorized by 9. 706.06, W .'s. Stats.) to me known to be the persons .. who executed the II r f ng instrumen and kno ledge the same. THIS IN!iTRUMENT WAS .RAFT... \ ! ! Leo_ A. Beskar, At torney #1003297 ... .... ................ .. ....... Li9 No. Mat.n St. "---J e..Terke.1sen------ --•---- ----------------------- I. River ..Fa11s_,__1,1I ... 402.2 ------------ -- -- -- -- ---- -- - -- --- N ry Public .. .- ....... . ......... x. County, Wis. ((Signatures may be authenticated or acknowledged. Both y Commission is permanent.(If not, state expiration rare not necessary) M _ 9 _ =xa.n.•:..r s ti..::.,: ii. - v :: ., - i .:.,.. , � J State of ubi .. ---=- =- N Notary P .. «.. ' nsl�� STATE BAR OF WISCONSIN . wnam c. n ¢c+r vMr.vT ni: f.AN rnN - rRACT FORM No. ]5-1982 37 ilw k". Wia. i a Y A i �DAr[ Part of the Southeast Quarter of the Southeast Quarter of Section 15, Township 28 North, Range 19 West, described as follvvvs: cvi i i ie ncii tg at the Cast Qua�ter corner of said Section 15; thence West along the Quarter Section line 1565.0 feet to centerline of State Trunk Highway "35 "; thence South 34 degrees 18 minutes East along the centeriine of said Highway 2072.4 feet to place of beginning; thence South 82 degrees 04 minutes West 303.4 feet; thence South 6 degrees 47 minutes West 147.0 feet; thence North 82 degrees 04 minutes East 411.2 feet to said centerline of State Trunk Highway "35 "; thence North 34 degrees 18 minutes West along said centerline 158.5 feet to place of h .+ ucyiit iriity`. a H4 5 - Iwo v � ; ' r.' J 4 G J/ � 1 i AGREEMENT THIS AGREEMENT made this 31st day of July, 1995 between James he ' r i Ciaycomb, r eferred to as C ayc omb" and Michael N. Johnson and Nancy C. Johnson, hereinafter referred to as "Johnson ". RECITALS A. Claycomb is the owner of the following described property: P art of the Sou - -east Quar o LII JU iz�. 11GQJL \.tUGl L VI Section 15, Township 28 North, Range 19 West, described as follows: Commencing at the East Quarter corner of said Section 15; thence West along the Quarter Section line 1565.0 feet to centerline of State Trunk Highway "35 "; thence South 34 degrees 18 minutes East along the centerline of said Highway 2072.4 feet to place of beginning; thence South 82 degrees 04 minutes West 303.4 feet; thence South 6 degrees 47 minutes West 147.0 feet; thence North 82 degrees 04 minutes East 411.2 feet to said centerline of State Trunk Highway 11 35 "; thence North 34 degrees 18 minutes West along said centerline 158.5 feet to place of beginning. B. The above described property is currently being sold to Joseph E. Rhodes and Harriet H. Rhodes under a hand Contract dated May 20, 1993, recorded May 24, 1993 in volume 1011, Page 52 as Document Number 499543. C. The Rhodes have defaulted on said Land Contract and Claycomb has commenced a foreclosure action against the Rhodes. D. The Johnsons have submitted an Offer to Purchase with respect to the above described land to Claycomb and Claycomb has accepted said Offer to Purchase. E. As part of the Offer to Purchase, the Johnsons will assume the Land Contract between Claycomb and the Rhodes. 113 rr- F. The amount that the Johnsons will assume on the Land Contract is $80,823.00 plus Claycomb will lend an additional $6,177.00 to Johnsons for a total amount of $87,000.00. AGREEMENT NOW,. THEREFORE, based upon the above promises contained herein, the parties agree as follows: 1. Johnsons agree to assume the Land Contract from the Rhodes in the total amount of $87,000.00 ($80,823.00 Land Contractt$6,177.00 new money). I Thcr illtsvrpct rata vii C iwia�w Luiiu vviit o iiuii be v /2 Na?vu vii a 30 year amortization with a five year balloon. 