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` Parcel 030-2091-80-000 02/10/20PA05 11:54 GE1 OF 11
Alt. Parcel M 26.30.19.769 030 - TOWN OF SAINT JOSEPH
ST. CROIX COUNTY, WISCONSIN
Current X,
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* BERRY, THOMAS J & DAPHNE J
THOMAS J & DAPHNE J BERRY
1361 AWATUKEE TRL
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1361 AWATUKEE TRL
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.290 Plat: 0078-BASS LAKE SOUTH
SEC 26 T30N RI 9W LOT 8 BASS LAKE SOUTH Block/Condo Bldg: LOT 8
EXC THE N Y THEREOF Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/09/2001 642391 1615/298 WD
07/23/1997 1046/89 WD
07/23/1997 1022/163 QC
2004 SUMMARY Bill M Fair Market Value: Assessed with:
6476 210,200
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.290 63,000 143,800 206,800 NO
Totals for 2004:
General Property 3.290 63,000 143,800 206,8000
Woodland 0.000 0
Totals for 2003:
General Property 3.290 48,600 118,000 166,6000
Woodland 0.000 0
Lottery Credit: Batch M
Claim Count: 0 Certification Date:
Specials:
User Special Code Category Amount
Special Assessments Special Charges 00 Delinquent Charges
00
Total 0.00
CERTIFIED SURVEY MAP VOL. 6, PG. 1554 LOT I
S89.2848•E 629.83' NORTH LINE Of THE SWI14 OF THE NWI/4 AND NORTH LINE OF GOVERNMENT LOT 6
314.91 314.92
0
0 ;n LOT 4
o /
0~I V.
_N
OT i °
LOT 8 3 E
LOT :V US ACRES 142,4S7A~SOSfT. a3
1O~ 143,732 SOFT. 3: w LOT 3
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z N N
CERTIFIE_ /SURVEY MAP VOLUME 6 P E 1523
n
- - - - - - „ S89. 28-48-E 295.18'
® S89 28-48•E 217.50' 1 /
19 - -
N89.28'48'W 503.18'
SIB'
TO.1a 1'1 •W S27.08'22•E
33.0Or 88.77' 4595
\
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LOT II LOT 12 °o
3.21 ACRES 3 3.03 ACRES \
' 139,981. SOFT. O 131,962 $0. FT. 9
0% LOT 2 \ ~0
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CERTIFIED SURVEY MAP
v zs31,10"W 374.61' VOLUME 8, PAGE 2325
589 31'1 -
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S89 31'l0'W
z 100.39
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385.19' LOT 10 S88 3V02•W 233.84'
32.78 ACRES
1127,908 SOFT.
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PARCEL IN
VOL. 861 , PG. 631
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SHEET I
SHEET 2
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G»%' STC - 104
f AS BUILT SANITARY SYSTEM REPORT
NER
i u 'I U
SUBDIVISION / CSM#~s-~'~ 3ow7 -IL LOT #
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~v
h v
J~
.V c r ,
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: C_ 5
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well J'Q House /,F Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 25- Number of trenches 2
Distance & Direction to nearest prop. line:
Setback from: well: dr' House CF Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: v2~ ~3
PLUMBER ON JOB: L z~~
LICENSE NUMBER: f,7Ae
INSPECTOR:
3/93:jt
p9rt Cntof4TiQWH.2S.30. IV TE'SEWAeSE S PN OUTH County:
d,Human Relations INSPECTION REPORT
and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.:
Permit Holder's Name: ❑ City ❑ Village R Town of: State PlanID No.:
Elev.: Insp. BM Elev.: BM Description: 1~ Parcel Tax No.:
0
TANK INFORMATION ELEVATION DATA A9300314
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic N Benchmark ~y /oo
Dosing
Aeration Bldg. Sewer a~67
Holding St/Ht Inlet 3,33 /06,09
TANK SETBACK INFORMATION St/Ht Outlet 3.613 /05,79
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic >/q NA Dt Bottom 5,71 -7/
Dosing NA Header /Man. 7 7i
Aeration NA Dist. Pipe Sga a3.-4
I 13 Holding Bot. System 6,61 3 /a-Z, 7 9
G,
PUMP/ SIPHON INFORMATION Final Grade y 7C,s, L
05 a/a ,u~
Manufacturer Demand
Model Number GPM
TDH Lift Friction Syestem TDH Ft
Loss I
Forcemain Length Dia. FFii Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION 7 a' 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) I x Hole Size I x Hole Spacing I Vent To Air Intake
