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Parcel 182-1016-10-050 04125/2005 10:42 AM
PAGE 1 OF 1
Alt. Parcel M 311801-21-01-01-00-000 182 - VILLAGE OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* SKIFSTAD, LINDA S & DENNIS J
DA S & DENNIS J SKIFSTAD
702 COUNTY LINE AVE
STAR PRAIRIE WI 54026
* = Primary
tricts: C =School SP =Special Property Address(es): Primary
T
Type Dist Description * 520 5TH S a~
SC 3962 NEW RICHMOND -
SP 1700 WITC
Legal Descripti Acres: 36.330 PI N/A-NOT AVAILABLE
SEC 1 T31N R1 W PT E1/2 NW1/4 D C AS BI ck/Condo Bldg:
BEG N1/4 COR 1• TH S 0
563.09' POB; TH S 00 D 1465.28'; TH ract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
N 89 DEG W 561.28° TH N 00 DEG W 01-31N-18W NE NW
1025.59'; TH N 88 DEG W 735.35'; TH N 00
DEG E 1043.51'; TH S 86 DEG E 991.60;
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1156/114 QC
07/23/1997 983/635 WD
07/23/1997 692/412
2004 SUMMARY Bill Fair Market Value: Assessed with:
53792 Use Value Assessment
Valuations: Last Changed: 09/08/2003
Description Class Acres Land L223,700 ove Total State Reason
RESIDENTIAL G1 3.000 18,000 241,700 NO
AGRICULTURAL G4 15.330 2,900 0 2,900 NO
UNDEVELOPED G5 10.000 20,000 20,000 NO
PRODUCTIVE FORST LANC G6 8.000 20,000 0 20,000 NO
Totals for 2004:
General Property 36.330 60,900 223,700 284,600
Woodland 0.000 0 0
Totals for 2003:
General Property 36.330 60,900 223,700 284,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 554
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 182-1016-80-000 10/16/2007 04:04 PM
PAGE 1 OF 1
Alt. Parcel 311801-12-05-00-00-000 182 - VILLAGE OF STAR PRAIRIE
Current 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
O - NELSON, MATTHEW A & ELIZABETH A
MATTHEW A & ELIZABETH A NELSON
520 5TH ST
STAR PRAIRIE WI 54026
=
Districts: SC -School SP -Special Property Address(es): Primary
Type Dist # Description ' 520 5TH ST
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 9.800 Plat: N/A-NOT AVAILABLE
SEC 1 IN NW NE PARCEL AS DESC IN VOL Block/Condo Bldg:
578/19 BEING S 365.27' LYING W OF RIVER
VIL STAR PRAIRIE FKA PARCEL 164D Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
01-31N-18W
Parcel Histo :
Notes: ryDate Doc # Vol/Page Type
03/04/1998 574283 1302/239 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/08/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.800 115,000 118,100 233,100 NO
Totals for 2007:
General Property 9.800 115,000 118,100 233,100
Woodland 0.000 0 0
Totals for 2006:
General Property 9.800 115,000 118,100 233,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 127
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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.:
GENERIIAL INFORMATION
Town of: State PI
PeSKIFSgI'AD, eDENNIS & LINDA E] City E] Village R
~
1
CST BM /Elev.: Insp. BM) Elev.:1 BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic c Benchmark 3 , 1'~ Old,
Dosing
Aeration Bldg. Sewer /a
r
Holding St/ Ht Inlet S
TANK SETBACK INFORMATION St/ Ht Outlet
Verit
TANK TO P / L WELL BLDG. Ai,l to ,take ROAD Dt Inlet
Ai, l
Septic NA Dt Bottom
Dosing` Header 4S,/Or
Aeration Dist. Pipe 03
Holdi~rg~ Bot. System ~j
PUMP/ SIPHON INFORMATION Final Grade S, 97 hr
~2,
Ma ufacturer De and
Model Number GPM
TDH Friction System TDH Ft
oss H
Forcemain Length Dia. Dist. To wen
SOIL ABSORPTION SYSTEM -
BED/TRENCH Width _ Length i No. O Trenches PIT No. Pits Inside Depth
DIMENSIONS d 5--K,51 DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHI Manufacturer:
SETBACK CHAMBER
INFORMATION Type 0 Model Num~
System:!',,ol-. z >o25r. 7 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 Syste y
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx u
Bed/T nter Bed/Tre~Edges 3S Topsoil El Yes EE] No [E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRAIRIE-01,31.18W, NW, NE, 5TH STREET -
.
