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Parcel 020-1281-10-000 05/03/2005 02:49 PM
PAGE 1 OF 1
Alt. Parcel M 34.29.19.1348 020 - TOWN OF HUDSON
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
" BURBACH, BRIAN P
BRIAN P BURBACH BRUCH SARAH A
BRUCH SARAH A
645 CHERRY HILL LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 645 CHERRY HILL LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 4.420 Plat: 0170-CHERRY HILL ADDITION
SEC 34 T29N R19W PT SW1/4 & PT NW1/4 LOT Block/Condo Bldg: LOT 13
13 CHERRY HILL ADDITION !
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/16/1999 606948 1442/315 WD
07/23/1997 967/310
07/23/1997 931/32
07/23/1997 927/458
2004 SUMMARY Bill M Fair Market Value: Assessed with:
49390 425,900
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.420 54,500 275,000 329,500 NO
Totals for 2004:
General Property 4.420 54,500 275,000 329,500
Woodland 0.000 0 0
Totals for 2003:
General Property 4.420 54,500 275,000 329,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 141
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
7 c34 053
Z A 6 P 3 2 KATHLEEN H. VALSH
REGISTER OF DEEDS
ST. CROIX CO., VI
Document Number Document Title RECEIVED FOR RECORD
St. Croix County 05/04/2005 12:08PH
AFFIDAVIT
Occupancy A>rtidavit EXEMPT #
REC FEE: 11.00
TRANS FEE:
vl COPY FEE:
Na e - Owner Typed or printed Cc FEE:
PAGES: 1
being duly sworn , states, under oath, that:
1. He/she is the owner/part owner of the followin Rparcel of land located in St.
Croix County, Wisconsin, recorded in Volume =LI'age 3 1-5- Document
Numbert&~~t. Croix County Register of Deeds Office: Record! area
A parcel of land located in the % of the r Name and Return Address
V. of on S'cr_
I~cc ~ P~- v Cj-1
T~ N - R II W, Town of ~ H T56a ;!r , St. Croix
County, Wisconsin, being duly described as follows (include lot no. and yS C rrY H
subdivision/CSM or detailed legal description):
42r of Sw % owtJ Pr. Nw % Lor r3 I 020 ad' - o-
C146 ,Cy 14r LL A D D I -V o Parcel IdafffK ation Number (PIN)
As owner of the above described property , I acknowledge that the septic system serving this residence is sized for a
bedroom home, or a design flow of gpd. The design flow is calculated by assuming ISO gpd for 2
individuals per bedroom. There are currently _occupants living in this residence; koccupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However. 1
understand that if there are intentions to exceed the number of permitted occupants, the system, will need to be
modified to aeeomodate any increased wastewater flaws and/or contaminant bads. I also,owledge that I will make
this information available to any future parties interested in purchasing this property. n~• , , , , ,
Dated this t_ day of LA ei u 2005 Ct ti B
AUTHENTICATION ACKN { ENT.,..°
Signature(s) STATE OF WISCONSIN )
)ss•
authenticated this day of St. Croix County. I
Personally came before me this 4 TH day of MAY
2005 ft" YP named
TORE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06. Wis. Slats.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED By
* PAULETTE ORF
Notary Public, State of Wisconsin
(Signatures may authenticated ackncrMedged. Both are not My Commission Is permanent. If not. state expiration date:
necessary.) 84~j-aj (4 Date: 12/31/06
IS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE"
n* kftnNNdn must be oorrpleted by submNer and E(Q( (!f required). OUW #j orrmVw such es the
17rwdfrg dausss, leagel descr** n, etc. may be placed on Vila tip pays o (Ow docurnent or may be paced on addnlonaf pages 0010
document. N2W Use o/ this cower page adds one page to your docurrew end,f 2A0 to dw recorino Me. W wwsh Stahdes, 59.517.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P- Ai c/e- A-G &-61(f
Mailing Address -Sd
Property Address ~O ~&-)?'e /-I I L L
(Verificatioln required from Planning apartment for new construction)
City/State Parcel Identification Number
LEGAL DESCRIPTION
N~ I JW 1 z of
Property Location /4, /4, Sec. T N- YW, Town
Subdivision l~l L L / TI J N Lot # /
Certified Survey Map # Volume ..Page #
Warranty Deed # (A0 Volume Z Page # 3
~
Spec house ❑ yes E~no Lot lines identifiable Dyes ❑ 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, joumeyman plumber, restricted plumber 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
days of the three year expiration date.
