HomeMy WebLinkAbout032-1006-10-150
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Parcel 032-1006-10-150 03/25/2008 12:05 PM
PAGE _1 OF 1
Alt. Parcel 03.31.19.33A-20 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
12/03/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - PINKERTON, CHARLES & CATHERINE TRST
CHARLES & CATHERINE TRST PINKERTON
587 POLK/ST CROIX RD
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 587 POLK/ST CROIX RD
SC 5432 SOMERSET ti
SP 1700 WITC
Legal Description: Acres: 4.800 Plat: 4889-CSM 19-4889 032-04
SEC 3 T31 Block/Condo Bldg: LOT 2
CSM 76 NKA I VIEW ACRES'04 LOT
(8.5 AC) NKA CSM 19-4889 LOT 2 (4.8 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-31N-19W NE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
12/03/2004 781639 19/4889 CSM
12/03/2004 781638 2708/458 QC
04/29/2002 677573 1880/236 QC
02/24/2000 618735 1491/525 WD
2008 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/09/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.800 57,000 99,200 156,200 NO
Totals for 2008:
General Property 4.800 57,000 99,200 156,200
Woodland 0.000 0 0
Totals for 2007:
General Property 4.800 57,000 99,200 156,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
c3CON,s
? * TY R.
„ r DODGE -74B 1 6 3 9
= S•2484
% CLEAR LAKF 4 VOL 19 PAGE 4889
RALSH
!,4 • a~ , ' z - 3 - ° 4-
Q REGISTER H. DEEDS
0
'°ry. NO SUVNE" ;ST. CROIX CO. WI
nnm11MON " RECEIVED FOR hECORD
CERTIFIED SURVEY MAP 12/03/2004 04:0011`111
Located in the Fractional Northeast Quarter of the Northeast Quarter of Section CERTIFIED SURVEY KAP
3, Township 31 North, Range 19 West, Town of Somerset, St. Croix County. REC FEE: 13.00
Wisconsin; being Lot 6 of the plat of I View Acres, and Lot 1 of Certified Survey COPY FEE: 3.00
Map Volume 15 Page 4176 as recorded in the St. Croix County Register of PAGES: 2
---Deeds Office.
tr(~ NOTE: The parcels shown on this f- ar subjject to State County
t~~ IJ ii~ R1 and Township laws, rules and regulations (i.e. ~.tlcind.. minimum
v- r lot size, access to parcel etc.). Before purchasing or develop ing
I to any parcel, contact the $t. Croix County Zoning office and the
II {~i i; appropriate Town Board for advice.
(,J U' - MAR 2 BEARINGS ARE REFERENCED TO THE NORTH LINE OF
THE NE 1 /4 OF SECTION 3, TOWNSHIP 31 N., RANGE
19 W. WHICH IS ASSUMED TO BEAR N89'52'22"E. NO TH
;7. NXCOUNT LOT 2
SI~RUEYQI`'StiECCRD CERT/F/ED SURV
MAP
C-K
V( L UME 16 PAGE L 7S - NoRrHrASr CORNER
l I _K SEC. 3-31-19
ST CAOIX AD (FOUND ALUM. MON.)
-N89' 2'22"E 2604.90'- -
N89'S2'2 9'5222"E 27,5,28,".-- L-i -N89752'22"E 1027.17'-
1302.45' N89'52 22"E 'Ill N89'52'22 "E 440.45
NORTH 1/4 CORNER `1(~ 275.28' 1 r NORTH LINE OF 7H£
SEC. 3-31-19 (A CENTERLINE S02*27 12"E NORTHEAST OUART£R
(FOUND PK NAIL) O PROPOSED 33.03'
Q ORI VE'WA Y
ISO C> <
A ~ / to (A
:0 Ln
N LOT t'w..;; ti v 1 J N'Lo ~s
1" Q V
ly i V' c J OTAL AREA m Cn Jr
i 301, 448 SO. FT. 4- LOT 2
1
I~ a 6.92 ACRES o TO TAL AREA:
Imo, ti rn rn 0 209,212 SO. FT
g v og` 4.80 ACRES 0 -
(C,1 6~s c I y 1 N
v 275.28' `CD, v
S89'52'22"W 440.45'
'tILY1D
AREA EXC. R- O- W.• ~Nd OD- 9
N 292,364 SO. FT.
