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042-1091-20-100
o NO 0 CA ASi 3�n r1 CD .� M 5 M � # c CD CD m CD d ^ B 3 3 3 ... z z j C_ 3 Z O L z N Z O OD = C W O iC �1 • > > ° O c . N c°'i ° m co m d j j Hy n y CD CD CD O 3 3 m m A O a m m O O y y m N o Z Z y c n m C_ y O , CD =r y p l CO a m 0 0 (n p �� N o co 3 n A a a n m C)i n CD CO CO 0 'a o o 3 0 O a o 0 0 O y N O N N O N N OI, M O a y 0) p d eo n �_ m a i (n z ( D m a S (a D l °1 (n z �D m 4 s cn z N a o CL D 0 = o a D (a D a CD IW m l CD IW o o m Q W o D O 3 o O O co c Cl) m m j j o j O Z m O 0 0 O co o OOD (D O co O O y 0 Co N w N o CD 3 'o 000�l o Z 000� To CC,pJ�� A O D 0 D CS < N z /yam CA CA (�A N o c N 0 N O D 1�R p C w No o ti v v, w j CD e °' °_' m S--' w m rr 3 d N 3 m 0) 3 d w a a o D CD O -_'i D CD O D m O O CL a a a CD CD I CD CD a N CD C CD C CD C O to M. O N :3. O LU 7 cc C CD C CD C COD CD CL w a a 3 a 3 a 3 a 7 (O z 7 (6 CD (b 0 ° c ° 0 °c N CL v a a �' G 0 (n -I W W� W� W m N CD CD rL a a , z C - OO C ^' Z y z N z CDD CD (D A Ca LU W A CD I I o��� CD a a v,o ° m a m a A ° a -o a c a o 3 c c T c ' CD T c 3 60 CL o a o��o� o a N om o a o m c CD °a m y (n N y (p N O C O O a m N o c2 3 n o 0 aoc �x a c pa Q c�AOa rn 0 0 3 a v 3 C D v_, m 'm C CD a a a (a a b aLl0) ��(o CD maNm m 60 m =r a mm n0) a (� =r .. n f,X° ° ti am O s O a Sm o o a cc m a a o o i b o CD m m oro w 0 0 o 0 0 0 CD CL 0 CL CL Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: A 4m 3 ( GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal info -4on 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: Jacobs, Dan Warren Township 042 - 1091 -20 -100 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer. INFORMATION Type Of System: CHAMBER OR YP Y UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 FE] No Fn Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1038 65th Ave. Roberts, WI 54023 (SE 1/4 NW 1/4 32 T29N R19W) NA Lot 2 Parcel No: 32.29.18.499F 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? (_� Yes [*No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) County anitary Permit Application ST CROIX COUNTY WISCONSIN In acoord 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04 1 m 1101 Carmichael Road to Hudson, WI 54016-7716 0 7 0 - Itr<3 (715)3811 -4680 Fax (715)386-4686 Attach complete plans for the sys n p r ss than 8 -1/2 x 11 Inches in size. County Sanitary Permit # ❑ 0 a.ff revlsioh application Da 1. Application information - Please Print all information Location: Property Owner Name. ~ ! / ��� S t ��'� 1/4!'� 114, Sec Z _V /tV k -� 4 �t� r t � �'� � X T � N. R � E (or) W Property Owner's Mailing Address ,"A , i Lot Number Blodt Number O� City, State Zip Code PJYenc 066` ?r Subdivision Name or CSM Number - 3 ," 3 r o aMr _ 4)/ s ' � y c. v 1. rs 5 11 T pe of Building: (check one) wily ❑Village CiTown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road G 5' II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ', V Parcel Tax Number(s) A) 1 1 2. ❑ Reconnection 3. ❑Non- plumbing 4. ❑Rejuvenation Q V Sanitation / z . Z . Yf B) Permit Number Date Issued State Sanitary Permit was previously issued 11 1S q Z (' IV. Type of POWT System: (Check all that apply) G 7 Non - pressurized In -ground ��' k a{ 6 �) ❑ Mound i C Q C ❑ Constructed Welland ❑ Pressurized in- ground ❑ Holding Tank � ()..e i ❑ Drip Line ❑ At -grade ❑ Aerobic Treatmer, ❑ Other V . Dispersal/Treatment Area Information: _ '3 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Api `�,/ �+�S. System Elevation 7. Final Grade Required Proposed (Gals. /day G� /� W"' " N Elevation b 1,4 - 7,7 /�- VI. Tank Information Capaicty in Gallons Total # of Mani - -corer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair / reconnenction /rejuvenationfinstaliation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumbers Name print) lum s Signat re (no stamps): iCAP/MPRS No. Business Pho a Num er ROZ Plumbers Address (Street, City, State, Zip Code) . � Afl- -5'4101 41a1 6 SS D iv,21L. � D • G�Uf� S Vlll. County Use Only Disapproved Sanitary Permit Fee Dale Issued Issuing Agent Signature (No stamps) C Approved Owner Given Initial Adverse' FD etermination IX. Conditions of Approval /Reasons for Disapproval: a 1. This application was submitted after - the -fact to repair a damaged pipe. If a system failure becomes present or it is discovered that the existing system was not originally installed in code compliant soils, the system will need to be replaced. 2. The existing system must be properly maintained and the septic tank shall be inspected and/or pumped ever 3 years. ST r1 tI^ 3�3 o BIOTI s • / ' Pile S ti4� s r� 'ev 60 . S f T S GT7bA,,-7 '*F � S Q ' ? M S. T. A14.5 i i M Ulbricht & Associates Private Sswa9e Consultants 655 O'Neil Rd. 54016 Hudson W' Wick r 3 3 `� s i vy Rg+r Al �ix, 5 . 3O3 `/ �✓U� . r Ulbricht & Associates ' private Sewage Consultants 655 O'Naii Rd. 540`16 Hudson W' Tib� 14 pQs 4 _ y t T� C 105.,' - r a `§ R SEPTIC 'TANK MAINTENANCE AGEEMENT t p f.k j ix Coun x .. .z, '� St . Cro.ty z t3 d. o OWNER /BUYER ROUTE /BOX NUMBER _ Fine Number_ CITY /STATE © et W i3COT1SsY1 ZIP PROPERTY LOCATION NL.