Length Dia. I 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 I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH.26.30.19 LOT 8 BASS LAKE SOUTH
a
Plan revision required? ❑ Yes ❑ No f
141
Use other side for additional information. j 1?3 tr € r' _7 ~P Id
07
SBD-6710 (R 05/91) Date I ke or's Signature Cert. No
ADDITIONAL-COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: ,
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY _
IC T e e-0,1 L/
STATE NIT RY RMIXAF
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~ / or
8% x 11 inches in size. he<{k if eA on to revious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
i` f. Ot 4V fi S F Y4 41 Y4, S G T 9d , N, R E (Or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
7'`Ys e
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
M ❑ State Owned VILLAGE ; D !3~ C
OWN ❑ Public ~d,.l 1 or 2 Fam. Dwelling- # of bedrooms PA EL I )
111. BUILDING USE: (If building type is public, check all that apply) 0
'Fo
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPEOF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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) ELEVATION
Feet S Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank ` uJe T
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's Signature: (No Stamps) MPRSW No.: Business Phone Number:
r 3s4 ~4r k G3 3FG- 3
Plumber's Address (Street, City, State, Zip Code):
D c S'
IX. CO NTY/DEPART ENT USE ONLY
'ry Permit Fee (Includes Groundwater Date Issued Issuing A m Sign ure (NOS p
❑ Disapproved Santa
Approved F-1 Owner Given Initial 6 Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) 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 wil 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 & 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 in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
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'h 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 110vorm; and F) all slzirig informatioo-.7-
- -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment oil standards.
SBD-6398 (R.11/88)
.S r® w~"" O ~d SS akG S'G !vfil2 OG✓/~ S'T a~d ,s P !7
N~~ ~~1be
SC X t S' d Yo H` ,UQY7l~ c~-ST -f• l~ ¢ S? A-of 4 t`r(JaS' 41
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DIVISION
L REPORT ON SOIL BORINGS AND SAFETY & BUILDING,
DEPARTMENT OF P.O. BOX 7969
INDUSTRY,
,LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (1-163.090) & Chapter 145.045)
LO N BLK. NO.: S B ~fSfON NAME:
LOCATION: , SECTION: TOWNSHIP/IA"(9MXTY: n/a Bass Lake South
26 Tao N/R 1.cLtw)W St. Joseph
SE /4~`~ /4 / MAILING ADDRESS:
COUNTY: OWNER' ~~E: 1353 Awatukee Tr1, l:udson, 1~Ji. 54016
St. Gr01 Richard Stout DATES OBSERVATIONS MA DE
TONS: E O O TESTS:
USE PROFI D
NO.BEDRMS.: COMME 1c/- DESCRIPTION: ~lew Replace 4-23-92 n/a
~tesidence 3
RATING: S= Site suitable for system U= Site unsuitable for system
CONNVENTIONAL: M=fUNjN -GROUNc DPRESSURE: SYSTEM-ING TANK' R ED SYSTEM:(optional)
L~dY J C~ U ®J ❑ U Cl S EJ U ❑S .I,~.`JI U conventional
DESIGN RATE: If any portion of the tested area is in the n/a
u Percolation Tests are NOT required class 1 Floodplain, indicate Floodplain elevation:
under s.H63.0915►(b►, indicate:
P FILE DESCRIPTIONS page 42 A0B
deciaml'
BORING TOTAL PTH R U ESTER-GHESES TO BEDROCK IF OBSIERVED ISEEI ABBRVS ON BACK jEXTURE, AND DEPTH
NUMBER DEPTHC ELEVATION OBSERVED • 75, l0yr~ /2, 1. , 1. 42, 10yr4/4, sil., .75, 7.5yr
B- 1 7.67 105.95 none >7.67 /4, l.s., 4.75, 7.5yr4/6, co.s.
,75, 10yr4/2, 1., 1.25, 10yr4/4, sil., .67, 7.5yr
B_ 2 7.17 105.58 none >7.17 4 l.s. 4. 0 7.5 r46 co.s.
1.42, 10yr4/4, sil.,.1•00, 7.5-
>7.25 .83, 10yr4/2, 1•,
B 3 7.25 105.75 none r4/4 l.s. 4.00 1 r5.4 co
, 1 ! .25, 10yr4/4, sil,, .83, 7.5 -
g_ 4 7.00 .s.
