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Parcel 040-1065-40-000 08/03/2007 08:51 AM
PAGE 1OF 1
Alt. Parcel 16.28.19.244B 040 - TOWN OF TROY
ST. CROIX COUNTY, WISCONSIN
Current X
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s)' O = Current Owner, C = Current Co-Owner
O - JUDGE, MARTIN T JR & DEBRA JO
MARTIN T JR & DEBRA JO JUDGE
414A N GLOVER RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 414A N GLOVER RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 4.550 Plat: N/A-NOT AVAILABLE
SEC 16 T28N R1 9W 4.55 AC IN NE NW N Block/Condo Bldg:
330.66 FT OF E 600.78 FT OF NE NW ASSM'T Twn-Rn 40 1/4 160 1/4)
INC 040-1041-90 Tract(s): (Sec- 9
16-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1032/01 WD
07/23/1997 1024/308 QC
07/23/1997 514/265
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 9.650 97,100 318,100 415,200 NO
Totals for 2007:
General Property 9.650 97,100 318,100 415,2000
Woodland 0.000 0
Totals for 2006:
General Property 9.650 97,100 318,100 415,2000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 115
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
00'0 00'0 00'0 WWI
sa6aeyo;uenbullea sasaeyo ImedS s;uewssessd leloads
;unowy AJOB04eo
apoo leloads jasn
:slelaadS
434e8 :a;ea uol;eo!;!pao 0 :;unoo wlelo ;1Ipa.io AJ81101
0 0 000'0 puelpooM
0 0 0 000'0 A4jadoad leaau90
:900Z Jo; WWI
0 0 000'0 puelpooM
0 0 0 000'0 A:pedoad Iea8u80
:LOOZ Jo; sle301
uoseem a;e;s le;ol anadwl pue-1 saaoy sselo uol;dlaosea
b66 L/60/90 :pa6ueyo ;set : suOljen len
000-0b-590 L-Ob0 0
:44!m passassV :enleAWPM aged IM3 Aaewwn$ LOOZ
00 90£/bZO I• L66 L/EZ/LO
(IM L0/Z£0 L L66 L/£Z/LO
adA1 abed/IoA # ooa a;ea
:tio;slH Iaoaed :sa;oN
0b-990E-Ob0/M a3663SSb' LL9/9E9 OS30
M6 L-N8Z-60 13021b'd b' OX3 '8 ZZZ 30Vd 110A ASO OX3
(b/L 09L ti/L Ob 6u21-uMl-39S) :(s);oejl '90d 01 S Hl b/ L MS N-1 3 01 IOW 13 96£ L
3 J30 b5S '2121 10 Ol 13 L9'bOZL M 030
9Z N Hl 13 69'LZZ N `10W 13 009 M 6 03S
~p18 opuoaplool8 2100 WL S WOO MS 3S id M6 L21 N8Zl 6 09S
319VIlVAV lON-b'/N field 000.9 :saaob :uopcIlmsea Owl
O11M OOL L CIS
NOSanH L L9Z OS
uol;dunsea #;sla adA1
Ajewlid . ; :(sa)ssaappy Atjadoad IelaadS = dS loo40S = OS :s1o!J;sla
9LOb5 IM NOSanH
3AV HOI2JCTW £ti5 L
or 'd2193a v 2ir 1 Nli2:IVIN '3Janr - o 3Janr or V2:193(1'9 21r 1 N1121b'w
a9uMO-00 juaiino = 0 `JauMO;uaiino = 0 :(s)jaum0 :ssaa
pPt/ xe1
0 00
adA1;lwaad #;lwaad # uol;eolIddV eajy sales # deW a;ea leolJo;slH a;ea uol;eajo
NISNOOSIM '.11Nnoo XI02io -is X ;uanno
.1021130 NMOl - 0170 a6EL'6L'9Z'60 Iaoaed lIb'
L =1O L 3DVd
wv Z9:90 LOOZ/EO/90 000-06- 6ti0 x-0170 laaaed
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
O
SUBDIVISION / CSM# r LOT # yy~
SECTION . , TN-R , Town of
ST. W
CROIX COUNTY, WISCONSIN
LAN VIEW
SHOW EVERYTHING ITHIN 100 FEET OF SYSfTE
Gam!
