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HomeMy WebLinkAbout040-1145-10-000 0 � c / ' © \ r � ƒ _ � ® I 7 / / < c @ c \ � ° ( Cl) $ ® 00 r') § o (D Q / o / / k : ` 00 :3 � § \§ 2 G / 2 a// O ` CO ■ B. ° p E c © 2 @ a> E E f , ] ® A 3 co 3 \ E E k C » \ k / § § /, 2 0 c C. o a Z "&A- \ r rr 2\ o 0 o g OI Q CL § 0 \ § §) I / ° > .e c� / { / \ J 7 $� - ^ 0 I Cr K k 4h- N) \ k z � i EJ0 { 2 } 0 @ jo k ( \ 3 CD 7 e / § \ k 0 ` z 7 P. { ■ § # G $ 2 CL 0 ) § ƒ ( / ' a > ] 0 � \ � 0 a / 0 . � � ) . � � ¥ � � . � 2 � 2 � { 0 G A § _o �§ §i �\ Parcel #: 040 - 1145 -10 -300 01/25/2005 08:10 AM P AGE 1 OF 1 Alt. Parcel #: 12.28.20.575D -30 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner " LENZEN, BRUCE G BRUCE G LENZEN 502 2ND ST 204 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 284 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 7.389 Plat: 1482 -CSM 16/4298 SEC 12 T28N R20W PT GL 2 LOT 3 CSM Block/Condo Bldg: LOT 3 16/4298 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 08/28/2002 688473 1961/27 WD 04/01/2002 675114 1865/90 WD 04/01/2002 675112 1865/85 WD 07/23/1997 891/249 TI 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 27253 762,400 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.389 523,700 240,200 763,900 NO Totals for 2004: General Property 7.389 523,700 240,200 763,900 Woodland 0.000 0 0 Totals for 2003: General Property 7.389 500,000 186,100 686,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1145 -10 -000 01/25/2005 08:09 AM PAGE 1 OF 1 Alt. Parcel #: 12.28.20.575D 040 - TOWN OF TROY Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): " = Current Owner RETIRED BRUGLER * BRUGLER, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 284 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 23.810 Plat: N/A -NOT AVAILABLE SEC 12 T28N R20W PRT G. L. 1 &2 AS IN VOL Block/Condo Bldg: 218 P 351 INCLUDES P1015 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/2311997 891/249 TI 07/23/1997 324/369 2004 SUMMARY /' This parcel will not get taxed. It exists soley Assessed with: 1 ! W for parcel history tracking purposes. Valuations: Last Changed: 07/24/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1145 -10 -100 01/25/2005 08:10 AM PAGE 1OF1 Alt. Parcel #: 12.28.20.575D -10 040 - TOWN OF TROY Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): ` = Current Owner RETIRED BRUGLER " BRUGLER, RETIRED Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 284 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 12 T28N R20W PRT G L 1 82 IN 218/351 Block/Condo Bldg: ALSO PAR IN GI-2 BEING PT LOT 1 CSM 7/2023 COM SE COR SEC 12;TH N 01 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 107.38';TH SWLY 33.11';TH N 37 DEG W 12- 28N -20W 66 ;TH N 02 DEG W 365.01'POB TH NWLY 39.39';TH N 66 DEG W 104.43';TH N 87 DEG more Notes: Parcel History: Date Doc # Vol /Page Type 04/01/2002 675112 1865/85 WD 07/23/1997 891/249 TI 07/23/1997 891/249 TI 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 07/24/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Sys) 57Y 5725': , 011 O9,�' :5/ - 2 , & - Z2 69 STC - 104 AS BUILT SANITARY SYSTEM REP OWNER M jozpA ,vie. 81f 06 LE ADDRESS 2S� G!�• v/� �UL� /�!/ • ° . 