6. 71 ACRES
PROPERTY DESCRIBED IN
DOCUMENT #
' 479.76' 235.62' _
N89'24'4 715.38'
I f special exception use permit is required for the
e dis rbance of slopes 20X or greater not identified on
t the pproved plot or CSM. This permit is applied for
thro gh the zoning office and is reviewed through a
iso o 150 pu c hearing process by the St. Croix County Board
1 -1 Adjustment.
INS GRAPHIC SCALE This map is exempt from Subdivision review under
SCALE IN FEET: 1 inch = 150 feet CH. 18.05 (A) 3 of the St. Croix County subdivision ordinance.
JOB # Wt057SU29-003 LEGEND: Prepared Y
Section Corner Monument
J=jJC!~ Consulting Group, C. of Record
Prepared for and at the request of: Set 1" x 18" O.D. Iron Pipe weighing
Phone No. (715) 246-4319 Charles & Catherine Pinkerton 1.13 pounds per linear foot
Fax No. (715) 246-3830 and Colleen J. Spencer
P.O. Box 325 587 Polk/St. Croix Road • Found 1" O.O. Iron Pipe
New Richmond, WI 54017 Somerset, WI 54025 Building Setback Line
Sheet 1 of 2 Drafted by. Jesse B. Suzan (100' from Right of Way) ,
Form- STC_ 104
AS BUILT SANITARY SYSTEM REPORT
f 'oWNER
5 TOWNSHIP r SEC. T.~ N-RW
ADDRESS )1 C•O
R IR COUNTY, WISCONSIN
t /rt e /'S G ~Zf ~r 7~ °Z
SUBDIVISION LOT LOT SIZE
. ' PLAN VIEW ,1. • ,
Distances and dimensions to meet requirements of 19-HR 83'
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,t
y.1; asMp r! Its tit J 1;
t/ ay r i r I
40
. d: its INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used/%O
Elevation of vertical reference point:_ Proposed slope at site: 49~ z
SEPTIC TANK: Manufacturer: 1 • .e -e Liquid Capacity:
'-'-''-Number of rings used: Tank manhole cover elevation:~
Tank Inlet Elevation: )P Tank Outlet Elevations yCZ
Number of feet from nearest Road: Front.0 Side0 Rear, ® /oo feet
• From nearest-property line s Front,OSide,ORear, "*10-40 feet
l~
Number of feet from: well ,~60building: •
(Include this information of.-the above plot plan)( 2 reference dimensions to septic tank)
SEE, REVERSE SIDE
P" CHAFER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevations
Pump off switch elevations Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
-Number of feet from nearest property linai. Front, O Side, O Rear Q Ft.-•_
'Number of feet from well:
Number of feet from building:
(Include distances.on plot plan).
SOIL ABSORPTION `SYSTEM :
Bdd:- Trench:
Width: • ~ -Lenith: .--Number 'of Lines: Area Built: ,
Fill depth to to, of pipe: D
Rear101t
Number of feet f m nearest property lines Front, Side, O ~C~J
O
Number of feat from wells 00"
N Aber of feet from building: .
(Include di lances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built: "
Has either a drop box O or dist-ibution box O been used on any of the above moll
absorbtion sytems? (C eck one).
HOLDING TANK
Manufacturer: Capacity:
Number of'.rings Used:•Elevation of bottom of tank:
• Elevation of inlet:
Number of feet from.nearest property lines Front, O Side. O Rear, OFt.~.
Number of feet from wells
Number of feet from building:
Number of feet from.nearest roads
Alarm Manufacturer:
Inspector:.. '
Dateds~~ % Plumber,on Job:
t License Number:
3/84::oj
_ ~ ~-avv oars
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 796 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
~Iy9 qq55 ~~{7
NEMNE 3 WJ 13' 19W State Plan I.D. Number
CONVENTIONAL ❑ ALTERATIVE If assigned)
Town of Somerset
PO i R ❑ Holding Tank ❑ In-Ground Pressure El Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Cro
Charles Pinkerton 587 Polk St. Croix Rd, Somerset ,W 53p p
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Byron Bird Jr. 3318 St. 1)5497
7.