I ~
Sr
/Z
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
i
BENCHMARK:
ALTERNATE BM•
SEPTIC TANK / PUMP CHAMBER / HOLDING_TANK INFORMATION
Manufacturer -ce,1,6 Liquid Capacity: Zgoa
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
;SOIL ABSORPTION SYSTEM
Width: L )(,Ea_ Length Number of trenFhes
Distance & Direction to nearest prop. line: S - l30
Setback from: well: ? r?D House ~ Z Other
ELEVATIONS
T outlet ~d . 5/
Building Sewer ST Inlet.
PC inlet PC bottom Pump Off
i
Header/Manifold Bo f system f"00,9
Existing Grade Final grade llvUfD
/ `
A~E OF NSTALLATION : l0 13
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: % t,±r
3/93:jt
1. Yf InIf v $ .19.24 5(Sart ~ 4$RIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
' (ATTACH TO PERMIT) Sanitar rmi
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P
X
/ Insp. BM Elev.: BM Descriptio Parcel Tax No.:
fVWNF le
17
'
TANK INFORMATION ELEVATION DATA A9 30 10
w
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic n~ zed Benchmark
l
Dosin //j l"d~o.
Aeration Bldg. Sewer
Holding St/,IzA Inlet ' 163,~-, O
TANK TRACK INFORMATION St/#f Outlet 3 e) 3. -3/'
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic >/(o NA Dt Bottom
`
po ' NA Header / , 03
Aeration A Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand 7° `~.5, r,.f Sr p~ '
Model Number GPM
TDH Lift Friction TD++---` Ft
Forcemain Legit Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
PIT f Pits inside Dia. Liquid Depth
I
BED/TRENCH Width Lengthy ' No. Of T enches
DIMENSION OD DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING anu acturer•
SETBACK CHAMBER
INFORMATION Type O fix. ) c+ikc a Num er:
System: e:d
DISTRIBUTION SYSTEM
Header /A4aai#oW- l Distribution Pipe(s) / x Hole Si x Hole Spacing Vent To Air Intake
Length & I Dia. `f Length _72 Dia. Spacing Ca
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seed ed xx Mulched
Bed / Tf4tpeWCenter Bed / Tstal;K Edges Topso C] Yes E] No E] Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 1fa.28.19.244B.
J,t/
4B 1
:'t
a)Q 0,V_,6
l~
Plan revision required? ❑ Yes ['NO
Use other side for additional information.
SBD-6710 (R 05191) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
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 OW R PROPERTY LOCATION
%4 S T N, R / E (o4fV
Irp
PROPERTY OW ER' AILIN ADDRESS LOT # BLOCK #
0 4,3 .2 -
CITY TATE ZIP CODE P NE NUMBER SUBDIVISION NAME OR CSM NUMBER
OY1 W p '
11. TYPE OF BUILDING: (Check one) aHc ZW t ~ CITY NEAREST R AD
State OWn@d VILLAGE
❑ Public 01 or 2 Fam. Dwelling- # of bedrooms -Y-e PAR EL Ax NUM ER
III. BUILDING USE: (If building type is public, check all that apply)
6.r Yo
1 El Apt/Condo j - - S o - /.v2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational F
acility
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. Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ SpecityType 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 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
DD x'64 p D ~'6 , ,r' sue" /Feet p Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- I Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank D S
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu er's Name (Print): Plumber's Signature: (No Stamps MWMPRSW No.: Business Phone Number:
Plu er's Address (Street, Ci , to , Zi Code):
5 o2-3
X. COUNTY/DEPARTME T SE ONLY
Disapprovedtary Permit Fee (includes Groundwater a e issued Issuing Agent s4wature (No mps)
Approved ❑ Owner Given Initial Surcharge Fee) Q /
Adverse Determination ~-0 V /~P
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years. -
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new'-
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to'be
s~ubmitted~to the county prior tQ,installation,
5. 0nsite sewage systems must be properly4Maintaih6d. The septic tank(s) must be pump-60V a licensed` -
pumper whenever necessary, usuaMy,eyerxy 2 to 3 years.
