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HomeMy WebLinkAbout040-1068-10-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Z-0 !:21 6 Al ADDRESS C&,,o , /P SUBDIVISION / CSM# LOT # N SECTION/ 7 T N-R j p i~n Town of 7"h-o y ST. CROIX COUNTY, WISCONSIN (-7,21- 11. 15YA PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM- E Cc f A 1 b~ L L lit o Pte- boy LOA OL NDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ J cp r _ r r BENCHMARK: ALTERNATE BM: L ~DO,oI o = 1 AIX SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,O 1 ~ro Liquid Capacity: A09 Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation /allons/cycle: ~ Alarm Location 9 4 7 . SOIL ABSORPTION SYSTE2 Width:. Length r, 1 _ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: ~ House Other ~4" Z~ / ELEVATIONS Building Sewer DO ✓ ST Inlet: /,3 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system p~~` c.S ~7e zs Existing GrAe Final grade 164~~ DATE OF INSTALLATION: rpe or / PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 1 7'~' 3 ILA 3/93 : jt t r Wisconsin Department of Industry, County: Labor and Human Relations PRIVATE SEWAGE SYSTEM Safety arm' Buildjng5 Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar284235 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SALMON JOHN TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r 040-1068-10-000 TANK INFORMATION "ELEVATION DATA A9700005 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet q f, /3 TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic ya NA Dt Bottom Dosing NA Header/ Man. g-mss S- Y• 7 " ' Aeration NA Dist. Pipe & -7 . q,5-. SS 9- 11, 9 gv, Holding Bot. System 4 q -(O8 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 7s' q 5 Model Number GPM TDH Lift I Loss meaem TDH Ft / k< I S71 Forcemain Length Dia. Dist. To well 71 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No_ Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS y / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: 5,L OR UNIT 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 E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 17.28.19.258A. E COVE ROAD Plan revisioed? ❑ Yes ❑ No , . ('1,A] Use other side for additional information. 1,/-Z SBD-6710 (R 05/91) Date s dots Signature Cert. No ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: Safety and Buildings Division v~■~r~L■~ r SANITARY PERMIT APPLICATION Bureau asniildingAVeerSystems 201 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. .moo / • 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 ❑ check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na e / Property potion __I-" 7/v ct h Jrl/J c /1~ 1i4 Wy ,1i4, S ? T ~r N, R 19 E (ore Property Owner's Mailing Addr ss Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number ov, _115t 5 I II. TYPE OF BUIL NG: (check one) ❑ State Owned ❑ City _ Nearest Road n Village !T ❑ Public or 2 Family Dwelling - No. of bedrooms E] 1191own OF d] 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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 _ E] New 2 P~'feplacement 3. E] Replacement of 4. E] Reconnection of 5. Repair of an System_____ System Tank OnlyExisting 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 ❑ S page Bed 21 ❑ 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 f? ~Required (sq. ft.) Proposed sq. ft. (Gals/day/s~ft.) (Min./inch) f-/ `it P q.q7 ,i Elevation A 11-ou-) 9t,14,PPeet 9 g OMet VII. TANK Capaat Site in gallons Total # of Prefab. Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete tructed Con- Steel glass App. New Existing Tanks Tanks Septic Tank or Holding Tank /600 wo-A CAn, . Lift Pump Tank /Siphon Chamber ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews a system shown on the attached plans. Plurryber's Name: (P ) Plumber's Signature: ( o Stamps) M&WZRjW N Business Phone Number: H,EIV)-y AV Plumber's Address (Street, City, State, Zip Code): 24 -7 W S IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issue g Agent Signature (No Stamps) Approved ❑ Owner Given Initial a( Surcharge fee) Adverse Determination Y' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS y 1 . A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. If. 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 D1 LH R. 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. 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 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 bythe county; E) soil test data on a 115 form; and F) all sizing information. --------------------------------------7------------------------------------------------------------- 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. 1 w N ` • U1 I c1 Ti:„. --)r- —11 ////7 7-------•.----. it _. w s I--ise • �ca chat/ r, �, - ' zm3C w � - m � rn -,-,.--*--- i - ' -' f . \ Q . f D 1 , Co w �� C Aga © VI .......VA 7Cf , 'Tl � �I (11, • , (� Y' l�1 a lc0 ' ,4:)'' ,. - °$ z m_.,.. 0 -,; �"'� Z � ` -, '\zzlsc, '‘ 0 , , , :,, ,,., „,...,li _ , QrA w.:1_E kt, , „ , , v, \ ep o � 0m il ,, c,°,`Or, • \, 0 \, *, (Jlt 1\01 rtkj • O \ 1,i ,c )---- R J `-1 \ 1 t,/ " .Th Lc(1 \ . to 'ik, .i,„. S.\if __ \ 'la,r1,`" '- -x cd 1 n oo -6 A A 1 _ (fa ,- 0 0 �c) } `" J ;k , . Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of Division of Saf. ty ai*d Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include,but not limited to: vertical and horizontal reference point(BM),direction and 5577 CR0/ percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location 30 t h) 5./41-MOA/ Govt.Lot , if./ 1/4 A'E1/4,S y7 T 2? ,N,R /7 E(or) Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# y'g3 g. caves 7) - — P4,P7- .f 35.2- /4Ci.es .i4 f City State Zip Code Phone Number ��/ Nearest Road 1-P/P5onl I eV/5 I Syd/!o I (7/5 )3 -3/9/ El city ?p gage LJ Town I 4-457- c-0v --"Ace . ❑ New Construction Use: [B�sesidential/Number of bedrooms --3 Addition to existing building E 4eplacement am� ❑Public or commercial-Describe: //ll Code derived daily flow 7,%d gpd 2 Recommended design loading rate •7 bed,gpd/ft2 '' trench,gpd/ft2 Absorption area required 60Y3 bed,ft2 ��J trench,ft2 Maximum design loadingrate '7 bed, d/ft2 •p g gp9 trench,gpd/ft2 Recommended infiltration surface elevation(s) s'� 1 ' 3 ft(as referred to site plan benchmark) Additional design/site conside ationsn,,E40�`'ri'fE-uJ��� : -2- LoN 6— it/i¢'i','OW 72r -(Je . c 5' A//o Parent material `JC / S///• -/,‘ s 4.fe.. '7 Flood plain elevation,if applicable Na ft S = Suitable for system �Conventional Mound In-Ground�Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system II1'S ❑ u u's ❑ U I I ❑ U ❑ U Ed 11 U ❑ S //fFP/1 fo// TY/'/ .soi/• SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench l / 0-/2_ /o Y/e z'/.i- 6',e Cr-.4a t c si"/. / ,C6K d5• C S zf . 2— • 3 z 11- ' /oYR 3/3 — Si( 1(5A,e dsi cs /I . 2- ; . 3 — Ground 3 /-2.5 /{/, /C f/ 5/ /-iS1, 4a+d-/2 eS /o , Y : •✓-- elev./ 9e•i ft. 9 2 -3/ 75 Ye ylV /5 /I fX i-e eS -- . 7 ; •pg Depth to 37�/!�v /O a ke /i�z•5: 6. ; . if. — — ,-7 'U limiting , factor .796_m. Remarks: Boring # - / 6'-/9/ /Or,e 2/2 oA��tii e Si/ /745h,{ Gi5% c S 2-F . - ,. 