105.50 none >7.00 1.00, 10yr4/4, r4,/4, sil., 1.00,_
1., ,
B' S 6.75 .105.70 none >6.75 00 , 10yr4/2. 1., 1.,00, 10y
, .
B PERCOLATION TESTS RATE MINUTES
DROP IN WATER LEVEL-INCHES PER INCH
TEST DEPTH WATER IN HOLE TEST TIME p RI D
NUMBER INCHES AFTERSWELLING INTERVAL-MIN.
P-
P-
P_ se desipn rate
P-
P-
the hori-
P_
all or borings distances. and the Describe what direction are and percent
elevation scale
PLOT PLAN: Show locations of percolation tests, soil borings and location the on dimensions of plan. Show suitable the soil surareas. Indicate
zontal and vertical elevation reference points and show thei
of land slope.
102.08
SYSTEM ELEVATION
10
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I
the undersigned, hereby certify that he soil tests reported on this form were co adeecbi me accor with the droee ures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are
TESTS WERE COMPLETED ON:
NAME (Print
CERTIFICATION NUMBER: PHO 246 62~~ ptionall:
Gar L. Steel 4-23-.2
ADDRESS:
1554 200th. Av.e New Richn nd lii. 401 CST SIGN E:
1STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
- OVER I J
IiR-S9D 6391, M. 02182)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 537,P7
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/Mi&~TY: LOT NO.: BLK. NO.: UBD ISION NA
NW '/4SU'/4 26 /T30 N/R19)i(-r) W St. Jose h n a Bass Lake
COUNTY: OWNER'S FME: MAI LING ADDRESS:
St. Croix Richard Stout 1353 Awatukee Trl,Hudson Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: 74-24-92 OFILE DESCRIPTIONS: PER OLA ION TESTS:
Residence 3 n/a ~E7New ❑Replace n/a
RATING: S= Site suitable for system U= Site unsuitable for system
r ONVENTIONAL: MOUND: IN-GR~OIUNDPRESSURE: SYSTEM-IN-F1LLHOLTIS NG TANK: RECOMMENDED SYSTEM: (optional)
®S ❑U ®S ❑U CAS ❑U ❑ S DO ®U conventional
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: class 1 Floodplain indicate Floodplain elevation: n/a
d.eciaMl' PROFILE DESCRIPTIONS page 42 AOB
BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH UO.ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-1 7.09. 101.65 none >7.09 .67, 10yr3/2, l.s., 6.42, 10yr5./4, co.s.
2 6.83 none >6.83 .83, 7.5yr3/2, s.l., .83,10yr4/4, sil., 1.25, 7.5-
B- 100.65 /4 l.s. 3.92 1 5 4 co.s.
.75, 10yr4/3, s.l., 1.50, 10yr4/6, sil., .50, 7.5 -
B-3 7.58 100.45 none >7.58 4/4, l.s., 4.83, 10yr4/6, co.s.
10yr /4
B-4 7.08 99.95 none >7.08 .83, 10yr3/4, s.l., 1.00,7.5 4/4 l.s. 5.25 co.
B-5 7.42 100.15 none >7,42 •75, 10yr3/4, s.l., 1.17, 10yr5.4, l.s., 5.50-
B-
PERCOLATION TESTS
TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 P R
P-
P-Elesign rate
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 97.65
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eto At
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I, 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:
ar L. Steel -
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST R
i t.
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a corplete and accurate soil test, your reps t include:
1. Complete legal description;
2. The use section must clearly indicate whethe- this is a residence or commercial project;
3. MAXI"1U I number of bedrooms or commercial use planned;
4. Is tF;- or replacement systern;
5. Co suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
:YSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. e the abbreviations shown here for writing profile descriptions and completing the plot plan;
7,A LEGIBLE diagram irately locating your test locations. Drawing to scale is preferred. A
jaet may be used ~r -A;
sure your benchmark a ical elevatiion reference point are clearly shown, ~ permanent;
. C _r _I to all appropriate boxe as to dates, names, addresses, flood plain data, perry i test exemp-
„ appropriate;
10. (such as f'~ A plain, elevation) does not apply, place N.A. in the appropriate box;
11. fc -i < 7d r3lace, your c :t address and your certification number;
1 IE and distr e as re(luired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL ! rF'TY WITH It' ;*.a 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 Sandstone
gr - Gravel (under 3") LS - Limestone
*s Sand HG1'.",' - High Groundwater
cs - Cc Sand P. Percolation Rate
reed s - and Well
fs Fig Blii _ Building
Is - Lc nd > Greater Than
sl - L:. rn < Less Thant
*I - L~-: Bn Brown
*sil Sil - Loarn BI Black
si - Sill Gy Gray
*cl CIS r L Y - Yellow
scl - Sandy =i y Loam R Red
sicl - Silty C-y Loam mot Mottles
sc - Sandy Clay vl// - with
sic - Silty Clay fff few, fine, faint
Ic -Clay cc common, coarse
pt - Peat min - Many, medium
rn Muck d - dist nct
- prominent
High water level,
Six general soil textures surface water
for liquid waste disposal BM - Bench Mark
VRP Vertical Referer._,;
TO THE OWNER.