y+ ,
-
C c~ f a
Plan revision required? ❑ Yes [~'NO
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
SANITARY PERMIT APPLICATION
COUNTY
r~'~~nlr,t In accord with ILHR 83.05, Wis. Adm. Code St. Croix
STATE SANITARY P RMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than a 3_
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
Dennis & Linda Skifstad NW % NE S 1 T 31, N, R 18 E (or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
520 5th St. 71
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
star Prairie W 54026 1(715 )248-37511 Desc. Vol 578/Pg. 19
0 CITY VILLAGE: NEAREST ROAD
11. TYPE OF BUILDING: (Check one) F1 State Owned
• Star Prair e 5th St.
J;LTOWN
❑ Public 01 or 2 Fam. Dwelling-#of bedrooms 3 PARCEL TAX NUMB R(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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: (Ch only one in tin . Check line B if applicable)
A) 1. ❑ New 2 ® Replacement ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit wa vio
450 usl ' sued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ® Seepage Bed 21 El Mound 30 El Specify Type 41 F-1 Holding Tank
12 ❑ Seepage Trench 22 El In-Ground 42 El Pit Privy
13 ❑ Seepage Pit Pressure 43 El Vault Privy
14 El 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.) PROPQSF$D (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 643 b6 44 .7 93.74 Feet Feet
VII. TANK CAPACITY Site
in allons Total of Prefab. Fiber-, Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank X 1 OUT 1 Huf f cutt Conc. F - F] F1
Lift Pump Tank/Si hon Chamber El I F-1 F] F1 I El
Vlll. 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:
dje~~ /
Byron R. Bird 1309 715 268-8317
Plumber's Address (Street, City, State, Zip Code):
1359A 100 St. Amery, WI 54001
IX. COUNTY/DEPARTMENT USE ONLY
0 1 ❑ Disapproved Sar;o.~;tary Pe rt Fee Includes Groundwater ate Issued issuing Agent Sign
Approved El owner Given Initial y L ( harge Fee) 6 9f
Adverse Determination yy~~ ` 7
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s 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 the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
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 s stems must be ro erl maintained. The septic tanks must be PumPe
Y P P Y d 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 & Buildings Division' 608-266-3815.
I
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.
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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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.
Vill. 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% 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 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) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
II
i
I
l SBD-6398 (R.11/88)
June 21, 1995
DENNIS & LINDA SKIFSTAD
520 5th St. NW4, NE4, S 1, T 31 N, R 18 W
Star Prairie, WI 54026 Village of Star Prairie
Nyt St. Croix County WI
Ito 3 Bedroom Replacement System
b
v
y
tz-
I
1 t tj
P r'
Wisconsin Department of Industry, SOIL AND SITE ON REPORT Page of
Labor &ro't Human Relations
Division of Safety & Buildings in accord wi Code
' COUNTY
Ce%
S7- Croi'
Attach complete site plan on paper not less than 8 1/2 x 1 - es irL§ e. st in but
not limited to vertical and horizontal reference point (BM) ction ar> of scat PARCEL I.D. # ,4 -18o /016 -80
dimensioned, north arrow, and location and distance to Qst roa~& 3
I QCf/-/e2 -'05rYYte
APPLICANT INFORMATION-PLEASE PRINT ALIT, REVIEWED BY DATE /jy
PROPERTY OWNER: e ~ PER . 1!4 ~ NJC 1/4,S / T3/ , N,R 18 E( ) W
hr~/'S i n S. S' I s a GO
PROPERTY OWNER':S MAILING ADDRESS ~jj LOCK # SUBD. NAME OR CSM #
0 e- C. 578 P l 9
CITY, S A E JIPCODE PHONE NUMBER ❑CITY [VILLAGE ❑fOWN NEA ES OAD
I Ja r r~r Z 6 r~~~a -?ai It
376.5 r e
[ ] New Construction Use [~C] Residential ! Number of bedrooms [ ] Addition to existing building -
Replacement [ ] Public or commercial describe
Code derived daily flow 450gpd Recommended design loading rate . -bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, ft2 S _1:4ench, ft2 Maximum design loading rate _ 7 bed, gpd/1`11:2~trench, gpd/ft2
Recommended infiltration surface elevation(s) 93.71 , ft (as referred to site plan benchmark)
Additional design / site con iderations SSA :o *,,vrfed
Parent material ~aGu Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system 9 S ❑ U fR S ❑ U S❑ U S❑ U ❑ S ~RU 08 SdU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
/nshk 4r C5 3(-p . S . C,
a V-27 ION P--L-►13 m 5bk m Ud r '~F-~o S ,
Ground 7-18' 7. y (o -v-- rr .5 6 s rr~ , g
elev.