SI ATURE 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
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE 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
Parcel 020-1281-10-000 05/04/2005 08:50 AM
PAGE 1 OF 1
Alt. Parcel 34.29.19.1348 020 - TOWN OF HUDSON
Current X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): Current Owner
* BURBACH, BRIAN P
BRIAN P BURBACH BRUCH SARAH A
BRUCH SARAH A
645 CHERRY HILL LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 645 CHERRY HILL LA
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 4.420 Plat: 0170-CHERRY HILL ADDITION
SEC 34 T29N R19W PT SW1/4 & PT NW1/4 LOT Block/Condo Bldg: LOT 13
13 CHERRY HILL ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-29N-19W
Notes: Parcel History:
Da Vol/Page
07/16/1999 606948 1442/315 WD
07/23/1997 931/32
07/23/1997 927/458
2004 SUMMARY Bill Fair Market Value: Assessed with:
49390 425,900
Valuations: Last Changed: 10/29/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.420 54,500 275,000 329,500 NO
Totals for 2004:
General Property 4.420 54,500 275,000 329,500
Woodland 0.000 0 0
Totals for 2003:
General Property 4.420 54,500 275,000 329,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 141
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 27.00
Special Assessments Special Charges Delinquent Charges
Total 27.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER act Sck UAL, TOWNSHIP /1f Lx-n
SECTION 3 / T a 2 N-R I/ W
ADDRESS ST. CROIX COUNTY, WISCONSIN
1.1 ~ az r 6Zk ~ VY\ r~ 5 5110
LL ~
SUBDIVISION ~~I r ry I~ LOT 13 LOT SIZE ~Q-
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Q(~n~ aYB ~~1 ~y r
8~-
s6'
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: Sw 5AC-C
Alternate benchmark1,~
SEPTIC TANK: Manufacturer: Paw-t%^5; is Liquid Cap. / a oo
Rings used: ?Manhole cover elev: V,, 3 Final grade elev: 93, o
Tank inlet elev.: $~~~Tank outlet elev.: 3?,-3
'
No. of feet from nearest road:Front>~ , Side , Rear Ft. ~o
From nearest prop. line:Front Side n Rear Ft.
No. of feet from: Well _N - , Building: f~
(Include this information in the above plot plan)
(2 reference` dimensions to septic tank)
SEE REVERSE SIDE
i
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear_Ft.
Distance from: Well Building
I
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
Width: /-Z Length c9g' Number of Lines:
-=I-Area Built/ Exist. Grade Elev. A0,45, Proposed Final Grade Elev.-160'('r'
Fill depth to top of pipe: 4;k111
No. feet from nearest prop. line:Front , Side
Y , Rear FtZL
No. feet from well: D~ No. feet from building 30d
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR: ~~yy
w-Q v-s ~Ir
DATE : PLUMBER ON JOB : C~a Jut A40
LICENSE NUMBER:
6/90:cj
LOCATION: HUDSON 34.29.19.1348 NE SW LOT 13
Wisconsin Department of Industry, PRIVATIt SEWAGE SYSTEM County:
` Labor and Human Relations INSPECTION REPORT
'Safety and Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 180268
Permit Holder's Name: ❑ City ❑ Village [jt Town of: State Plan ID No.:
CHULTZ, CHAD HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
020-1281-10-000
INFORMATION ELEVATION DATA A9200347
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark lam `S~
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet I 'd-- 3
TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet
rl
Septic NA Dt Bottom
Dosing NA Header / Man. d d d q
Aeration NA Dist. Pipe o1 Nor
„I ~'q loS~
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade a,~ /Qa~B 3
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length EDia. I-1 Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width Leng h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN 1 N
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of tzo CHAMBER / Mode Number:
System: ,&,o IS _J60 ' ^/6N Fi 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/Tr nchCenter Bed / Trench Edges c2 N74' Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)'
)CATION: HUDSON.,30,a 29.19.1348,NE,SW, 1& 13 ~R
t `n
o
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 1/0 a
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
:iDILHO SANITARY PERMIT APPLICATION cou
In accord with ILHR 83.05, Wis. Adm. Code
..,..,,.,,,a.