3 Z Z /*/-26 /a y,P 3/3 — Si/. )--Fs.6/- 7r,e '5 " • ,S, •6 3 -36 /o YR yY 4 l y,e d% ec _ g Ground V 31)ik /)W s� ,/Lrp-e, s• St - ea -- elev. f '•/5' ft. f-- . Depth to limiting , factor /r ' in. Remarks: CST Name (Please Print) Signature Telephone No. ,ot3 r 7l/6,e,77- - 7/5=386 -9/g — Address Date CST Number Ulbricht&Associates //-9 ' CrS7--(i1--4/12 Pr va a gtremst ' 655 O'Neil Rd. Hudson,Wis. 54016 • S / )( 57 , ORIGINAL PROPERTY OWNER Td�7�� -S�'//40� SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure G D/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Consistence Boundary Roots �' 3 / 9 iy Bed i Trench ior/2 L/2-- S-// /f.Shie 'r.►fe Cs L-F . Z • 3 Z /1-/9 i6 w f 3/3 5/ 1 sut 4..72 es . 2— .3 Ground 3 /.3/ /o /�//� 3/� .J/t ZfuI,� �i� �s elev. l(Jf •S Depth to 111.7- y/c 54 lW`-eiY a f�j . d — .-1 •O limiting factor >9�f in. Remarks: Boring # Ground elev. ____ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Consistence Boundary Roots Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330(R.08/95) JAtiI85W r E/Si caUE P -7--------------\ W w N — ( I -1 • C' y It o r °o °moo N `^ Ri C\ .. ///7 7----"•-------...,...m_— O / w xa,vc S\ Q • y tn m Qw 'A J Q W w o m ' m- op,A W � y � rn b N o n m 7b n 4 tn' 1 oo i m v c_ 1 w s IN ` ° Cam^ (1 C Q . " l --,.....-_ ;:el .r ,m C .. ()) kt4 R 4 \ -''. \ \ I �^ o Ni 1 i),F)//) -e.M)/ , 0 Z y o pw via"- I H 0., 1/4., A 1 ,,, J t 8 T C - 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 ~1 S a h iY1 el N/ Location of property trJ 1/41/4, Section T BN-R--= Township T P) Mailing address Al s -3,L- c~dr 1y . Address of site S c1 _ b ` Subdivision name Lot no. , Other homes on property? Yes No Previous owner of property T7 Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes '"No Volume /!57 and Page Number l 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 references to a Certified Survey Map, the Certified Survey Map' shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) an (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in office of the County Register of Deeds as Document No. 5-21 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property,.for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Sign re of Applicant Co-Applicant e of Si nature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ' 'a MAILING ADDRESS PROPERTY ADDRESS /Lf T= (location of septic system) Please obtain from the Planning Dept. CITY/STATE yuc~ S LUG <;-/y & 1,6- PROPERTY LOCATION 1/4, 1/4, Section, T -;Z 8 N-R W TOWN OF _T J, C ST. CROIX COUNTY, WI SUBDIVISION 14 LOT NUMBER l v ' ` CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration da . SIGNED: DA'I'S: -77 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 von 1157PA-.131 5383G9 TERMINATION OF DECEDENT'S PROPERTY INTEREST - Joint Tonancy or Life Estate Termination [s. 867.0451 or - Summary Confirmation of Interest in Property [s. 867.046] Decedents Name _ Honora A. Salmon a/k/a Nora A. Salmon Address of Decedent at Cate of Death City State 21p l ► i r R ord ' Cty• Tk. cr Hudson WI 54016 Z- Date of Death Social Security Number JAN 9 1996 . 5-12-69 397-34-9944 ;,t^ 9:30 A. G1 ' Presentation of Death Certificate.