3. Monthly payments shall be in the amount of $668.95 per month. 4. Johnsons agree to put $5,000.00 of the new money from Claycomb in a special bank account. Said funds are to be used for construction /improvements on said property. Dated this 31st day of July, 1995. J es ClavconYb M N. John n T f -- " AAA Ji I A Nar C. has r i VOL .113r'p ',-� The above signatures have been subscribed and sworn to before me this 3 o r't riav of 10V INS S 1M &. Notary Public -Ma w" ' .' State of W isconsin'$ MV commission B ;�26, 1998 (Notarized for Jai�,e�f�0 �c�P °• .b) This document was drafted by: ...•.......° °° °' The above signatures of Michael N. 1... �. R 1.1 .r li.w joss — pi 1+ i u Boles Johnson and Nancy C. Johnson subscribed ROM Beskar, Boles & Krueger S.C. and sworn to before me this 31st day P.O. BOX 138 of July, 1995. River Falis, WI 54022 71 5- 425 -7281 .� J ie T�rkelsen, Notary Public S ate of wisconsi,n Mq�mmission expires May 9, 1999 L: =K JANE EL8EN Publ ic tsc� sin ST AUG 1:1995 &t 2:30 Roc r c ; ,.._ . � 0 s 0ti0 ,ic T 0 C7 o c o 3 n 3 a� O C ;D m N 0) c m O= Q 6 T Z �. `A O N -< N t4 p O 0 K _ W ° (D N 3 ? O Q 3 N N W o N a v °° N C 00 N C Z a ° A A z l �. v ( D m CL r' W w O zt 2 3 � O O Z I, _ CL O j( '"' o Z W CW77 < N O N OD O x1 O Z n O c C l) A A N O A .. c N C < 'S Z 0 0 0 a 0 0 0 m: Z• n ai t ai A o C v1 fn vi m CD C N A 3 T; N cr !V y co o D o O O a N O cn CD p N m v m F c m m c jo m d N N d o O a O p Z A y N Fo c n a G W W m N cn a CD CL 3 c. A A 3 3 0 !, m cn CD CD I N A I - v W 61 A N N N CC C N Q C N CD -n 3 3 a) c a m c 3= a �' z z a 0 0 o N n N �• n 3 CL o!1 y _ � h (D C NJ Q O N A ti O b cn m de o O e» O ° o o CL CL I� .� a R e , :j =-- 3Z � � d W CPO d � A rn a cj �o v GO O -A i Q 'ro rn s rn Q V QN l Parcel #: 040 - 1063 -10 -000 01131/2007 11:04 AM PAGE 1 OF 1 Alt. Parcel #: 15.28.19.239D 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Ow n er s O = Current Owner, C = Current Co-Owner MICHAEL N & NANCY C JOHNSON O - JOHNSON, MICHAEL N & NANCY C I 318 HWY 35 RIVER FALLS WI 54022 I Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 318 HWY 35 SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description. Acres. 1.160 Plat. N/A -NOT AVAILABLE SEC 15 T28N R19W 1.16A IN SE SE COM E Block/Condo Bldg: 1/4 COR SEC 15, W 1565 FT TO CL HWY 35,S 34 DEG E ALG CL 2072.4 FT TO POB; S 82 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) DEG W 303.4 FT, S 6 DEG, W 147 FT,N 82 15- 28N -19W DEG E 411.2 FT N 34 DEG W TO POB Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1133/346 LC 07/23/1997 1011/52 LC 07/23/1997 1011/51 WD 07/23/1997 823/465 2006 SUMMARY Bill #: Fair Market Value: Assessed with: i 158211 203,200 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.160 38,000 147,400 185,400 NO I Totals for 2006: General Property 1.160 38,000 147,400 185,400 Woodland 0.000 0 0 I Totals for 2005: General Property 1.160 38,000 147,400 185,400 Woodland 0.000 0 0 i Lottery Credit: Claim Count: 1 Certification Date: Batch #: 140 Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 00; A '7f� 9F� AS BUILT SANITARY SYSTEM REPORT R D e M111717 TOWNSHIP Troy SEC. 15T 2S -R l�J A 35 No.,, River F - ails, WI ST. CROIX