r (710
SEPTIC TANK/ !GL:g S
LOCKING COVER
MANUFACTURER. LIQUID CAPACITY. TANK INL LEV.: TANK OUTLET ELEV.: WARNING LABEL
PROVIDED: PROVDED:
ocr~ 7A' y7%3 YES ❑ NO ❑ YES NO
BEDDING: VCfOTDIA.: VefarMATL.: HIGH WATER NUMBER O ROAD: PROPERTY WELL: BUILDING: VENT T FRESH
C..a. C..O• ALARM: FEET FROM LINE: 0f # AIR INL T:
❑ YES NO ❑ YES NO NEAREST -40~
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF PU ❑ YES E] NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue
CONVENTIONAL SYSTE 8..Z_j
'
BED/TRENCH WIDTH: LE1qG NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS C~
GRAVEL DEPTH FILL DEPTH q~ DISTR. PIPE DISTR. PIPE DISTR. PIPE M ERIAL: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
- - ~
BELOW PIPES: Ov~ CO 4 ELEV. NLET; ELEV. END:, OOK' PIPES: FEET FROM LINE: / / AIR INLET:
/8 ' yO NEAREST-+' /o) - 540. 70 >'Ps
h' c~-
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
T MARKERS: OBSERVATION WELLS;
N
SOIL COVER TEXTURE: 7PE
YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
& cc/ _e_1 Al
- l-le Q Q/
S T-j ~v cr? < ,W(- n cl/ ~~-f optic v~7
,
_Retain in county file for audit.
Sketch System on
Reverse Side. SIGNAT RE: TITLE: 5515'-~
Zoning Administrator
SBD-6710 (R. 06/88)
SANITARY PERMIT APPLICATION COUNTY
LrDILHR 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 3~---9 7
8% x 11 inches in size. ❑ Check if re~si on 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 OWNER PROPERTY LOCATION
T , N, R X E (off W?
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
Ao'/- - G re r fc
CITY, STATE ZIP CODE PHONE NUMBER _ SUBDIVISION NAME OR CSM NUMBER
8v'r 17.25 / 7 3ys~r
. TYPE OF BUILDING: (Check one CITY NEARE§7 ROAD
II t
El State Owned VLLAGE A~,
❑ Public ~91 or 2 Fam. Dwelling-#~ of bedrooms R EL Ax N B R() O~ 1 ~'O 6 o
111. BUILDING USE: (If building type is public, check all that apply) 33
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 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 130 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. ❑ 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) C~ ELEVATION
0/00 Id-0 KP_4 7 pZ L ~ / tj • / Feet G Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Se tic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
Vlll. 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) MP/MPRSW No.: Business Phone Number:
won r. 3 l /5 ,?G l
Plum r ddress (Street, City, State, Zip Code):
OQ
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved SaRi)ary Permit Fee (Includes Groundwater a e ssue Issuin Agent Signature (No ~nd ps)
/ Surcharge Fee)
Approved ❑ Owner Given Initial eJ Q
Adverse t rmination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
F
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
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% 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; (lose 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.
SBD4M (R.11/8e)
APPLICATION FOR SANITARY PERMIT
8TC-100
This application form 1s 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 petmit issuance. -Should this development be intended tot teseli by
owner/contrector,(spec house), then a second form should be retained and
completed when the property Is sold and submitted to this office with the
apptoptiate deed recording.
Owner of property
Location of property .4-.i/4 ' 1/4, Section T.~~•R.~-Y
Township j< S c 7
Mailing address
Address of site
•
Subdivision name
Lot number -
Previous owner of property
Total also of parcel
Date parcel was created
Ate all corners and lot lines Identifiable? on _ 110
Is this property being developed for resale Gaper house)? as V, -No
Volume ~V and Page Number_ 5 as recorded with the Register of Deeds.
•.r•------ o•--•--------------- •-••--w------
INCLUDE WITH THIS APPLICATION THE FOLLOWINCI
A WARRANTY DRED which Includes a DOCUMENT NUMBER, VOLUME AND PACs NUMISR, and
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. It
the deed description references to a Cs titled Survey Map, the Cettifled survey
Map shall also be required.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(Vel certify that all statements on this form are true to the best of my (out)
knowledge= that I (we) am (are) the owner(s) of the property described In
this Intotmation form, by virtue of a warranty deed f ecorded In the office of
the County Register of Deeds as Document No. 2 ~ ~1 54 1 and that I (Ve)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, tog the
construction of sold system, and the same has been dul recorded in the office
of the County rter-ot Deeds, as Document No.
