HomeMy WebLinkAbout161-2006-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 556324 0
Personal information you provide may be used for secondary purposes [Privacy Law, S. 15.04 (1)(m)].
Permit Holder's Name: 7City X Village Township
Parcel Tax No:
Andrews, John & Marcie Village of North Hudson 161-2006-50-000
CST BM Elev: Insp. BM Elev: BM Description:
~ ~ ~D ~ Section/Town/Range/Map No:
13.29.20.844
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Z ~ Benchmark
D ng /"75- D/. .Z /00. d
Alt. BM /p
Aeration 17- 2 r '?,0,' 33
Bldg. Sewer :
Holding
St/Ht Inlet
Ox G~
TANK SETBACK I MATION UHt Outl 5CH vU
12,
TANK TO J/I EWELL BLDG. Vent Air Intake ROAD Dt
Septic j 2 o q~ /3 om 6, 3; r (VA -4 LZ
n
Do ' t z I / eader/ an. 2
Aeration Dist.
Holding v t- U • 2 y
Bot. Sys em
PUMP/SIPHON INFORMATION Fin I rade
a~ no v44-, c~QQ i 3. l a i S
Manufacturer / Demand St Cover
GPM 3 r(il\S-2 r'S~ 2 ~Z
Model Number
T5 -H Lift Friction ss stem Head TDH Ft Q
Forcemain Length Dia. Dis . to Well
(v ` a dP~
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I s/
DIMENSIONS Length No. Of Trenc es PIT DIMENSIONS No. Of Pi s Inside Dia. Liquid Depth
SETBACK SYSTE✓M TO P/LS- BLDG WE LAKE/STREAM AC IN
Manufa er:
INFORMATION I ✓
T Pe Of System: ~'l~~ CHAMBER R `
~f/ Model Number:
DISTRIBUTION SYSTEMS tuk 6-%.'3
Header/Manif r Distribution
Pipe(s) ~ 2 r L ~ x Hole Size x Hole Spaciae- a it Intake
LDia Length 1 Dia Spacing 2 X
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only l ~~1
Depth Over - I Depth Over xx Depth of ~neA-(
Bed/Trench Center Bed/Trench Edges Topsoil Seeded/Sodded xx M hed
Yes [E No ❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:
Inspection
Location: 229 Sommers Landing Rd N Hudson, WI 54016 (NW 1/4 NW 1/4 13 T29N R20W) Sommers Landing Lot 9 Parcel No: 13.29.20.844
1.) Alt BM Description
2.) Bldg sewer IengtJb_= 0 f
- amount of cover = t 4v
Plan revision Required? ❑ Yes No Use other side for additional information. L~
Date ~
SBD-6710 (R.3/97) Insepctor's Signature Cert. No.
County
Safety and Buildings Division St. Croix
$ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
p Madison, WI 53707-7162
55Z32
s tv ~POMfit A licati bn State Transaction Number
In accordance with SPS 38-T iCode, submission of this form to the appropria q tal unit Na
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS itted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1 m), Slats.
1. A lication Information ase Print All Information Same M /►1 e
Property Owner's Name / parcel # La
John & Marcie Andrews 161-2006-50-000
Property Owner's Mailing Address Property Location /
229 Sommer's Landing Road North Govt. Lot C/ !t
City, State Zip Code Phone Number NW NW Section 13
(circle one)
Hudson, WI 54016 (715) 381-6935 T 29 N; R 20 E or W
II. Type of Building (check all that apply) Lot #
❑ 1 or 2 Family Dwelling - Number of Bedrooms 1 4 A ` Subdivision Name
Plat of Sommer's Landing
lock #
❑ Public/Commercial - Describe Use l 4 ne"-A Na
❑ City of
❑ State Owned - Describe Use CSM Number 11 Village of North Hudson
C.) Na 11 Town of
t
III. Type of Permit: (Check onl one box on line A. C mplete line B if applicable)
A. I V--
El New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date d
Before Expiration Owner Z7Iss C
IV ,Jype of POWTS S stem/Com onent/Device: Check all that apply)
_
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Informatio : 42 In lltrator "Q4 Plus" standard chambers & 6 endcaps, Wieser Concrete filter canister w/
Pol Lok PL-525 effluent filter
Design Flow (gpd) Design Soil Application Rate(gp f) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
600 Gpd 0.70 Gpd/Sq. Ft. 857.15 sq. ft. 870.60 Sq. Ft. ✓ 93.50'
Vl. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o
New
New Tanks Existing Tanks / w b U F'i
nn rn wc7 a
Septic or Holding Tank Filter canister 1,250 ST 1,250 1 & 1 Wieser Concrete X
Dosing Chamber
VII. Responsibility Statement- I, the un ersigned, ass a responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) ;Plumber' Signature MP/MPRS Number Business Phone Number
James K. Thompson < 6144r~-)a ,
MPRS 30021 (715) 248-7767
Plumber's Address (Street, City, State, Zip Code
340 Paulson Lake Lane, Osceola, WI 54020
VIII. Coun epartment Use Only
Approved ❑ isap T~Y97.5 Date ssued Issuing t Signatur
yaa g 29 ~z
❑ iven Reason for Denial
IX. CondiReasons for Disapproval
1: 'Septic tank, effWent fifter and
dispersal cell must all be services I maintalk
as per management plan provided by plumber,
2. AN aeOwk requirements must.be.mainWndd
as per q*llio ble code 1 ordiii
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 11/11)
• 50i! eda(ua£'a~~,o,~
• 40Cal&e-d A)AV 5e
/
596--1e;
wu-d sol, CO/. 5-00A.