� 3t, w w 1, Section 30� T O` - 1 N, R W, Town of 00, '(`f , St. Croix County, Subdivision �-�J� �e� , Lot numbe P P _ . Im ro er use and maintenance of your aIeptic� system could result in it s premature failure I to handl e wastes. Proper er maintenance con-- i sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system.can,,affect the function of the septic tank as'a,treat- ment stage in"the waste disposal system. St. Croix.County residents m_y . 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 prope maintained. The property owner agrees to submit-to St. Croix County Zoning a certification m for,,.s,igned _by the" owner and by a master plumber, ourne roan '' lumber restricted lumber or' a `licensed .,p- umper�:;veri- fying that.(1) the y on -s wastewater disposal system is in proper operating `condition . and "(2) after inspection and pumping (if.nec- essary), the septii less'than 1/3 full'oCsi fudge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y o I /WE, under. signed, have read the above requirements and agree P g N to maintain the private sewage disposal system in accordance with x r+ the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. '_Certification form must be completed and returned to the St. Croix County Zoning Off:Lre within 30 days of the three year- expiration - date._ T SIGNED DATE St. Croix County Zoning Office, P `d . Box .'98* Hammond,' WI X4015, x :z- 715 7 96 2,2 3 9 or 715 -425 -8363 °> Sign, 'date `and.•`return to above address. i DOCUMENT NO. STATE BAR OF WISCONSIN FORM I — 1M TWO ,PACE Rtatavto FOR III/CORDING DATA ' WARRANTY DEED 441044 @SDK 821'x? REGISTER'S OF FICE This Deed, mach- ha•tween Robert G. Harbek and ST. CROIX CO., WI Judy M. Harp, husband and wife as joint tenants, Recd for Record Grantor, S E P 01 1988 and Dani B. Jacobs and Vivi A. Jaeobs,.husband and wife as survivorship marital property, W 8:3 A AMA . Grantee, �� Riqwv of a*& Witnesseth. That the said grantor, for a valuable consideration of one dollar aiU other valuable consideration e St . Croix cum's•:.. to Grantee thr followin dr- cr:ba•d real estate in (' State of Wl.'C ; Lot Two (2) of Certified Survey Map in Volume 6 of Tax Parcel No:... .. ............................. Certified Survey Maps, Page 1683, as document number 414443, filed in St. Croix County Register of Deeds Office on July 14, 1986, being located in the Northwest Quarter of the Northwest Quarter (NW 1/4 of N+9 1/4) and the Northeast Quarter of the Northwest Quarter (NE 1/4 of M1 1/4) and the Southeast Quarter of the Northwest Quarter (SE 1/4 of NW 1/4) of Section Thirty - 7Wo, Township Twenty -nine (29) North, Range Eighteen (18) West, Town of IVarren. Subject to Colbeth Drive right- of-way �Q over the Southerly portion as shown. FEE This IS. RtA homestead property. (is i I is not) Together wah all and singular the hereditaments and aj:purtt w,nces Anti Robert G. Harbek and Judy M. Harbek aaarranta that the tale is gord, ut.ieia:.s:bie in fee simple and :rac anti cicai uf en:rumLrat, c, rx•.pt all restrictions, covenants and easenents of record, if any, and w•:11 warrant and dr ':.e Dated this August jy 88 Robert G. Harbek Judy M. Harbek AUTHENTICATION ACKNOW'LET)GMENT Sig-nature r;I ;-TATF OF tiCirr ,Nr,'. St. Croix a',,ir.••nt.cnted th:- .a; 1:+ i t i•. t`. AuquU; [2otxl rt G. HariA-!k ajtri' rtx w +, '46rixc , rIT1.E '4 F: \llti:k z V: o ". P 1i: P.oh rt F ',-;a 11 F-1CHAPUS F. NALL & H;-RP I S 522 SecriM Stre- t Hudson, aI 54Oh6 .RTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS teOR WHI14MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION F:O. BOX 7969 BUREAU OF PLUMBING MAD.I$ON,uNI 53707 $t %,NW1 -R18W CONVENTIONAL ❑ALTERNATIVE I State Plan l.D.Number: Town o� Waitcen ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound (If assigned) Cotbeth Dtui,ve NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Dan,i,e2 9 Viv Jacobus Route 2, Box 113J, Robetc6, W1 54023 c/,a ? -,?$ (30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV. - Name of Plumber. J MPIMPRSW No.. County Sanitar Permit ber: Lyte J. Myeu 6219 St. ctoix 127� SEPTIC TANK /HOLDING TANK: MANUFACTURER - . LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. ❑YES ONO OYES ONO BEDDING. VENT CIA.: VENT MATT HIGH WATER NUMBER OF ROAD. PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM LINE AIR INLET. OYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY 1 PUMPM11111 I J PUMP SIPHON MANIA A.CTUFiER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO ❑YES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER Of ':PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) EYES 1:1 NO NEAREST ON SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F'"'IIf I IIIA1,11 TI 11 J MATI HIAL AND MAHKwG or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: WIDTH LENGTH NO OF DISTH PIPE SPACING, COVER UTA -PITS LIQUID BED /TRENCH TRENCHES / Mnr HIAL PIT DEPTH. DIMENSIONS (� GRAVEL DEPTH FILL DEPTH [ PIPS DISTH PIPE DISTR PIPE MATERIAL NO UI 1 NUMSER PROPERTY WELL BUILDING. VENT TO FRESH BELOWE/ ABOVE COVER EV.INLfI ELEV END PIPES FEET FROM -LINE AIR INLET: MOUND SYST 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- 1:1 YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE I II HMANI NT MAHKE HS OBSERVATION WELLS _ YES ❑NO OYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DFP7H OF TOPSOIL S()OOFU JEE UF1) MULCHED CENTER EDGES 1:1 YES. E1 NO 1 YES ONO OYES 0 N PRESSURIZED DISTRIBUTION SYSTEM: B ED / TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIP[ FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH I D STIR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND - >ELEV, ELEV. CIA. ELEV. PIPES DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO 1:1 Y ES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER F. '.. LINE ERTV WELL: BUILDING: I FEE r +R0 , OYES 1:1 NO OYES ❑NO ,J NEAREST„ Q/n, �^ �^�O 00T cork I Sketch System on Retain in county file for audit. Reverse Side. IGNATURE - . TITLE: DILHR SBD 6710 (R. 01/82) Zoning AdI1bLnZ6tXatotL �R SANITARY PERMIT APPLICATION COU Y In accord with ILHR 83.05, Wis. Adm. Code 6' '�e C D�LH STATE SANITARY PERMIT # 1ta� s —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES n NO PROPETY OWNER PROPERTY L CA ION (j �' /a a, S .52_T_-; , N, R �� E (o Kw PROPERTY pWNER'S MAILING ADDRESS LOT NUKO ER BLOCK � MBER SUBDIVISI �AME CITY, STATE ZIP CODE, > PHONE NUMBER CITY NE ST ROAD, LAKE OR LANDMARK c7L_T' t S S�Ul. � VILLAGE : II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family Z 81 4 44,30S OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. 9New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System xisting System 2. 9 A Sanitary Permit was previously issued. Permit # $ 3 V Date Issued 7 Ll ? 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1, a. X Conventional b. ❑ Alternative C. ❑Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP f In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 9 Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): (� G �v .S i �j 8 /� �O Feet XPrivate ❑ Joint ❑ Public VI. TANK CAPACITY Site in oallons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank D �� --!' Cl d % D/UC Li Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system sho y_ T on the attached plans. Plumber' Name (Print): Plumber' Signat e: (No tamps) P/ PRSW No.: Business Phone Number: 1 , � Plu ber's Address (Street ty, State, Zip Cod Name of Designer: 2 z 8m � �� »�zs VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ## CST's ADDRESS (Street, City, State, Zip Code) Phone Number: S IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved F Owner Given Initial urcharge Fee Adverse Determination ' X. COMMENTS /REASONS FOR DISAPPROVAL: I SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems -must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground .ater included the creation of surcharges (fees) for a number of regulated practices which WisCO can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried roaiure is used in your building is returned to the groundwater through your soil absorption o m or the disposal system e d s osa site used b our holding tank P YY 9 pumper. P P The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department oflNatural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) 'Ls ` APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Y� ,( _.5? a � ��� CO 1 Location of Property N _ _ 1 4, Section , T N -R W Township Mailing Address � w JJ3 G Jy J Laioyl Address of Site ,y ZIT ,.zy Subdivision Name C-0 Xk Lot Number Previous Owner of Property �!°(`�" & Total Size of Parcel Date Parcel was Created 1 y ] (e T Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _� No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number volume and Page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATIO I (We) ceAti6y that att .statements on thi.6 6onm ane t ue to the best o6 my (om) h.nowtedge; that I (we) am (ate) the owners) ob the pnopenty descA bed in this in6onmation 6onm, by vi ttue ob a wannanty deed %econded in the 066tce ob the County Register o6 Deeds Document No.: 5/.3 ; and that I (We) pne3entty own the proposed site 4on the sewage d zpoz z em (o I (we) have obtained an easement, to nu.n with the above descx bed pnopenty, bon the con3tnuc ion of said system, and the name hays been duty seconded to the 06jice o6 the County Register o6 Deeds, ae Document No. N //j ) SIGNATURE OF;OWNER SIGNATURE OF 0 -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED m czp/ W 4 • o _ / I � Ca H DEPARTMENT OF REP RT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY„ DIVISION LABOR ANb P.O. BOX 7969 HUMAN R,ELATIO RCOLATION TESTS (115) MADISON, W1 53707 (H63.09(1) & Chapter 145.045) LOCATION: � : , SECTION: TOWNSHIP /MUNICIPALITY: OT N9.: BLK O.: SUBD VISION NAME: '56 40 3�/ �l�/01 0Ar'r ,en - _ lv COUNTY: OWNER'S BUYER'S AM I MAILINGADDRESS: �� C ro:r obtr�' rG+� USE ". ., 'DATES OBSERVATIONS MADE' NO.BEDRMS: C MM /�) R TIO S S: Ir �. ew Residence , ,F1 Replace., T 2 RATING: S= Site suitable for system U- Site unsuitable for system "' r O_NTIO M UND: �� 1[V-G ND- ❑� : S S . -1� L Q T � ` R d r1I�GMT1raI'1�i tional) Aft • X R S UU r � p} �`� S � O If Percolation Tests are NOT required DESIGN RATE: If; any portion of the:tested area is in the under s.H63.09(5) (b), indicate: 3 A Ss T Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL H T R UNDWATER- INCHES` CHARACTER'O ,'SOIL WITH THICKNESS, COLO(I, TEXTURE, AND DEPTH NUMBER DEPTH LEVATION OBSERV D H TO BEDROCICIF OBSERVE (SEE ABBRV.ON BACK.) 7 /s /a; �: i «yM B� t, � � 3.sL'6r► r/1.