1<<r p SUBDIVISION / CSM# "" P0 O .2 SECTION 2 T 26 N -R 2 0 W, Town of TiPoy ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM NOTE o LP _ ALL NON CC THE NT TANKS SHA EA TR RLY ABANDONED PROPE BE pRiG FOR ILHR 83.03(2). INDICATE ' - Provide setback and, elo-vation information on rever Provide 2 dimensions to center of sept fan' r , �Q,vG��.c �CeiP Sil� IOO. f BENCYMARR: �� � �a ALTERNATE BM: y O� of ii S7 .1 /VEX 7 7 SEPTIC TANK / -.PHIEP -- GRABB / HnTmia; TANK I I OR MATION o-� Manufacturer: R%P(I)FSTf;Ot- / Q ��� ffT /a Liquid Capacity: Q om• - Setback from: Well 7 -7 5 House 7 3� Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location ':SOIL ABSORPTION SYSTEM Width: T ength .5•o Number of trenches Distance & Direction to , nearest prop line: �' SOV Gi 7 ' Setback from: well-: House l � • .. ,Other e • ELEVATIONS 3 � Iv 95. g 54, 3 Building Sewer / ST Inlet. ST outlet. PC inlet / PC bottom Pump Off x eader /Manifold Bottom of system Ek i rade Final grade P�� DATE OF INSTALLATION: )( t V� Z PLUMBER ON JOB: LICENSE NUMBER 22 • 4 e 3 - 7 S INSPECTOR: AEow (T le�� �T Utwketit a As c Pclvate $ewa6e C 3/ 9 3: j t 655 all 540~ 6 Nudson, � O 38G $ a - � Q 0 -� m I I► --� � � nt y � fti o 7 p' kj H � z 00 7r kA �- lie 1� I /* WiApridn Department of Commerce PRIVATE SEWAGE SYSTEM v Safety and Buildings Division Count Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary err2 Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Brogler, Josephine & Jim Troy Township CST BM Elev.: / I Insp. BM Elev.: BM Descriptio : Parcel Tax No.: 040 - 1145 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic L r P 26D Benchmar Z 6,G, 3 OI•cZ Dosi ng Alt. BM Aeration Bldg. Sewer Holding St / Ht Inlet s' q6 TANK SETBACK INFORMATION St/ Ht Outlet (, .!S 9� 4 �� TANKTO P/L WELL BLDG. Ae lntake ROAD Dt Inlet Septic (VD > 8D� �--� NA Dt Bottom - Dosing NA Header/ Man. o Aeration NA Dist. Pipe ` . (0 0 2. ', Holding Bot. System I- . 0 q�: Pump/ SIPHON INFORMATION Final Grade , Manufactu emand St cover Model Number GPM L X 1, � TDH Lift L oss Ion Syste TDH Ft I� 4t2 �i ►. g• Tip 2r m ead Forc In Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BIarB. TRENCH Width / Len th ! No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Ma of ctur r: SETBACK INFORMATION Type O CHAMBER � / r odel ode Number: System: (2^4. Z r'C* > 160 (M OR UNIT - a DISTRIBUTION SYSTEM Header/ Mani of Dist ibution Pipe(s) o ize x. Hole Spacing Vent To Air Intake Length tA Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: ( Include code dd lscre n S o 5 Je n� et ns ection oD inspection Location: 284 West Grove Road, uc so 14 16 e (N W l / 1/4 12 T28N R OW) - 12.28.20.575D 1.) Alt BM Description= � - 9 °'_ �" "� 2.) Bldg sewer length= - amount of t cove r= G " " - � - U� e v. e � �r r.� U`nu cnt,r�2 t S ° "�►2 -_ " -_ ' _ - Plan revision required? ❑ Yes PI No Use other side for additional information. DES• os, SBD -6710 (R.3/97) ®^ _Dade ` /� Q sp cto� s igrla Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: IN 6 � d � i E 3 3 t X Aa��PE.SS 2 8 9e 60- "00-Q- RD • 11-OPSOAD s5 C Safety and Buildings Division Vi sconsin SANITARY PERMIT APP.,I.ICr>�,10N 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, WFa. - Adm' ,ode;' 7 � Madison, WI 53707 -7302 f • Attach complete plans (to the count co only) for the s le ounty P P Y PY Y ST• Ge0t than 8 vi x 11 inches in size. 1 � � ; • See reverse side for instructions for completing this appall , rr a e Sanitary Permit Number Personal information you provide may be used for secondary purposes 1 1� +1 '¢ heck it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ,� %rah �Ste Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT AL s ' N Property Owner Name a Prope t "t p 4Q i K P R V /..