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Parcel 040-1163-50-200 12/13/2005 08:50 AM
PAGE 1 OF 1
Alt. Parcel 25.28.20.633D 040 - TOWN OF TROY
Current k 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
O - HAUSCHILDT, TODD S & CORTNEY L
TODD S & CORTNEY L HAUSCHILDT
276 GLENMONT RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 276 GLENMONT RD
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 4.150 Plat: N/A-NOT AVAILABLE
SEC 25 T28N R20W PT NE SE BEING LOT 3 Block/Condo Bldg:
CSM 11/3021
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-28N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1152/231 QC
2005 SUMMARY Bill M Fair Market Value: Assessed with:
103310 262,300
Valuations: Last Changed: 09/06/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.150 67,000 185,500 252,500 NO
Totals for 2005:
General Property 4.150 67,000 185,500 252,500
Woodland 0.000 0 0
Totals for 2004:
General Property 4.150 67,000 172,100 239,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 309
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~ ' tj-
D~ i
ADDRESS 0-7 ~IQhPkO+►'f' Rpct p~
SUBDIVISION / CSM# LOT #
SECTION 2 5~ T )-g N-R. In -W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
t ,►~,1 bthc~ `Fop VG pip, _ tool
BENCHMARKJ to Oil weSf*e"A w
ALTERNATE BM: Y1C,
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: M1)6V"kvML PeVA-k Liquid Capacity: 160
Setback from: Well House Other
rr Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
-j Alarm Location
-~'~,e We 11 t I
r S N,~.~ ~ he~~S S r wed ~pY ~ bedv~'h ~av~e IS 3 lO~v~~7y,
Rq -.SOIL SORPTION SYSTEM
2
let rjWidth: Length 7 ~ Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer Ih fJ# ST Inlet : $,/b ! SIT outletl 4 1S P~~" e,
PC inlet X 14- PC bottom Pump qO/f' fA
Header/Manifold I VIA'- Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: Y I(~
PLUMBER ON JOB: sruCe-
LICENSE NUMBER: P
INSPECTOR: V p
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human-Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION
❑ City ❑ Village lk Town of: State Plan ID No.:
PeflXV°61fjht":, DIANE E.
I Troy
CST BM Elev.: Insp. BM Elev.- BM Description: Parcel Tax No.:
_N1 Ag-9500401
TANK INFORMATION ELEVATION DATA ll'
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ,r e~ ° 1 f t %CCLi -f Gc Benchmark 1 / 166„ 6
Dosi n la 1.6
Aeration Bldg. Sewer
Holding St/ Ht Inlet $ 3(0~ ~d ((p~
T SETBACK INFORMATION St/ Ht Outlet i
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake A7t
Septic } S~ NA Dt Bottom
Dosing Header 4l_ G,/ b & i 97 ~71
Aeration Dist. Pipe - 6.33 47703
s
H g Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Demand!!' "gin .7
Manufa
ctt~
Model Number GPM
TDH Li Friction System TDH Ft
oss Fmead
Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DI NFERSTONS, SYSTEM TO P/ L BLDG WELL LAKE /STREAM _-tiA~CHIN6_1_ Tv nu acturer:
SETBACK Number:
INFORMATION Type Of y1~ orJ j ``ORUNIT `J~
System: 'nap
DISTRIBUTION SYSTEM
Header wv Distribution Pipe(s) / o le i x H t To Air Intake
Length Dia- Length 2L Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At- rade Systems On
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulc e
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Troy-258.20W, NE, SE, G.2enmont Road
n
Plan revision required? ❑ Yes 8.1 o •
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
SANITARY PERMIT APPLICATION Safety and Buildings Division
Bureau of Building Water Systems
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 sYstemr on paper not less County
f
than 8 112 x 11 inches in size. $ I
• See reverse side for instructions for completing this application State Sanitary Pe it Number
Zq 0
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name 1 ropert Location
e 4usc t Id 1/4 1/4,S _57 T29 , N, R, (or
