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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS f C~• J4 Z~
SUBDIVISION / CSM# LOT
SECTION. T N-R 16- W, Town of~~
ST. CROIX COUNTY, WISCONSIN
L-PLAN VIER
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
I~ I
~ i zz o ~
I I
I
0
sV h4/,~
V
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM: 6~ r a
SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION
Manufacturer: Liquid Capacity: 0- 0 Q /40
-ZL
Setback from: Well Zc9-e,, i House Other/
Pump: Manufacturer Modell Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length S.3 Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
~0/
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold 111"Z5. Bottom of s stem
Existing Grade Final grade
DATE OF INSTALLATION:
p~b /
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
I
L lexpar-FOREf Qwk6 *,31.15W PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
' INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary F-
GENERAL INFORMATION rmi-t o.:
El City El Village % Town of: State Plan I o.:
Permit Holder's Name: 1i
nsp. BM Elev.: BM Description: Parcel Tax No.:
0/ 1-~OA D, 1 014-1013-40-200
TANK INFORMATION ELEVATION DATA A9300317 7 ~7 S
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S C Benchmark 22 1110, 40
Dosin
r
Aeration Bldg. Sewer 5Cj 97. a1
Hold St/ Ht Inlet i,71' 9751~
TANK SETBACK INFORMATION St/Ht Outlet 27/ 97 -RS' Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Header?
Aeration NA Dist. Pipe 7-
5-Holding Bot. System 7,33' S
PUMP/ SIPHON INFORMATION Final Grade
Manufa er Demand st
Model Number GPM
TDH Lift Lrictio ea TDH Ft
Forcemai gth Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of renches PIT No. Of Pits Inside Da quid Depth
f DIMENSIONS 531 DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA anufactur
SETBACK CHA
INFORMATION TypeO yte ,,y Model Number:
15NIT
9R
2
System: c1
DISTRIBUTION SYSTEM
Header/ M nifolcl d Distribution Pipe(s) x Hole Size x Hole.Spacing Vent To Air Intake
Length Dia Length 50 / Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System
Depth Over Depth Over xx Depth Of xx Seeded./.$ ed xx Mulched
No
Bed/Center Bed / T+ewd=Edges Topsoil es No E] Yes El
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION : FOREST. 6.31.15W
37
~ a ?~t~ ~ rt.--,,G~ ~C/./~' ~ ,,y,t~~CL2~l`. .Zer < tl.
Plan revision required? E] Yes o
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
r
t
aaT01ILHO SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 19? IIZI
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 WNER PROPERTY LOCATION
,I~ /TcirQ e Jar 6 % S T-7/, N, R45= (o
PROPERTY OWNER' MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: Check one CITY L NEAREROAD
rr--~~ ( ) State Owned ❑ VILLAGE : ,nd 5 j ~
❑ Public E2h or 2 Fam. Dwelling-# of bedrooms AR L B R
III. BUILDING USE: (If building type is public, check all that apply) Ll -l p
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEV TION
~ rc5 - ..-7 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank 2~~. . F1 F-1 . 1:1 El 1 1:1 El
Lift Pump Tank/Si hon Chamber
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' ature: (No Stamps) . MP/MPRSW No.: Business Phone Number:
l ' ~G'
p..1 n rr
-7
Plum is Address ( treat, City, te, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY 1000,
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a ssue Issuing Agent Signature (No Stamps)
Approved E01 Owner Given Initial b d Surcharge Fee)
Adverse Determination q / ~
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/68) 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 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 perm)t 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 maintafned. 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 & 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..
Ill. 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 a//,.
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% 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.
.