STATE SANITARY PERMI
-Attaph complete plans (to the county copy only) for the system, on paper not less than ❑
8%x11 inches in size. c ifrev i nt viousapplication
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PRO E TY OWNER PROPERTY LOCATION
d. ~ 1VF %4 5 Lo%, S 3 T , N, R J'j E (or)PROPER OWNER'S M (LING ADDRESS LOT # BLOCK #
1 C _ _ ,q ~ -Q_ 13 N/
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR S~ NUMBER
luhQee~ SSlI Jl1 r•
11. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned ❑ VILLAGE
IN TOWN OF: O
❑ Public ~'X]1 or 2 Fam. Dwelling-#of bedrooms 'PARCEL TAXNUMBER ) 4).AD
III. BUILDING USE: (If building type is public, check all that apply) PG-TO /-3
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
40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. VO 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 P9 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
120 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
Ii-SO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
/ o /0 .5 6 9 91X_ Feet O ZY5 Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete structed glass App.
Tans Tanks
Septic Tank or Holdin Tank QU'~ F1 F-1
Litt Pump Tank/Si hon Chamber
_FF1 El R Fj
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 Si a e: (No Stamps) r/MPRSW No.: Business Phone Number: -7 vg Z to ~ .1% . 1.SG.3 S L3S
Plumber's Address (Street, City, State, Zip Code).
~ i cSnvv~~ n~ w 0
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Iss ' Agent Sign ure o Stamps)
PV ~a Surcharge Fee)
Approved ❑ Owner Given Initial
Adverse Determination lqc~l 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. ~Y6ua`sanitaryq permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage 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' owher's,name and mailing eddress. Provide the legal description and parcel tax number(s) of
where the system is to be ipstalled.
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 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 quXve; pump model and Qump man facturer; D) cross 6. lion of the soil absorption system if
required bythe county; sb1t data ~r*rm; and F) ~llsionoinformation.„ ,
GR0UND*ATER 5VK6HARGE
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)
APPLICATION FOR SANTTARY PERMIT
S T C - 100 r-
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.
- - - - - - - - - - - - - - - - - - - C - - - - - - - - - - - - - - - - - - - - -
Owner of Property '~C44-LALTZ-
Location of Property E: ~4 Sw 'r, Section , T 2 9 N - R i9 W
Township pmos-O1J _
Mailing Address xy-V, 7F/SV-e7 l LA"g,
4,uto5o "t
Subdivision Name ~~~,tr~(LI?/y 1_}1L1..
Lot Number
Previous Owner of Property 5A-tA Nlb"x.:'Y(~
Total Size of. Parcel 4.4-2,,
Date Parcel was Created r
Are all corners and lot lines identifiable? X% Yes No
Is this property being developed for resale (spec house) ? Yes X No
Volume 1;0-1 and Page Number -J-A1 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE. OF THE FOLLOWING:
1. Warranty D
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
Tn addition, a certified survey, if available, would be helpful so as to avoid delays
of the revLewing process. Tf the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPER7"V OWNER CERTIF=ICATION
I (ale) eohof y that aff 5-taternen-t~s on ,thi,5 {ohm an.e ,thue to the best o4 my (OuA)
Iznowtedge; that I (we) am (cute) t:h.e, own-en(A) o{ the pnopetty d"enibed in .this
inAonmat ion Konm, by vii tue o4 a waAJ an.ty deed he eohded in ,th.e. 0 44ice o A the
County Regadtotr o~, Doork nA Vonomen.t No. 4 IL'7 and that I (wn.)
P.I.mentky own .th.e ph.opobed bite bon. ,the. aewage. i6po-6a F5y's-te.m (OA I (We) have
ob.taine.d an ea e.mevtt, to l un with the. above deScAibed pnopeAty, AoA the
con5tA.action oA Aat.d AyAte.m, and .th.e..same. hart be.e.n dufy ne.eonde.d in the 046i.ee
oi( the. County Re.giAten oA Deeds, aA Doeumenr No.
SIGNATURE OF OWNER C~J SIGNATURE OF CO-OWNER (IF APPLICABLE)
q !J 4L
DATE SIGNED DATE SIGNED
err -...~.wi,rr~. r ~.:...._»_.Y..,.....
THIS SPACE RESERVED FOR RECORDING DATA
DOCUMENT NO. WARRANTY DEED
STATE BAR OF WISCONSIN FORM 2-1982]
4$8 VOL.- -967PAGE311
REGISTER'S OFFICE ,
Sam E. Miller, a single person ST.CROIXcni W1
t Reed for Record 'i
SEP C x:1992 i'
- - • --•---Cfiad • D•:---ScYiiil-£z -•aric1---~reri
conve s and warrants to Ofi 10:00 A. M
chultz,_, husband--and•_ wife- as suzyiyors .fferital.......
nnAA
•-•rty
Re8TslerofDee&
-
RETURN TO
the following described real estate in _..__...St,__..tiX'0~.]S ..................County,
State of Wisconsin:
Tax Parcel No:
i
i
Lot 13, Plat of Cherry Hill in the Town of Hudson, St. Croix
County, Wisconsin.