6. If you have questions concerning yout,orisite sewage system, contact dour lodal code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be co nplete and accurate this sanitairy permit, applic~ion 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.
t
IL Type of buil'ding'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% 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 bytfue.epunty; E) soil test data on a_j;,54orm; and F) art sfzng information..,
GROUNDWATEf t'SIIRCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
-The monies,c0ected through;theese surcharges are used for mon4Qring groundwater ground
water"cbfltaroiriation investigations and establishment of standai'as,
SBD-6398 (R.11/88)
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DAVE FWMM PLUM WNG
Licensed Perk Tester & Plumber
#3233 #3289
Fogerty Heigh#s Road
ROBERTS, WISCONSIN 54023
Phone 749.3656
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
'INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME:
s -1/ s~) /4 /T,-,r N/R E ( ,eo -
COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
USE DATES OBS NATIONS MADE
TNO!.BEDRMS.: COMMERCIAL DESCRIPTION: PR FILE DES RIPTIONS: ER OLATION TESTS:
L 4/M 1 Residence 1 ONew ❑Replace 7 ? 7 ?
O
RATING: S= Site suitable for system U= Site unsuitable for system
rEIS ONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
DU OS Du EIS DU DS au DS Diu
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: - 7~ 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. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
?t - 7Y 11s.rr S.
B- 1 7 ?'f, 79' o-II / / ~.mss- 3b AW5 w sr`
B- B D off, > M e! S Cod .P
zd- yd ,8„.Hs.
B- >//o -i~ ~7 s w ( - ~~r 6
B_
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPER INCH ES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D
K512 3-3 3 S7
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 ~~.eg E ~.f C
*Y,
i ~
3
4 3
_ _ . . _0
of
o
A4
a
a~ I
1`tQ.iC, ~.ny
/KM
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e ~ r SFE f~ioty~ ~i¢~
I, the undersigned, hereby certify that the soil tests reported on this for a JI ord with the procedures and methods sp~cified in the Wisconsin
Administrative Code, and that the data recorded and the location of th e s correct to t my knowledge and belief.
4
NAME (print): TS WERE COMPLETED ON:
Licensed 3~Testt3 && Plumber VC( ,
ADDRESS: Foarty eIg S K9110 -C fm TIF CATI N NUMBER: PHONE NUMBER (optional):
s~
"alff"
lima im-titom 18CONSIN 59023 sr 93 Z'Zef
Nr C SIGNA,~1R~
It ~OIytOFlC
F
DISTRIBUTION: Original and one copy to Local Authority, Property OwnQ e e
DILHR-SBD-6395 (R. 10/83) - OVER -
I1%rSTRUCTI0 : O COMPLETIN FORM 11: - SBD - 6595
To be a con and accurate soil test, your report mu de:
1. Compiet, ~ acription;
2. The use sr. ;clear srahether this is a raxsidersce r3r comrroerc;ial presject,
3. MAXIML of b comrnerc al use planned;
4, Is r,;s a r cem.,,
5. Cc ty sati ASITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OT~ _ ARE R(. ;UT BASED ON SOIL CONDITION.-;
R. PC - 11 abbreviz-o n here for writing profile descr" r)d completing the plot plan;
7. AI'" BIBLE diagri" urately locating your test l0cati03~;f. jog to scale is preferred. A
r ay be use -f i rrl;
8. 3enchr3Eark r:rd , ical elevation reference point are €al w:r, and are permanent;
9. Cos _ >ropriate boxes as to dates, names, addresses, flood plains 9 ,t percolation test exenip-
Lion, ''I I
10. if tier, n (such f -l Alain, elevation) does not I ly, place N,A. in the appiopi-iat:e box;
11. Sign the " place You t aridness and your - ;n nuirrber;
12. Make legi! and & r as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL i',U': :TY WITH ' DAYS OF COMPLETION.
ABBREVIA- ,'S FOR CERTIFIED SOIL TESTERS
Soil ' tes and T Othr- Symbols
st- )rse (over 1( BR r c',
cob bble (3 - 10") SS - idstcne
y: (under 3") LS Limestone
;d HGW High Groundwatei
cs "uarse Sai: Prrc Percolation Rate
rned s Medium Well
fs - Fine S - Building
Is Lc..,1 - Greater Than
sl - Sa;idy Less Than
~ i Loam Broevn
"sii - Silt Lr B1 k
Si - Silt: ap' pry
~cl ;lay 4 Oc<
scl - Sa,)dy s R, 1
sic! Silfy C L ; rnn r - Mottles
sc; Sandy Clay - wi -'!I
sic silty Clay ffl few, fir7f'
~c - Clay cc commo", -
pt Peat irim Many, r
In - muck d - distinct
P prominent:
HAIL High Dater IevLl,
Six general soil surfac€ rater
for. liouid was d BM - Beanch II
VRP Veitica' Pont
TO THE OWNER:
This soil test report is the first steplin 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 a propriate local aoth.ority in order to
obtain a permit. The sanitary permit must be obtained and posted pnior'to the start of any construction.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
LABOR AN P.O. BOX 76
HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: WNSHIP LOT NO.: BLK. NO.: SUBDIVISION NAME:
s - V/ sw %44 ~ /T;~~ N/R E ( TO ,eo -
COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS:
USE DATES OBS VATIONS MADE
NO. B Rt-COMMERCI AL DESCRIPTION: ROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence l .r ZNew ❑Replace 7/~~ Jr? 7/~,~9?