,P. zd w.
~Xi 5 ~i v>q uJ
~.,ll V
oPA-r\
lawn
As p~,~,C~ /50
deck d• 8 rr(
c.l rvtarK~ ~
r ~Ibedr mom ;d: 9 Tod a,~/OZr
SSartee1¢lav~=1 1 Se-,,~Z
A,o~~x• /dca of `
/5v P.X,sj~ n~q d40 isa St /,1 /via sccsl t77rsc}c~Y~~ JF
Sc~Fact elegy'=93.x- ,
f---' Prapc7ed ~ ~ 83
t d rr~rs,-~m + ~
t ° ✓a.ldt. ~ ~ ,
Somers v - k y ao. o
file jrkbor-1„q~es:denceadell P~oposedcGsp~s~1 e~/ra .z/xE
UU w/ 5•~/~c t~r~' ~¢5/" Sidc~~
v¢~a~
u/{2eC
Fns'/~a~idF 5
'ee Sr c~f+7Gc
Conventional POWTS Index & Tilte Sheet
Project Name: Andrews 4 bedroom Replacement Conventional POWTS
Owners Name: John & Marcie Andrews
Owner's adress: 229 Sommers Landing Road North, Hudson, WI 54016
Site address: Same
Project Location:
Subdivision: Lot 8, Plat of Sommers Landing
Legal Description: NW114NW1/4, Sec. 13, T.29N., R. 20W., Village of North Hudson, St. Croix Co., Wl.
Parcel ID 161-2006-50-000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calcualtions
Page 4 System Cross Section
Page 5 System Management Plan
Page 6 Filter Specifications
Page 7 Filter Tank Cross Section
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Certification for Utilization of existing septic tank
Page 1 I Waranty Deed
Attachments: Soil Evaluaiton Report
Mater P ber Res 'cted Service: James K. Thompson, Dept. of Comm. Credential #30021
01
Date: 2 T
Signature: COO
Page 1 Of 11
Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01)
♦ EXis'~'~y e.l~,✓a.~ are
• Laea.t ted/ ~?roja
4=
~
.So~►.~ 4 ~Yj~.rc.,e. ~~~5
a-9 Sommer34'"c(i)2g
A dsvrl, c,J/. 5-feo/4 (v
~ot 8 o~L'SornrrrP.rs
.find:~q~ 5e 72 f1t
,P. zo w.
ov
sI Sp
~ ~So
dn'✓e~ E~~^~f
davc ~rvtarK~; 9 T~ o~/c~
ssanccl ¢lev~el ~ ~`'~e•
~1So'I_ p ` • 5
APjc~dX•%caov/ of
!SO ?.XiS~in dr;~~acis~ ~i3l~i~►9 7"" ~~e~bdsso/~.t7itsc.}'~`/6~
t d rru•s,~m t ~
iO j/0,/✓4C.
or'f~ ~I2~fjkbor!',-+q~e5:da.~Ce~e~( Proposerlc~G'sp.~-s~C'e//arCZ/.~6
~Q~~'~6or;~y
~c Sr ~c+icc
Andrews 4 Bedroom Dispersal Cell Sizing Calculations
1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft.
3. Absorption area required: 857.15 N. ft.
4. Absorption area as proposed: 870.60 sq. ft. (42 chambers + 6 end caps)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.10 sq.ft, EISA
857.15 sq. ft. - (6 endcaps)(5.10) = 826.55 sq. ft.
826.55 sq. ft./20.00 = 41.33 chambers required
Number of trenches: 3 @ 14 chambers per trench (42chambers total)
Trench width: 2.83'
Trench length: 58.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 21.00'x 58.00'
Pg. 3 of 11
Soil Absorption System Cross Section
0L_1.20 ft 97.--5
I Gtr, AQ` ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap 91/5-0 ft
Leaching
Chamber ft
System Elevation
z,~3 ft &-e4 ft &.66 ft
Soil Absorption System Plan View
s9 ft
.2.,r3 ft
ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
F- Leaching Chamber Specifications
Manufacturer And Model 6-6~akl&A&S
EISA Rating ZO . U sq ft per chamber Soil Application Rate O, 7 gpd/sq ft
_&CAQ gpd Design Flow 7 Soil Application Rate 0.0 EISA Chambers
3 rows of -,,6 :-chambers each.
Page of
Conventional Septic System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(l)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to
be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized for a I
year period. Afterwards, effluent dispersal to be alternated between cells to allow use of each cell for a two year period.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248-7767 or the St Croix County Zoning Department at (715) 386-4680.
Pg. 5 of 11
• • Filters
PL-525 EFFLUENT FILTER (`UMFRCI
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters.The
PL-525 is rated for over 10,000 GPD Alarm Accepts PVC
(gallons per day) making it one of accessibility '
the largest commercial filters in its extension handle
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16'
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off 10,000 GPD
the system so the effluent won't
leave the tank. No other filter on
the market can make that claim! Accepts 4" & 6"
SCHD. 40 Pipe
f~'~
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned `
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified ~r
0
by an alarm when the filter needs
servicing. Servicing should be Gas deflector
done by a certified septic tank Automatic shut-off
pumper or installer. ball when filter
is removed
1. Locate the outlet of the U.S. Patent No# 6,015,488
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4 or 6 outlet pipe. If the
back into septic tank. filter is not centered under the
access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
431"
2 A
LAAD m0
m l n x
U
O Z D A A A
TZ
D A N N r Z
rfm> On
A D
Zm 8.,
2 Ll om
m
~ r a
r n
A =
m A
m
O Z /
C O
i 18" MIN.