Propert Ow a 's Mailing Address Lot Number Block Number
(C ff) La+it
City, State Zi Code Phone Number Subdivision Name or CSM Number
I11t 0 015' )
A450.1 5 $6~
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road
Village pp i
Public 1 or 2 Family Dwelling - No. of bedrooms E] Town OF V` %P)l
9ti RD CJ
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo pYD 1163 'tO
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. [57( New 2. E] Replacement 3. ❑ Replacement of 4, E] Reconnection of 5. E] Repair of an
System___ Tank OnlyExisting System Existing System
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
12XSeepage 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
u ~ Required sq. ft. Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) q Elevation
5_0 l ~ J Q • , { 7,0 Feet W. Feet
VII. TANK Capacity
gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Exist in strutted
Tanks Tanks
Septic Tank or Holding Tank OD ` khShyy ~'=pry ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber IPA- ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW NO.: Business Phone Number:
3~8a
it- USG 6'3 -7 ~r7
.1 Prl
Plu ber's Addre s (Street, City, State, Zip Code):
S- of hl X0 ef G ryv / w~
IX. COUNTY/ DEPARTMENT SE ONLY
❑ Disapproved Sani ry Permit F e (Includes Groundwater ate Issued Issuing A ent m s)
Surcha rge fee)
Approved ❑ Owner Given Initial
Adverse Determination * V~_
`
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
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, 608-266-3815.
y~
To be complete and accurate thisaainixary permit application must include: `
1. Propertyowner'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.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smallerthan8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale orwith complete dimensions, location=of tsolding 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 4urve; 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; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor a1hd Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST. ~~x
Attach complete site plan on paper not less than 81/2 x i h ' include, but PARCEL I.D. #
not limited to vertical and horizontal reference point ( I on and % of ale or
dimensioned, north arrow, and location and distanc rest r`' 0
APPLICANT INFORMATION-PLEASE PRIN I "FIQAky.-tea REVIEWED BY DATE
PROPERTY OWNER: PROPE ATION
~'OD l~i~rU S Ct} l l_ fly' s'`~ # N F 1/4 S F 1/4,S Z S T 2 8 N R Z O E (or)z
44 OCK # SUBD. NAME OR CSM #
PROPERTY OWNER':S MAILING ADDRESS
CITY, STATE ZIP CODE PHONE NK , dGI ❑VILLAGE MrOWN NEAREST ROAD
w 5400 I~IS)7,a ~ ui`( ~~htwT Rul~~
New Construction Use Pq Residential / Number of bedrooms - [ j AdditiQn to existing building
j j Replacement [ I Public or commercial describe
Code derived daily flow gpd Recommended design loading rate o--I bed, gpd/ft2 0- 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 S61 trench, ft2 Maximum design loading rate Qs--l bed, gpd/ft2 0-9 trench, gpd/ft2
Recommended infiltration surface elevation(s) °1-1- O ft (as referred to site plan benchmark)
Additional design/ site considerations TSZ c~f=s 2~Y 1t'1 ~O~D - S tied ory t~ Str 3 F 3
Parent material S rc►. spy O~'f►NftSN Flood plain elevation, if applicable ►J- H- ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL 7ING TANK
U =Unsuitable for s stem S ❑ U ®S ❑ U WS ❑ U US ❑ U ® S ❑ U k'U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1-~
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Ta,S 3v o• S -'LI tO `1 R 5) Sly Z'F sNh Y" Ground 3 2-1 -41 -).s
Ll R 31 y - S 1 c S bk yrt ~'~H C g o• G- S
elev. t tz 3! 6 S o s 9 rn e S - o.~ o. 8
tioe_3ft 4413
Depth to 5 bb-83 lDi R 31~ S $ 61r O 99 r,.t j - 0.7 o.
limiting
factor
> 83
Remarks:
Boring #
0-8 I'D FEZ - S1~ z 3b~z yw~- ~S 3v-F o.S o.b
b mot. Z~Sbh m ~h cS 1 v~ o-S €o.
