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XATHLEEN H. WALSH J
REGISTER OF DEEDS
ST. CROIX CO., MI
Document Number Document Title RECEIVED FOR RECORD
St. Croix County 08i08 08 :25AM
AFFIDAVIT
Occupancy Affidavit EXEMPT 11
REC FEE: 11.00
3 0 S�n T1i vvt \ a.�n TRANS FEE:
Y COPY FEE:
Name — (Owner) Typed or printed CC FEE
being duly sworn , states, under oath, that:
PAGES: 1
1. He/she is the owner /part owner of the following parcel of land located in St.
Croix County, Wisconsin, recorded in Volume Page Document
Number St. Croix County Register of Deeds Office: R000rdboArea
Name and Return Address
A parcel of land located in the K of the _ K of Section - 3 J 0Sh a4^ .4 I,i rva-" 11 Ca c.�CLV,
T Za_ N — R _ jg_ W, Town of Tiro y • St. Croix 5 3 3 6i 1 e4 T-Z o oe.I
County, Wisconsin, being duly described as follows (include lot no. and 14 Lk �(g o ►� , W l SLI o I L,,
subdivision/CSM or detailed legal description): �-
�_Ot 41p C0 LLV\ y46j00 TIYS� �A dc4illa v,/ Pa0roel s—)o- o00
T Ol.J Y1 C� TY'o� I s"tr � �`CO�x�Kk
As owner of the above described property, I acknowledge Qiat the septic system serving this residence Is sized for a
3 bedroom home, or a design flow of gpd. The design flow is calculated by assuming 150 gpd for 2
individuals per bedroom. There are currently _.S occupants living in this residence: _(g_ occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However, I
understand that if there are intentions to exceed the number of permitted occupants. the system will need to be
modified to aeoomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make
this information available to any future parties interested in purchasing this property.
Dated thi g day of Pvv u S�"
to
• s ' VI,
AUTHENTICATION ACKNOWLEDGMENT.
Signaturo(s) STATE OF WISCONSIN
/ '""
aultnenitcated this day or St. County.
Personally came before me this �_ day of W C
UD 3 the aboye named
TITLE: MEMBER STATE BAR OF WISCONSIN
Of not to me known to be the person(s) who executed the foregoing
authorized by 1 700.00. Wis. Stats.) instrument and acknowledge the same.
TENS INSTRUMENT WAS DRAFTED BY
4CA I*eet� t47 - 1,✓als
e Notary Public. State of Wisconsin
(Signatures may be auBrenticated or acknowledged. Both are not My Commissyn is permanani. if riot. state expiration date:
necessary.) Date-L-2: a
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT DO NOT REMOVE"
7ft &Ax i ift. must be corryukted by gams A radon accuses. and EV (M rued). OBrerhd MWWn such as 1be
Pudh? dam wapal desarpwL etc. may be placed an o* I1rst page or" dooranent ornNy be placed on addVonal papas 01 ` 0 10
doownwit. &W Use of Ngs oowr paps adds one page to dew do nwit and ;12 the 1000111M Are. Wsoonsh Shfutss. 59-517
STATE BAR OF WISCONSIN FORM 2 — 1982
KATHLEEN H. WALSH
WARRANTY DEED
REGISTER OF DEEDS
ST. CROIX CO., WI
DOCUMENT NO. vo;. 1432PAU 337 RECEIVED FOR RECORD
RICHARD 0 STOUT 06-07 - 1999 :30 PH
.
11ARRANTY DEED
EXERPT A 17
CERT COPY FEE:
COPY FEE*
conveys and warrants to TRANSFER FEE:
Ve� RECORDING FEE: 10-00
n
PAGES: I
N
wife as &11rMiXQ91hi9__ mar N
I t THIS SPACE RESERVED FOR RECORDING DATA
i i NAME AND RETURN ADDRESS
th following described real estate in SL. Croix County, j .
State of Wisconsin: 1 ROX 750 109 L MINI A
Lot 46, Country Wood first Addition, Town of.
Troy, St. Croix County, Wisconsin. Together
with and subject to easements, rights-of-way, cpv
enants, reservations and restrictions on the
D - 76
plat or otherwise of record. Oq
PA CEL IDENTIFICATION NUMBER
This deed is given in full and final satisfac-
tion of that land contract between Craig Allen Meidinger and Jody
Marie Mei dinger and Richard 0 Stout dated October 1, 1996, recorded ij
ii October 1, 1996, in the office of the Register of Deeds of St. Croix
gned to Kimberl
e135, as Doc. No. 550228, assi y Ij
1; County in Vol. 1201, pag
D. Loetz and Josh M. Cowan on February 25, 1997,which assignment was
recorded March 6, 1997, in Vol. 1226, page 341 as Document No. 556432. ii
is not
This homestead property.
it (is) (is not) of D easements, restrictions, rights-of-way and covenants
E I w arranties:
of xc rTC11onA.