COUNTY, WISCONSIN. $URDI'VISZON -- - - - - -- LOT - - - - -- LOT SIZE PLAN VIEW r - istan.ces and,dimens1ons to meet requirements of H63 _ THING. WITHIN 100 FEET OF SYSTEM At r, r rJ l ' r a . Z di a e o th Arro I SC BENCHMARK: (Permanent reference Point) Desc i e: t10 Eievati,on of , vertical reference point : Lc�,'r�_ a s _te : w... SEPTIC TANK: '1Januiacturer: Wieser Liquid Capacity: 1000 gallon Number of rings on cover: _ ion � Tank manhole cover elevat 43 Tank Inlet Elevation: 7 Tank Outlet Elevation 9 1 PUMP CHAMBER Manufacturer::. Number of gallons N tuber of gal. pump., set or-a cycle gallons; total capacity o distribution lines gallon: size oT pump head; gallon per minute horsepower brand name of pump and mode numb ; Type of _warning ev ce HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Ty of warning.device SEEPAGE PIT SIZE: Number o pits Feet a3ameter feet liquid depth seepage pit in et pipe- elevation `�--m of seepage pit e evat on feet. ` :_ number of lines t 1 length depth r ` h length -—�-- . REQUIRE INSPECTOR .�.._._�, PLUMBER ON B Pau R. Cudd LICENSE NUMBER MPRSW 273 DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &•HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 79$9, BUREAU OF PLUMBING MAbISON, WI 53707 ,ACONVENTIONAL ❑ALTERNATIVE State Plan I. D. Number: Ilf assigned) El Holding Tank ❑ In- Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Dennis Muzz Highway 35 N., ki Fa tZ, W1 1 -1 Q - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SF SF, Section 15, T28N -R18w, Town of Tnoy Name of Plumber: rP/MPRSW No County Sanitary Permit Number: Paul Cudd 2739 St. Ctoix 58869 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: J TANKOUTLETELEV_ : WARNING LABEL LOCKING COVER P ID OVED: P I nn YES ❑NO NO BEDDING: VENT DI VEN ATL. HIGH WATER I N UMBER ROAD: PROPERTY WELL: BUILDING: r ENT TO FRESH ALARM. �� LINE: O IR INLET. FEET FROM -- DYES ❑NO OYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING. LIQUID CAPACITY. PUMP MODEL. J PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO A A DYES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPE, IONA NUMBEROF 'PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) DY ES NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of wi LE JGTH DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall ce e u II ORCE the soil is dry enough to continue.) /11N CONVENTIONAL SYSTEM: e WIDTH: LENGTH NO. OF DISTR. PIPE SPACING. COVER J INSIDE DIA.. #PITS: LIQUID . D/TtfT, l+ I e7 TRENCHES. TERIAL: PST DEPTH-. � GRAVEL DEPTH FILL DEPTH JDIITR. PIP DISTR. PIPE DISTR. PIPE MATERIAL: NO ISTR NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INL T. ELEV. END PIPES ET FROM LINE q AIR INLET: C� L /� . C! ] Z NEAREST- ----1i 6 eCG•S MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER I TEXTURE PERMANENT MARKERS JOBSERVATION WELLS YES NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. S SEEDED. MULCHED: CENTER. EDGES. ES NO ❑YES ONO DYES 1:1 NO P SSURIZED DISTRIBUTION SYSTEM: . °. WIDTH: LENGTH: TRENCHES: LATERAL SPACING. GRA7 FLOW PI .: FILL DEPTH ABOVE COVER: CRIiA�N91fOA1,. it MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOL MA E IAL: N . DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.. DIA.. ELEV.' I PIPES: DI A.: 1�rEvAT� AND tSTRfSUT"fON. HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED ttFIATI PLANS DYES El NO 1:1 YES El NO COMMENTS: PERMANENT MARKERS: OBSERVATI N WELLS NUMBER