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f Parcel #: 004- 1032 -95 -001 10/13/20P 3 P
AGE 1
Alt. Parcel #: 14.28.15.222 004 - TOWN OF CADY
Current XI ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
KEMER C SPEER O - SPEER, KEMER C
3138 30TH AVE
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 3138 30TH AVE
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 14 T28N R15W 40A SE SW EZ- U- 1459/018 Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
14- 28N -15W
Notes: Parcel History:
Date Doc # Vol /Page Type
09/15/1997 1263/629 QC
07/23/1997 846/98
07/23/1997 807/551
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 04/17/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 2,100 0 2,100 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 2.000 24,000 21,000 45,000 NO
Totals for 2006:
General Property 40.000 26,200 21,000 47,200
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 26,100 21,000 47,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 0411712001 Batch #: 511
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 004 - 1032 -70 -000 10/13/2006 12:28 PM
PAGE 1 OF 1
Alt. Parcel #: 14.28.15.219 004 - TOWN OF CADY
Current I X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
KEMER C SPEER O - SPEER, KEMER C
3138 30TH AVE
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 14 T28N R1 5W 40A NE SW Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
14- 28N -15W
Notes: Parcel History:
Date Doc # Vol /Page Type
09/15/1997 1263/629 QC
07/23/1997 1095/610 QC
07/23/1997 846/98
07/23/1997 807/551
more
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 04/17/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 40.000 1,900 0 1,900 NO
Totals for 2006:
General Property 40.000 1,900 0 1,900
Woodland 0.000 0 0
Totals for 2005:
General Property 40.000 1,800 0 1,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REP RT
Owner N,
Property Address
City/State
Legal Description:
x .
Lot Block - Subdivision/CSM
- !5F- '/4 S:[' /,, Sec: T -R S Town 6( '- /' PIN # o9y- io?Q
SEPTIC TANK -- DOSE CHAMBER -- HOLbING ,TK INFORMATION:
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Tank manufacturer 4n Size ST/PC Setback from: House -1,2� Well
Pump manufacturer Q ,,�,�„� Model
Alarm location T Jo g- (HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: K1 en, A. wl Width Length Number of Trenches
Setback from: House I-io Well PIL Vent to fresh air intake
ELEVATIONS
Description of benchmark T-*? o �c J - "s,9{ c — i a h A/" Elevation /0
y
Description of alternate benchmark Elevation
Building Sewer / ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines () () ( )
Bottom of System ( ) ( ) ( )
Final Grade () ( ) ( )
Date of installation / °7 A e, Permit number 7 State plan number `
r
Plumber's signature icense number -Q-2) e-� f 4 Dated /
Inspector
Complete plot plan �+
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NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDI ;&'", RTH OW
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Wisconsin Department Commerce /
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count yS, . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar l�gthNp.:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)j.
Permit Holder's Name: p,Lity_J - I Village Town of: State Plan ID No.:
SPEER, KEMER p
/x.28•/ , Z�z
CST BM Elev.: Insp. BM Elev.: BM Description Parcel b"*L; 1032 -95 -001
' w A X11 6 01 All 1 1
TANK INFORMATION ELE ATI N DATA A9800537
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchm o
Dosing
S
Aeration Bld . ewer
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet
ir
Septic pu NA Dt Bottom
Dosing NA Header/ Man.
Aeration Dist. Pipe
F Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH
'oss Lift Friction System TDH Ft
Forcemain Length Dia. Fi Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia77 Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACH anu ac
SETBACK CHA BER
INFORMATION Type Mode Number:
Syste 2 OR UNI
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
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 ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATION: CADY 14.28.15.222,SE,SW 3138 30TH AVENUE (�
lop
�Pr oy. IWJ gds
dived?