l< C>
77 ~j Fri
I A \
r ~
37" / I 2
c
I / I ri
v, \
D.
m
m ~ s
m
(7 A ~
A A
to
! A T
Z CA I -
I 7'
N A I
I m N
m
A
r i
D
O Z_DI
I V) _
r*~ C m, :r,1 I
- D
D F-
O
U D y
D y -
o I
Z
cn
FiLTER CANISTER DETAIL SCALE 3/4' = ' REV N0
WIESERCHURETE DRAWN BY SWT i _
1
Z SEPTIC MANUAL w3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008
REV. JAN. 2008 800-325-8456 FILE: SHEE 3
1
fl_
t t kc
r
- -a C ;
y
, 0-
0
ti
`
t~ o 200.00
R 0
Lo b
t~ Q
0-
!Q NVV_N
ku'l 1 t;, $ 00,
o
t~ a O
C
00 .00
.f J i t`~ f J
r 1
~0 74 C//
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
)ohn mou e_ AY)Arc-L1.
Nlailing Address 22 s Rat fJ 1. r \Aj
Property Address 22!? l t„r~ Lai J ,-vr' N ,'k4 S3_y__1 W l 5/-+ C716
(Verification required from Planning oning Department for new construction.)
City/State ` Parcel Identification Number 2CD(o - 50 - 00p I
LEGAL DESCRIPTION
U;l (Q'4c
Property Location 0' /J , ~'/a , Sec. 13 , T 29 N R 26 W, 4ewn of S~r►
Subdivision Plat: f S G✓- , Lot 1
Certified Survey Map , Volume Page # -
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑ yes ieno Lot lines identifiable i,?y~es 0 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(() and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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 Plannim?
Zoning Department within 30 days of the three year expiration date.
I/ we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of 7alty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) ;7 /r, is 42,7 o6;-7,7 oa /f located
at: ','4. 1 4, Section ToNvm_,2_gN, Range 2e W,
~f , St. Croix County Wisconsin.
tns ection, I certify that I have found
p y the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service a/ .201.7,
Did flow back occur fi-om absorption system? Yes No r/"
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 15-0 P&4111
Construction: Prefab Concrete Steel Other
'Manufacturer (if known):
a« ank (if known): ,26 Ye~~
5i'c2ensedTPlurnber' mber (if known)
Signature) (Print Name)
iTitlc) (License Number) 4PRS
l Date
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
.-administrative Code)
Rev. 9, 2008
A,/aar/W
VOL 1646PAGE 345
STATE BAR OF WISCONSIN FORM 2 - 1999 6 4 6 S 401 1
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Ernest H. Betker and Lynn J. Betker, RECEIVED FOR RECORD
husband and wife
05-25-2001 11:00 AM
_ WARRANTY DEED
Grantor, and John M. Andrews and Marcie L. Andrews, husband and EXEMPT A
wife CERT COPY FEE:
- COPY FEE:
TRANSFER FEE: 900.00
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if mare space is needed, please attach addendum):
Recording Area
Name and Return Address
Lot 9, Sommers Landing in the Village of North Hudson, St. Croix County,
Wisconsin.
f ~3, 3 5 ig
161-2006-50
Parcel Identification Number (PIN)
This is homestead property.
(is) (F XOO
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this o~ day of May 2001
* * Ernest H. Betker .
• * Lynn J. Betker
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
County ~ss.
authenticated thia-ftf W Mates _ S
CC"" Personally came before me this day of
Notary Public May .2001 the above named
State of Wisconsin Ernest H. Betker and Lynn J. Betker, husband and wife
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to he the person(s) who executed the foregoing
inst d acknowledged the s C.
authorized by Q 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, W1 54016
My Commission rs ermane (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary,) &J
• Names of persons signing in any capacity must be typed or printed below their signature. Information Prove:■ionala Cw„p2ny, Fond du Lm. W1
STATE BAR OF WISCONSIN 60 0 85 5-2 02 1
WARRANTY DEED FORM No. 2 - 1999
060(
2294
Wisconsin Department of Corgi eI - -VE SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings i ccordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
„ ~ A 7®
Attach complete! site PIanh~pdr-nbt IdSs than 8'/= x 11 inches in size. Plan m `y County ~ St. Croix
include, but not limited to. vertical and horizontal reference point (BM), direction and
percent slope, scale or dimlamsfeir I*OQUd'lbcation and distance to nearest road Ocel I.D.
N~r~ryU 161-2006-50-000
`tease 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
John & Marci Andrews Govt. Lot 1/4 1/4 S 13 T 29 N R 20 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
229 Sommers Landing Road North 9 na Sommers Landing
City State Zip Code Phone Number _I City e Village J Town Nearest Road
Hudson WI 54016 (715) 381-6935 North Hudson Sommers Landing Road North
New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
bel Replacement J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for conventi S dispersal cell with 0.7 gpd/sq.ft./day loading rate. Recommended
trench elevations to b 3.50'.
Boring # J Boring
ke Pit Ground Surface elev. 97.36 ft. Depth to limiting factor >96" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. T-Efff1#1 *Eff#2
1 0-34 10yr3/3 none Ifs Osg dl gw 2fm.5 1.0
2 34-46 1Oyr3/6 none Is Osg dl gw 3f,1.7 1.6
3 46-96 1Oyr4/6 none s & gr Osg dl 1v.7 1.6
r~
Horizon #43 contains approx. 50% arse fragments.