ti $ 2 ~!6 sil
...........i$K
3 zo z9 s `1R ~/y _ s ~ ~ Z`_S b~ wl v~,. cs - o• y o.s
Ground
elev. Z 9-$S 10`1 tZ 3!6 - S el 6~ t7 S~ w~ 1 -
1o0•b ft
I
Depth to
limiting
factor
>
Remarks:
T Name:-Please Print Phone: 15 - 4 2 5 - 016 5
Arthur L. We erer
Address:
e-gerer_:__So_il_„ Tes_tin.g. & Design Service-P.O. Boar 74 River Falls,WI 54022
SignaEUre: Date: CST Numbert
8-g5 M00576
PROPERTYOWNER ~'cKvSC~4 SOIL DESCRIPTION REPORT Page Z ofr 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Bcund@jy Roots GPD/ft
Boring # [Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
:.:3 0-8 lo`tR 31z - St 1 Z'FSbk vn'{~. 0.,S 3v~ o, s o.6
Z~sb v~ 0.5 0-
Z q l u `l 2 3 ~6 SO
1t 1vL' f e S
Ground 3 19-18 -).S`iR Sly S) 1CS\bk wt \j CS ~ o•y o 5
elev.
toy. ft. Z&-8y lo~ttz 3J(, - S 61 o sg m 0.7 o.$
Depth to
limiting
factor ,
I
Remarks:
Boring #
>k:;>:>::<::>:::«:: ~ b- ti ~ b `t ~ 3 t Z S 1 ~ Z'Fsbk w~.`Fh a. S 3 ~ o• S . o- 6
Z 8-Z3 LO `1 R. 31 b - S t I Z`FSb1r~ '~h CS v o S o. 6
3 z3-3o 7.S y2 Sty - S~ 1~sbk ~tU fb. Cg
Ground
elev. 3o-8y 10 `i. L- 316 - S AG1. 59 wt - o• o, g
ft.
Depth to
limiting
factor
Remarks:
Boring #
5 tio`1 ~z 3 l2 - s l L `~S~h w,'~ C S 3 o_ S o• b'
Z
5 Z ~s-~ 0 1 U`'t tZ 3 Ib s i I zi S bk ►n'Fv c S VA
3 ~o-So 1u`ttZ3ll~ - S ~ G►• ~ Sg y,.l l - a-1 u. `b
Ground
elev.
92-5 ft.
Depth to
limiting
factor
7 Sa
Remarks:
Boring #
o_ 8 tiO`~R-3Lz 1 Std b12 Y~`Fh a-S 3v~ o•So-~'
h}:
6 Z s 23 10~~ 3I6 Si 1 Z~bk ~n'f~ ~S lv~ ~.S! o.
3 z3 ~9 ~.S y 11 -3 y s Z c-swl~ VA V`Fh ~S - o y Q..S
Ground
elev. ~ 29_83 tO~•t~.. -t/(. -
lbb-\ ft.
Depth to
limiting
factor Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
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715 ) 425'-0165 M00576
CST Signature Date Signed' Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pap 1 of 3
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 8112 x 11 inches in size. Plan must include, but ST• C- X
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
T-&D t-> '~r~ S C-~{ 69VT-. ~ N F 1/4 S E 1/4,S Z S T 18 N,R Z O E (or)QV
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK If SUED. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER [-]CITY ❑VILLAGE MrOWN NREST ROAD
SOU w 1 S~[o( (~IS)386~ 2A~ R.1~D
New Construction Use [X) Residential / Number of bedrooms 3 AdditiQn to existing building
[ j Replacement [ J Public or commercial describe
Code derived daily flow LISD and Recommended design loading rate o -t bed, gpd/ft2 0- 8 trench, gpd/ft2
Absorption area required 6y bed, ft2 S61 trench, ft2 Maximum design loading rate Q-_1 bed, gpd$ 0-9 trench, gpd/ft2
Recommended infiltration surface elevation(s) It (as referred to site plan benchmark)
Additional design/ site considerations -CTZC1tNS R~torlti'1CvD~~D- S ~o oN >?rCBer 3 oF3
Parent material S t~>✓D~ 1 13U Tl jhsV4 Flood plain elevation, if applicable H- It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK
U = Unsuitable for s stem ER S ❑ U 0S ❑ U WS ❑ U BrS ❑ U ® S ❑ U ❑ S 2'U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Boundary Bed Trends
>~l_: 0-1 ~o~lt~ 3! Z - sit 2`~Sb1~ w.~ 3v ~ o. s o_6
>s Z -z~ ~o ~l R 316 is I 1 Z~ soh mfr cS o-s 0.`6
Ground 3 2.1-Z,~ -)-S LtfZ 31V - S 1 ~Sb>z y„~'~'►^ 05 Q•~ o•S
elev. t o `i R 31 b S D a g m e s - o.~ o. 8
tioe-3 It. 28-03
Depth to S bb-83 loll ft 3A. S d 6ti O s9 - 0 7 a'6
limiting
factor
> $3'.