This soil test report is the first step in securing a sanitary permit. The county or the Department may rerluest
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a rmit application must be ibmitted to the appropriate local authority in order to
obtain a permit. T ~y permit mus ~-id posted prior to the start of any construction.
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS: FIRE NO :
LOCATION: 1/4,1/4, SEC. _T_N-RJ[
TOWN OF: '7`~e~'~ ST. CROIX COUNTY
SUBDIVISION:T ~sC ELI -e- 5& &,2t LOT NO.
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 to
help with the cost of the 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 the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
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 form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED: l V~
DATE : 10 1
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
APPLICATION FOR t)AIIITART PERMIT
• 9TC-100
This application form Is to be completad In full and signed by the ovnet(s) of
the pcopecty being developed. 1ny inadoquacles vlll only re3ult In delays of
the pztnlt Issuance. -should this development be Intended for tesalt by
owner/contractot,(spec houaa)# thon a second form should be retained and
completed when the property Is sold and submitted to thla offles vith the
appropriate deed reeordlnq.
Own:c of ptopecty , gELe,17a*1 ✓oCz,
Location of property .5'Zf 1/4 Z-.,1/4, Section _v7G T. _z__r _L_w
Township 5' 7- Clas•r-.440 Gt
Kalllnq address l3 s3 4 Gwo tu'b``
• Address of s i t s G If e sol f,1.C1
l u bd l v l o l o n mere Act 5S S /L. -y A "e `3 o c~~ Z2
Lot number X
Previous owner of property 1^ y -e- s 7 G ,4t2-e,','-e kr
Total sire of parcel
Date parcel vas created 4ke-v jg;z
All all cornets and lot lines Identifiable? es lao
Is this property being developed tog resale (apes house)T,_ Yes No
Volume 'FAr and Pegs )lumber L as recorded with the Roglster of Deeds.
INCLUDE VITII TN19 APPLICATION Till FOLLOWINCi
A VAAAxNTY D¢ID vhlch Includes a DOCUNINT NU1f6IR, VOLUHR AND PAOt )(t!}fetR, and
the sv -kL OC TIII RBOt9TRR OF DRKD9. In addition, a eettlllad survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Ceitifled Buevey Hap, the Certlfled lurvey
Kip shall also be required.
PROPERTY MIER CERTIFICATION
I(val certlty that 811 statements on this form are true to the best of my (ov.t)
knovledgel that I (we) am (ate) the ownetts) of the pcopecty described In
lhIa Information (arm, by vlttus of a warranty deed recorded in the office of
the county Reglater of Deeds as Document No. l? I and that I (ve)
presently own the proposed alto for the aewage disposal ayaten (or I (we) have
obtained an easement, to run with the above described ptopecty, for t.t.e
constructlon of sold system, and the same has been duly recorded In the office
of the,Coynt Aeq ate of Deeds, as Document No.
sl nature of 0 nor flignatuts of Co-owner (it Applicable)
t?OL3
Date t e~gn8luce Data of 819nature
iJOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DAT.