F2] Boring # Boring
V1 Pit Ground Surface elev. 99.31 ft. Depth to limiting factor >1 10" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2
1 0-29 1Oyr3/3 none Ifs Osg dl gw 1fmc 0.5 1.0
2 29-42 10yr3/6 none Is Osg dl gw 1vf,f 0.7 1.6
3 42-110 10yr4/6 none s & gr Osg dl - - 0.7 1.6
D
Horizo 3 contains approx. 40% co Arse fragments.
* Effluent #1 = BOD5> 30 < 220 mg and TSS >30 < 0 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signat e: CST Number
James K. Thompson 5~ - 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Os ola, WI 54020 8/21/2012 715-248-7767
4
Property Owner John & Marci Andrews Parcel ID # 161-2006-50-000 Page 2 of 3
3] Boring # Boring
J Pit Ground Surface elev. 100.20 ft. Depth to limiting factor ->125" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Muruell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-40 10yr3/3 none ifs Osg dl gw 2fmc 0.5 1.0
2 40-72 10yr4/6 none S Osg dl gw 1fm 0.7 1.6
3 72-125 10yr4/6 none s & gr Osg dl - 1vf 0.7 1.6
h300%%/.arse Horizon #43 contains approxfragments.
F-1 Boring # I Boring
~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring # -I Boring
F-1 I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-5330 (R.07/00) A.C.E. Soil & Site Evaluations
~ / cSUi~ a✓Q~u¢f~'o»oorE
~ EXi3~~rq e.l~,✓a~w~
• ~eated~D~o~ 5~~
M /
5cale
Ilz
✓ c yl0 ~e'~'„z29~
Y V ~,q Som M l!.S ~1r~ e(i~j iCrv -
,4o 6 8 oc~&~ o~L' Ser~rrter'~
,ClMd:/ry, Se e. 13/ r2f/t.
w.
;Cl
E s- LJ
Loci/
~4 opr..,,
• /'Ar
As p~ Isa
T 'l68 V --id: P 710 of/°f
' se-,-.,Ke .
ssanec!¢lel.~•1 o e14W ILV e'
¢.,yiSfr~ny di3~ti.Sa.O w:csa/ m. ~ \ \ ~ ~'S/°
Sw~ecc elegy' = 9,3co- ~ ~ \ \
% Q
~r \ \ ~3
So~rrlerJ - r NCO
00 49.0
tLk
l
f'
gervr"h n
F~. 3 o{.3
~a Safety and Buildings Division
SANITARY PERMIT APPLICATION 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 system, on paper not less County
than 8 1/2 x 11 inches in size. 51, Cie o
• See reverse side for instructions for completing this application State Sanitary Permit Number
3E ZI(- -
The information you provide may be used by other government agency programs ❑ Check it revision to previous plication
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Prop`gLt Owner Name Property Location
IL L.A `e boill- i -N- kjkf-oooooo"" )q l!1 /4 A//J 1 /4, S /3 T 7Z 01 , N, R 70 ftor) W
Property Owner's Mailing Address Lot Number Block Number
C"Io So L a 4`41;.-1 7z-a fJ
lol Ci , State Zip Code Phone Number Subdivision Name or CSM Number :5LD vy\ ry%Ar%
Intl
. TYPE OF BUILDING: (check one) ❑ State Owned Co'tyn Nearest Road
ige L4 AO Public 1 or2 Famil Dwellin - No. of edrooms OF b.~SG. L .ll
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 13, Zg.Zo a `f
1 ❑ Apartment/ Condo t " - 5-O'tooo
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) 4A
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5 ARepair of an
------System ________System Tank Only________ Existing System g-
B) [/A Sanitary Permit was previously issued. Per. Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed le/((Ci4'.45 210 Mound 30 ❑ Specify T pe 41 ❑ Holding Tank
12 ❑ Seepage Trench J 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit x 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION: ~ag
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required ov i' ft.) Pro~se~d+(sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
5 hVA- 9/57, Feet q0 Yo Feet TANK Cap cit
VII. in llons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks lull eptic Tan or Holding Tank El El ❑ 11 E]
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, th d d, assume responsibility f inst I t' of the onsite sewage system shown on the attached plans.
91uliew's Name: Print) ignat e: (No Stamps) rP/MPRSW No.: Business Phone Number:
~r✓ j'y?~~ `?rd ~r X055C0 7/5"-31 ~Z/30
eylrlilt O Address (Street, Cit ate, Zip Code):
/0 2 Cr - 5/'t-~ S-f - ~..~s cam/ W-7 . S 46 /,6
IX. COUNTY/ DEPARTMENT USE ONLY
ate Issue Iss ing A ent Signature (No Stamps)
E] Disapproved Sanitary Permit F e (Includes Groundwater fee)
/
[/Approved F] Owner Given Initial /K/~rS ~ LPCooiio-
X. Adverse Determination
CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS k
1. A sanitary permit is valid for two (2) years. J
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.
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 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 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 by the county; E) soil test data on a 115 form,- and F) all sizing information.
GROUNDWATEiR SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (flees) 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.
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division County
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Ptivacy Law, s.15.04 (1)(m)]. 353192
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
Betk Village of North Hudso
CST BM E ev.:- Insp. BM Elev.: 7T~ription: Parcel Tax No.:
161-2006-50-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. A
ir Ito ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom
Dosing NA Header/ Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand St cover
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H
Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer.