Remarks:
Boring # 6
o-
Z Z 8-2p ~bK2 316 - sil Z~Sbh m cs >'31 o-s `o. ;
3 zo 19 S `lR y/y ~ s ~ ~ ~ S b12 wt U- cS 10 y o.s
Ground
elev. Z 9-$S ► 0 `t I>- 3!6
loo•bft I -
Depth to
limiting
factor
? 8Sy
Remarks:
CST Name:-Please Print Phone-
Arthur L. We erer 715-425-0165
dress:
e-gerer- S_oil_ Tes-tin.g. Design Se,rvice--P.O... Bo-x_ 74 River Fa11s,WI 54022
Signature: _ Date: CST Number -
M00576
PROPERTYOWNER YC~~Sc-~k\\.D~_ SOIL DESCRIPTION REPORT Page?- of 3
PARCEL I.D. #
Depth Dominant Color Mottles Structure GPD/ft
Boring # [Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
YA `F~r.- 0..S 3 v F D• S a
~!6 S 1 1 Z'FSb1~ wtfti eS 1~~ o.S u 6
Z g-tq IZ It IL
Ground 3 19-zb ~.S`1R 3!y S) 1CS~1~ mv~~. CS o•~{ 0.5 l;
elev. 1p~~ 3f(, - S EL 6h c, S vh
\oo, ft. ~ zE-8y g o.~ o,~
Depth to
limiting
facto
Remarks:
Boring#
t. Z 8-Z3 LO `-t R. 31 S 1 1 Z'Fsb12 wf'1^h cs 1 v a S 0 6
3 z3-3o -)-S yfZ Sty g1 Z~sbk 1~v F~. cS o•\f
Ground
elev. 3D-8y to `•tR 316 - S AG1. O g9 w1 ~ - o• ~ o, g
Depth to
limiting
factor
r,
Remarks:
Boring #
o 5 \,Q A R- 3 t z s 11 Z `FS b1z wt~r c g 3 o_ s o. b
''kl w, g v o. S ! o. G
t< 5 Z ~s-~. 0 1 U`-t R 3 /b s i t 2`~ s bk -f~. c
3 u~-so 1kYtVz-'~Il~ - S G~ o Sg r~ 1 - a.1 u. `b .
Ground
elev.
-S ft. f
Depth to
limiting
factor
Remarks:
Boring #
a•-S 3 v o. S ~ 0.- L
o-
U-S
fi:>......... 3 Z3 Z9 S y R 3 y - s I 1 cSb1t vn v __c S _ o. y o.si{
Ground
elev. Z9 3 l u ~t iL -5/(. - S 4 G~ O s ~ Yin O.7 0•
1bb.\ ft.
Depth to
limiting I~
factor
Vii{
Remarks: I!`,
SBD•8330(R.05/92)
ii
PLOT PLAN Page 3 of 3
SCALE 1"= 30
I e("
t'Z-boo 6
-
t
' B- 2
,i
J I l 2E pt-+~c..N-~►-i ~T
3 I ~
I i
~TL X00 _ - Ta
ON S"l6 tt~ SlUpt < 1°~~ l1U S~s?l~1'1
sigh DI ft, Puz P1P~ C S~ LL~V~Tt~lt~g~
s•S
s
N UTL ;
~vvs~ ~ BF ~fi' LET ZS' Pty `f~..~cFf'~S',
IA-) IEZJ- so"
41
-a
a
tn
f*~p
Z T ctl- a i~MH S'x s-~-' Loxjc 13 `T?rE Hjhj)x1ufi1
s R oM M p Z l-?-&J CWe-j , tft" S ,X, -)S ' LOroc wmcti t S
n~,ti1Mv R~Q' D. t=o1Z q ~D121~10~" IC'~~ wbU~ ?cz~vbp~ q
L►~R.6 ~R, I.U~GtTR L'Pc3`n1U6 S`•1 S'1"~~ .