• ^f R#Ymrt / 33 Os.4t /VOn1� fps ,. 3,ls " ,. C B-2 ,A ov.L !. /7'81st /. 3 3 Qrr 3., !r� , /3% , 8-V 's ai��' ,1 S 14o. 7L '! 3 s / ; I7 ty s . 33 !X, .► B- 9.73' S/ 2.n• B- 6 g.�Y iao. 3t sets /, $... 6 S PERCOLATION TESTS TEST DEPTH•, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER JWELLING INTERVAL -MIN. PERIOD 1 PER 1 PER INCH -P- 1 SoAM 3 6 < ? P. Z 3 S 'Y �� < j P- y! Z Pill / <3 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 locatiorr on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION I � � � � ► ` I I � I TN _ I -� - - --- --- , 411� or y- -- - -i- �--r- — -- , - _ 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 CQJMPLETED ON: ae 5 (5�Y ADDRESS: CERTIF ATI N NUMBER: PHONE NUMBER (optional): s CW) 6k )l 6 3 Ll1 - 7/ 5-3,P6 —� F� CST SIG ATU I ' DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/62) OVER x - , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY I. DIVISION HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: u p r TOWNSHIP /MUNICIPALITY: LOT NO.:BLK NO.: SUBDIVISION NAME: 1), 1)/. /T 1 N/R L (o r) W COUNTY: O E 'S BUYER'S �A AILING ADDRESS-- USE `} DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL D S R PTIO : ROFILE DESCRIPTIONS:- PERCOLA71ON TESTS: ❑Residence El New ❑Replace, RATING: S= Site suitable for system Um Site unsuitable for system r ONVENTI NtA''L: MOUND: IN_ -GROUN ESSUR : S STEM -IN -FILL OLDIING TANK: RECOMMENDED SYSTEM:(optional) []S [JY 1 E1S E1U CIS EA OS EI EIS EM If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: I Fl indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H T GR UNDWATER- INCHES CHARACTER `OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT gr, ELEVATION OBSERVED EST. HIGRE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 9 v / �or1t ,./ e,= , y7s'a.. .W •67.8 . S'/!� .92'8 ! � y�i eMs j�.• w ,P�y B- 'S 7, d 91.7 ,ao� . v :• B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD I D 2 PERIO 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. SYSTEM ELEVATION POW_ i .. ,. t � ; i TN 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER z �a STC - 105 r S EPTIC TANK MAINTENANCE. AGREEMENT, 5t.. Croix County z OWNER /BUYER ` ROUTE /BOX NUMBER � - } j� " ` 1 Fire Numbe CITY /STATE O'kes ri ZIP a PROPERTY LOCATION: Section T CA N, R W, I .. Town of W0. fle - , St. Croix County, Subdivision DF Lot number f I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- l sists of pumping out the septic tank every three years or sooner, if needed, by a- licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste' disposal system. St. Croix.County residents ma be eligible to receive a g rant 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 f cartiffeation form, signed by the' owner and by a master 'Qlum, , . `s r .ea .. jou rneyman Y plumber ,w; restricted plumber or .a li censed ' ' puuiper�x vreri 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 oC sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o £ y A,,. I /WE, the under have read the above requirements and agree to 'maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ►a ment of Natural_ Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkr- e.within 30 days of the three year. expiratiom,date.•. SIGNE C � Y DATE St.': Croix Caut►ty Zoining Office 'tlh: Bax 9g r Y t Hammond, WI` X4015 15-*796 -23 a 715 45 -8363 s ; t� ::.Sign, .k "d`ate and 'xeturn .to' above address. i DOCUMENT NO. STATE 14AR OF WISCONSIN FORM 1 - 1988 •.10 s►AC[ ■ucevco VON RECORDING oArA WARRANTY DEED 441044 BOOK 821 1447 REGISTER'S OF C� This Deedd made lx•tween Robert G. H and ST, C ROIX CO., W1 Judy M. Harbek, husLend and wife as joint tenants, Recd for Record Grantor, S E P 01 1998 and Daniel B. Jacobs and Vivi A. Jacobs,. husband and wife as survivorship marital property, of 8:30 A /J Grantee, R ll RapNIN of Doak Witnesseth, That the said grantor, fora valuable consideration of one dollar and other valuable consideration .Dove s to Grantee the following described real estate in St. Croix NL- -N I T C State of Wisconsin: Tax Parcel No: .................................. Lot %o (2) of Certified Survey Map in Volume 6 of Certified Survey Maps, Page 1683, as document number 414443, filed in St. Croix County Register of Deeds Office on July 14, 1986, being ocated in the Northwest Quarter of the Northwest n9 (� Quarter (NW 1/4 of NW 1/4) and the Northeast Quarter of the Northwest Quarter (NE 1/4 of M9 1/4) and the Southeast Quarter Of the Northwest Quarter (SE 1/4 of NW 1/4) of Section Thirty - Two, Township Twvnt} - nine (29) North, Range Eighteen (18) West, Town of Warren. Subject to Colbeth Drive right- of-way ; Q over the Southerly portion as shown. FEE • This .. 