SBD-6398 (R.11/88)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, ~ p DIVISION
LABOR AN P.O. BOX 7969
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON, W1 53707
' (ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: WNSHI /MUNICIPALI Y: OT NO.: BLK. NO.: SUBDIVISION NAME:
S'w'/5w'/ /T /N/R/,5ri ( ar
COUNTY:: MAILING ADDRESS:
USE DATES OBSERVATIONS DExli~K IO
NO. BEDRMS.: COMMERCIAL DESCRIPTION: I 7017U DESCRIPTIONr--IPERCO-LATIO19 TEST
Residence New ❑Replace
v- d~$
RATING: S= Site suitable for system U= Site unsuitable for system W o r 1~' 026
ICS ON ENTIONAL: MOUND: IN-GROUND-PRESBURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
S❑U 1,2 S❑U ®S❑U ❑S®U ❑SA 6 r
i
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the O
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO G R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED EST. HHIff_HESF_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
10
B- o
2 o
[B-
PERCOLATION TESTS
EST DEPTH WATER IN HOLE TESTTIME DROP I WATER LEVEL-INCHES RATE MINUTES
t NUMBER k%QN 6 AFTERSWELLING INTERVAL-MIN. PERIOD P R D P R PER INCH
oo,
P-
P-
P_
P_
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 reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
40 61,
k k
t i
/ i
r ( 111_- lei.
I
v f z
40
k
s
,
r
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^-e
000
_4 0000, 1 C_
_7
I, the ersigned, 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:
ADDRESS CERTIFICATION NUMBER: PHONE NUMBER (optional): 1 -5 4
CST SIGNATURE.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
L DILHR•SBD$6 9 R 101$3)_ OVER -
PLOT PLAN
PROJECTI~ADDRESS
,~14 Se-.)1141S VI/T~1 N/R I, -W TOWN _ r COUNTY i~,
MPRS Byron Bird Jr. 3318 DATE -
BEDROOM_-;7 CLASS PERC ,2:7 CONVENTIONAL -GR D PRE SURE
CONVENTIONAL LIFT- MOUND_ HOLDING TANK
SEPTIC TANK SIZE., ~ LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
* H. R. P. oc cs~_'~ .--~7 c ~
O Borehole Q Well Scale Feet
O Perc Hole System Elevation
Uent
12"
Grade
TYPAR COVERING
2"
12" 3' q 6' O 3'
I Sewer Rock
6
i 1.2'
~r
f A 44,
d
~ co
i f
Alp
r r
60
i
;4 10
56-31-(5- SCUS'~j ! f A~- '
. , . « c s t7 ? UL 2 6199p► 8
E, CONNELL
Register of Veew `9
460776 ~ SL Croix cD.
f
CERTIFIED SURVEY MAP
LOCATED IN THE SWI/4 OF THE SWI/4 OF SECTION 6, T31N, R.15W; TOWN OF
FOREST, ST. CROI X COUNTY, WISCONSIN. OWNED BY: BERT D. PETERSEN
P.O. BOX 11.7
CLEAR LAKE, Wl"5',4005
NOTE: BEARINGS ARE REFERENCED
TO THE SOUTH LINE OF THE SW 1/4.
(RECORDED BEARING).
NORTH LINE OFTHE SWI/4-SWI14
N89053'36"E 377'- N89•53'36" 91:8.7'
UNPLATTED LANDS 355.42 42'. 270'-
„ 1
Dert. test S29.15'23"E
site 161. 21 1.25 ACTER
O In \ n SEE NOTE ON
N89°53.36"E 421.03 )WA►:• sHEEr 2OF2.
E. me or Iineti 0 ....,4
it
S I"
r \ _M
3 6.28' 19"E
202.52 ~f \ ei
N \ %O ` 5 j
(A,
A `
O. v 563.20'27
z• t0 93.43'
J, 3 \
LOT I
187i1=AC. TO WATER'S EDGE
18.48 AC. TO MEANDER LINE APPROX. DRIVE
(804,973 SO. FT.)
..z• G~ 3
500.00' 300.00 • ~j 3 n tD:
S89037 00 W 800.00 In
IREC. AS S89•58'20"W) co H •J:
A: . ' A ? L try to
.0 To 9!: AID060
• ON TO ::XIsr:A'G 3 POND I gyn.
L,
• PA14CL 8 t r''
N POINTS FALL IN WATER.