RATING: S= Site suitable for system' ' U= Site unsuitable for system
ONVENTIONAL: MOUND:' - IN-GROUND-PRESSURE: rYSTEM-IN-FI LLIHOLDING TANK: RECOMMENDED SYSTEM: (optional)
EIS ❑u ❑S ou EIS ❑u EIS au EIS au - w
If Percolation Tests are NOT requirad DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED ST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- /0 41M C /I I ~Lozp
B- L , P, > y6 -io 1 s / o / se s
~l - 7Y l~r.rr S.
B- X-o OA, > ;m. ^1 Nyr 5-10 S w e Lod 'e A. S.
w 36- P~ nnr
td- yd F'n~+S.
> e9-61
-17 rl 17-,).X IfAmj
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH
P_ yL p/ 3 S
P-
P-
P_ R 3 G v
P_
2 3
37
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
F ~r I !
i e Nl~- -
_4
[ S 1v ( ~osc +
i I
N
s
+
I
+ ~ h0+
+
I
I, the undersigned, hereby certify that the, soil tests reported on this form were made by me in accord wit the procedures and methods spcified 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 : DUE FOGBM PLUMBING, TESTS WERE COMPLETED ON:
Ucensied Perk Tester & Plumber
3233 #32$9 71,2-
ADDRESS: e e S 111080 CERTIF CATI N NUMBER: PHONE NUMBER (optional):
mile! ISCONSIN 54023
CST SIGNATy1RE: r--~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
10 19.80
•
136 C
N
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N
853.:2'
400 I
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136 D 136 E
M
to \ \
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665.94 165
139 315T- _
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139 81 N
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\ %O
411.20
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61 LOT 2
% d' 139 B 2_
sw /
3~ S w
. 8 -
LOT 4
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SEC. 9 \ 1
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER MAeg?/n/ T -FUiocf 2lg 27 Tu/36Ff
ADDRESS: c FIRE NO:
LOCATION: N £ 1/4, Nat 1/4, SEC. =_N-R 1 T W,
TOWN OF: 196y ST.-CROIX COUNTY
y~ P'l ,.FL•#
SUBDIVISION: LeT t*._ le;g0 d- ~~lya
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:
1. '~e_
DATE:
St. Croix County Zoning Office
911 4th St. -
Hudson, WI 54016
STC-100
This application form is to be completed in full and signed by
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the pormit 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 MAA- i^/ 7- -7,06e 7VQ& 'Ir-
Location of - property N E 1/4 NW 1/4, Section 1 .T a8 N_R ~W
LOCAT/oN F
Township o a A -n _ ly e/yj -5f4f, T~s N-R~_w
Mailing address
'Aa
~m
Address of site
Subdivision name
Other homes on property? yes~_No
Previous owner of property -RIQ-1A0,6 14, 57r,-jul-TZ A,,,o PNywr 14 ScNU.7Z
Total size of parcel ys
Date parcel Vas created
!'Are all corn.ers and lot lines identifiable? --X-Yes No
Is this property being developed for (spec house)? Yes 4No
Volume and.Page Number ZP~ 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
1(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.-~02 - , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has been duly
recorded in the office of County Register of deeds as Document
No. Sow
Signature of p is t Co-applic
ll T 9,,?