1 5 . S1VV homestead property. (is 1 is not) Together with all and sin the hereditaments and appurt-w,nces And Robert G. Harbek and Judy M. Harbek warrants that the title f3 good, :n,ic .a,lbie to fee simple and :rev a:D: clear ui encumt,ral,ie, txrot,t all restrictions, covenants and easements of record, if any, and will warrant and dr -e 'r.e Dated th.:a 3. { ,j,,y or August lb 88 (SEAL) !'tA'. f: /�='• ��C {.. IaEAI. Robert G. Harbek ICEAL. SEA 1. Judy M. Harbek AUTHENTICATION ACKNOWLEDGMENT Sig-naturel;I -TATV OF W!rl f\ j St. Croix ) auti.eat.cated th:- pia Aurjust 4 .�. ' R `�t:; t.n -e r..,, •1 Itokrt G, Harter :4 '�((xi�wt. 71TLE `4 F.\IINAI �:T1":is P.ot.E rt P +a 11 PICHARUS NALL & K I S 522 Seco d Street Hudson, .v1 54016 x , � Iulf tl •.. 1 1•- ,,. i DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 � -y � ., Lb ONVENTIONAL ❑ALTERNATIVE I S,,,, Planl D. Number: (11 assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE. Robert Harbek Rt. 2, Box 113, Roberts, W1 54023 BENCH MARK (Permanent reference pnmt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REE. PT. ELEV SE NW, Section 32, T29N -R18W, Town of Warren N,, m,. 1A Plumbe, . J MPIMPFISVI No.. Coumy. Sanitary Permit Number_ Richard Hopkins 1059 St.Croix 83801 SEPTIC TANK /H OLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED PROVIDED OYE ON O OYES [—]NO BEDDING. VENT DIA. VENT MAT L.. HIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILbI WILDING IVENT TO FRESH ALARM FEET FROM LINE AIR INLET DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER J BIDDING LIQUID CAPACIT`/ PUMP MODEL J PUMP SIPHON MANUF ACTUREH J VIARNING LABEL LOCKING COVER PROVIDED PROVIDED. ❑YES ONO DYES ONO I OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPFHTV 1 1 1 ,11, 1 111,111,1111; VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE IAIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST -1• SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH nlnMt a 1+ 1 11AT1 111111 nNO 10AHKINI; 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: BED /TRENCH WIDTH LENGTH I NDENCHES DISTR. PIPE SPACING COVERIAL: PIT INSIDE DIA -PITS LIQUID DIMENSIONS GRAVEL DEPTH FILL DEPTH 1 1TIIPPl IS DISTR PIPE DISTR. PIPE MATERIAL NO. DISTR NUMBER OF PR OPERTV WELL BUILDING VENT TO Fill Sit BELOW PIPES ABOVE COVER E I TV INl F I ELEV END PIPES FEET FROM , LINE Al. INLET NEAR EST —s MOUND SYST 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. OYES ❑NO SOIL COVER TFKTUHE PFHM nNf NT MAHKI HS O iSt HVAIION WI I I S _ ❑YES NO _ ❑ YES ❑NO UE PTH OVER 1HENCH BED DEPTH OVER TRENCH BEU DEPTH OF TOPSOIL `SIIUUF (1 SEE UFII MULCHIO CENTEH EDGES ❑YES ❑NO ❑YES NO DYES 1-1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH _ LE N(iTH NO.OF LATERAL SPACIN(; (i HAVE DEPTH BE LOW PIPI FILL DEPTti ABOVE COVE ti BED /TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATE HtAL NO UIS TH IJIS TH PIPF D)ST111HIJ 11ON PIPI MATI HIAI & MAHKINI, ELEV ELEV. DIA ELEV. 1 DIA. ELEVATION AND DISTRIBUTION INFORMATION HALE SIZE HOLE SPACING UHILLEU COHHFCIf.Y" COVER MA TEHIAL VENTICnI IIET CORRESPONDS TO nPPR(N(U PLANS ❑YES L1 NO OY ES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS- NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE DYES ONO OYES ONO N I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. DILHR SBD 6710 (R. 01/82) wIeconsin APPLICATION FOR SANIT RY PERMIT DI Sf. . L C OUNTY o EPF1RTmEnT OF (PLB 67) UNIFORM SANITARY PERMIT rEW 01 0u STRV,LRBOFi6MlKTWnREUaT10n5 r"r — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING DDR SS Eot t lipp- L k Z 0 P PROPERTY LOCATION CITY: V C. 114 WW 1/4, S `,. , TA N, R E (or LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEA ST R J AD, L KE OR LANDMARK STATE PLAN I.D. NUMBER y I TYPE OF BUILDING OR USE SERVED ❑ 1 or 2 Family Number of Bedrooms: ❑ Public (Sp cify): ^ •,, 'f � i cri THIS PERMIT IS FOR A: New System ❑ Tank Replaceme t ❑ 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 Pr, fab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Qoo Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ N ound ❑ In- Ground Pressure Total *of Pri ifab. Site Steel Fiberglass Plastic Gallons Tanks Cor crate 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 Fee ►: t <� L I X Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private se age system shown on the attached plans. Na a of lumber (Print): Signatur MP /MPRSW No.: lPhone Number: Plumber s Address-1 Nam f Designer: � ' %� F• :f I / f� �.J %' �' � ! I �C r� COUNTY /DEPARTMENT LSE ONLY Signature of Issuing Agent: Fee: Date: -- � ❑Disapproved /� [F /`� El Owner Given Initial J /' Approved Adverse Determination Reason for a va Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bu eau of Plumbing, Owner, Plumber APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to 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 /contractgx,( "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 O e- , -- , J V d Location of Property A '-4 Section �� , T N - R W Township V finc.ElVl Mailing Address Ql. Subdivision Name Lot Number Previous Owner of Property Z S 4 L F)'/ Ili Efl-• Total