• 0 NO IRONS SET
v y y
' ~ 2 y Mf1RyH y
SOUTH LINE OF THE SWI/4
; 3oo.go' 1 6.00,
890 54. 440"w Q
N89.37'00"E w 1325.00' 789-3 C. T. H. -0t sag-37 00 W 185.,
fsW CORNER OF SECTION 0,- SE CORNER OF SECTION
T3f N,R13W. If COUNTY in 3 W 6, T31N,R15W 11 "X24"
MONUMENT FOUND). < °pg 00 IRON PIPE SET).
"t M N
N'4 N ~ ~~~WIl3iOt
o GON
x
O x SET 1"X 24" IRON PIPE WEIGHING 1.13 LBS. PER LINEAL FOOT. OVA)
4 s 1 112" IRON PIPE FOUND.
JAMIM IL
G I.tr . ? WEEM
R sRECOROEO AS
8.1804
&ORMG VALLEY
SCALE 1" - 200' 'fo
i=i;~lyll'Rl:~i li5'J~{Wr: i?'ll'+.;Ii: I3f.A1V!~Y'•;•''s ~ ~
0 100' 200, 400' /W`i:/U,~Ih~:ic~IV1N1117.1!
SHEET I OF 2
~M
JAMES M. WEBER S- 1804
09- 138 THIS INSTRUMENT DRAFTED 8Y. GATED Mgy V,
REV. 5 -22- 90
Vol. 8 Page 2247
• I
DESCRIPTION
parcel of land located in the SW 1/4 of the SW 1/4 of Section'6,
T31N, R15W,'Town of.Forest, St.C.Voix County, Wisconsin, more fully
described as follows:.
Commencing at the;.SW corner of said Section 6: Thence N89°37'00"E along
the South-line-of the.SW 1/4 a distance of 1325.001; Thence NO°23'00"W
33.00' to a point on the northerly right-of-way line of C.T.H. "Q",
said'point also being the POINT OF BEGINNING:
Thence continuing N0023'00"W 435.60';
F
Thence S.89e3710011Wk800-.001,-to the northwest corner of the Certified
urvey Map reco p3 d~ volume '6 of-Certified Survey Maps, Page 1595;
* •Recordec as S88 w)
Thence N002310011W 642.72' to a point on the South line of the North
215' of-the SW 1/4 of the SW 1/4;
Thence N89°53136"E along said line 421.031;
Thence NORTH 137.751;
. Thence•N89°53'36"E 355•.42' to the beginning of a meander line along Harmon Lake;
it
Thence S29015123"E•along said meander line 161.211;
Thence S3602811911E along said meander line 202.521;
w,
Thence S63e20127"E along said meander line 93.45' to the end of said
meander line;
Thence S1°31'12"W (recorded as S1°32'W) along the westerly line of the
Certified Survey Map recorded in Volume 6 of Certified Survey Maps, Page
508, a distance of*853.48 to a point on the northerly right-of-way -
ly right of way line
of C.T.H. "Q
~ "v
Thence S89 °37' 00."W along said right-of-way line" 5,4.A-4A--
Thence S0123•10011E along said right-of-way line 12.001;
Thence S89e37100•"W.along said right-of-way line 175..00' to'the point
.of beginning.
Contains 18.71 acres more or less,.including all lands lying between
the meander'line and the water's edge-of Harmon Lake. Subject to
easements, right.-of-ways or conveynaces of record. +u
0
ALSO: That portion of the bed of Harmon Lake formed by the northerly
extension of the East.line and the easterly extension of the North k
line of the above described parcel.(As shown on.the face of this map).
£ontains..1.25 acres, more or less, to the water's edge of Harmon Lake
subject to all ownership•rights, public or private.(*See surveyor's note.) r
SURVEYOR'SICERTIFICATE
It James M: Weber.,'registered land surveyor, hereby certify: That in
full compliance'with the'provisions of Chapter 236.34 of the Wisconsin
Statutes-and the-provisions of the St.Croix County Subdivision•Ordinance,
I have surveyed-and mapped the above described parcel of land and that
such 'plat is a correct representa.t:on • thereof': -
d this
Date Si
3 day of 11990. G Q A
.