Date of Signature Date of signature
~ ~~N / U
~o S
~ .._._~y
-
i~
t A U G -_1. 1.- s, 3 T H U 9::30 D O U E L E 00 ,.LURES P 0 2
/ M
That certain parcel of land located in the Northeast 1/4 of the
Nori..hwest 1/4 of Section 16 and the Soutn cast 1/4 of the Soouthwest
1/4 :of 'Section 9, Township 28 North, Range 19 West, Town y,
St. Croix County, Wisconsin, more fully described as follows:
Contencing at the North 1/4 corner of said section 16, the OS
BEGINNING, of the parcel to be herein described; thence
00°4415611W (assumed bearing on the North/South 1/4 line of said
Section 4l 16 a distance of 334 03' (recorded as S 01050'W and S
1 22 .~0 E 330.661) , thence S 89 49,15211W 589.51' on the North line
of the Plat of Glover Station (recorded as N 89°09140"W anod West,
600.781); thence N 01°25 42"E 558.93' (recorded as N 01 23115411E
$58.351); thence N 26°11' 161IW 427.48' (recorded as N 2610'4 311W) ;
thefiice N 28a551231IE 44.52' (recorded as N 28 53'1011E); thence S
54°5,4' 1011E 591-.77t (recorded as S 54°56' 2311E 592.001); ther!,.e N
W51S' 2311E 300.00' (recorded as N 28°53 $10f1E) i thennce S 54°54' 1011E
66.38' (recorded as S 54 5612311E); thence S 28 5512341W 334.68
(re(orded as S 28°53110"W) ; thence S 430513411E 329.78' (recorded
as S 43('06'23"E 329.691) to the POINT.,GF BEGINNING, containing
9.645 acres, being subject to easement over that 66' wide roadway
as shown on that certified survey *ap recorded in Vol. 1, Page 222
of St, Croix County Certified Survey Maps and also being subject to
a 66' wide roadway easement for ingress and egress described as
fat) c,;wS :
Co1re-inencin at the North 1/4 corner of said Section 16, ther;c e N
43005' 341IW 329.78' (recorded as N 43a0612~11W 329.690) to the POINT
OF 1? GINNING, of said easement; the~ce S 280 552311W 209.090; thence
N e$)'2011011W 260.291; thence N 01 25' 4211E 66.69' (recorded as N
01 2315411E); thence S 80°20 101E 223.001; thence N 28°55' 2311E
204,061; thence S. 54°54110"E 66.38' (recordded as S 540 5612111E);
then(,e S 28°55'2311W 34.68' (recorded as S 28 5311011W) to the POINT
OF BWGINNING, of said easement.
The above described parcel also being subject to easements of
record.
n
v aiu.e:iM1y' t,.u in ..S~L"n-G +e-'.•----------------_Y^~ ~ iiTSOi1A21 - Rr37,.t~ ~R' ~
KI!
AUG- 1 1 -93 -r Hu 9 = S0 31) 0UELE 00 4.LURES P . 0 1
e `yam
j)Q(;~Q!A NT NO. WARRANTY DEED THIS SPAC:[ hE6ERVCb fig Nt' r1aeIN0 oATw
y I I
STATE BAR OF WISCONSIN FORM.?-1988
Richard H. 5chultz•_and__Phy_ilia„A.__Shul.&............... I
hiaGran(1.ana wif •as__$uryiyprship_m rital,p
conveys a,,d warrants to Martin T.-_Judge___ant _I?ebr J;••3udget___•_
hi~~bind. and..w f~..~a ..~uxv YOx h ~ D~ r ta.~,.Pxapex.t
i .
! RETURN TO
.t
1
.
the fa -
. _-.._..__._.r.....
1',ur T. • described real estate in -CXOiX County
State of lV.~.t~~naitt:
Tax Parcel No
Sce ettached sheet for legal descriptir-
post-tt'• brand fax transmittal memo 7671
From
Co.
Dept. Phone # eM i. }
Fax / Fa><~/ ~jv
is riot homeatead property. ;
Xle) (is not)
I'areption to warranties.
ea.iementss restrictions and rights of way of record, if any.
Dated t;.i:; day of [......jUly................................: :H 93...
(SEAL) .....(SEAL)
« Richard H. Schultz
......._(SEAL) +
. ..(SEAT.)
w « Ph lib A. Schult
AUTHENTICATION { ACItNOWLRDOMFNT D
3i~t,n#~.rnft~) STATP, OF WISCONSIN
sn
n
- ------county.
31gna{.tsCc(s) ,'1'xrlC. VC w1pVVLruAAr
1
. . ............County. 2
sutbeptiratod this day of 19 ereonally came before me this o~ -,.day of
lkly 19,_91. the above namod
- Richard. ..-Schultz.------....................__...,
TITLt : UPMBER STATE BAR OF WISCONSIN PbXZiis _A.,,Schultz
(Ei nqt . . .
sm.horixed by j 746 .06, Wis. State.) to me'known to be the person vAo executed the
foregoing in trument and ac nowled6e t'•tn t >;»>e.