TOGETHER WITH and easement for ingress over Outlot 112" of the Plat
of Cherry Hill.
tat '.6
VIM
This iS not homestead property.
.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way
of record, if any.
day of September 19.
SEAL) (SEAL)
Spam bE M1 e r
ti,..;;; (SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGBI&ENT
Signature (a) ...........S................. STATE OF WISCONSIN
ss.
. • County.
authentica ed this Zft4lay of_ September.., 19_-92 Personally came before me this ................day of
19 the above named
Kristina-•Ogland------------------------------•...__..
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 SY
Kristina Ogland
Att-0rriey__st--i;air----•-•---•-•--•----•-•--•----
• Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
)
date : 19
•I
*Names of persons silnina in any capacity should be typed or printed below their signatures.
1Rliern-in I nnil Rlink ('.n Inc
SEPTIC 'ANK `1ALVTV1ANCS AGREEMENT
Sr_. Croix Cuuncy
OWNER/BUYER ~L*V'NL_jZ
ROUTE/BOY NUMBER I11 XXbC~IGc-i,► ~A~~►£ Fire Number
CITY/STATE HV 05'01'% W1 ZIP 540 ~6
P^OPERTY LOCATION: ~c, SW 't, Section 14 T '7A N, R 19 W,
Town of05.013 St. Croix County,
Subdivision 4%LA- Lot number
Improper use Xnd maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
siscs 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 attect the Eunctiun 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% uE the cost of replacement of a failing system,
which was in operaci.on 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 L/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
I/TdE, the undersigned, have read the above requirements and agree
to maincain.the private sewage disposal system in accordance with
the standards set forth; herein, as set by the Wisconsin Depart-
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 dace.
SIC,dE0
DATE
St. Croix County Zoning Office
P.O. Sox ?'_7
Hammond. 'il 54015
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?',ILITY EASEMENT. 14
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()EPAfiTMENT OF REPORT_O_N_SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY' DIVISION 7969
LABOfi 3707
-PERCOLATION TESTS_(115) MADISONP.O., WI BOX 53707
AND
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
LOCATIO SECT~TONN TOWNSHIP/M Riff,'XLITY: LOTNO.: BLK. NO.: SRDI VISION NAME:
NE 1/4 SW 1/4 34 /T 29N/R 19E;6r►W Hudson 13 n/a Cherr Hill
COUNTY: W YER'S NAME: IMAILING DDR SS:
St. Croix -Ge1rd- Schultz 1703 Wittaker Ave., White Bear Lake, MN.551 0
USE DATES OBSERVATIONS MADE
I p~ EST S:
No,B DRMS.: COM RCA ESCR PTIOlew ❑Replace 8- O24-92 I n/a O
~~tesidenca 3 n / a
RATING: S= Site suitable for system U= Site unsuitable for system
'ONVENi"IOFVAL: MOUND: IIV-GROUND R' E URE: SYSTEM-IN•FILL OLDING TANK RECOMMENDED SYSTEM:(optional)
Fxas ElU US EA RIS EJU EIS UU E]S EJU conventional
DESIGN RATE: If any portion of the tested area is in the
If Percolation tests are NOT required
under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n /a
PROFILE DESCRIPTIONS Page 66 CON _
BORING TOTAL DEPTH TO GROUNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED S IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i
-9, 10yr4/2, L.; 9-24, l0yr s
B-1 84 103.6 none >84 25-54, 7.5yr4/6, Is.; 54-84, 10yr5/4, S.
0-9•, Yr , L•; - r yr:) , si
B-2 84 103.40 none >84 28-84, 10yr5/4, S.
-12, 10yr4/2, L.; 12-271 10yr , si
B-3 84 102.65 none >84 27-84 10 r5/4, S. -
0- _ , Y r
0-10, Oy r si .
B-4 80 100.20 none >80 23-40 110rr4/4,Lls.• 40-80, 10yr5/4, S.
10yr4/2 L., 10-26, 10yr4 4, sil.-
B-5 84 100.75 none >84 26-84 10 r4/4 S.