James M. Weber S-1804 Mae AL
~
WEBER LAND SURVEYING Vera
RIVER FALLS, WI 6.1904
(715)=425-0164 ~ •
WISH
SURVEYOR'S HOTEs"i
A portion of the bed of Harmon Lake is ii{cluded above to comply with y''i~I♦O SU R,
a condition for approval of this map by'the st.Croix county comprehensive +~♦401et
Zoning parks and planningy Committee,.and does not intend to imply a
determ;nation of •ownership•of said portion of the lake bed.
SHEET 2 OF 2
This instrument drafted by
Vol. 8 Page 2247
DOCUMENT NO. WARRANTY DEED , SPACE RESERVED FOR RECORDING DATA
k: STALL BAR OF WISCONSIN FORM 2-1982
460572 S76 PAGE zM
REGISTER'S OFFICE:
Charles A. Setala and Muriel F. Setala as ST. CROIX CO., Wl
,point. tenants,__.. Recd for Record
jUL 18 1990
_ at 8:30 A. M
convey., and %,.;rrallts to . ..Bert D...Peters-en..and. Sharon.... d
.__.A... .Petersen husband.-and-w.i.£e,...as .-survivoreewl~
ship..marita. _..prop.er-t-y- Register of Deeds
. -
RCTURN TO
the following described real estate in _St..- C-roix _County,
State of Wisconsin:
Tax Parcel No:
(See Attachment I)
TRA"S
SIA- L
FE£
This is,not homestead property.
(is) (is not)
Exception to warranties: Municipal and zoning ordinances of record and
recorded easements, restrictions and reservations.
19th June 19.90
Dated this day of
-.-(SEAL). (SEAL)
Charles A. Setala _ --Mari el -F, - .Setala _ I O
- i r~
All
- .(SEAL) c _ ( EAL)-
HELEN 17'ENGMA
NOTARY PUBLIC-MUMESOTA
. .
- - - - - RAIVISEY COUNTY .
My Comm. Expires Oct. 6 1994
AUTHENTICATION WW4AMK NOWLEDGMENT
Minn s
Signature> of•• Charles___A,_-_Se STATE OF WMIp a
SS.
y y County. day of
authenticated, trhis - A ~ July--, 199k Personally came before me this 19.0
; June 19-9Q_- the above named
=
-C~.~------------------------- Murk1._F..- Setala
= ---------Bert D-.-----P-e---n
----t-------ers--e---------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
ert..D.....P.eters.en.,...Att_orney--at. Law
x
Clear.. e,-. ~1I----- 5400------------ Notary- Public .Ramsey--- ('ounty,
(Signatures may he authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19---------
*Names of prrsorv awning in any rapacity tihnuld he typrd or Iu•int.rd br•In,v Ihrir siV11:111n•cs.
WARRANTY DrED STATE BAR OF WISCONSIN
No. 19R Ri ,Hain L.M1C:11 Ph-1,
FORM 1' !nr
_ 7 ! V PAGE 254
ATTACHMENT I
A parcel. ot: land loc.*!ated in t-hc: SW 1/4 of the SW 1/4 of Section 6,
T31N, R15t•, `Pow!i Fore.: L, St. C.r.oix County, Wisconsin, more fully
described as fo.1.1~,c•,:;:
Commencinq at the sW corner r,t said Section 6: 't'hence N89°3710011E
alone ti-ic• 'uut-Jj l.i.n(of , S 1/4 di;;t:.ance of 1325.001;
't'hence :>8)° 3 7' 00"14, 800.0 ;
Thence 1140°23'00"W 642.72' r.<) a point un the South line of the North
215' of till:: SW 1/4 (;)F th(!'