�/Z a, S /Z— T 2d , N, R 2-OE (o W Property Owner's Mailing Address Block Number 2- Coke 29' N� �-- Cit Code Phone Number Subdivision Name or CSM Number r/ �YO!!o I (M 7Cr Y2- 7 OF II. TYPE OF ILDING: (check one) ❑ State Owned ❑ C ity Nearest Road Z ❑ V age ?'R W . G- APOVL� El Public r 2 Family Dwellin - No. of bedrooms ion OF �� • 111. BUILDING USE (If building type is public, check all that apply) Pff rUj TaJXT*dqber(s) �.a �'a8•, �75 0, ovo 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ N n Ho R�CEIvL P Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sale pairs 11 Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Par = 1 Service Station / Car Wash [] 5 Hotel /Motel 9 E] Office/ Factor ; °oQQ y � .� . 1 Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. C box on , pl' e) A) 1. ❑ New 2 Replacement 3. ❑ RepI ryie�t 4. onnection of 5. E] Repair of an - - - - -- System - - - - -- -- System ------- - - - - -- Tank -- / �,___. - istingSystem -____ Existing System -- f - - ------- - - - - -- - B) ❑ A Sanitary Permit was previously issued. Permit Nu m `' ' Date Issued V. TYPE OF SYSTEM (Check only one) hl/ C41A Jay/ �N f'� �,� --�, �.� p,� s j ,,, (re Non - Pressurized Distribution Pressurized Distribution Experimental O her 11 []Seepage Bed 21 [:]Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Weepage Trench 22 ❑ In- Ground Pressure 42 [] Pit Privy 13 [] Seepage Pit Rza 2 y ` " X 3 7 e2444-eq S 0 f !j LjVal61l4 F 14 ❑ System -In -Fill Q � is AX4.1, O 3 3 ' )e, d 5 ` — � f 7 (v VI. ABSORPTION SYSTEM INFORMATION: 70,75 '— 96 4 S 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gais/day /sq. ft.) (Min. /inch) Elevation �� 7 5'0 � 9. ?s Feet 13.7 Feet VII Ca acit . TANK in gallo s Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st acted Steel glass A pp. Tanks Tanks Septic Tank or Holding Tank ��-Q� — 1� 00 07�f • El 1:1 El El 11 Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: ? i( z�3 - 1S 7!S • 3 e • 818'5 Plumber's Address (Street, City, State, Zip Code): ,s 7 b �ezP . W' ` S q IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued issuing Agent Signature (No Stamps) (Approved ❑ Owner Given Initial 07D Surcharge Fee) Q Adverse Determination ooZS -b X. CONDITIONS OF AP ROVAL REA ONSWIS PPROVAL nn-- 7 wti�"� ao su> SBD -6398 (R. 4/99) i1RSrr y t to ant ne ro. .on, r 1. '� r INSTRUCTIONS 1. A sanitary,perrrr► t.* valid -for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership orplum,*ber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior -to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) e must be pumped by a�licensed pumper Whenever necessary, usually every 2 -to 3 years.; ' F 6. If you have questions _concerning your ons.ite.sewage system, contact your local code administrator or.thre State off Wisconsin, Safety'and Buildings Division, 606. = 260151. - To be complete and accurate this sanitary permit application must include: I. Property owner's name`and moiling address 4 1rbvide the legal description and parcel tax number(s) of where the system is to be installed. fl. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vl(.' .7aAinformation :, Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and nlafufaciur�r name „indicate- prefalj c>tsite constructectyar�d.tank nlieral. Complete for all septic, pump /siphon and ho)d n tankts for this s stem. Check`ex p erimental a rov 'I ' l if tanks receive "d experimental product approval from g Y p pp Y A P pp DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc,.1, address and phone number. Plumbei-mUst sigri'apptication-fofm , +. IX. County rpepprimdrtt y s e X. Degartm9ent Use.Only. Complete plans ands'4 ecifications not smaller than 8 x 11 inches must be submitted: t®t'he county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation refer #rtce..,pointV ), Complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump,'performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the'c'odnty E) coil test data on a 115 form; and 6'all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect`g you rtidwater: The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. p4f 1 — o AD JUS T ED PLOT �� c o oD ,DlAlltl 2-31 �� � __ -- _ 13 7 axis � /,clYr �- iNS R /oa y,—� for ( sue - . — NE 1 0 O ' *,pwf57t1 /l r.QCrS 7` 4« . ALL NON - CONFORMING I TREATMENT TANKS SHALL _ BE ABANDONED PROPERLY �jk _ /fir FOR ILHR 83.03(2). � TRH Q� LI d- 3 ,� �q �,73) pint - SST o�a� 2-- , � , , o pep 7A c5� �9y, 3 � ,° � : ; ; \fig, .