OF; PROPERTY WELL: BUILDING: FS T 0 LINE: ❑ YES ❑ NO YES ❑ NO NEAREST Ur 0 ICI Sketch System on Re county file for audit. Reverse Side. SIGNATURE: / TITLE. DILHR SBD 6710 (R. 01/82) '�� I 1 wiscpnsin APPLICATION FOR SANITARY PERMIT :. + D 1 L H R (PLB 67) St . Cr oix C OUNTY e oeRHRTmenr oc UNIFORM SANITARY PERMIT # InOUSTRM, LRBOR 6 HUMRn RELRTIOnS I — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Dennis Muzzy Hwy. 35 No. , Rive PROPERTY LOCATION XXXX SE 1 /4SE 1/4, S 1 5 , T28, N, R 19) W ol��x Troy LOT NUMBER I BLOCK NUMBER J SUBDiVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER -- - -- - - - - -- STH 35 TYPE OF BUILDING OR USE SERVED 140. Y 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ 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. IN 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 1000 1 X Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: Weiser' s Concrete Products 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 Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Class I 624 624 ® Private El Joint El Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): ignature: MP /MPRSW No.: Phone Number: Paul R. Cudd 1 2739 (71 425 -204 5 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, WI 54022 Arthur We erer (576) COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved /0 -40 �,! El Owner Given Initial JY12AIU 0, 62J,&, r 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 �l INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 t , 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, DILHR, State of Wisconsin. 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 /contractql;,( "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 � 3 T, Section , T - � N - R 7 W Township Mailing Address �� lJ Z) Subdivision Name Lot Number Previous Owner of Property �t 412s /J /"© & Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house) ? Yes L,- No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. 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. --------------------------------------------- PROPERTV OWNER CERTIFICATION I (We) ceAti 6y that aU 6tatement6 on th,%s jo rcm aAe tru to the but of my (ouA) knowte'dge; that 1 (we) am (oAe) the owneAlb) of the pnopehty de.scA-i,bed in this .injonmation 4oAm, by vi4 tue aj a wauanty deed necoaded in the 066 ice o6 the County Reg-csteA o� Deese as Document No. 3 / 39' ; and that 1 (we) pnee entt y own the pno poa ed site bon the .sewage po bra. - system (o,% I (we) have e obtained an eaeemeat, to nu.n with the above deeeAibed pnopenty, 4o4 the ea c ti on o6 a a id b yztem, and the .dame has been duty tecoxded in the 0 j 6ice 06 the County Reg"teA ob Deeds, ae Document No. ). oda 10 SIGNATURE OF OWNE SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED st' I DOCUMENT N o. STATE BAR OF WISCONSIN FORM 1 -1988 THIS SPACE RESERVED FOR RECORDING DATA WQ4R DEED i� VOL dlifl i PAU ` �9 This Deed made between ._..�l1. ell- A. ...Br_a1an,•..divorced - -- REGISTERS OFFICE and__ not• remarried _ A.K.A�-- Shez�rl- -Aru;- ST. CROIX CO., WI& B ------------ - - - - -- - - - - -- Rec'd. for Record #WS 1 5t•h --------------------------------------------------------------------------- - - - - -- ---------- - - - - -- Grantor, i; "t'y of June A. D. 196 and__.. ---- Dennis -L.__ 1I uzzy.._and._Bar_ bar_ a__Jean._Muzz_y,_.husband ------ 10: &, --- and_ Wife - -as -- j- oi. nt�.