{. (1~L I certify that I have viewed a certified copy of the decedent's death certificate. ftNtar of Deod3 sigFo6 to Aegister of Deed's t b This interest In re:.: estate Is terminated under (check one): d-~ Record this document with the Register of Deeds ' XXs. 867.045 which pertains to real property in which the decedent was a joint tenant,* in the county where the real estate is located. had a vendors or mortgagee's interest, or had a life estate. *(You must provide a copy of Recording fee is $25 as per s. 867.045, 867.046. >s the deed establishing joint tenancy.) Return to: C. L. Gaylord _s. 867.046 which pertains to (t) real property of a decedent specified in a marital Attorney at Law property agreement, and also to (2) survivorship marital property. (.,)u must provide a P.O. Box 46 copy of the deed establishing survivorship marital property.) River Falls, WI 54022 Presentation of real property tax bill. k Present with this document a copy of the real property tax bill for each parcel for the year immediately preceding decedent's death. Presentation of deed establishing joint tenancy or survivorship marital property. This deed is found in volume/reel 315 pagehmage. 34 of (check one) Records X Deeds_ • * Description of the real estrde. Include only the extent of ownership (or vendor or mortgagee's in;--: ast) in land at the time of the decedents death. H the extent of land is exactly the same as an the deed, a copy of the deed may be attached to describe the real estate. The legal description of the property is as follows. (If more space is needed, attach pages.) ` NWk and S~ of SWk of NEk and NWT of SEk and S~ of SEk and NEk of SEk, except the tract of land lying and being NEly of Highway running through and across the NEk of SEk of Section 17-28-19, St. Croix County, Wisconsin. DECLARATION: I, we declare that this document is, to the best of my (our) knowledge and belief, true, correct and complete and is in -conformity with the provisions and Limitations of the Wisconsin Statutes. N more s ce is needed, attach pages.) Name and Address of Person Receiving Property Relationship to Decedent Signature (Notariz, Date ~r John J. Salmon Son 1-5-% r„ 453 E. Cove Road t Ki-Wr , Wt 54022 AUTHENTICATION or ACKNOWLEDG MENT The above named person(s) was sworn before mhe w (dat ^ January 5, 1996 v This document was drafted by (print or type name below) signature of notary or other person Q'~, Y_ C. L. Gaylord, Attorney authonzedtoadmrhhsteranoath (as per s. 706.06.706.07) River Falls, WI 54022 1O 9 Y ti Print or typenarne C. L. G1ylt7rd State of wlscoriw, County of Pierce V B L% wsc-n Register of Deeds Association Form w-, io (1/52) Title Attorney ~rnir~.sioe• ' S ertnarient t it % . 1 . Z ~ A } '~l .t At' i J~* y'~ . r J Vol- 3q 315 WARRANTY VUL) SPATE OF WISCONSIN-FORM No.. 1. 1 This Indenture, 3fnde tl:ia day of ~i bttworn :;Ori r: -r'_: , u12 C, - - VOL .115 t PArE part of the Crst Dart. and 'r•, c~.: J. 511ru.^., r_ sinrle .rtan pan Y of the socnnd par,. WITNESSETH, That the said pan 405 of the first part, for and In consideration of the Sum of c.. ":c:Fanc'. . i•re ..unf rec. era'. nclIX' to - t ^er i In hand paid by the said part Y of the second pan, the receipt whereof Ss hereby coafes td and acknowledged, he given, granted, bat2lined, sold, remised, released, aliened, conveyed and conErmed, and by these mrosents do ' D give, gruff. bargain, sell, remise, release. Wen, convey and confirm unto the said party of the second part, his heirs and assigns forevor, the following described tat "tat*, situa-ed in the county of St. -'rc i:: , and State of Wisconsin, to-wit: • ; "c rest (1r ) u Sec`.. vin-.e•en 17), he South alf -,S1) of t.,c So,.t.vr~_t ..w::xr t!je r cast uarter (!M") c ti rv.rt en (1?); The Northwest quarter ? of le Sa,t:cast l_9:'tcr r( 1 Sevcntecn 'IV; T}e S"th. "aif (SI) of the Southeast ua:ter (Se.;.) of Section Stvcrteen (°he `i -ast '%arfer of tae Soc•_heast .carter (SE?exeeptinC th3 t:-et of lane. lyin;• am. 