°�., .�. �o. 7�� y 3 y v _ f �P . �9Pf'�err�h v�tiT C,9 ,, s� , Ao 9iP�f�C � 7•Co S.. 1 r T/P�.v CTT Iff &f770 i ----------�--_ . ceo SS SEC T /off TlRf ws//v G- IlU fi G - Te 4 #f. e4 M0'7( '��i1� �i�t11� ' '' 14 OPEL , , 3 & 'a L-aV6- Gu; 34 e 5 Q FF TO Tf 7-ILIA-1 - Iff 1,r , y C�'o SS SEC T /off 5m) 6- z- 7 eA 7 -- o R s h�l � C� pr9Ci'� � ' �''i1��u>i �1��'�� .� , y OI��L , . 3 • �C �o , a ,� PvA 31. e sQ, Fr To - r t c.. p4 s L=- 7 ati . iff JIM `l3. 70 iv z 7kfFol�e 6 3.75' r >, r� 1 Y Wisconsin Department of Industry SOIL AND SITE EVALUATION / 3 Labor and Human Relations • Page of Division of Safety and Buildings in accordance with Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz l'must , Co .ST C, j At include, but not limited to: vertical and horizontal reference point (BM), it on anrr - „� percent slope, scale or dimensions, north arrow, and location and dist ape, o neare�tioad4 4 ParCerl . # 8•2 o•57 S.� APPLICANT INFORMATION - Please print all inform n. Revieweq by Date Personal information you provide maybe used for secondary purposes (Privacy L w s,W5.04 (1) (MMLi?v�`, Property Owner Pr ocation SDSE In i N!2- �eV Tt M i3R�y t' �at C ( �► AV' e '•`1 1/4,S T 28 ,N,R Z' E (or) RE BEST. ' Property Owner's Mailing Address L �Bi Subd. Name or CSM# e �'� � 3Ru5tE(Z /v 271 Cou �D. o r- 23. 4 3 City State Zip Code Phone Number 5a ,T Nearest Road k�lei ,Sow t,�?I • Si�ol(o ( 7.5 )3W • i?if 1-1 cit Village L� Town M5�5 6/000E” [__1 New Construction use: Residential / Number of bedrooms 1– Addition to existing building 5 , Replacement ❑ Public or commercial - Describe: e Code derived daily flow 36Z g Recommended design loading rate ' 7 be c, gpd /f1 • o trench, gpd/ft p • Absorption area required ad, f 3 `J trench, ft Maximum design loading rate . 07 be c, gpd/fl �* trench, gpd/ft Recommended infiltration surface elevation(s) 5 �' • ft (as referred to site pli in benchmark) Additional design /site considerations •S,ae- tv0r ae ( o Parent material 54NP ov Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system [� ❑ u C� S ❑ u Q S ❑ u ❑ u [ s El u ❑ S SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench io 1 ! 3 G.S )-f- . 7 :. 8 8' /o Y.W fel o o , IS /,*-t ,e e5 • 7:4 Ground 3 9• f / 0 yiQ !f .s ©► s — — 7 :.8 elev. .�ft. Depth to limiting factor 7 9 � p in. Remarks: Boring # 2 /, GQ� 4j 2� .7 : � /3 ..:.: , o '3 �o .Ve 31 — v.C�/ <S 14. ,e 406 es' -- • 7 :.8 Z, . D .7-6 ; 3 0 . s ,S Ground / elev. - 70• - Depth to limiting factor : in. Remarks: CST Name (Please Print) Signature Telephone No. oa��T 71 - 38G'f3! ss Address Date CST Number / 17 • 0 27 22Ce� 7 S rc Private Sewage Consultants 655 O'Neil Rd. I� Hudson, Wis. 54016 /� b /. dlvv�S w 0 v�t• - �tW S YS J�- 40 3 Rep 2- -,fv tea• �+y' N 7`iiF / Ctii; t- ��,k ova '{•D 15 �,uSf�llrF -7'r'o �v R� PROPERTY OWNER Page of �,Q SOIL DESCRIPTION REPORT Z 3 � � • PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench yt 213 Z / �,e w . s VA MI yekll� I Ground — Apo elev. a ft. 6 — ,�,. -�P• IF s 0,S4 �2 Depth to limiting factor 7 / •8 �-� , Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # , Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) 23 ^ � � 26 maxis ri�v�i ?