- t�enants---------------------------------------- -------------- - - - - -- ------------------------------------------------- - - - - -- ------ - - - - -- ----•--------------------------- •-- - - - - -• it ...................................................... ---- - - - - -- ............................... , Grantee, Iowa of DOW$ Witnesseth That the said Grantor, for a valuable consideration.0ne ( 1 00).D -01 ar..a.nd_ ather.- good. . and.. valuable. consideration I� RETURN TO conveys to Grantee the following described real estate in ._St...Zr.oiX ............. Ii County, State of Wisconsin: Tax Parcel No: ----------------------------------- 1.16 acre parcel of land in the Southeast Quarter of the Southeast Quarter (SE 1/4 of the SE 1/4) of Section Fifteen (15) , Township Twenty -eight (28) North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin, described as follows: COn-IENCING at the East Quarter corner of said Section 15 in the center of the town road; thence West along the Quarter Section line 1,565.0 feet to the center- line of state trunk highway #35; thence S 34 East along the centerline of said highway 2,072.4 feet to the point of beginning of the'l.16 acre parcel of land; thence South 82 West 303.4 feet to a fence line; thence South 6 West along said fence line 147.0 feet; thence North 82 East 411.2 feet to the centerline of said highway #35; thence North 34 West along said centerline 158.5 feet to the point of beginning, and containing 1.16 acre of land, including a highway easement of 55 feet in width. f T RAN Fa This ------ is ....... ........... homestead property. (is) K4m$ Together with all and singular the hereditaments and appurtenances thereunto belonging; And....... rantor. her- ein.------"---•-------------------•--------------------------------------------- - - - - -- ---------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants, reservations of mineral rights, and highway rights -of -way, if any, of record and will warrant and defend the same. Dated this ---------- _---- - - - - -J - -------- - - - - -- - - - -- day of ---------------- 4-une --------- - - - - -- --- - -, 19 ---- 84. -------- (SEAL) ........ .ld/ -- ... - -- (SEAL) * _.__.• ............................. ............................... • -Sheryl- .A.- - - Br own ----- ----------------------------- A.K.A. Sheryl Ann Brown - - - - -- ----------------------------------------------------------- (SEAL) ------ •-- _- - - - - -- ................................................ (SEAL) 4 • AUTHENTICATION ACKNOWLEDGMENT • Signature(s) ------------------------------------------- --- ---- -- -- - - -= -- STATE OF WISCONSIN ' as. r,.t/l c t -------- - - - - -- County. authenticated this ........ day of----------------- ---- -- - --- 19 - - -. -- Personally came before me this ---- Z5 ! day of ........ - me ........................... 19 ---- the above named - - - - -- ------------ - - - - -- ----------------------------------------------- - - - - -- - -- --- ---------------------- ------ -• •---------- •- •- -... -• ---- ......------ ..._ - -• • -- ' - I - - - -- - -- - E _ - -- -- -- - -- • S _ _ -- -- - - -- B - -- --- -- - -- .• - - - IS _ _ -- -- -- -- I N _ ---------- . ................ hery_l. Brown............................ ...... TTL : B E AR O WC ONSN (If not- ----------------------------- -------- -- -- -- ---- -- -- --- •- - - -- ----- ----- -- ---- -- ----- -----•- - -;, -: --- . authorized by § 706.06. Wis. Stats.) to me known to be the "rl46n A,. who. executed the forego' nstrumenb.Mti�l•ackno i(d 6�the same. THIS INSTRUMENT WAS DRAFTED BY -------- - --- -----� ---�{-O-i- 7�-�-',_' � .:..................__._ , ------------- -DAMMA- _IILIAQK:•• - C 2,- --- - N�� � se.w A . = -------- - - - - -- Notary Public _ t _ 111_.�I- _.Walnut_.3t. Ra ver_Falls_,_ W 1__ --5 Q22 y _ - ••_ -'- -- --_ County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission ",i� at. (if' lips state expiration are not necessary.) �/ 1-......... 9 ) date: ................... f'.: 1 . 6 *Names of persons signing in any capacity should be typed or printed below their signatures. • z H 9 STC - 105 r r 9 ` H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d •.J Y C. 7 J (/ OWNER /BUYER ^ .�i L 1 //' /„ •,% %" � i . �� ? ✓i �� /.l � Lt � � t� ROUTE /BOX NUMBER � � C )�C• j( S� „ �1- Number �1 (f CITY /STATE ZIP PROPERTY LOCATION: .<,t'_ Section , T R __,�f W, Town of , St. Croix County, Subdivision , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, 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 was-te disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to PP y y P three year expiration. HH • E I /WE, the undersigned, have read the above requirements and agree z „ to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by ,thy Wisconsin Depart - w ment of Natural Resources. Certification/form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. i 2 H = a3 o�° w w �'`< w co K c co fo p 8 ja z ? o ? cu 0— o _ n c o N -E o -- co g u 6.pvC*l m g o xp a CCD n O 0 O W 0 3 a O m 40- �� �`c9. 3°,c c ZS �� o w N w w c o�oCL CA < N N C r tit/ w B w maw at o y C N co CA „ �(A 0 cDCDCD a � a a(DC, 3-•(A �D � m 2 ° cD�saro N m e o U,, fl, w rt 3 .. C D (D w��QC� y O c c c n d, �3a cQCC� R1 ao f w c CLI ,o w ' CL ( A N om '' . 5 �u�o mcca 0 q(A; I a O< a C 0. n7 C CD �^' p 0 i a 3 3 °d . w 9 6 a s O < CD CD Xir DEPART , Y, f OF REPORT ON SOIL BORINGS � %� DIVISION � � 5 TY &BUILDINGS INDUST j /� LABOR AND . PERCOLATION TESTS (/ t <`p ` ''� P.O. BOX 7969 HUM,gN RELATIONS 1 � yi !9 ISON, WI 53707 (H63.090) & Chapter 145.045) ��� C 4 LOCATION: SECTION: TOWNSHIP /Mtttd eW*ttT-Y: OT N NO.: SUBDIVISI AME: SE S4 '/a \ S /T z /R W �-�� — COUNTY: OWNER'S BtPY"'S NAME: MAILING ADDRESS: Sr. cmo`� �EI.�IJ l s Nl u zz ti' \� �� 3 S NonT1.i ��1 � I.vl sv USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMERCIAL DESCRIPTION: PROFI E ESCRIPTIONS: ERCOLATION TESTS: I (Residence A ❑New Replace I 4 t ( 4 _ 8 (C (/ S t/ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND•PRESSUR_E: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ©S ❑U NS ❑U �S ❑U El ZU El ®•U k S BS If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5) (b), indicate: �. Floodplain, indi Fl elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- I"e*ditS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH U* ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0.8' V�`c��h 5i I Ts ; z. O' uDtc 8>1 s i ; 1• l ' Br, L ' c, a' UOkT3 �•o'UDKZ3�, Z.Z' fah L; B -Z 8.s S�.y K�oIJE - 7 8.S y.s >1 s et <>^ Ts vD1t0�,si1; 1.5' 16 -n L ; B- o�e✓ 7 8, S o,a' B�, is y' �� S I ��- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PERIOD PER INCH P. ) .O ►vo 5 Z 3 �� Z 3j y Z 31V Z P _ z Z 3 P_ �.) ' �i� )Isi 1 -7 i8 3 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. - (3 - F�-, a e L" SYSTEM ELEVATION r E .��___m _ �_ __ _ e - ( ' F N Le IiIlz t E 14 3 N �+� 3 + P1.sv? , ..,, �._.. .. _ ,... 