Size of Parcel L g,`70 Date Parcel was Created - A0 eqz (:�x ! Are all corners and lot lines identifiable? No Is this property being developed for resale (spec house) Yes 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. -------------------------------------------- PROPERTy OWNER CERTIFICATION - I (We) cma, y .that aU statements on -thin 6okm arse tAue to the beat o6 my (ouA) knowledge; .ghat I (we) am WAO the owneh(s) o6 the pnopenty deaeh,i.bed in this in6onmati.on &nm, by viAtue o� a wwiAanty deed neeon.ded in the 064ice o6 the County Reg•i iten o6 Deeds a.5 Document No. ,j 3 / 03 J and that I (we) phesentty oun the pnopoaed .bite bon the sewage dizposat system (on I (we) have obtained an easement, to nun with the above du c i.bed pnopen ty, bon. the con�stnucti..ox o6 amid system, and the same has been duty neconded in the 066ice o6 .the Count RegisteA o6 Deeds, as Document No. S4� 1e q_3 ) . S URE C6 OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) - -Z TE SIGNED DATE SIGNED - i MC.!Ow Cmnro® DOCtIN 1T NO. STATIC HAR OF wISCONSIIf -FORM 1 vol 6�`; . ,...x.76 r SSVED F DEED A' j THIS SPA RESEIIVEO F RECORDING DATA REGISTERS OFFICE THIS DEED, made between Ja H- Derin and_ ST. CR41X CO., WIS. Naomi A- nPringorr gltchana a Wi fa , and each l,i Q flr+A 1,0r 0� •• ttec'd. for Raoord N>is_�#,}�„ Grantor dAW of �'ch q.D• 19 80 and Robert - G. Harbek and Judy M Harbek •30 A H inhand and W+fP ac mint Tenants at • Grantee, fie' s W i t n e s s e t h, That the said Grantor, for a valuable consideration Vi f e e — Six -- gundred 5 630 00) RETURN TO conveys #o:Grantee' the folloari described real estate in St. Croix ` Couclw - State , Of Wit aairsfn: ' -4 at cefta_in parcel o_ f land _ loc ated in �tle - Northwest Quarter -the Northwest-- - -- Quarter (NWkNWk) and - in the Northeast Quarter 'of the Northwest Quarter (NE4Ntf) of Section Thirty - Two (32) , Township Twenty -Nine (,29) North, Range Tax Key No. Eighteen (18) West, Town of Warren, St.Cro -ix Co., Wis. fully describe as fgllows: Commencing at the corner of said Section 32, thence S 00 00'.00 "E 1118.76 ft. along She West line of - the Northwest Quarter of said Section 32;,thence go N 87 25'05" E 80.08 ft. to the POINT OF BEGINNI of the parcel to be herein described; thence go N 87 E 907. -61 ft; thence along the chor of a curve concave to the South, having a radius of 22,803.31 ft.go N 88 42'00" E 1100.96 ft.;thence S 04 W 783.83 ft. (Recrded as_S 06 )-;thence along the centerline -of a Town Road go. S 84"" 17'49" W 400.421t; thennce' �aiongg :the chord gf a : conca 'to the _ South6a6t, having a • radiu6 of 4', 88 'ft go S 83. 69'36" W 193 , 9 fz . ; then S W 104.63 ft • thence leaving said centerline &o lit 01.20' 22" E <, 640.79 ft.;_ thence - S 89.06' 50" W 1259.88 f t . ; thence - N 0000'00" E-169.57 f . _ to the POINT OF BEGINNING,_ containing 18.70 acres, more or less,- being sub ject - to easement over Southerly portions of said parcel being traversed by This is not homestead property. existing _ Town Road (is) (is not) Wit•, tcs Together with all and singular the hereditaments and appurtenances thereunto belonging; 1 ILI"L I And. a n d - w li 7 warrants -that the title is good, indefeasible . in fee_simple, and free and clear of encumbrances except easements and restrictions ,and rights -of -way of record THIS deed given in of that certain land contract between the parties,dated p 15,1979,Rec.' Aug.16,1979,Vol.599,pps:.269 -270, as Doc.# and will warrant and det same. - 359101 Dated this 6th day of March , 19 �0. ( For purposes of this description all bear gs are referenced to the West line of the,NorthWest Quarter of Secti 3 ,Township 29 orth, Range 18 West assumed N 00'00'00" E) (SEAL) (SEAL) * * Jame H. Deringer (SEAL) (SEAL) * . • Naomi A- 1)eri ngpr AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated thi da y of STATE OF WISCONSIN 19 as. PIERCE County. Personally came before. me, this 6th day of * March �1980 above named James u TITLE: - MEMBER STATE BAR OF WISCONSIN Deringer and Naomi A. Deringer, (If not, ' husband and wife authorized by §706.06, Wis. State.) This instrument was drafted by _ Leo A. Beskar known to be the person S_ executed the.hom- ttorney at La 'instrument and acknowledged the same. 125 North Main Street River Falls, Wis. 54022 �` : p T (Signatures may be authenticated or acknowledged. 4oth * Ctrrathia Elliott are not necessary:) n "1Qotary Pierce County, Wis. jA QoWission is permanent. (If not, state expiration date: 7 _/4 *Names of persons signing in any -capacity must be typed 6r Nal 0 Fit .signatures. WARRANTY DEED —STATE BAR_ OF W19CONSIN, FORM NO. 1 -1977 FILED 0 a3 1979 afto go °ft6 CERTIFIED SURVEY MAP JIM DERINGER 33.5Q Part of 'the Northwest 1/4 of`the Northwest 1 and R FC o, �' x',83.83' - -part of the Northeast 1/4 s os ° o e • E `S t 1.. of the Northwest 1/4 of j Section 32, Township 29 •v,o OC. 3 ''�� F" t i 6�. 04 S >.