`1'iience N89'53' 36 alonq {.ict line 421.03' to the POINT OF
}'3LGTNI\+L*;(y:
Thence NOI:",.'}-1 '137.7"o';
Thence N89053'36"E 647,29;
Thence S1031'12"W 137,81 feel:;
Thence S89°53'36"W along said line a distance of 643.68' to the point
of beginning, _
Contains 2,04 acres, more or less, including a portion of the bed of
Harmon Lake subject to all o,„nnership rights, public or private, in said
lake bed,'
nOGLIMENT NO. WARRANTY DEED 5 SPACE RCSERVEU FOR RC ( HDING DATA
STATr. BAR OF WISCONSIN FORM 2-1982
460570 ,,r. 876PAGE248 REGISTER'S OFFICE
Wayne F. Kaczmarski and Marlys I. Kaczmarski, ST. CROIX CO., WI
Recd for Record
husband.and wife, JUL 18 1990
convVy, and wair;alits to -Bert Petersen and Sharon A: 8: . 30 A. A4
Pet.er_sen, husband and wife., _as .s.ur.va.-vorship . Register of Deeds
mari.tal...prQp.er_t-y,---
I
RETURN TO
.
the following described real estate in 5t . Croix __County,
State of Wisconsin:
Tax Parcel No-
(See Attachment I)
S `
This is not
homestead property.
(is) (is not)
Exception to warranties: Municipal and zoning ordinances of record and
recorded easements, restrictions and reservations.
Hated this 13th July 90
day of - . 19
- - .-.-..-(SEAL) - (SEAL)
a - n
- - - - - - - -W--..y-e--Ft...Ka•.czma ski -
. (SEAL)L' -....(SEAL)
* Mars I. Ka marski
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN
Polk ss.
authenticated this ________day of___________________________ 19...... - - County. 13th
r nally came before me this ..._....day of
July------------------------ 1990--- the above named
acne __Z, Kac zmar ski...and_• Mar ly s
Kaczmarski_,.._husband_-and.._..
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
aut orized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY -
"All
.Bp.xt.__D..-..P_et_ers.en,.-.Att-orney--a-t-- .
J
~A11h i'.<<i~~fi 1'?a
Clear Lake WI
54005
xy o ao nc otar ' PIIi tic ---..--•------County, Wis.
(Signatres may be authenticated or acknowledi;e~',Foinm5sion is permanent. (If not, state expiration
are not necessary.) , -
July
"e:, .3. 1994 P •Namvs nr iiernon:i civning in nny ru parity Auld be lypod or prink-d 1"4611' Ihoir i~puiiurr..
WARRANTY DEED STATE BAR OF WISCONS?N k'i~rousin Loyal I:I:u Il. lur.
FORM No. 2- IIJS2 dl it cpnko 1L'i
S 76PAGE249
ATTACHMENT I
A parcel of land located in the SW 1/4 of the SW 1/4 of Section 6,
T31N, R15W, Town of Forest, St.Croix County, Wisconsin, more fully
described as follows:
Commencing at the SW corner of said Section 6: Thence N89037100"E.
along tho South line of the SW 1/4 a distance of. 1325.001; Thence
N0°23'00"W 33.00' to a point on the northerly right-of-way line uf•
C.T.H. "Q", said point also being the POINT OF 13EGINNING:
Thence continuing N0°23'00"W 435.60';
Thence S89°37'00"W 800.00' to the northwest corner of the Certified
Survey Map recorded in Volume 6 of Certified Survey Maps, Page 1595•
,
Thence NO°23'00"W 642.72' to a point on the South line of tine '%Ior.th
215' of the SW 1/4 of the SW 1/4;
Thence N85°53136"E along said line 1064.721;
Thence S1°31112"W (recorded as S1°321W) along the westerly line of
the Certified Survey Map recorded in Volume 6 of Certified Surveys,
gage 508 a distance of 1061.77'to a point on the northerly right-of-way
line of C.T.H. "Q"
Thence S89°37'00"W along said right-of-way line a distance of 54.44';
Thence SO°23'00"E along said right-of-way line a distance of 12.00';
Thence S89°37100"W along said right-of-way line a distance of 175.00'
to the point of beginning.
Contains 17.84 acres more or less, including a portion of the bed of
Harmon Lake subject to all ownership rights, public or private, in
said lake bed.