23rd October
A.D., 19 — it
Dated this day of
(SEAL)
i t (SEAL) it
(SEAL)
(SEAL)
AUTHENTICATION
ACKNOWLEDGMENT i.
'� :t
State of Wisconsin,
Signature(s) ss.
— St. Croix County.
I
19 Personal came before me this 2 day of
ii au thenticated this day of Optober 19
-91L, the above named
Richard O. Stout
i t
;I TITLE: MEMBER STATE BAR OF WISCONSIN
It (if not,
authorized by §706.06, Wis Stars.) to me known to be the person who executed the foregoing
instrument a nd acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Janet P. Stout
1363 Awatulrzee T�.
Public,
Notary
County, Wis.
it Hudson, Wi. 54016
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (i( no t, state expiration date:
necessary.)
- - U lo
htntar P blte..
I Names o r Pe rsons signing in any capacity should b kyetatm bil—VIAeco w Lego awk Co. Ina AJV
' X0ffl4 nsin ?NSIN miau—, Wa.
: 1 WARRANTY DEED Barbar gtT
S'I'. CROIX COUNTY ZONING DEI'AR
AS BUILT SANITARY REPO �`� 10 T
A
Owner j os1 4
Address jVE0 '
City /State _?l J5, ,. �,>, j... F R
Legal Description: "M
%3 \ ys
Lot A Block Subdivision/CSM # C j T.
'/+ L '/+ �, Sec. 3 T a 8 N -R K W Town o rt !Z y
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer .�w { �� �„ r
� Size ST/PC L Setback from: House I $ Well P/L 9 I s
Pump manufacturer Yv 4 Model n A
Alarm location v✓ }4-
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
r�Tr p, G
Type of system: 1 v c N, ,, s Width 3 ,. _ Length - 25 Number of Trenches 2
Setback from: House 3o' Well P/L s ' Vent to fresh air intake x.50 °
ELEVATIONS:
Description of benchmark _ Tv,, I , b -,.
� Elevation 1 c, v, 0 0
Description of alternate benchmark Ton Gor c wa t� Elevation 9 9, 2
Building Sewer _ R 3 , 9 5 ST/HT Inlet Q 3,3 4 ST Outlet q 3. 7 PC Inlet r'u A
PC Bottom _w= Header/Manifold Z , 3, Z Top of ST/PC Manhole Cover ��. 9 7
Distribution Lines (t) _ q Q, 3,� (�) � 2 1 s ( )
Bottom of System ( ) R 1, G L ( ) 9 a , y ( )
Final Grade ( ) 4 3 , q , ( ) 13 7 ( )
Date of installation 131 19 Permit number -� ( j - ,- State plan number
Plumber's signature 1' License number a� o sS 4 Date /21/4A
Inspector
complete plot plan a
Wisconsin Department o iCommerce PRIVATE SEWAGE SYSTEM 1ST. ROIX
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitatjipg0 @j8W_:
Personal information you provice may be used for secondary purposes [Privacy L)jw, s.15.04 (1)(m)].
Permit
OWEN e• & KIM Il �yy❑ Village El Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description Parcel@4 c —
? Q ) d l ro r, P p a 1 1 83
TANK INFORMATION ELEVATION DATA A9
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ' D 06 Bench 1 ,� l�l•$ — j
Dosing ¢ .6 a4—
Aeration Bldg. Sewer 7 e 9 3
Holding Olf Inlet �f �(� el 3.3Y
TANK SETBACK INFORMATION (9 Outlet
TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet
Septic N J r Z NA Dt Bottom
Dosing NA Header / Man. ��{� q2. ?j
Aeration NA Dist. Pipe 4?' C 7 . 2 31 2–
Ter 9 -ro Z ! S
Holding Bot. System T f /0 '7#
y /o. o.