4 . 3 , , 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: pR`m �_, bV EG 1Z J D y- S V ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER (optional): Sycl )1 Sn 6 - IIS- 4ZS -01 6.V CST SIGNATU E: oo A RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; :3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5� Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; PS. PLEASE use the abbreviations shown here for vktriting profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be. used i{_ desired; B. Make stare }four benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, narnes, addresses, flood plain data, percolation test exemp- tion, it appropriate; 10. If the information {such as flood plain, elevation} does not apply, place N,A, in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as re(tuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Sian- (otter 10 ") BR Bedi k cof) -- Cobh!o l3 - 10 ") SS - Sandstone gi - Grave, (under 3 ") LS - Litnestone *s - Sand NGW - High Groundwater cs - Coarse Sand Perc -- Pi�fcolation Rage med s l led u-i Sand W -- ` ve11 f - Fine Saild Bldg BUiiding is L o ,iny Sand Grva ier Thy- "sl - Sanely Loam Less Than I Loan) Brn - Brown sil atilt Loans BI Black cl -- <'lay Loam Y - Yellotn: sc! Sa-dy Clay Loam R - Red sic! Silty Clay Loani mot - Mint Nes so ` 3ndy Clay w/ vv; t rill °;1 Clay fff - f ,,r tir v, fa n *c - -- C l�.y ce - comr;;ors, coarse ht -- It ra, nim - Ktiny, mod tern n') _.. "t'1!,_ ;k d - distinc? p - prominew, HVVL - High Meter hovel Six g ri ral Soil textures s',jface triter for I gold vtaste disposal BM -- Bench Mlad< VRP - Vertical Reference Point TO THE OWNER; s nis sm! tcrst report: €s the iit Step in Securing a sanitary permit. The count.v or the Department May €equest of Th -, test in file field pi "im to permit issuance. A coconl *:£o of pl,,ins foi the pnvate s�'tem nd a pe,rri - 14 applic-muml must he suhmitted to the apps - o lriaio local auihoiity in order to .taifl w } t,ci;iit , h+ sali,ta-r y f.. mi f ,i._, l;a f, .;f ctfi, u'Y3(;f p{)'et�;d {y3 t_'1r'r3 f:oe °,tart (3f any f onstructsa7rl, i �i j r C) A� PAGE * r CROSS SECTIONY OF A BED S STEM - •— RDOvE )U��NEDT. tZA Z' OF AGGREGATE= _ 4-- SOIL FILL —; DI5TRIBUTIOti PIPE pPPROVED Sy1ITHETIC COVE -- `� MATERIAL OR 9" OF STRA4 OF, MARSH HA`.3 jo OF %Z - 2 1 / oAGGREGATE ELEV. OF 9Z FEET - T DISTRIBUTIOU PIPE TO B1= AT LEAST 4 0 IUCHES BELOW+/ ORIGIQAL GRADE AQD AT LEAST 20 WCHES BUT MO MORE THA► -1 L2- iNCNES BELOW FWAL GKPIDE MAYIMUt DEPT " "F{ OF 1- XCAVATIOU FROM ORIGIUAL GRADE .✓ILL BE b IUCHES - MINIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL BE INCITE S SO SIG"CD: ,L L1GE►�SE UUMBER:� Owner's name San. Permit No. r r H63,05 PLOT PLAN Show: Location of building served uA Dosing chamber V Vertical/horizontal reference point �� Septic tank i � • Building sewer System elevation is Z•Z� El Effluent system EA Well [uq Replacement system area Property lines w /in 50' of system Distribution boxes Scale = \ _�-�� , or dimensioned �q Pump and controls: — 14fr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan E>u ST, pRV JET ` 03 �Z' • '� 1O \coo • tl .�dp0 ors @o1ruE'1 x ZS 11RP � I j 3 I � Cl i �Z eta P. � � �� ►.��c F�`N Ct_ \� � OP C'R�"y LI � � By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.Croix County and the St.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. �s na ure 1� N'7