�c„ .w o � � Q North, Range 18 West, � �� i 1 0 - Town of Warren, St. Croix a i County, Wisconsin. o GOT ♦ ♦ In t t m 1 Z % ON 0 N ,v6 ►_ t -- C^v<:loR.O� /?AOiC/5 I O, O9 36 W 1 Nay o t i s 8z ° oi CEP "W 1 1 .. I U` o Indicates 1" x 24" iron .0 V pipe weighing 1.13, lbs. /ft. set. • Indicates 1 iron BEAR/N6S REF' TO pipe found. N v' ThE WEST• L /NE" O� T.Oy W, A SS C/MEO .NOO 00'00 "-. ♦�������p`,SttG I0 ttlAii����4 JAMES L . APPROY MURPHY : _ _ : S - 1 0 4 2 i 0 RIVER FALLS V L S. ` JUL 111979 = j 1 ; Q) I ST. :OUht'► '' ���`���iiigFO • LAND'�`��� `` ,. .0 "PREM. ;.M PLANNhv1;. !! / /! / /ll.Il111U111titU11 N N &.4D h . .O #MI TTEE m ` o James L. Murphy % r Registered Land Surveyor (Description N62. reverse) PROVAL OF THIS MINOR SUBDIy � m • DOES NOT MEMEAN ISIC 0 /V 1 Vol. 62 1 BURDING SITE APPROVAL FO N 01 Certified Survey Maps 1�FE O R SEPTIC SYSTEM 1c39t5 - R TO St. Croix County Records 20. 9) A/00 0 00 ooE St. Croix County, Wisconsin Volume 3. Page 8211 :50 00'00"4 a- • ST C- 105 r ' - H SEPTIC 'TANK MAINTENANCE AGREEMENT o St. Croix County d y OWNER /BUYER U �� / � H M ROUTE /BOX NUMBER Fire Number l e CITY /STATE s$� �(J _'L11' PIMPERTY LOCATION: /(,t� '4, '4, Section -3 1' o It 4W, Town of - � �.G �� St . Croix County, Subdivision Lot number Tmproper 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 li censed sULti tank LumLer. What you put into the system can affect the function of the supL is tank as a treat - ment- stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for L;. max of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1.978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new syste agree to keep their systems properly ma intained. -- -- The property owner agrees to submit to 5t. 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 f.urm will be sent approximately 30 days prior to three year expiration. o E I /WE, the undersigned, have read the above requirements and agree on to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- a went 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. SICNED �L DATE ✓ i /� b St. Croix C.►unty Zoning Office P.O. f-ox 98 Hammond, W1 54015 715-7S6-2239 or 715 -425 -8363 Sign, date and return to above address. v_ (A • � m g fD � A A fD O c ►��' c �(n(o w �� O (D _a a (D (D O A O 9 c (D cl g D p W O 6 (D O (O CD 0) w O c N A ID cn C . ) _ =t _ - _ I gr ... m =r co 0 O fD a C .+ o c0 _w .�. ? (a = Al 0 =r 7 p1 C � c O C 3 o a. OA O w S c l< Q m 7 .-. '.' 0 - Al N N o m o -•o o.� ° O (D W �p N C A C O c a n , (O Q ° ° ° o yc •( Q "�� O A .A-+ C (p W � 0 W c p' Q CD CL CD ca m O N (D fD ^� w m -,�' N��cD. D Z �+ w m w �' = A (D a N A 3 N W N n D L" �- > > o N o °Z'0a(c�' y ac A (D C Al 3r� va���� s j N CD � N a w Ui = a_ o ao No C M , (D a (n c C -� 9 0 0 O fD . N 111 Y/ o.o a1 c ° aw o m m w a -- m v1 O 0 . O Q S a =r c '< ?' m(,D 3 r a A O +n tG 7 '< y� (D O Ol 0 ::.. d c W C CD C O Q C CL ? C ( �+ " 0 5 a (D O O ' !:..:..... 111 3 m �; co a ° m Z DEPARTMEkTTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 H0MAN,RE6ATIONS MADISON, WI 53707 (1-163.090) & Chapter 145.045) LOCATION: ECTION: TOWNSHIP /MUNICIPALITY: OT NQ.: BLK. O.: SUB D VISION NAME: S }/ W �/ 3;- / M /R /F i (or 04.0- -en /4 COUNTY: OW ��ER'S �M RR � MAILING�DDRESS�u A TS #- C#,*. . LL USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMER IA DESCRIPTION: I � ,. � PROFI C I T O S: L I N TESTS: Residence /�, I�New Replace S ` RATING: S= Site suitable for system U= Site unsuitable for system CONY NTIONAL: M UND: ❑� IN -GROUN ❑U R_E: SYSTEM-1 ❑S ❑ S S4U LHG T M 6.,w-, EN _ ..1 .(o ti S ❑ U l S 7 � g x .� �• If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /, 3 Cj! Ss Floodplain, indicat Fl elevation: WOO, PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER -INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH L H NATION E NUMBER DEPT OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ,7 /s /.s s; ,.!►y B» s1� 7, t>L'a.• slur w I V soot B- 11 33 9t &* SO, . Silo Cs 1r, B-2 ,D /dv.4 B-3 , Z f� p't /, /7'B/S /� /. 3 3 `(3w S 3r �jl► � (�N S I �r ,e .YJ Vast � B- y 9.75 �.�. S� B `r p 3 31.r S s, 2 .d' 8h s. V .,_ 3 y" 16 5.449 46+ .2 of PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER WELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER PER1003 PER INCH P_ ! S 3 6 < ? P- it < i P- y1 Z / <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. SYSTEM ELEVATION 94. 6 it IV i z , t R t N i. QhF/1iw� N1I�T•�t ! • 9 _ m t ' i I owti 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. NAME (print): TESTS WE FIE CQMPLETED ON: ae iF L u s � >r ADDRESS: CERTIF ATI N NUMBER: PHONE NUMBER (optional): CST SIG ATU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) —OVER - 4 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 HOLING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing 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 if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to elates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot 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 required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Sandstone gr — Gravel (under 3 ") LS — Limestone *s — Sand HGW — High Groundwater cs Coarse Sand Pere — Percolation Rate med s — Medium Sand W — Well fs Fine Sand Bldg — Building Is — Loamy Sand > — Greater Than sl - Sandy Loam < _- Less Than �l — Loarn Bn — Brown sil — Silt Loam BI - -- Black si — Sill Gy — Gray cl — Clay Loam Y — Yellow sci — Sandy Clay Loarn R — Red sicl — Silty Clay Loam mot — Mottles sc — Sanely Clay w;' - with sic — Silty Clay fff - -- fever, fine, faint Y c — Clay cc; common, coarse pt: Peat mm — Many, rnedium m - -- Muck d distinct p — prominent HkN/L — High water level, Six general soil textures surface water for liquid vvaste disposal BM - Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soil test report is the first stop in securing a sanitary perrn t. The county or the Department rnay request verification of this sail test in the field prior to permit issuance, A complete set of plans for the private seviiage systern and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted paior to tne ste o of arty constructiorre l _ INDUS T TR Y, REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSY, DIVISION LABORALVD PERCOLATION TESTS (115 MADISON W 7 HUMAN REILATIONS 10 (H63.090) & Chapter 145.045) LOCATION: SECTION:♦ C I T OWNSHI P /MUNICIPALITY: LOT NO.: BILK. O. K. N: SUBDIVISION NAME: 1/4 1/ /1 N/R L (or) n COUNTY: O E 'S BUYER'S AM F,: / MAILING ADDRESS: q� � I USE DATES OBSERVATIONS MADE I ND. BEDRMS.: ICOMMERCIAL DESCRIPTION: IPROFI E DES RIP♦ ONS: 1 PERCOLATION TESTS: ❑Residence ❑ New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: NPRESS SYSTEM -IN -FILL HOLDING ANK: RECOMMENDED SYSTEM: (optional) ❑ S ❑u ❑S ❑U ❑ IN- GROU D - ❑U URE: ❑S ❑U ❑S G ❑u If Percolation Tests are NOT required DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodp elev PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHJIt ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 9,v /00. �O/Il Q *&j /sl,�/•7S'Q..St, 3.oT'8«s/Y� w eft mmp .67 '8/s/ .9L"8«f �t/.4s 8r•s•• w ,`� B- 7• d 91. 4• „yep . yt• B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P R 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. SYSTEM ELEVATION _. _ r 3 i _. r . ., _. .r.�......_. I _ �.. _.... q.,........ ,,,,.. ._. .. -� j ..... ._ !. -- .,.. t - Al tN 1 { 3 s 1 f 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. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) OVER — f - .... ... «.Mn•_w•wrr.w.rirrr +..• , .rw.• . u.. ...a....a+.. «.:...:.<,..wrraa aurwwu.lWMrwM++l� \ B. L. 6 7 PL OTA N r, c..: 1 S S EC `r 1 0 ICI Ind A M E Ka e � A p t �` __... __. _. N -� M E {�1 s 0CAT (0 N_.�i S, _c. , L C E N 1 L . A T E I PL01 M 0 z ",D V i } w 1 n / � ,< �; IN :'&I - EL 95 Next to P1 - t� i Fivu Foss" w I if w 6, Y, P C-Ogt\ /0 t ( "Odes rewr- Est B' r' O C30�e Ito 1p SI tCS 1 Y • :'► �.. k Sri loc�� t� 1 . 1 G nu �x fsrl"rN5 �NC� lie U.K ht e S a ,. Col beRt� 1 .: e TAN - -hvM.. Nol FRESH AIR INLETS AND OBSERVATION PIPE ' CP.OSS SECTION Approved Vent Cap Minimum 12" Abovc Final Gra LID 4" Cast Iron Above Pipe Vent Pipe p >; To Final Grad(--- Marsh Hay O S ynt h etic C overing Min. 2" Aggreg�alc Over Pipe '\V Distributi_o�n� �/ �— Tee Pipe A Q � Aggregate Perforated Pipe Below Beneath Pipe —Coupling Terminating At rti of � t/ Bottom of System . Form -- S x C - 104 AS BU SA NITAR Y SYSTEM REPORT OWNER ,�jq �r�z TOWNSHIt- a f�7?/�� SEC. T Z�N -R W ADDRESS ST. CROIX COUNTY, WISCONSIr1 4 --�- S UBDIV Sii ,J�/ _ LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements' of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N 92 INDICATE NOR ROW MY BENCHMARK Describe' the ver ical refer poinj. used S i�C S f l ice c/ �fX� 6 ;J am ` S' C. , CCI� 2 � c ' ro s >�z Elevation€ vex i r Ca reference point : Z Proposed slope at s site,., SEPTIC TANK: Manufacturer: � C Liquid Cap acit y: QdQ G Number of rings used Tank manhole cover eleva: on° Tank Inlet Elevation: . Tank. Outlet Elevation: Number of feet from nearest Road: Front,0 Side,0 Rear, 0 ____ — feet from nearest -property line Front:,0 Side ,�Rear�,� � � feet • a Number of feet from: well ` buileing: 7 (Include this Information of the above plot pl.an)( 2 reference dimensions to 'septic tank)_ SEE REVERSE SIDE P CHATTER Manufacturer: _ M.quid Capacity: Pump Model: / Pump /Siphon Manufacturer: Pump Size Elevation of inlet�� Bottom of tank elevation: �•: Pump 'off switch levation: Gallons per cycle: Alarm Manufac urer: _ Alarm Switch Type: Number of et from n.,;.re3L property line: Front, 0Side, 0 Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: S X Trench: Width: c Length: Number of Lines: ! Area Built: o r � Fill depth to top of pipe: Number of feet from nearest property line: Front, Q Side, 0 Rear, 0it . Number of feet from well: Number of feet from building: s (I!±clude distances on plot plan). SE' AGE PIT 14 Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: vv Area. Built :_ Has either a drop box O or distribution box O been used on any of the above soil I absorbtion sytems? (Check one). HOL NG TANK Y 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, OFt. Number of feet from well: Ntwiber cl. feet from building: Number of feet from nearest road: ._._ Alarm Manufacturer: Inspector: i ` Dated' b Plumber on job: 12 �4 License Number: 3 /B4:mj