B-
PERCOLATION TESTS
TEST DROP IN WATER LEVEL-INCHES RATE MINUTES
D1 PERIOD2
DEPTH 1AFTERSWELLING TER IN HOLE
NUMBER INCHES INTERVAL-MIN. P RI PER INCH
P-
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 99.65
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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.
TESTS WERE COMPLETED ON:
NAME (print
Gary L. Steel 8-24-92
ADDRESS: *CERTIFICATION BER: PHONE NUMBER(optional):
1554 200th. Ave., New Richmond, Wi. 54017 71 246-6200
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) -OVER -
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C APPROVED Sj)J IETIC COVCR
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OR MARSH HAY
IrLEV. OF OF l2-21/2 AGGREGATE 'P°U^
DISTRIF)UTIOIJ PIPE TU BE AT LEAST WCHES BELOW ORIGIIJAL GRADE
AAIU AT LEAST LO IIJCHES BUT IJO MORE THAIJ 42 INCHES BELOW FINAL GRADE
MAX'MUM pEQtH OF EXCAVAT100 FXOM OR16WAL 6~111)F- WILL BE y _ IIJCHES
nNlMUM Oi:Pni OF EACAVATIO" rAOM. CA~I6I1rJAL 6RAOF- WILL BE 'y8 INCHES
SIG►JCD:
LICE►JSr I.IUMBEI2: /
DATE : S 11. /6-0 R9
REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1
IQ/22Y92 09:01 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/22/92 AREA: MJ
Activity: A9200347 10/22/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 34.29.19.1348,NE,SW, LOT 13
Parcel: 020-1281-10-000 Occ: Use:
Description: 180268
Applicant: SCHULTZ, CHAD Phone:
Owner: SCHULTZ, CHAD Phone:
Contractor: POWERS, CALVIN Phone:
Inspection Request Information.....
Requestor: POWERS, CAL Phone:
Req Time: 14:10 Comments:
Items requested to be Inspected... Action Comments V Time Exp
00012 FINAL INSPECTION V
Inspection History.....
Item: 00012 FINAL INSPECTION
I
r DEPFRTIIAENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
JDUSTR'i
LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969
3707
HUMAN RELATIONS MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145) guk"
LOCATION: SECTION: TOWNSHIP/MitWRIX&LITY: OT NO.: BLK. NO.: SUBDIVISION NAME:
NE 1/4 SW 1/4 34 /j 29N/R 19EEtt.r►W Hudson L13 n/a Cherr Hill
COUNTY: WK UYER'S NAME: MAILING ADDRESS:
St. Croix bah Schultz 1703 Wittaker Ave., White Bear Lake, MN.551 0
DATES OBSERVATIONS MADE
USE PROFILE E R PTIONS: ER OLATIONTESTS:
NO.BEDRMS.: COMMERCIALDESCRIPTION: Cam-,
residence 3 n/a Jew ❑Replace 8-24-92 n/a
RATING: S= Site suitable for system U= Site unsuitable for system
rMSONVENTIONAL: rugs D: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑U ❑U RiS ❑U ❑ S ~U ❑ S Cell conventional
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.ILHR83.09(5)(b),indicate: class 2 Floodplain indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS page 66 CoD2
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.)
-9, 10yr4/2, L.; 9-24, 10yr , si
B-1 84 103.6 none >84 25-54, 7.5yr4/6, ls.; 54-84, 10yr5/4, S.
0-9.,10yr , L.; - , yr , si
B-2 84 103.40 none >84 28-84, 10yr5/4, S.
102.65 -12, 10yr4/2, L.; 12-27, 10yr4 6, si
B-3 84 none >84 27-84, 10 r5/4, S.
0-10, 10yr4/2, L.; 10-23, yr , si
B-4 80 100.20 none >80 23-40, 10 r4/4, ls. ; 40-80, 10yr5/4, S.
-10, 10yr4/2, L.; 10-26, 10yr4/4, sil.-
B-5 84 100.75 none >84 26-84 10 r4/4 S.
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER I RATER IINCH NUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PE O
P-
P- se desip rate
N ~
P-
P
y~ G 9 N elm
P-
T ~
P-
n
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suite e s elves. Indi ae scale nces. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show h ce-elevatio ings and the direction and percent
of land slope.
SYSTEM ELEVATION 99.65
~ s
1 emu' ~ ~ ~ _ to
r
,
- E31-
T
,
m._
E
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:
Gary L. Steel 8-24-92
ADDRESS: CERTIFICATION UMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 71 246-6200
9 CST SIGN
7 00
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
T W .