PUMP/ SIPHON INFORMATION Final Grade - 7 4 j3•ti5
Manufacturer Demand Fj -c
Model N ber GPM 12 u r 3
TDH Li Friction System TDH Ft
oss Fi
Forcemain Leng la. Dist. To Well
SOIL ABSORPTION SYSTEM
BED Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid pth
DIMENSIONS 7 DIMEN I N
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM ACHING F acture: INFORMATION Typ l _�/�� � O A N T R e Num er•
Sy a W� anw. O
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
i r
L Dia_ Length - 7S Dia. _te Spacing IZG.htvH <S GF tP
Length �
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: TROY 3.28.19,SE,SW 533 GILBERT ROAD – COUNTRYWOOD LOT 46
C . -QC, +, PJ M — Tv �^ovsG - �uv►cl�t
Plan revision r uired? ❑Yes (�'No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspectors Signature Cert No
Safety and
ofBui i
SANITARY PERMIT APPLICATION
Bureau of Building Water S ystems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less county
than 8 112 x 11 inches in size. S T y tp
• See reverse side for instructions for completing this application State Sanitary Permit Number
y ou p rovide may be used b other g overnment agency p rograms ����
The information
y p y y g 9 y p g ❑Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pr erty wnecName Property Location
Q _
74 5Z 1 /4 SLj, 1/4, T 28 , N, R (or) W
Property Owner's M in Address Lot Number Block Number
41Q
Cit ,State Zip Code Phone Number Subdivision�Name or CSM Number
oo� ( to Z1 Zt. - l� 0_,
` Y W 00
TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
❑ Village pD
❑ Public a 1 or 2 Family Dwelling - No. of bedrooms 3 M Town OF ✓4 �ouuCv o�
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) --1
1 E] Apartment/ Condo cjq — 1 S _ `
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. A New 2 ❑ Replacement 3 ❑ Replacement of 4, ❑ Reconnection of 5 ❑ Repair of an
System - _ -_ - -__ System Tank Only __ ---- - _ - - - _ Existing System Existing System
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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 .Seepage Trench 22 ❑ In- Ground Pressure l 42 ❑Pit Privy
13 ❑ Seepage Pit 1 h'F� i7r.�7J i" Cb� coJ 43 ❑ Vault Privy
14 ❑ System -In -Fill .• r j(
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
4 J C Q " 7 7 ". 9 Feet 4. S ^ Feet
Cap H
VII. TANK in Total # of Prefab. Site Fiber- E p
INFORMATION g Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic A p p
New strutted
Tanks y/�
eptrc an 600 dOCI r R i t� Y1�7� A ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamberl 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'sName:(Print) Plumber's Signature: P o Stamps) MP/ W Business Phone Number:
C dt r (i els z �i .� .Ss 71.5 �� -:21 S
Plumber's Address (Street, City, State, Zip C ode):
04a b )`, cy F" 01 , S 41v�
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (lnduciesGroundwater D ate Issued Issuin gent Signature (No Stamps)
(,$Approved ❑Owner Given Initial SO too Surcharge fee) P
7 ] 8 6
Adverse Determination f �•�
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SHD -6398 (R. 05/94) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Divi. ion, Owner, Plumber
�. L ort -1(P CO►tHt�y la 0OcQ � J0--P I C OVA N
4 ScL 46 2.02 4c, -
5 NiGN Up4r-��
1N F117RATION 0406m
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Wisconsin Department Industry
Labor and Human Relations 9 SOIL AND SITE EVALUATION REPORT P 1 of 3
Division of Saff3ty 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mus,'iriclu'de, but ` TD,
not limited to vertical and horizontal reference point (BM), direction and % of slope scale or PARCEL` dimensioned, north arrow, and location and distance to nearest road. p APPLICANT
INFORMATION— PLEASE PRINT ALL INFORMATION Vt DATE
PROPERTY OWNER: PROP VLOCATION
Richard Stout GOVT. t1d SW i /4,S ``Tr' 28 N,R 19 : k(or)W
PROPERTY OWNER':S MAILING ADDRESS LOT # 15fIC #,. SUBD. NAM( R�0M #
1353 Awatukee Trl . 46 Wood
CITY, STATE ZIP CODE PHONE NUMBER []CITY [:1VILLA 'E' N'" NEAREST ROAD
Hudson, WI. 54016 (715) 549 -6731 Troy Tower Rd.
[x] New Construction Use [ x] Residential /Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft
Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate .5 bed, gpd /ft 6_ trench, gpd/ft
Recommended infiltration surface elevation(s) 91.36 ft (as referred to site plan benchmark)
Additional design / site considerations alt. site= 90.36' system el.