- 218-t 715 )25=rrJL5 1400576
G
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER D t h e E "Usc
MAILING ADDRESS v i r► P woO~J u e -~r J n o)o h W /j
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning 'D`ept.
CITY/STATE ~J5" LPt_3 5'' Z o /
r z
PROPERTY LOCATION 1 F 1/4, SE 1/4, Section T_gf_N-R A 0 W
TOWN OF TV, D v ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME Qr/~ 8> / , 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 date.
SIGNED:
DATE: I I CI /5
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S 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.
-----------------------------------------1--------------------------
Owner of property .D 10, h e E. Hans c4J' d~
Location of property NE 1/45[-: 1/4, Section 2 7 T d29 N-R Z W
Township Ti/79y Mailing address Ic 3 p; hetyoa~ Lake #
H Aoy) goy o /Z
Address of site 76 Qh w1
Subdivision name Lot no.
Other homes on property? Yes X No
Previous owner of propert(Q ~ Dt W )vMr P11eVkr % )p
ro d i~t~~Vi~sl~+
Total size of property , S- Ru &4v
Total size of parcel 4~ 7h 1 V3 r►,e►.. er ~S 3
Date parcel was created _ rc 2 7
Are all corners and lot lines identifiable? Yes X No
Is this property being developed for (spec house) ? Yes 4 _No
Volume o 8~ and Page Number S-y g as recorded with the Register
of -Deeds---PcxJ s g~ -
_eq-qQ _V- X20 ~p au•.,~., 3}Ks'91
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) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. y5`3 830 , 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.
~S3 830
Signature '-of Applicant Co-Applicant
f~
Date of Signature Date of Signature
453830,
M¢sw" In U.S. Patent end Ynxi meA otNcs
QUIT CLAIM DEED. Short Forme Statutory Form No. 27-S ARelvieted 2J891 .ee.,senpueasn+naoo etncr.n.a,etuess~ot
QUIT-CLAIM DEED*
Gacy L._ Hauschildt (unmaccied) a►• of Fairfield County, Ohio
for valuable consideration paid, gronts(s) to Diane E. Hauschildt
(unma cc i era) whose tax-mailing address . s
1600 Pinewood La., Hudson, Wisconsin
the following REAL PROPERTY: Situated in the County of St. Ccoix in the State
Wisconsin
of Ow and in the Town of Tcoy .(2) desccibed as
follows:
NE 2 of SE ; of Section 25-28-20
Except W /D rods of S16 Rods theceof rRANSFa
REGISTER'S OFFICE F X~~T
ST. CROIX CO., WI
Recd for Record
NOV 3 01989
at 9:00 A.M
* aey~>d~r of o
Prior Instrument Reference: Vol. Page of the Deed Records of St. C co i x
County, QbFGC wissonsin (*)4AU)()5"76UXXofX "
]f5tesXXh~kFGSC~C~67fXdEXrXiKX Witness his handM this day
of July , 1989.
Signediand acknowledged in the presence of:
wITNW GARY L.HAUSCHILDT
WITNESS
State of Ohio Ccunty of Franklin SS.
BE IT REMEMBERED, That on this day of July 1989 before me,
the subscriber, a Notary Public in and for said county, personally came,
Gary L. Hauschildt the Grantor(s) in the
foregoing Deed, and acknowledged the signing thereof to be his voluntary act and deed.
IN TESTIMONY THEREOF-1-have hereunto sgbsc•_beK my name and affixeAm seof•,5,n. 1 day
and year aforesaid.