STATE BAR OF WISCONSIN FORM 2-1982
433
417
REGISTER'S OFFICE
ST. CROIX CO., WI
Reed for Record
ERNEST C. PETERSON and VANGIE PETERSON,
- -
Grabtodsand wife, - of 140V 0:1988
- - 8:30 AA
M
- - - a and $4.'W conveys and warrants to - RICHARn-- O JA-----NE--T P ,
-
S.TO-UT.,-_.a-s--SurvivQrship---ma i-ta------------ Register of Deeds
Grantees-----------------------
-
-
P-TUPN TO
-
the following; described real estate in .-.5-t._--CX•.QiX...... County,
State of Wisconsin:
The SIB of the Mf4 and the N`v'-4 of the S44 and Govt. Lots 6 Tax Parcel No-
and 7, except two parcels recorded in the Office of the Register
of. Deeds, St. Croix County, Wisconsin, Vol. 300, pg. 204, and Pg . 553, all in Sec. 26,
T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, further described as follows:
Commencing at the West 4 corner of said Sec. 2611, said corner being the point of beginning
of this description; thence N00°42153"E along the West line of the NW34, 1304.60 feet;
thence S89028148"E along the North lines of the SW4 of the NW4 and Govt. Lot 6, 2040.76
feet to a 1" iron pipe located N89°28'48"W, 13 feet more or less, from the water's edge
of Bass Lake, and is the beginning of the meander line along said Bass Lake; thence S42°
51115"E, 411,72 feet; thence S52052132"E, 169.35 feet; thence S39D36'55"E, 223.90 feet;
thence S04°35'00"E, 84.79 feet; thence S65°46'42"E, 143.47 feet; thence S11146'33"W 114.07'.
feet; thence S30039141"E, 181.51 feet; thence.Sl5°54'39"E, 279.17 feet; thence S43°36'56"
E, 329.28 feet; thence S21"21'01"E, 117.09 feet; thence S04°53'36"W, 479.60 feet; thence
S70036125"W,175.50 feet; thence S87°22'28"W, 176,22 feet; thence S43°51'36"W, 189.23 feet
to a 1" iron pipe at the end of the meanderline; said pipe being located N89°51'27"W, 13
feet, more or less, from the said water's edge of Bass Lake; thence N89°51'27"W (Rec. as
East) 183.31 feet; thence S10°08'33"W (Rec. as N10°E), 300.00 feet; thence SO0°08'33"W
(Rec. as North), 45.97 feet (Rec. as 33 feet); thence N89054'33"W along the South lines of
Govt. Lot 7 and the NIA of the SM4-, 2414,97 feet; thence NO0°00'17"W along the West line
of the SW4, 1337.75 feet to the point of beginning, above described parcel contains 165.44;
acres including all lands lying between the meander line herein described and the
water's edge of Bass Lake, which lies between true extensions of the Northerly line (sur-
veyed as S89028148'1 E 2040.76 feet) and the second most Southerly yNlinne(s(sE eyed as N89°
This -1S -nOt------------- homestead
(is) (is not)
THIS DEED GIVEN IN SATISFACTION AND CONFIRMATION OF THAT CERTAIN LAND CoNrRACT mmEEN nt
ABOVE PARTIES DATED AUGUST 1, 1978, AMID RECORDED IN THE OFFICE OF THE REGISTER OF DEEDS
FOR ST. CROIX COUNTY, WISCONSIN ON-SEPMIBER 21, 1978, IN VOL. 581, PAGE 476, AS DOC. NO.
351882.
Dated this - - --A"--------------------------- day of - - 1988
(SEtAL,A.iV:7~ ate -/~i+..~(r - - - -------------(SEAL)
$ 285.00 -minus__$-161-, 00 pr-~yously--p-aidy Ernest C. Peterson
Jl _ -
- - -(SEAL) (SEAL)
-
Vangie- -Peterson- _
AUTHENTICATION ACKNOWLEDGMENT
I'
Signature(s) STATE OF ARIZONA it
i'
ss.
/ CCZ--M ---------County.
authenticated this day of 19 Personally came before me this _-_---day of
-_C'- 10-$--- the abe 'teamed
- SzX1CS~---~..---P~tr~rson__a.nd__Vag1~!:.-.,--~' ~I
I
Pe_terscin~ his-_wife--------------=-~►Tis..::-A i
TITLE: MEMBER STATE BAR OF WISCONSIN r
(If not- ti
r
authorized by § 706.06, Wis. Stats.) S
to me known to be the person whdr xeca ted the
foregoing instrument and acknowledge-'the,.sanle,
THIS INSTRUMENT WAS DRAFTED BY
Robert W. Mudge, Attorney 4
G V-
M U DG TFORTE-12& --LUNDEEN--- = -
ILBERT ,
Hudson,___WI 54-0f 6------------------ Notary Pub1 ---State of Arizan,A"
- - -
(Signatures may be authenticated or acknowledg=ed. Both My Commission is permanent. (If not, state expira~t,u-
are not necessary.)
date: -CQILiti11$$ID11- IC@$ y I~ 19
*Names of persons signing in any capacity shoe u
WARRANTY DEED Wkmnsin Lmal I31ank Co. Inc.