- L'��S &P ov7 q�� for ALL NON - CONFORM TREATMENT TANKS SHALL�� �D BE ABANDONED O NED PROPERLY FOR ILHR 83.03(2). 7q Of �1 j TR l PD s 26 - , _ r �evfi a 5 3 hti 3 By 7 y e �,�� P, T-s 3 e1 3 R 9 DA - FA , =ToPS -- 5� If7 ° STS T1��,J MCP. L,PV -cam° UibtId%t & Associates uttants private Sewage � 6650 'Neil Rd' 54018 L HudsOn. Wis• (,� y 11 pt ` O P1 Ye a .�``�� ♦SC � Uoi s$ r 'p -. HIIOSON. WI � S �s I G"t � -30 ,�oa� Sid 00, 0 , coN c�tf�- � s s5J74 M I p F :- AD UO ►EP FL01 FL ooD DIAIi / yo yo 4SfllmEp so l for o ,�' ` 7p0. P ✓� -F-J 2 ALL NON - CONFORMING T TREATMENT TANKS PER BE ABANDONED 83EO (2) FOR ILHR 7R 4 7, 3 7P� OF lam S +-ed ffW l 3 y'7 ��D 5 3 y f�- i T 3 ©i 3 _ ST CROIX COUNTY • SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM er U ner /I3u � �GGv� -Q (�( �/ Y Mailing Address Property Address �7 CdU� ��• �7 "�%���� �� (Verification required from Planning Department for new construction) City /State! Parcel Identification Number D y /.S `� • �� � LEGAL DESCRIP / ION s y Property Location j '/, '/� Sec. 12, T Z � N -R W Town of ���/ 1 Y ee , Subdivision �� T o� _2 3• '7�l - , Lot # Certified Survey Map # olum ,Page # Warranty Deed # �6s'�1 , Volume / , Page # 2 �� Spec house O yes Wn"o Lot lines identifiable B yes O no SYS'T'EM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a maslet 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 slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days ZURE ;OF ear expira S / 1 6 0 APP LIC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) 9m (are) the owner(s) of the described above, b virtue a arranty deed recorded in Register of Deeds Office. S � 49 SIG TURE OF AP LIC NT DATE * * * * ** Any' information that is mis- represented may result in die sanitary permit being revoked by the Zoning Department.****'* ** Include with tills 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 �v g!F, ll� e � • , - 465814 _^ Sg1wE249� APPLICATION FOR' 101. • • Fif Apocadon and AWrognate area with Replster of Deeds • TRANSFER OF.YROPfRTY TO SURVIVING JOINT TENANT, LIFE TENANT OR REMAINDERMAN (Section 867.045, Wis. Statues), REGISTER'S OF FIC and /or Sr. CROIX CO, Nip • SUMMARY CONFIRMATION OF INTEREST IN PROPERTY Rec for Record (Section 867.046(2), Wis. Statu —) JAN ? 11��91 DOES THE PROPERTY LISTED BELOW CONSTITUTE ALL OF THE PROPERTY IN Cf 3: P. $A WHICH THE DECEDENT OWNED ANY INTEREST AT THE DATE OF DEATH? �It YES( NO F] of De ed s Decedent ^ Date of Dealt — —T Soc al Seamty kumber Edward E. Brugler Jan. 7 , 1991 474 -10 -0207 Address of Decedent a; Da'a of Ueath City State Zp Coda 284 W estg rove Rd. Hudson — WI 540 1. Stocks, bonds, savings and checking accounts, and vendors' �— Parson Serial or Full Value At Date of Death inwrests in land contracts (if more space :s needed, attach Receiving � p ro � dy Account Property Transferred Under schedule). P r Number s.867.045 o s. 867.046(2) from line 3) $ 's TOTAL V ALUES . . $ $ Transferred Under Person Receiving (check one) Pro letter 2 Real (check ( a, b or Assessed c Estate s. 867.045 s. 867.046(2) from Line 3 8ekrw) Vakiation I Equalized Valuafion Recording Data r X a 180 00.00 208 500.00 Vol. 324 Page 69 Pl us easement in 96-9 and an other easement that run - -- � g OPIW � i n �— - DECLARATION Fili=of are that this application is, to the best of my (our) knowledge and belief, true, correct and complete and is in conformity with the pro visions and the Wisconsin Statutes and does not release any tax Iiabdities. � 3. Name and Addr ess of Person Receiving Property