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem I El S ❑ U [3 S ❑ U 1 4] S ❑ U ®S ❑ U EIS ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Botxldaly Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
`ti...1.. 1 0 -11 10 r2/2 none 1 2msbk mfr gw if .5 .6
2 11 - 10 r4/4 none sicl lfsbk mfr gw if .2 .3
Ground 3 25 -34 10 r5/4 c2 7.5 r5/8 sicl m na gw na np np
elev.
94. Y6 4 134-80 10 r4/4 none lfs lcsbk mvfr na na .5
Depth to
limiting
factor
+ 80 11
Remarks:
Boring #
1 1 0-17 10yr2 /2 none 1 2msbk mfr gw if .5'.6
2 1 17-27 10yr4/4 none sici 2msbk mfr gw if .4.5
Ground 3 1 27-36 10 r4/4 none sl 2csbk mfr gw na .5.6
elev. 4 1 36-84 10yr4 /6 none Ifs osg mfr na na .5 " .6
94.6 ft.
Depth to
limiting
fa�t 8411 T _T
Remarks:
CST Name: Please Print Phone:
Gary L. Steel 715 - 246 - 6200
A ddress:
/ J5,54 200th., Ave. New Richmond, WI. 54017 m02298
Signature: Date: CST Number:
4 -24 -96
PROPERTY OWNER Richard STout SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # pending w
Lot #46
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo nclay Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T Tren ch
3 1 0 -15 10 r2 2 none 1 2msbk mfr cfw if .5 .
2 15 -27 10 r4/4 none sicl lfsbk mfr if .2 .3
Ground 3 1 27-82 10yr4 /4 none Ifs osg mvfr na na .5 .6
elev.
94 ft.
Depth to
limiting
factor
+82"
Remarks:
Boring #
..... ....... ... > 1 -13 10yr2 /2 none 1 2msbk mfr - 9w if .5'.6
%<::.: :._;:< Z 3 -28 10 r4/4 none sicl 2msbk mfr
Ground 3 8 -80 10 r4 4 none lfs os
elev.
92 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
-17 10 r2/2 none 1
� 1 2msbk mfr if .5.6
5x4
}::::. .. 2 7 -3 2 10 r4/4 none 1 f . 2 .3
sicl lfsbk mfr
Ground 3 2 -80 10 r5 4 none lfs os
elev.
93 ft.
Depth to
limiting
facttor
Remarks:
Boring #
v
�r
µ'
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Richard STout New Richmond, WI 54017
MPRSW 3254 SEgSW4 S3- T28N -R19W (715) 246 -6200
town of Troy
lot #46- Country Wood
N
1 " =40'
BM=top of 1" steel pipe C el. 100
0
z4
Gary L. Steel
4 -24 -96
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer , t4 'k X ;vy Cep tk\d
Mailing Address r-1 cog EX �_► ►yt
Property Address b �o
(Verification required from Planning Department for new construction)
1
City /State _gooso w , W', 54 Parcel Identification Number 0+0 — 12 35 — '70
LEGAL DESCRIPTION
Property Location SE ' ' / SW '/4, Sec. _3 T _ c j(&_ N -R _L9.__ Town of `TRo j
Subdivision [c7�. °N`�P. -� �tiE�� , Lot # 4(
Certified Survey Map # — , Volume '— , Page # '—
Warranty Deed # 5 6 32 _ ' Volume 1 224 , Page # 341
Spec house ❑ yes CSno Lot lines identifiable Oyes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tauk 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.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
IE NATUW9;APPLI A T 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 prope described above, by virtue of a warranty deed recorded in Register of Deeds Office.
I SIGNAM F PP IC N DATE
* * * * ** Any i or t on t is mis represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Incilyde with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
2. 01 AC.
\\, 87, 761 S0, FT. ,
r o
N85 /l 42 'W
\ 35.00
\\\ \\ 368 2 3 —
\ 019, 46 , E
\ � N76
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45 C) T
1 = 2.27 AC. N
n
Z 98,915 S0. FT. c L3
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2.02 AC. ° `_
41 �
88,005 SO. FT. N () I
/
i S84011'50 "F LOT
37 3.72'
i
33 ,E
33
l0
M 21
47
2.03 AC. —
/
88,261 S0. FT.
S73o 2 N
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446 gp! ��0
/ 48 I —I a c r),
�I
-J I S 2.53 AC. L _ 110,261 SQ. FT. I L1 i OO' V
s o ? 1 , too, r e
49 sy 0
)9 AC.