Notary Public, Attocney, my'commission si, o ,xpli, ion
This instrument was prepared by ESrian r._ H-r7 flt-rqt-r, A"trotney 2f `S
1577 South High Street
1. Name of Grantor(s) and marital stags. Columbus, Ohio 43207, (614) 444-9911
2. Description of land or interest therein, and encumbrances, rlservcr6o-%, ecceptions, taxes and atsessmoms, if any.
3. Delete whichever does not apply.
4. Execution in accordance with Chapter 5301 of the Revised Code of Ofsin
Auditor's and feccocko's Stamps
• See Section 5302.11 Ohio Revised Code
DOCUMENT NO WAILAAN'rr DEr4D
SrATE OR WilSCONSIN-FORM 10
346841 I VOL 1 57r! J TIII! R[SERV[O FOR RECORDING DATA
THIS INDENTURE, Made by.Il1CHFJ. -BANK.-TW1'TP IY...---•-• REGIST04 OFFK*
Puy, nt Plan ST. CROD( "11 14,
aS..Z'raSte_fC17G_toe. Gaxrit.MA__Ys
a Corporati ~nized and existing under and by vi--tee of the laws of Rec'd. for Rewrd ft 27th
the State of grantor, of..--_.E 9rMWia__._ _ • ay of Feb. /.l. 19 78
County, HinnesotBereby conveys and warrants to...jG&FU.3..__B_Al1SQ'=-. t 8.30 A. , M.
t-------••--.....
1~ 1
tierll.itS._..-•---.....____._..__.._.._-_..... grantees.....,
of..._.._.._.._.Sett..SXS?]N.._.._.._........_..~__-_..---- County. Wisconsin, for the of owwo
sum of ...Tbi xttY-.eagbt_.Ulo.usand_.=A_M/lao .1S.3~. Q02..----•------•
- -
15 _ _
RlrrURN TO
j the. following tract of land ill..._...-.-.S.ta_.CMiX-..___ County, John D.
I Heywood
State of Wisconsin: 205 locust, Hudson, WI 54016
I
NE% of SM of Section 25, Township 28 North, Range 20 West, EXCEPT a one acre
parcel ccmnencing at the SW corner of the NEN of SEh, Section 25, Township 28
North, Range 20 West; thence East on the center of the town road a distance of
10 rods; thence North parallel to the quarter section line a distance of 16
! rods; thence West a distance of 10 rods to the quarter section line; thence
South along the quarter section line a distance of 16 rods to the point of
beginning. Consisting of 39 acres, mare or less.
ZRMSM
53ff.
FEE
(I! N=MBSARY, OONTtN'rN I)BMCRIPTION ON. RAVICRS1 SID!)
In Witness Whereof, tl d tYor has caused these presents to be signed by_ Ls_-~a_.FIr._.Y_e.i fir 45
Trust Admiriistrati~ Tutewohl Tr
and countersigned by R.. ._.....iqei
at_--R1chf,ie1d,-Hi=esata_--- and its corporate stA to be hereunto affixed this
........day A. D., 19...7-8..
SIGNED ANY) SUALED IN PRESENCE OF RIC11FTYr BALK TRUST-_OCl[!)F?ANY,_. d_-Minnesota
Corporation, as Trustee TtLeyZrate
Garr M.-- a Retirement Plan
- trt~Lfit on of
r
COUNTERSIGNED: ' `
R. Tutewohl
Tru I,
STATE OF MINNESOTA
`
HENNEP - . IN County-
Personally came before me, this ...._17 _ day of........ ehrV4;y A. D., 19..7$.,
L. (.Z.1_.1 t si a R. J.•.Tutewohl_,--Trus ..AcC.t....~ f.t 9E l dtjt
of the above named Corp, Ipn to me knorrn to be the persons who executed the fore oing instrument, and to me
known to be such BalilllUzampipcof said Corporion, and ac owledged tl}lhey executed the foregoing
instrument as such officers as the deed of said Corrtorat_on, by its ority. ' /
7
-
T-ni A. Amundson
THIS INSTRUMENT WAS DRAFTED RIt..........~
• LC'S 0. A.KLPI nSON !