SETBACK
INFORMATION TypeO CHAMBER Model Number:
System: 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 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2:
Location: 229 Sommers Landing Road N, Hudson, WI (NW1/4, NW1/4, Section 13 T29N-R20W) - 13.29.20.844
1.) Alt BM Description=
2.) Bldg sewer length=
-amount of cover = J`~ I" r
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-671 0 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
S p
0
55 € „z
5 ~
i
3
. I
1 I I
f_
t
9 I s
i
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page ' of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
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 S{ , C r o I q
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I. D. #
APPLICANT INFORMATION - Please print all information. Re iewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). <
Property Owner Property Location
l.r 11 I ~t~<e ° Govt. Lot n (1J 1/4 n W1/4,S 3 T ;29 N,R q W
Property Owner's Mailing Address t~ Lot # Block# Subd. Name or CSM#
I.;'q SpC.-I erS~t^n1 inc
City State Zip Code Phone Number ❑ City Village ❑ Town Nearest Road
~ cQ,~ l 1 5) 386 -)61S o O _f "It o vi sorners kni w
❑ New Construction Use: ❑ Residential / Number of bedrooms --44 L- Addition to existing building
tA Replacement ❑ Public or commercial - Describe:
Code derived daily flow 6 _ gpd Recommended design loading rate i S bed, gpd/ft2 1 L trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 1aximum design loading rate I S bed, gpd/ft2._trench, gpd/ft2
Recommended infiltration surface elevation(s) q e I - r) ft (as referred to site plan benchmark)
Additional design/site considerations 0 t 1 S i C f°', , p n
Parent material 1.0e_1;5 a ~ Q r 4 S_ 2, te Flood plain elevation, if applicable W PC ft
S = Suitable for system Conventional Mound T In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system [ S❑ U S❑ U L S F-1 U VS ❑ U ❑ S U ❑ S E1,u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
t 1 o°II 10 r 3 I 5~ f rjSrh~r
Ground 50 _~c) ~,5 r S
elev. .R T S 05 m ~
44-1a4 -7,S r s ~S p , rr I
Depth to
limiting 3 ~p a
factor
L 0U in. r^
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
CST Name ((Please Print) c Signature ~y C Telephone No.
tom::..
Address Date CST Number
1432- LAO-h-, Sat-
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~Qffi'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
elev.
ff.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
~ INVIPONAERTAL ~Y 0[516N
1432 120' STREET, NEW RICHMOND, WISCONSIN
715-246-2454
Tom Nelson
Certified Soil Tester 227387---Registered Sanitarian SR00713
`L, r n I C Q et~rC ~,r
r)w'/4 hw/y Sec I3 '%j0 R26w
t4
a goo
I howse
9-
-JEW
77 g~
S YS rCr+~ e'QVc..`F c ~ n ~I
1V
vt 5 , 5 6
I
SCALE 1"= 3 p' < Tom Nelson
BM 1. 'Top of SeP41c 0,cni P'Pe, e.~¢v too
BM2 /
Toe of +cr,l,~ r_Ifc,rto4. (~~(~2. c?1QJ ~UV,gS f~.~-
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer )4.x~
Mailing Address _Z 2 C-A vn v s LcA^4; x c C2 J- M -
Property Address
(Verification required from Planning Department for new construction)
City/State t~ ti 3- ~--,o N , W Parcel Identification Number
LEGAL DESCRIPTION
Property Location U'/s, t W'/+, Sec. /3 . T--aN-R W,- of
Subdivision -i C c o lC +-c^ o v--l , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # 5 U l 1 , Volume 10 , Page # 4 !S'-I
Spec house ❑ yesno Lot lines identifiable ❑ yes ❑ 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 tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
e e year expiration date.
r 60 / ~e l
SIGN TUBE OF APPLICANT 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
Z; scribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
o 12911181
F OF APPLICANT DATE
Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.
Include 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
pp + ,App ,p A• r,
•w era! `.Nr x'',;,~' rk~1= t~~' k-3 r:- , wt` _y «.;s.
T,,s ,roes acraMrso ran aseao,i,e oarA
DOCUMENT NO. STATE BARwOF WISCONSIN
IDEEDRM i-lM
* TER'S OFFICE
50MG 01.1019pw 457 FU
CROIX CO., Wi
This Deed, merle between and.----------------- eed fob Rocc:rd
xat:herl;i M.._Strand1..humDa4d..±4~§d..xi~t
2 ig~3
(;raptor, 8:p0 A. M
,nd__.$1CTtali ~..a,.._lktkat..a►ea~.lpone.~~..Hat)ceac,--lu~sr$ad-a~-.xi.fa
bolding- q wrvivorsDip•,siarital .proparty______________________----......
kd*W of Deed+
- grantee,
Witnesseth, That the said (creator, for a valuable consideration
saTUN1 To
conveys to (irate, the following dno %W real estate is .A1<,,AZOLN
County, state of Wiscolule:
Lot 9, Somers Landing in the Village of North Hudson, Tax Pared No:
St. Croix County, Wisconsin.
l&/f 70v(0' -S~-DD o
Mn
E
.i
This ~.M,. bmsestsed property.
Together with all sm singular the hereditament, and apper"asneM thereunto belonging:
.
And...._A,...E>cia..~t>ri<a~..and_.xai;patina.M~.~.treuad
warrants that the two is good, indrfeasibie in simple and free and dear of encumbrances except
sasewzts covenants and restrictions of record.
t
arA will warrant and defend the sane.