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. 'Croix County
OWNER/BUYER
ADDRESS_ FIRE NUMBER LL(!j 1 e
CITY/STATE__C, ,o6r C ZIP
PROPERTY LOCATION : ~W 1/4 , SI 1/4, SECTION_.(a, T N-R_]"~-L_W
TOWN Of- , St. Croix'County,
SUBDIVISION , 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 a 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,
7'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 Co. Zoning Officer within
30 days of the three year expiration date.
SIGNED:
DATE•_
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
STC-100
This application form is to be completed in full, and si ned b
the owner(s) of the 9 Y
ro ert
i p p been developed. property An
11 onl Any
inade uac
y result in dela q ls
s of t
y he permit issuance. Should development be intended for resale by owner/contractor,(spe is
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
Location of p7-
flailing ertyWl/4 SLR 1/4, Section' N-R 15 W
Township address PO Re ~ 1-7
Address of site wuu L~~? ~,A (U S-
Subdivision name i(\ A
Lot no.
Other homes on property? yes____Z__NO
Previous owner of property kor yj r
1-1
Total size of parcel
Date parcel was created 13~~C)
Are all corners and lot lines identifiable?_
Yes No
Is this property being developed for (spec house)? Yes 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 & 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. 6 --~a
o~:n the proposed site fo the sewage disposalt system)
err Ie(we)
obtained an easement, to run the above described rt, for
the construction of said system, and the same haso been duly
recorde ipn the office of County Register of deeds as Document
No.
signature of ap¢licant
Co-appl cant
i •
Date f ignature
Date of Signature
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
1151 P.O. BOX 7969
L
LABOR R, AND PERCOLATION TESTS
HUMAN RELATIONS J MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: ~TOWNSHIJ/MUNICI PALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
~w~/vim ~ /T 14/9/SE ( ore-5 "
COUNTY: MAILING ADDRESS:
mix ~,-~0® ~°-J l/7 G/,~~a,~~ `
:5
7 ;Z
USE DATES OBSERVATIONS MADE,024.11
NO. BEDRMS.: COMMER IAL DESCRIPTION: PROFILE I TESTS:
XResidence New ❑Replace `p_
RATING: S= Site suitable for system U= Site unsuitable for system ~B k- 026
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
SDU NS❑U ®S❑U ❑SEZU IHEIS 6
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the O
under s. ILHR 83.09(5)(b), indicate: Il Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST.HI HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- o O -LQ !3
B-
PERCOLATION TESTS
} EST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
f NUMBER 401111ft AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P- tie (o
P- 6 12
42Z 41;
P-
P-
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 reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 9 • y,5"'
- -
x ~
a }
E
F
3
o ~/o
I
m
a :
I, the ersigned, 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:
ae?
ADDRESS
~72t -5el CERTIFICATION NUMBER: PHONE NUMBER (optional):
Z 71r~2~~ Ill
CST SIGNA URE.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER
SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet
may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if
appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and yur certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL
AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob - Cobble (3 - 10") SS - Standstone
gr - Gravel (under 3") LS - Limestone
's - Sand HGW - High Groundwater
cs - Coarse Sand Perc - Precolation Rate
med s - Medium Sand W - Well
is - Fine Sand Bldg - Building
Is- Loamy Sand - Greater Than
'sl - Loamy Sand - Less Than
'I - Loam Bn - Brown
'sil - Silt Loam BI - Black
si - Slit Gy - Gray
cl - Clay Loam Y - Yellow
scl - Sandy Clay Loam R - Red
sicl - Silty Clay Loam mot - Mottles
sc - Sandy Clay w/ - with
sic - Silty Clay fff - few, fine, faint
'c - Clay cc - common, coarse
pt - Peat mm - Many, Medium
m - Muck d - distinct
p - prominent
HWL - High water level,
surface water
Six general soil textures BM - Bench Mark
for liquid waste disposal VRP - Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system
and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary
permit must be obtained and posted prior to the start of any construction.