'uci:; :'ortf:east-! _r~ss .1 ort:r_•act "crier (MLI) of tltr "utl:Pae_ ...artt.r (Si, 5e.ct`_~n `:c:th, -.inre .:i r teen ,.fie.. ;~tcrs c estate in the said premises.) e (Can. ) ~ ~_r r, KY r t TOGETHER with all and singular the hendltaments and appurtenances thereunto belonElns or In any wse appertaining: and all the estate, tight, ' title, interest, claim or demand whatsoever, of the said part of the ant part, either In law or equity, either in ^-Ase"m or expectancy of, in and to the above bargained premises, and their heredttaments and appurtenances. TO HAVE AND TO HOLD the said premises as above dncrtbed with the hereditament, and appurtenances, unto the said part y of the second - part, and to h j g heirs and assigns FUREYER. t AND THE SAID ,to: n P. Salr:.cn and Lora A. Salmon, his :,ifs , 'i gar tier-:,c lve n , their belts, executors and administrators, do covenant, grant, bargain and agree to and with the said part v of the second part, his heirs Lad "signs, that at the time of the unsealing and delivery of these presents *;rev are well salzed of the premises above described, a, of a gor . sure, perfect, absolute and :ndefeasibls estate of inheritance in the law, in fee sample, and that the same are free and clear from all tncumbrances whatever. and that the above bargained premises in the quiet and peaceable possession of the said part y of the second part, .^.i.s heirs and ft assigns, against all and every person or persons lawfully claiming the whole or any part thereof, will forever WARRANT AND DEFi\D. IN WITNESS WHEREOF, the Bald part of the first part he hereunto set hand and seal this day of A;;ril , A. D.. It Signed and Seated in Presence of chn P. Salnun (SEAL) "avlcrd John ? 'al::on 'a;lord Nora Sal-.on (SEAL) .',,vin rzi%r°n I flora A. Saffron C. Alv' n ncnn nf-,:.n I (SEAL) 1 STATE OF WISCONSIN. (SEAL) Pierce county. `a Personally came before me, this ,Otit dy o, April A. D.. 1e S3. i the above named Jon F. $alnrn :C:c :'.ora A. Salton, his wife tome known to bothe person S who executed the foregoing tnstrumant and aclm'swledged the same. j _ . Received for Record this 1st day of C. L. Gaylord C. L. G.1Ylord A. D., It 53 , at 3 t 1,; o'otocY P. Y. (Seal) NotarlPubllc, Pierce Oeaaq,wfs. -,avi" 170M Register of Deeds. 1g7 Commission expired 321+ A. D., II i3 Deputy. 0ARRk1;iTY DEED. STATE OF WISCONSIN-FORM No. 1 NUMBER This Indenture, ~adethls 21St day of April A. D., 1953 , between John P. Salmon and Nora A. Salmon, his wife, part ies of the first part, and J John J. Salmon, a single man part y of the second part. WITNESSETH, That the said part i.es of the first part, for and in consideration of the sum of even Thousand Five Hundred and no/100 to them In hand paid by the said part Y of the second part, the receipt whereof Is hereby confessed and aelmowledged, ha \ given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said party of the second part, his heirs and assigns forever, the following described real estate, situated in the County of St. Croix and State of Wisconsin, to-wit: \ Northwest Quarter (NW,) of Section Seventeen (17); the South Half (S2) of the Southwest Quarter (S;71,) of the M \ Northeast Quarter (NE 41) of Section Seventeen (17); The Northwest Quarter (NWY) of the Southeast Quarter (SE-4) J of Section Seventeen (17); The South Half (S}) of the Southeast Quarter (SE9) of Section Seventeen (17); The Northeast Quarter (NE}) of the Southeast Quarter (SEn), excepting the tract of land lying and being Northeast- erly of Highway, running through across the Northeast Quarter (NE-41) of the Southeast Quarter (SEJ) of Section Seventeen (17); all in Township Twenty-eight (28) North, Range Nineteen (19) West. (Said Grantors reserve unto themselves a life estate in the said premises.) 