Deed this .........,.3 day of JE1= 19-M...
...(SEAL) - r.4-e.. L '".4 ..............(SEAL)
tic Strand .
(SEAL) (SEAN.)
T•atherine_~.•.3tranv
AUTHRUTICAT=ON ACKNOWLZDGMUNT
STATS OF WISCONSIN
Signatore(s) .~.__~f~F:LC_~CrBl9~lk»~d....--------•----...
ss.
T.~tthar3ne.ll...SLzand,..kiuth~iasl..ftnsl. xi a._.. County.
_..daf aL Pmsonally came before me this _-day of
it the above named
- -
- - - - - - - - -
_ ?-Zilit Cori
STATE BAIT O! WISCONSIN
(It not .
wthorised by ?O6.Ag. Wis. Stab.) to ass knows to be the person who executed the
foregoing instrument and acbmwiedge the same.
THIS IMMUMENT WAG DRAT ED BY
.
?.O~i__L+~~a1Jtt _,gts~nG,__ IiAOA.._. 4Q16 Notary Public __....__.-....-•...t, -------Conn*.y, Wis.
iG permanent (tf
(signatures may be aui,'tientieated or ednowe leaged. Both m" Commission nostate expiration
19
ors raft necessary.) )
date- -
•Nnes ad pmmm @Uv.-i is nay eapaeitr aboold be bpd or prin,d belvo dbdr ds>'aeaa n
aTATH HAa 7l wtGC01,8I1i wbeonsin Lssal Duet ya Ins.
WAaaAMTT ORM roan W46 1- leaf Y~waokae, wb,.
Form- STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP /~s~.✓ SEC. T N-R W
ADDRESS S me G, a vcO G_~- - ST. CROIX COUNTY, WISCONSIN
SUBDIVISION T '
, LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I ,
10
eINDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used 'aQ ccs j i S'
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: . Manufacturer: Liquid Capacity: ,oo,;7 d
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front10 Side,9 Rear, 0 feet
From nearest property line Front 10 Side,O Rear, ® feet
Number of feet from: well building: f
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: _ Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, Q Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: / Lenith: y C . Number of Lines: _ Area Built:
Fill depth to top of pipe: .3e -
Number of feet from nearest property line: Front, O Side, Q Rear, 0irt.~
Number of feet from well: ? S
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
abscorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number: 3-Z -
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O! BOX 7969
BUREAU OF PLUMBING
MADISON, WI 53707 XX
6J ONVENTIONAL• DALTERNATIVE State Planl.D.Number:
+
❑ Holding Tank D In-Ground Pressure D Mound (lfassigned)
NAME OF PERMIT HOLDER: AODR ESS OF PERMIT HOLDER INSPECTION DATE:
Wayne Mozeh Hwy 35N, Rt.2, Hudson, WI 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELE V..
Nw% of the NA, o6 Sec. 13, T29N-R20W, V,iMio,4 N.Hud6onjot#9,Sammetus
Name of Plumber: ~MIMPRSW NnCountySanitary Permt Number
WiUiam SchumakeA 382 St. Cnaix 79163
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV TELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
Z ~ t ( DYES ❑NO DYES DNO
BEDDING: VENT OIA . VENT MA7I HIGH WATER NUMBER OF ROAD 1PROPERTY WELL. BUILDING: O
FRESH
M LINE JVENTT
AIR INLET:
2( FEET NO Nj'J J+~ I J _
DYES ❑NO ( DYES
DOSING CHAMBER:
MANUFACTURER. BEDDING- 11-111UID CAPACITY PUMP MODEL JPA(:TIIR t WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO DYES ❑NO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION AL OF PH OPEH TV WELL HUILDING VENT LE FRESH
(DIFFERENCE BETWEEN ET ROM LINE AIR INLET:
PUMP ON AND OFF) DYES ❑NO _ NEA ST_-~
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1, EH MATIHIALANDMARKIrva
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH' LENGTH NO OF DISTR PIyE SPACIN(I COVER INSIDE Uln -Pt T'S LIQUID
DIMENSI Ia THE NCHES / NIAI~HIAL PI-~ DEPTH:
ONS ! iVl l/G
J -1
GRAVEL DEPT H1 FILL DE PTH UIST H. IPF OISTH PIPE DISTR. PIPE MATERIAL NO DIS{ NUMBER OF PROPE R TV WELL BUI LDING. VENT TO FRESH
BELOW PIPES, I ABOVE COVER ELEV INLE I ELEV END PIPES LINFEET FROM E
- NEAREST-; AIR~NIT
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
D YES ONCE meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PENMAN[ NT MAHKF HS ORSEHVA TION WELLS
DEPTH OVER TRENCH BED DEPTH OVFR TH ENCR HE 1) DEPTH OF TOPSOIL SODOFD DYES SEf DE ❑NO DYES MULCHED ❑ NO
CENTER EDGES
DYES. ❑NO DYES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LA7EHAL SPACING GRAVEL DEPTH HE LOW PIPE- FILL DEPTH ABOVE COVER
TRENCHES. -
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IN O UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
FLEV.: ELEV.' CIA. ELEV. PIPES DIA..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING GRILLED COHHECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ❑NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:.
FEET FROM LINE
DYES ❑NO DYES ❑NO NEAREST
.
lye _ ~
Sketch System on in county file for audit.
Reverse Side.