q Plan revision re ❑ No
Use other side for additional information. RA
SBD -6710 (R.3/97) Date Inspector's Si nature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
Vi In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. ST CROIX
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Chec'�f revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
KEMER SPEER SE 1/4 SW 1 / 4 , 5 14 T 28 r N, R 15 Rte) W
Property Owner's Mailing Address 3138 Lot Number Block Number
30TH AVENUE
City, State Zip Code Phone Number Subdivision Name or CSM Number
WILSON WI 54027 (715 )
II. TYPE LDING: (check one) ❑ State Owned o it Nearest Road
Vila
Public x 1 or 2 Family Dwelling - No. of bedr 0 Tow OF CADY 30TH AVENUE
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ?,
1❑ Apartment/ Condo 06q , v J Z r Q " — 00 1
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4_ IM Reconnection of 5. ❑ Repair of an
______System _______ Tank Only______________ Existing System ________ Existing - yytem
B) ® A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 [2g Mound 30 ❑ Specify Type 41 []Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
Feet Feet TANK Capacity
VII. INFORMATION in ga llons Total # of Manufacturer's Name Prefab. S steel Fiber- plastic Exper.
New Existin Gallons Tanks concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑
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) Plumb 's Signature: (No St p) MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON 220292 715/772 -3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE SPRING VALLEY WI 54767
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater DY a — te — Issueed Issuing gents_
Owner Given Initial
Approved ❑ Surcharge Fee)
/J/
Adverse Determination / /(p � �7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
i
I
SBD -6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety a auildings Division, Owner, Plumber
I
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be 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 or plumber 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) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. 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.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. 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.
i
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 112 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; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference point:; 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 coum:y; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
December 4, 1989 . Office of Division Codes and Application
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
ROBERT ULBRIGHT Owner: KEMER SPEER
655 O'NEIL ROAD ROUTE 3, BOX 114
HUDSON, WI 54016 RIVER FALLS, WI 54022
RE: Plan Number S89 -03304
Project Name: SPEER,.KEMER - RESIDENCE County:. ST CROIX,
Location: E,SW,14,28,15W Fee Received: 130.00
CADY Date Received: 11 /30/89
This letter is to acknowledge receipt of the Petition and Plans which you
submitted to the Office of Division Codes and Application, Section of Private Sewage.
Your Petition and Plans will be processed within 30 working days.
If necessary, inquiries can be made by calling (608) 267 -5119.
PLEASE RETAIN THIS LETTER.FOR REFERENCE. The plan number shown at the top. of
,this letter must be provided if you callus in regard to processing.
Sincerely,
ANN E. ADDIS
Section of Private Sewage
Division of Safety and Buildings
PAC017 /0005n/ 4
cc: KEMER SPEER,
County _ M Plumbing Consultant Local
— Plumber _ Environmental Health _ Y Facilities Need Analysis Section
__ —SSWMP _Dept of Agriculture,, „Private Sewage Consultant
COMP: 1 11 .
ELEM: 12
SSD -6423 (R. 08/88)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ) �tr S r2 - f-� r
Mailing Address l S 22D+' ) NU e- im W , "S 46 z 7
Property Address 313 8 3u+ Au ,.-
(Verification required from Planning Department for new construction)
City /State o v1 i 40 Z7 Parcel Identification Number
LEGAL DESCRIPTION
Property Location 36 ' /a, Sw `/4, Sec. IL/ , T,�8 N -R /5 W, Town of �d �
Subdivision , Lot #
Certified Survey Map # . Volume , Page #
Warranty Deed # 6 S 3 3 , Volume _ .,� Page # v2
Sec house ❑ es ❑ no Lot lines identifiable ❑ es ❑ no
P Y Y
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a three year exp' 'on date.
SI NATURE OF APAk NT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property escribed above, by v' a of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APP , DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
** of Deeds office
Include with this application: a stamped warranty deed from the Register PP P h' g
a copy of the certified survey map if reference is made in the warranty deed
PETITION FORaNAR1ANCE WISCONSIN DEPARTMENT OF OFFICE USE ONLY
OF A RULE IN THE INDUSTRY, LABOR AND HUMAN RELATIONS Petition No.
WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY & BUILDINGS — Number
P.O. BOX 7969, MADISON, WI 53707 E—
Name of Owner Building Occupancy Or Use Agent, Architect or gin
Eneering Firm
Em :� U - 0 1( - e - •SPEC E t eve �
sp Tenant Name, if any Street ,
655 0 NEIL RD., HUDSON, WIS. 54016
Street & No. Building Location, Street & N TER PLUMBER LICA40.
N-3 0 X A�
liifJ" MINN
AGC R 6 DESIGNER UC. NO.00663
1 ev r3A . INSTALLS
city State &Zip City � /S /ilf,v 54• Aunty Phone (S —,3 `�/
R 1 u ek tr 4 7 4 01 x
Name of Contact Person
Phone 6 O Plan Numbers) O T i4 Qf C kr
A M` IF KNOWN G � .
1. Rule of the Wisconsin Adminstrative code cannot be entirely satisfied because:
5oi4 3 z / ` 0,�� -v(rS CST Z ,9 G' �'i�i "��Tid /3� _ - - --
" Il ii SE�f So�U�/ S�t Tv.P9 T l7 __/f T _-� -- -------------
- �- ------- - - - - -� -- - - - - -- - - --
3. In lieu of complying exactly with the rule, the following g1ternative is proposed as a means of providing an equivalent
degree of safety:
'
I Rp SAD Re,&,4CI ,6 /0OUW v 5�`
•fTZ SLiyll�
- -- p --- - - - - -- - - - - - - - -- ------ - - - - -- --
w ----------- - t -
/Llivi���1 /00--- - - °F__ S� f _ /'/0� 0 s• f l r�
3. Supporting arguments are: /
I os ?i�ilDc?.t?D_ �S_� S - 4190e
lk
TICP _-- SA_o - was - - - -- 1_- — _`__ �� 2,� Y��'s r9UD
VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED
or Contact Department at (608).267 -7843 The De
For Fee Information See ILHR 69.15 P
NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless Power
of Attorney is submitted with the Petition. `" -' `
r
being Y dul sworn. I state as petitioner; that I have read
(NAME of PETITIONER Please type /print)
the foregoing petition, that 1 believe it to be true and I have significant ownership rights in the subject building.
OFFICE USE ONLY
Sianature of Owner Date Received Amount Paid Receipt No.
Subscribed and sworn to me this date:
County, Wisconsin.
Department Action
ate
Notary Public Office of The $ec: Mary D
My commission exuires: -
I'd uU0•i n r, a some ve • a v111 vV1lL pVIt 11rVJ Her V omrr I T a OUILUINUb
LABOR AND 115 PERCOLATION .TESTS DIVI
HUMAN RELATIONS ( � P.O. BOX 7969
(ILHR 83.09(1) & Chapter 145) MADISON, WI 53707
p GF N CV flit /��E/l'
LOCATION:
E T TOWNSHIP LOTNO.:BLK
Y: NO.: SUBDIVISIO NAME:
5 - 4 !/ SA / /T- N /R!s E (o cAD/ T 0 0'C
COUNT WN R BU ER'S NAME: MA L N AD R SS:
11- 'erReR SP, � 'I�-) • S� o X 4 1, i v E4 �� l I f, &J I's x 90 Z Z
USE — — L — DATES OBSERVATIONS MADE
NO. B CO M R PTION:
Residence New ❑Replace ^� TS:
121 u
RATING: S= Site suitable for system U= Site unsuitable for system "�'� S7yGLy f s •SFy� �'� /�'�/!G -uOR, f}M �R1
MS 19U M El s [ JU I" � J ®U S� R aU L Q �G TANK: R �EM�E STEM : (optional )
U •w� ?I � �3'e. to Lo
If Percolation Tests are NOT required DESIGN RATE;
under s. ILHR 83.09(5)(b), indicate: d [ Floodplain, any portion of the tested area is in the
�' r! indicate Floodplain elevation:
PROFILE DESCRIPTIONS A" `DFC -(."4 } c.