•!.'S INSTRUMENT WAS DRAFTF-0 BY
JoBc) h D. Boles - Attorney at Law
~.R...w..~~1l..~
River Falls, WI 54022 (715) 425-7281
Notary Public _ (;ounty, Wis.
(Signatures r,-.ay be authenticated or acknowledged. Both My Commission is per anent. (If not, state expiration
are lob ~,±.~e' ;arY•1
date: X9.
ONeLmos of 4-l.,n3 dghinu in any capacity -should be typed or printed below their signatures. -
STATE AAn OF WISCONSIN Wiscona r I ,y "•er,% Co., Inc.
JU L- ; - ? 3 THU 3 -4. 4. DO U FLE 00 LURES
R _ 0 1
':ties ca-catn p-j-pal of land locarxd in the NortrMeO t 1/4 OF. tote Nortrw=t 1/4 or 5•mtirn
16 and the 1/4 of the Sout hwwt 1/4 of Section 9, Tow whip 28 North, min v
19 West, Tow of Troy, St. Croix county, wiscansin, mare fully dascr bed as. fou
C.aamencing at t~ ie North 1/4 corner of said Section 16, the POW OF ~FNNW, of
the parct+l to be herein des=-!bad; tthmnm s W0441SW W Cessrsaad bearing an the
NdxWSouth 1/4 lime of said Section 161 a diwranine of 33¢-O3' Cad as S 01`-i0'w
end t i • i~ w'e 3.- .fits' } ; Vwme s 89049"52"1:1 S89. Sl' on the Mw -d line of the Plat of r l ovar
Station [rte: r d as N 890M' 4(r"14 and hest , 6m - 78') ; t1-tertca N 01 a2S' 4211E MO.93 ,
{recorded *-IN 01x'2315414E W8.351); tt w=a m 260I1' 167114 427.48' {recorded as N 2601014'1"54}
tttertce N 2$ t:~'z3"'E 44-5x?' o
c { t"aeordsd as N ? 9 53 1(r"E) ; VW-1ce S 54°54' 1011E 591.7/1
{r'ecarded S 54 56'23"E 592.00') ; Uvrw= N 28 S542311E 300-00' {recorded as N 285) 110'-E);
t him S 54 54 * 1Cr'E 66.38' CJ"acorded as S 54096' 2311E) ; thence S 2865S' 23"14 334. f,."i •
(r-ecar-ded ag S 2S Mtl0" 1d); thence 3 43005'34"E 329.78' {recorded as S 43°06'23"€ 329.69' )
to the PorNT of rrs1wDolcontaining 9.645 acres, being subject to earAmw m over that
86' wick as shower on tact certified as-vey neap recorded in Vol. 1, 'age ?"_.z of
St- Q-o i x C-JW,ty Ccrt: i f i ad S.twey Maps and also being subject to a 66' tide r•gc~c ha :y
easaeaent for 1r:y ---1s ~ ~s deses.-ibed as follows;
C0=M~cing $t V a North 1/4 CWTter of said Section 16, thw e N 430051341-M 3?3.78-
(r Voorded " N 4'300:6 23"14 329-M -A to the POINT OF SEri MIM of said • t irw-c
S 28055'23"'SW 2t:3 t14• • ' 0 easement; a ttte ice N 80 20' 10"14 260.291; tttertce N O1 2514211E 66.8.9' (r-or= r.lnd
as N Ol 23' S4`IE) ; ther>ca S 800201109E 223.00,; thence N 28055' 2311E 204.061; therv-.e
S SX° 10"E f;B"38' (recorded as S S4056'2T'E; th~c S 28a5'S'23"W 34.68' trroara~i,~~
es S 28 to Aha POINT OF BMINVIAG, of said easement.
1 he above d r;r r- iht'tf pat'cel also being subject to easm of re=ward.
Stets of Wirrsx ;in)
_Cot nr y of PiowL;a)
I, Zau-e~r>tca if , bttphy, Reglst a rad Land 94-vry0r, do hereby ca-tify tin t I have ea rcyr d
the above d4~ :rit~nd and =*4md pr opa.ty u==rd1n0 ia official record end that this
crap and der-(71-'ipr,1on are correct to the hest of my knowledge and belief.
Post-It' brand fax transmittat memo 7671 • nr,~gPS ►
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