Hugh H. Gwru►, Attorney rFti " APu ►is ..........NenA-3?i]n.._.._....__.County,
Gwin, Gilbert & Gwin c- ji M
- My-a--t'*~Mt`l4QUAT75 n (expires) (is)-------7--2Q.-SQ-........-
HUDSCU, WISC "IW-5401
(Section 59.51 (1) of the Wisconsin Statutes prr.•des that a'1 a-cruments to be recorded shelf have pfamty printed or typewritten ttereon
the names of the grantors, grantor, witnesses and notary. 4s^-um '9,113 similarly requires that the name of the ppeerson who, or gusem-
mental agency which, drafted such instrument, shall ce --aed_ npe+-r,ven. stamped or wr.tten rtereon in a legib!e manner.)
WARRANTY DFED-11- Coryoratlw■ STATE OF WISCONSIN wtsconetn Legal Blank ComDaoy
F!'EY No. 10 Milwaukee, 'Via. t Job 1!092 )
A r
FILE D d 4
D
NOV 3 0 1995 ►
9 KATHLEEN H. WALSJAN - 3 1996
Register of Deeds
SL Croix Co., WI $T CROIX 1~jy
1"" ~ ~itEy
536934 CA
CERTIFIED SURVEY MAP
LOCATED IN THE NE 1/4 0= THE SE 1/4 OF SECTION 25, T28N, R20W, TOWN OF TROY, ST.CROIX CO., WI.
PREPARED FOR TODD HAUSCHILDT.
NOTE: BEARINGS ARE REFERENCED TO THE E-W QUARTER I C. S. M. VOL. 9
SECTION LINE. (RECORD BEARING). PA,QE.,2404
E 1i4 CORNER OF SEC.
3133L 25. (COUNTY MONUMENT
II FOUND).
W 114 CO C. S. M. VOL. 7 PAGE 1992
(COUNTY MO MENT FOUND). " _
7
S89°59' 39"E 3952.5 R=N87°27' 06"w 4ANR
S 88°59' 39"E 1324.76'
M DR I,VE•
N POWER LINE EASEh1ENT ~C• -0 I U4.,U'
M :
HIGHWAY SETBACK LINE
Lu : <o
zo DoT 2
r CO
30.54 ACRES
(1,330,351 SO. FT.) 3
J ; 29.88 AC. EXC. R. 0. W. 00
( 1, 301, 602 SO. FT.
)
co v
e
~ o 0
Vi:
4,
N S 89°59' 35"E 295. 33'
~o
280.00,
VE EXISTING SHED S 89°56' 26"W o
7
R• S88°03' 22"W a
LOT 3 NOV 3 0;'95
N 4. 15 ACRES I
(1)( 180,969 SO. FT.
'6 4.01 AC. EXCL. ,
3
co: v R. 0. W.
w: (174,81 1 SO. FT.) n and to g
o d I
Parks Committee) M M
CL: k
00 (D
Ih' N If - rr,-corded ? 3 O
cli
M ' °p C. S. M. VOL . 7
N Nvit; r.a 30 days of - w
0: o k; rO+ral date '
165.00' O
:N 88052'36"W w shall be
_
d
fV41 k.
p cr> o
Lu: M !n
h-: to:Cp PROPOSED DRIVE LOCATION ' z
Z
• HIGHWAY SETS,+CK LINE
130. 79'~ tl S 88°52 35"E 74~. 23' g 872. 02' f
M
GLENQ
fl T.
- - N 89°58' 05"W 871. 84' ro
o .ROAD
SE COT. SEC. 25.
(COUNTY MONUMENT
• 1" IRON PIPE FOUND. FOUND)
O SET I" X 24" IRON PIPE WEIGHING
1. 13 L BS PER LINEAR FOOT.
r
200 0 200 400 600
b`6.
GRAPHIC SCALE - FEET
95-86 THIS INSTRUMENT DRAFTED BY JIM WEBER SHEET I OF 2 JAMES~1 SWE4 R80.~ "
DATEDN R+ASVEYING
„ , VOL. 11 PAGE 3021 a