1~,ID ft.
Depth to
limiting
fro
Remarks:
Boring #
Ly- Z rrsbk m o 3f= w 7 8
~
Ground; LO U rn .7
elev.
Depth to
limiting
fac ,
Remarks:
CST Name:-Please Print Phone:
Y
Address: J R-Cj
a D v~ood e S/~-~ g'7~
Signature: Date: 9~ CST Number:,3,, I
PROPERTY OWNER (~.~nn;5t ~Tr~G 5~~ro SOIL DESCRIPTION REPORT Page' ;f3.
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
y- lob l3 s 1
Ground 3 3a-7c, 7,5 ~+I G ed s
elev
(LA) ft.
Depth to
limiting
facto
-7'7L, Remarks: 0. U pf! 0
Boring #
1 o=s t o (Z ~I~ S I 2f1s ' K fh Ar C 5 3-Fco • S
t X -7 -S `19-`l 1 msbK v-Fr
Ground rr ed.5 b 5 n , -7g
elev.
~j 110 ft.
Depth to
limiting
facto;
p Remarks:
Boring #
1 o
Ground c 5125
elev.
7,4 Oft. '~7~ 0`f X13 S
13
Depth to
limiting
f
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05192)
-71
UI LP Z--
0
410
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6IM
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0
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Cy A
MAILING ADDRESS C~ .
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE L'\ ` 0-A
PROPERTY LOCATION 1/4, 1/4, Section S TW
TOWN OF S~aY Pr~,,~~ r ; , ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME PAGE \ L , 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: jL1
DATE: 1~ 11~~~~IT
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
•
rr,' .r. • 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.
Owner of property ~ ~a V-" C~- C. C~ `~;"~C' A
,T N-R _W
Locution of property i 1/4_1/4, Section
v , \W1 I
Mailingaddress
Address of site
Subdivision name Lot no.
Other homes on property? Yes ~,No
Previous owner of property
Total size of property C~,
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 __k-_No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
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. Rr Q"a q 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.
4 .J V
Sign ture of App cant Co-Applicant
J i_r/1f, f l9_5
Date of Signa ure Date of Signature
DOCUMENT NO r _
~~t 578 r A r f 19 STATE BA WAR ANTY SCONDEED FORM 1
o 'FBI THIS SPACE RESERVED FOR RECORDING DATA
This Deed, made between Henry _ S,-_Larson_ and- nie__- REIGISTERS OFFICE
ST. CROIX CO., WIS.
huband_and__w.fe----------------------------------------------------
- Recd. for Record this
Grantor day of ru7y A.D. 19 78
and -..D ennis-J,~__Skifstadand_Linda_S.Skifstad,husband--
nd - wife. as_ _ j o nt_ _ tenan s t------a: J~ M.