SIGNATURE: TITLE
DILHR SBD 6710 (R. 01/82)
MIR
mmmmnil* '""5`°nsm APPLICATION FOR SANITARY PERMIT Jld:e_
DILHR (PLB 67) COUNTY
m oevaanW OV UNIFORM SANITARY PERMIT #
. ousTa, caeoa s Human ce canons
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size,
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
Vol- we
PROPER LOCATION y:
VA) 1/4 Wall /4, S '3 , T p; N, R (f E (Or row LLAG A-11
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
o
j- D7~ Q - S' 2ney !T
TYPE OF BUILDING OR USE SERVED
yam 1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: ee
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
S , t-) Private El Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on he attached plans.
'Oen
Name of Plumber (Print): Signature: MP MPRSW No.: Phone Number:
Oq -7
Plumber's Address: Name of Designer:
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
'I<- p J Approved ❑ Owner Given Initial
'01a 0, O 6 Adverse Determination
Reason r ap val
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
J
114~/ j~~~f~
30
41,3`
19.)e ye
- ly
faiN~~f
3 p 0~1 ~5
-8t T! of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
I~;DU5TR'Y, DIVISION
LABOR AND PERCOLATION `TESTS (115) P ° BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: E i fiOWNSHIP/MUNICIPALITY: T NO.:BLK. NO. SUBDIVISION NAME:
Zlt~ At~a1q SOMM( ks d L
NW 1/4Nwl/4 /3 /Ti9 N/R7o$(o tLLddi,E F 1qoi►r
COUNTY: oWffEff%70VER-s No ING ADDRESS:
1 `
`~T L C,5 ix 0-, =R E-AU ~Lb(/AE W r
USE DATES OBSERVATIONS MADE
NO. 8 COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIO FICOLATION g
14Residence / New ❑Replace
So,~s Book a6i U14AQn7 Ox -NuAkigkh
RATING: S- Site suitable for system U- Site unsuitable for system Soils P LAj , ' zA
TIONAL; OUND r S CJU ME:ISYSTEPA
C]u Q FU L ❑ TANK: RQ MMENDED SNA t (o C: I )
MS I S O I S ZIU MLJ SY IN-GPDLtJD-PR55S
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5) 1b), indicate: CL i¢'SS Floodplain, indicate Floodplain elevation: 4A
PROFILE DESCRIPTIONS
BORING -rOffAL 691V t: u ES I. ER-INCHE CHARACTER IL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION 8S R TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
o-O.z gLsTS 02-0,5 81Qn►S16k a.S-5.0 $LM •S
•~.[~-~4 Alt j M 5 6..A-7.°s QRN MS,t6l Crc 6Com
B- `~a ~ty 2`3 NONL- 3 4b k cod
B- 8,-Lo /00 z~ i`~c>~ve g ?a o`er i;.k SETS 0.4 9.6 tt l: h'~S
-..z &N eN M si6k cam C- r,
8-4 /()1.77 > 7/6 D-Z.0 gt_M`a Z.0-3.6'9¢NM S 3.6-71 8#.NS{6?PLb
B_ 766 /OZ 81 U o.4 &oAV o,4-3+ Um"S 3.4-4.7S~RN
t4o,46 } 7 00 - 7,0 Air S+ G C o6 Coo,
B-
p ~r PERCOLATION TESTS
DEPTH . WATER IN HOLE TEST TIME LEVEL-INCHES DROP IN WATER RAT I UT
NUMBER 44S AFTER SWELLIN INTERVAL-MIN. PE PERIOD 31 I PER INCH
P. / 3.30 ' E 99 • 0 3 r Z >7 > Z < 3
P- Z .0.,:>, NON E- 9.5 ~ 3 > 2 > 2 > 2 < 3
P-
P- i I Q 1 L KC
P- -
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation refereoce points and show their location an the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96.5
L T i `~Q MLt SI LY5i~1raIkit,
Loc. Y%+ i ol~
63 Rs Z
i t rtkNATt
. i ~ 15~~~q ' P-Z • ~ h°~ ~'p ;'~./STS rn
wJ ; ti ~ . I P I r I,M~ 3 I ! ! 3.Q9'jo
rs /f~ NS Pfd ; 16~ ~4 , 53 ScALt-
/3°y~ L7 ' -fie - rt- zs; zq_ 21= 33~ - 1 ~3C~`
UDSON i I q
~
cro" r _I' i i i 90.5 ?PTic SY57€M ctw LOT g
I
a o
t.~ t N NO N st >;5
~]~'1- RA►~)G.t~.PANT~A'C j~CM LINe
;
~IASI aT A~~><t 13r]i,L sr4~T pfJ dI5 r r46_7
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
I,I~QVEY .~o~c~lsOnl q 9_ /98~
ADDRESS: t CERTIFICATION NUMBER: PHONE NUMBER (optional):
407 .~ECUni 4 S; /fub•so N ir/t 54016 3.444 '-386-40E30
CST SI ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. )
I~ 1311.HR-SBD-6395 IR. 02/82) -OVER
-
APPLICATION FOR SANITARY PERMIT
STC - 100
i
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 Wayne Moser
Location of Property NW NW k, Section 13 , T 2 9 N - R 20 W
-s---
Township Hudson
Mal 1 ing Address HWy 35 N. Rt • 2
Hudson, Wisconsin 54016
Subdivision Name Sommers Landing
Lot Number -9
Previous Owner of Property Al Penfield
Total Size of Parcel Acre Plus
Date Parcel was Created July 1976
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) 7 X Yes No
Volume 740 and Page Number 233'- as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTy OWNER CERTIFICATION
1 (we) ee4ti6y that att 6tatement6 on th,i.6 6o4m cute tAue to the but o6 my (ouA)
Iaiuwtedge; that 1 (we) am (cute) the owneA(b) o6 the pnopehty ducAi.bed in .thi.6
in6unmation. 6onm, by viAtue o6 a waAAanty deed neconded in the 066ice o6 VLe
County RegiA ten o6 Deed6 " Document No. ?oR'l ; and that 1 (we)
pi.e,sen.tty own the pnopoaed site bon the .6ewagge di4po6a~6y.6tem (on 1 (we) have
obtained an eaaement, to nun with the above ducA bed pnopenty, bon the
conz.tn.uction o6 6aid sybtem, and the .name ha6 been duty neeo)cded in the 066.ice
u6 the County Re.g.i~sten o6 Deed6, as Document No. 432283 ) .