Relati onship to Decedent Signature Date a. Josephine L. Brugler Wife 1/21/91 284 Westgroye Rd. p y� Hudson, WI 54016 b. I I To be completed by Register of Deeds Swom t be re me on . uar 21 1 9 91 Viewed Death C Vol. 48 Page 331 (local or state file number) Signature Prins or Ty aTr+ r } e8 �S�flbhell I certify that I have mailed or delivered copies of this application State of Wis tjsiiF 7� �� Y = as provided in s. 867.045(3) or s. 867.046(4), Wis. Stats. on County of = t SX - Crc x My commission iDA irAy AWil •'?3 January 21, 1991 _ i Date This application was draft&3 iuy (prltt 4r4ype name below) Jose L. Bru gler HT•t to (R. 790) Register of Deeds (signature) GidIGItVAi I ! .) ) WARRANTY _PEED. S TATE OF WISCONSIN—FORM No. 9 NUMBER This Indenture, Made by ...... qarl A. Gustafson and Pearl F. Gustafson . his wife, ..................................................................................................... .......................... ................................ . ........... ......................... . . . ... 247612 ............................... ...................... ........... ................................................. ............................................ ........................ ..... ........................................................ .................................................. grantor of._._ .............. St. ix ................. • Cro .................. ......................................... ..... ..........County, Wisconsin, hereby conveylgand warranig to Edward E. Brugler and Josephine L. Brugler, husband and wife, as joint tenants `4 . ----------------------------------------- . ...................... . ............................................................................................ ............ L ................................................................. ........................................................... 11Y ... ......... . ..................... C Wisconsin, for ............ ... . ...... ............... . .......................... ..... . .............. ............... . .................. . . .. . ............................... grantee of. ....... . ..... S—t-* .... Croi ( 1k the sum of. ....... Eight.00n Thmimd ... ......................................... Do.:Llars .....• the following tract of land in ........... 151.0 orgiX ......................... County. State of Wisconsin: Government Lot 2 of Section 12-28-20, except the S 577.5 feet and except the E 40 feet of the S 1057.45 feet thereof and excepting; commencing on the E line of said Goverment Lot 2, 15 rods S of the NE comer; thence N on said E line 15 rods to NE corner thereof, thence W an N line of said Government Lot 2, 18 rods; thence SEly to point of beginning* One—half interest in part of the SEJ of SW of Section 7-28-19, described as follows: Commencing 24.75 feet N and 385.66 feet W of SE comer thereof; thence N 31 W 106.85 feet; thence W and parallel with S line of said SE of S44 426.98 feet; thence S 90.75 feet; thence E and parallel with the S line of said Section 7,, 483.39 feet to place of beginning. One-half interest in part of the SW of Section 7-28-19, described as follows: Commencing at a point on the W line of SW of said Section 7, 1J rods N of the SW corner thereof; thence E on a line parallel with the S line of said Section 7 a distance of 60 rods; thence N on a line parallel with the W line of said SW 51 rods; thence E on a line parallel with the S line of said Section 7, 43 rods; thence S on a line parallel with the W line of said S* 51 rods; thence E on a line parallel to the S line of said SW 52.67 