-
-
- -----------------•---------------------------------------------------------------Grantee
Rsyistsf of Dos
Witnesseth, That the said Grantor, for a valuable consideration_Qf_
one--dollar_.a d_other--good--and__valuabl.e__co_m ideratiQns__-_.
conveys to Grantee the following described real estate in -St--.Croix RETURN TO
County, State of Wisconsin: Maki 8 Ludvigson
A parcel of land located in the Northwest Quarter Osceola, WI 54020
of the Northeast Quarter (%14 of -14) of Sectio ni 1,
T31N, R18W, being further described as follows: Tax Key No.
Commencing at the North'Quarter Corner of said Section; thence South 0008122"
Eastalong the North-South Quarter Section line 1149.22 feet to the point of begin-
ning; thence South 88034132" East 1034.28 feet to the beginning of a meanderline
along the Apple River; thence South 32008134" East along said meander line 158.45
feet; thence South 41023126" East along said meander line 288.87 feet to the East
line of the Northwest Quarter of the Northeast Quarter (NW-4 of NEQ), said point
being also the end of the meander line; thence South 0011152" East along said forty
line 21.22 feet to the Southeast corner of said forty;thence North 88034'32" West
along the South line of the said forty 1308.96 feet to the Southwest corner of said
forty; thence North 0008122" West along said North-South Quarter Section line 365.27
feet to the point of beginning.
Said parcel includes all land lying between the meander line, the easterly ex-
tension of the North line, the East line of the Northwest Quarter of the Northeast
Quarter (NW14 of NE-14) and the water's edge of the Apple River, containing 0.3 acres
more or less.
FEH
EXEMPT
This is not
(is ) (is homestead property.
not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And----- Henry _.S,--- Larson__and._Minnie__ Larson-,._grantor,-----------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements and restrictions of record
and will warrant and defend the same.
Dated this _ + , ~
-2
day of ._._~~+[l.../__1
19.78.--•
(SEAL) /t~~ _._..------(SEAL)
He Larson
-----•-----------------------(SEAL) - - - - -----(SEAL)
* * Minnie I. Larson
-
AUTHENTICATION t1L ACKNOWLEDGMENT
- -
Si atures authenticated this IR Ac?-_- day of STATI, OP W1800N1512-T
ill+ - ]9---78- ss.
* ------------------y --------------County.
y of
da
- - + Personally came before me this
- the above named
ALIaTl-O.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY to me known to be the person who executed the
foregoing instrument and acknowledge the same.
Maki-_- Ludvigson,-_ Attorneys at _Law
Osceola, Wisconsin 54020
(Signa.tures may be authenticated or acknowledged. Both Notary Public __________________________________________County, Wis.
are not necessary.) My Commission is permanent. (If not, state expiration
date- 19------
-Names bf persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE, BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No.1-1977 Milwaukee, Wis. (Job88228)
°NER; g? i S k"-F5 ra , TOWNSHIP SEC. T- N, R W
0. ADDRE6S3'roj r (bra.`r ~`-e ST. CROIX COUNTY, WISCONSIN. --,F-j~--
'dDIVISION LOT LOT SIZE
PLAN VIEW S Tel I- Nra
-Distances b dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
wood 5
3.~„
o
"),40a S,
pt `TIC TA.N,'K(S) I, DDO 9 MFGR. Jo S e Ca T CONCRETE STEEL ,2c
NO. of rings on cover Depth %O/r DRY WELL y2.
'NCHES NO. of width length area.
no. of lines width l g,' length Y " area ci 3 5L f ' 3
depth to top of pipe
3UMGATE 8 "
RATE Q AREA REQUIRED (2 AREA' AS BUILT Y 3,A p
:claimer: The inspection of this system by St. Croix County does not imply complete
=pliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
tem operation. However, if failure is noted the County will make every effort to
-,ermine cause of failure.
:ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM.
~'INSPECTO
DATED PLUMBER JOB GU
LICENSE NUMBER`` 8'S
z -
REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM
San.itany Penm.it2
State Septic
NAME owndh.ip St. C,%o ix County
Laca.iary' Secian~TN,R~GI
SEPTIC TANK
Size gattonz. Number of Compantmen.tz
D.iztanee Fnam: Wet b~. 12% an greaten ztope it
Bu.itd.ing it. We.ttandz ~ .