1 ($8.25) (R. S.) (Can. ) I i i i TOGETHER with all and singular the heroditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part of the first part, either In law or equity, either In possession or expectancy of, in and to the above bargained premises, and their heroditaments and appurtenances. TO HAVE AND TO HOLD the said premises as above described with the heroditaments and appurtenances, unto the said part y of the second part, and to his heirs and assigns FOREVER,. AND THE SAID John P. Salmon and Nora A. Salmon, his wife t for themselves, their heirs, executors and administrators, do covenant, great, bargain and agree to and with the said ~ part y of the second part, his heirs and assigns, that at the time of the enseallng and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all Incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part y of the second part, his heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, will forever WARRANT AND DEFEND. IN WITNESS WHEREOF, the said part of the first part ha hereunto set hand and seal this 30th day of April , A. D., 19 53 Signed and Sealed in Presence of John P. Salmon (SEAT) C. L. Gaylord John P. Salmon C. L. Gaylord Nora A. Salmon (SEAL) C. Alvin Ronningen Nora A..Salmon ' C. Alvin Ronningen (Sgt) STATE OF WISCONSIN, l (SEAL) J as. Pierce ()cunt'. _ 3 WisgonsinDepartment of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION n GOVT. LOTS 1 /4'yuJ 1/4,S / 7 T Z r AR E (orrv PP PER OWNER':S MAILING ADDRESS LOT If BLOCK # SUED. NAME OR CSM # CITY STATE V ZIP CODE PHONE NUMBER []CITY []VILLAGE mfOWN NEAREST ROAD V) New Construction Use [ Residential /Number of bedrooms [ ] Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow 4/0 -0 gpd Recommended design loading rate 7 ed, gpd/ft2 • Y trench, gpd/ft2 Absorption area required tT8 bed, ft2 7Sd trench, ft2 Maximum design loading rate __._7bed, gpd/ft2 • Y trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ?_&GWA~K -ft (as referred to site plan benchmark) Additional design / site considerations c a Parent material J.C410~ Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem S El U S O U 0S 0 U TEIS O U ❑ S U ❑ S VI U SOIL DESCRIPTION REPORT Boring # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Horizon in. Munsell QU. Sz. Cont. Color Gr. Sz. Sh. Bed T rench Ground elev. P /W_'_7 ft. Z P-12. 7. - VA, L S / ° ~ . 2255 Depth tom' Y..l r limiting - 4A factor r~ Remarks: Boring 0- 3 2 .A ° aE Tjkf z 3 - 4~ O Ground elev. ft. S_A/ .5 62 Depth to limiting factor Remarks: CST Name:-Please Print Phone. r~ o Address: 3o w O -3 ja33 Signature: Date: ~~/.z 9 f r CST Number: PROPERTY OWNER J:eloorwa SOIL DESCRIPTION REPORT Page x of 3 PARCEL LD. # Depth Dominant Color Mottles Texture Structure Consistence Botxxian+ Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench JrZ -le 3 7114AAK 4d Ground elev. ft. 1.3 Depth to c A X& limiting fac~torr~ tG Y - o o- s d SG /YIL - .7 .8 Remarks: Boring # R-. r d-9 - 2 Ground elev. /Aq.,2 ft. ' Depth to limiting factor Remarks: Boring # z 9- 7. s s~ ~rL s F Ground elev. y_A 0/s C- A? Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks, O ~ b 0 W h ~s b e Z Y, ~ r a rn 3 av W ,vZOI Ito C w ~ r --P , ~ ~ i i. i ~ - i'. _ ~ ~ { ~ ~ r ~ y j j 1 . ~ - - V _ _ T:.. ~.f.. s _ i r.; n y .i ,y- iY ~ '=3 f ..t ~ ~ -