SIGN URE 0 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
Z. 7
DATE SIGNED DATE SIGNED
H
z
ST C- 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT H
St. Croix County z
d
9
OWNER/BUYER Wayne Moser
ROUTE/BOX NUMBER HwY 35 N. Rt. 2 Fire Number
R
CITY/STATE Hudson, Wi. ZIP 54016
PROPERTY LOCATION: NW k, NWk, Section 13 T 29 N, R 20 W,
Town of Hudson , St. Croix County,
Subdivision Sommers Landing Lot number 9
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
0
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- pa
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
54'
St. Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
'DOCUMENT NO. WARRANTY DEED-By Corporation
P. Me STATE OF WISCONSIN-FORM 10
• 4114~0s31 l40PA5f~ THIS SPACE RESERVED FOR RECORDING DATA
CC77a7 1 REGISTERS OFFICE
THIS INDENTURE, Made by SOMMERS LADIMra, INC. $T. CitOIX CO., WiSa
Rec'd. for Record this 20th
a Corporation day of A. D. 1916
duly organized and existing under and by virtue of the laws ofthe State of Wisconsin, grantor, fSii 3 :15 P l1A.
of ST. CROIX County, Wisconsin, hereby conveys and warrants to %~ds
MURRAY A. KNECHT AND WAYNE MOSER. V
Tenants in common - MBiNN N Osdt
grantee s, of EAU CLAIRE County, Wisconsin, for the sum of
RETBRN TO /YIOS2/eJDs
s5 a 7 fC7/~E
the following tract of land in S Cr(a1X County, State of Wisconsin: A/-AZA/,9 i. S
Lot 9, Sommers Landing Plat to the Village of North Hudson,
St. Croix COunty, Wisconsin
Subject to easements and restrictions of record.
In Wittim Whereof, the said grantor has caused these presents to be signed by Allen P. Penfield
its President, and countersigned by Sandra J. Penfield , its Secretary, at Hudson
Wisconsin, and its corporate seal to be hereunto affixed, this h day of Apr i 1 , A. D., 1986 .
SIGNED AND SEALED IN PRESENCE OF
AC)
by pp nle
kcdv
~ l to
Allen P. Pe
; "t
COUNTERSI NEDi tea. ~.•'i
Secretary
Sandra-J,_Lfield
STATE OF WISCONSIN,
St. Croix' ge'
County.
Personally came before me, this g t lay at A jp r i 1 A. D., 19 8 6 All e n P. P e n f i e l d
, President, and sand-ra -J- Penfield , Secretary of the above
named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President
and Secretary of said Corporation, and acktaqw4ed* that they executed the foregoing instrument as such officers as the
A
deed of said Corporation, by its authority. 'g
Kim M Kolashi nsk i
This instrument drafted by
Notary Public $ fir. -~G X County, Wis.
Al? g n P. Penfield rR•~ w
My Commission (Expires) (Is) Karch 1-8, 9
(Section 59.51 (1) of the Wisconsin Statutes provides that all In strumonts to he recorded shall have plainly printed or typewrittm there" the
"am" of the grantors, ItMoJess, witnesses and swtsry).
WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 1Q ItG~tssN.®
+ti
r m
x
~ m
c v,w ? °m ~ co°
o "mm ~c °°mm
3 'o
coww~,X~
°coZ °
?
m p° (D o a m N_0
o = M cn m N
8 m
:E (D Oo ~~~i°m'w~
._n• w m .a
CD c N Q
n
s~ Fr 8
ca ° 3 a o .°»°ccD "(0 w cco,
o
=off
=0,~ co ow 2m)
a j l< c- E: s c
Z = c•<Q.0 g :03
co m wwcn
w m o
3.~m ~v
~ ~
w c .mc9o
<°cn coL72-
CD Dc - m
O n _ n n
O (D ~p O
C co w '0
CL a' m ° r'aQ° Uwi C
r CO)
0NN NfD~Z a
vt m v,
=r 0) En
w
m -1 9 CD
s 0.Mo 3~0 a N D D
COD. C m
v;wm c=arn~ V) V
a
v 3~° vm5~3
N N 0
7 n m ul'
CD %Qm 2
o0o No0 cam a
cn o c mr• c co m vi
w a ~o~~'w L7
a o ~ ch rm- O. w o' IT1
-4 aaaa0 °
ao Q3 r> v,'
r§O P
a~ 3 m
m00 G)coo oN_moCD
a 0 O (a a c c~D c cD m
<._a cow ~m=r ID 0 0. =r c
a~3 cDO°3
m o* t0 a S. o: m o o r' 3
CD 0
i 0 0