H.ighwaten it.
DISPOSAL SYSTEM
Diztanee Fnom: Wet it. .12% an greaten ~stope it.
Bu.itding it. Wettands Ft.
H.ighwaten it.
FIELD DIMENSIONS:
WiRh ab trench 9-6t. Depth o6 rock betow tite l~f2,in.
Length o6 each tine it. Depth a6 rock oven tite :2- .in.
Number.- as tinez Depth o6 tite below grade-li in.
Totat .length o6 tinez it. Stope ob tneneh cn pen 100 it.
D.izLance between tine,5-j6--,x. Depth to bedrock it.
otat absonbtion area 2g Depth to gtoundwatex
v 2
~Requ.i&ed area it
PIT D MENSIONS:
Numbe)c ab p.itz navet around pitz yes no
Outside d.iameten Depth below .intet it.
2
Toxat ab.s onbtion a a it z
A
Area tequi)Led t rn
2
INSPECTED B ITLE
APP ED DATE 1 2 t7 191
REJECTED DATE 197
A~V
~1 MADISON, U4'i`;t;;~h tiSl ! c ~37r,3 3 c
ril• ON 2~.,•tt. F3GFS ANF; A"i i` :f, 7 E' ":'..TS.
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BER ! S TTc D~
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SOIL HORI NG TESTS
EST' TC)j al UEr'TH Uc ~ H TC ~ R ?UN'~MA t F R, INCHES I CHAq r; i HIC,KN' 3, INC'J
w lJut1 >rF INC HF _ / T I MATED H;rH --T D t_ t t; ( Dtt t E if ~)R 6F Y))
ti,3S'-F41 FI)
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PLAN VI =W (Locate percclat~ontests,soii bore hole,, anti suirahle soil areas,)
Indicate or; the plan tl:e location and square Poet of suitahle areas inc'i .ate nurnhei of squ Ire feet of ahsorption area tr
r+eeded for building type and occupancy. indicate scale
or distances, Give horizonta! and vertical ref';.-e ce points. It di at= sI
,
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)
I
r
_ j
v
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n ,
Fn k
1 the undt si4riect, her'!!,Iy re 11V .pia) le o>, )tst', ed on a t.
' a n:6 ittr.`1rr(i. S[:~L'G'Ied i')'! 4. bj,Sr.C_ t!)~ I d~.' - _ }r. r7
to th~w Giest if krioviikd! < and be! r
State and County State Permit #
PLB67 Permit Application County Permi
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
pehh"s SK,'fsTc, STyrt, Pr~10r14 e
B. LOCATION: k t , N 4. Y4, Section , T,?j N, R j (or) W Lot# -City_
Subdivision Name, nearest road, lake or landmark Blk# Village
lam/) Township J'7b r Pig; 1'P
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family x Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher ( YES NO Food Waste Grinder YES )(NO # of Bathrooms
Automatic Washer _ y YES NO Other (specify)
E. SEPTIC TANK CAPACITY Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement _ Prefab Concrete x
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area 4-1 /D sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length j Width 17' Depth #a;"' Tile Depth '30"' No. of Lines -:3
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land 0- Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil ~T ster,/
NAME &A e ✓ a7@ h d k r f4c K s-o c7 C.S.T. and other information
obtained from Hoa (e*A=/builder).
Plumber's Signature Go, 4-36-1-P MP/MPRSW# 5-17 Phone 407 V -3 7 y3
Plumber's Address Qe it 3 7 O~ c e o 4 44 -111, 04-S/ 6 R o
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
T
41 o~ aIV`--F ,Q T
14
l
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a k S
Pf_on, _wCtI ( S, Tc 1.~.~e// Ne? _ y eT'
i r ?a b e o v e r S6' J IVs 7 c 4 e j
Do Not Write in Sp Be ow F R DEPARTMENT SE -I eg e) -~0
0-
Date of Application'" - Fees Pa' : State County Date
Permit Issuedk!Rsow=d (date) - Issuing Agent Nam
Inspection Yes No Valid# Date Recd
1. county (w recopy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
Revised Date 6/1 /76