rods, more or less to the E line of said SWI,; thence S on E line of said SW4 1J rods more or less to the SE corner thereof- thence W along the S line of said SWI 155*67 rods, more or less to the SW corner of said WV thence N along W line of said SVF ij rods to point of beginning; One -half interest In part of Government Lot 2 of Section 12-28-20, described as follows: Commencing at the SW comer of Section 7-28-19; thence N on the E line of Lot 2, Section 12 li rods; thence W parallel with the S line of said Lot 2, li rods; thence S parallel with the E line of said Lot 2, li rods to the s line of said Lot 2; thence E on S line of said Lot 2, lJ rods to the place of beginning* The West 24.75 feet of the E 64-75 feet of the N 553.56 feet of the S 578.31 feet of Govern- ment Lot "2" of Section 12-28-20* Meaning and intending to include all lands and interest in lands of the said Carl A. Gustafson and Pearl F. Gustafson, his wife, located in Section 12-28-20 and in Section 7-28-19,, St. Croix County, Wisconsin. IN WITNESS WHEREOF, the said grantor .. 6 ha.Y0--hereunto set—Ahiiir ._.._...hand 5 and seal v ............................... day of .................. ......... . .. . A. D., 19 Carl A. Gustafson ........ . . . . .. ........................( Signed and Sealed in Presence of ($19.80) Carl K.""GiiiiV40 ii6ii R.S. Pearl F. Gustafson ......(SEAL) l Can* C. E. Webster ............................................................................................................. (SEAL) .............................................. -•---........ ..._........................... P. D. Larsen .......................................................... . .................. . .............. . ....... STATE OF WISCONSIN, ss. ..................... SIM .... Q=1X ........ . . . ................. I Personally came before me, this ........................... ........_213(1.........._...... --•---------- •-•- •-....._..........- _........... A. D., 19.56 ....... ........................... day of .......................... aly the above named .... 9M! A ... Gustaf pqn-an.d P.earl --- F GA§!tAf§Pn,...h!p--:9!fb ... . ................................................ I ............................................. . ........ .. .. .. .. .. ... ....... .. .... .. ... .. .. ..... - ... ..• ... . ..... ....................................................................... .............................................................................................................. ........................................ ..................................................................... to me known to be the person. A ... who executed the foregoing instrument and acknowledged the same. Received for Record this ............ 31 .. ...... ........_.................day of ... J43Y .................A. D., 19-56_ at..... IQ ........... o'clock &M. . C. E. Webster .... .. ... . . . ..................................................................... ...................... C. E. Webster ........................... .......... -Dwdd Hum .................................... r(Seal) Notary Public,_$1.9 Qroix. ....................................... County, Wis.. Register of Deeds. 0 k - ° fD PI J % k k A MA § g 0 ■ X- z o w W o �. : § i § a k( e - ƒ ` C ° CL w� of �\rCD C v /kk § ■ ■ m0 C Or m ear � . \ \ $ § k J i Q / CL 2 ��� � r (A � ° S \ n � & % "m, ' O § J k k k a ■ p ■ ■ ■ I § ƒ 7 E I ; z e c = z / ° Gmg � 7 E$ f/ ° w 7 R[m .§ §§� f & :3 m \ E CL § 2 £ 2 _ -4 co ■ ■ ® o § / 2 7 @ � � 0 f/ k C ■ V § § N E E CL z z '� ■ ^ 2 { q .. m \ (D k ^ 0) � / ■ � ° 0 % cn ƒ � y � § � ■ � ) % � 2 � k 0 \ ?? �t �