BORING TOTAL P
HT R UNDWATER- INC
NUMBER DEPTH 1N ELEVATION HES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 2, / ' -2 S )k, c gs",. C' Si/ . 2 Pt-AYy Si
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g. 3� .�� 7?�• �Q ' ��a •w �i<'.cS,� • .fi� , S' LJ• a4 . f�r ,S'il /.o ' a- so
sq. eye, NofS ,o VV. AWY4-fD C
B� �'J ��" 7S� �' "< �s • a.�. s -i . yi' G' '� V. P • yi' w a� Sy s :�
oR • 14 01 3 C L *Sr 'Ve 75
B- 3,0 �- / Z$ I t• S 'S GfVa S 9 ' -A/ Q,v . Si
,0 CI
B- Xo't -I `" / AA44,4 4
g.s 3.0 1 oeyLt �..� •�, '�3ae� �l — � - x CEp"f`
PERCOLATION TESTS
TESr NUMBER INCHES FTERSWEL�NG INTERVAL-MIN. W
P- PER INCH
ATER LEVEL-INCHES ATE INUTE
P-
P s ite
P_ n
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 ele
of land slope. vation at all borings and the direction and percent
SYSTEM ELEVATION _ f o yek S Co \
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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
dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
AME print : 1 , j
HOMESITE SEPTIC PLUMBING CO. TESTS-WERE COMPLETED ON:
DDRESS: RD ' 141 insqnN 1 Tu 1 2.
R(WATULBRIGHT CERTIFICATION NUMBER: PHONE NUMBER(optional -
R LIC. NO-M07 M.P.R.S. V z--
MINN. INSTALLER 6 DelIGN6R LIC. N0, 000 CST SIGNATURE: C j
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STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
LHR -S80 -6395 (R. 10/83) — OVER —
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P4 L7 HWESITE SEPTIC PLUMBING CO.
665 O'NEIL RD., HUDSON, MS. 54016
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j f MS. MASTER PLUMBER LIC. NO. 330? M.PA&
MINN. INSTALLER 6 DESIGNER LIC. NO. 00663
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STATE BA4 OF WISCONSIN FORM 3 — 19% 3
+ DOCUMENT NO. QUIT CLAIM r °ED
Lisa C. Jensen, Trustee, Kemer C. Speer, Alternate ' I I '
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hrarung P& . 7kk,�k) 17I:I:cUc-<L1gLE -j- „XT 3j REGISTER'S OFFICE
quit-claims to �; IX CO,, WI
ewer peer W Record
P n Any 36 Wi 1 non WT 54027 5 1997 7
10:00 A M
the following described real estate in St Crniir County ?' ' mot, 1��
State of Wisconsin: 1 i R ter of pew
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NE 1/4 of SW 1/4 and SE 1/4 of SW 1/4 Section
14, Township 28 North, Range 13 West.
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parcel Identification Number (PIN)
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This i s homestead ro ! ;
P perry.
(is) (is not) I
Dated this 6th day of September 19 97
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(SEAL) , l
_ jisaX. Jensen
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(SEAL) i z !SEAL)
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Keme C e
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AUTHENTICATION ACKNOWLEDGMENT
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Signature(s) STATE OF WISCONSIN
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Pierce County li
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authenticated this day of ,19 Personally came before me this 6 t day of ++
Sept embe r .t 9 97 the above named
* Lisa C. Jensen and Kemer C. Speer �I
TITLE: MEMBER STATE BAR OF WISCONSIN ,)
(If not, to me down to b who executed the ?+
authorized by § 706.06, Wis. Slats.) for sarpe.
THIS IN:'RUMENT WAS DRAFTED BY
Julie C. weer w =; vv�--
Wend tiu rt1
Notary .�uWic / i ' . County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My Commission is • permaoOnt (If not, state expiration
necessary)
date. A umit .20,''_000 mcxxx 11
�Mames of Pesons sign", in any caPxrry Should 1e typed ar onnted bebw Meo 9 naNres
e S83 „rF )Oz 3a i
QUIT CLAIM DEED STATE BAR OF WtSCONSj% Nelco Inc I=0 Box 10209 Green Bay NI 54307 -020p
I Form No 3 -- 199