1 gnatuto of owner Signature of Co-owner (if Appiieabie)
Haul ot''Signatuto Data of Signature
• DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1
p WARRANTY DEED
938 UQI. 6U1 I I ~t 318 THIS SPACE RESERVED FOR RECORDING DATA
THIS DEED, made between Wlllizp W. Haase mid Opal H. REGISTERS OFFICE
Haase, husband and wife, as joint tenants, ST. CROIX CO., WIS.
Recd, for Record this _ 21st
Grantor day of Se to A.D. 19_79
and Charles Pinkerton and Catherine C. Pinkerton,
husband and W fe as t 9 On A, , M.
i.o'I?1t' tenanfis,
Grantee, Rpbhr of Do
W i t n e s s e t h hhat the said Grantor, for a valuable consideration
One dollar and other valuable consideration
RETUR TO
conveys to Grantee the following described real estate in St. Croix Century 21' Tndianhead
County, State of Wisconsin:
Realty, Inc. , New Richmond,
Wisconsin 54017
Tax Key No.
~I
The NE4 of the NFL of Section 3-31-19.
Subject to recorded easeumts, reservations, and rights of way,
it
i
TR SFER
$A00 o
FEE
is not
i This homestead property.
I
i (is) (is not)
~i Together with all and singular the hereditaments and appurtenances thereunto belonging; ~I
And Wi11iaill W Haase and Opal H. Haase
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
~f
i no exceptions,
f
and will warrant and defend the same.
Ii
Dated this 19 th day of September 19 79 j
I
I
(SEAL)^'~G~ SEAL)
* * W'lliam W. Haase
ii
(SEAL) al - d"mv, (SEAL)
* * Opal H. Haase I
I i±
I'
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF WISCONSIN I i
j 19 ` SS.
St. Croix County.
Personally came before me, this 19 th day of
* September, 1979 the above named j
j TITLE: MEMBER STATE BAR OF WISCONSIN Willi= W. Haase and Opal H. Haase
(If not,
authorized by § 706.06, Wis. Stats.)
i
This instrument was drafted by
I
i
uted th fore-
Eric J. LUndell to me known - Lck=~ who exec
going instru n d e sa e.
New 12ichlrond, WI 54017.
r
John alsh'ft
(Signatures may be authenticated or acknowledged. Both
~I are not necessary.) Notary Publ County, Wis.
My Commissl pet` ' l ot, state expiration
date: Dec. At 0~' 19
"Names of persons signing in any capacity must be typed or printed below their signatures. t%
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1-1977 'Ziwb ;ft"ba.,c. i
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
w
OWNER/BUYER cr
0
ROUTE/BOX NUMBER, /%~~c-% Fire Number.
CITY/ STATERT ZIP s l'v.s rt
PROPERTY LOCATION:','/z_~-_ Section 3 T_,~LN, RqW,
Town of sz-T 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 con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed 's'eptic tank pumper. What you put into
the system can aFfeect-th-e function of the septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix Countyy residents may be eligible to recieve a grant for
a maximum of 60% of the cost-of replacement of a failing system,
whit 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 County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or. a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2)..after inspection and pumping (if nec-
essary), the septic tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
H
I/WE, the undersigned have read the above requirements and agree 0
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart- W
went of Natural Resources, Certification form must be completed •d
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IWDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOC -TI ON: SECTION: TOWN /MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME:
T N/"El d~
COUN MAILING ADDRESS:
USE DATES OBSERVATIONS MADE - 3
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IFER 01 A STS:
'Residence 4--.- ❑New Replace
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optionall))~
giS DU fs~s ❑U S OU ❑ S ®U EIS ®U
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: 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. EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 7.~ y~
B-
B-
-Ca PERCOLATION TESTS
TEST DEPTH , WATER IN HOLE TEST TIME DR I WATER L V L-INHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D2 PERIOD PER INCH
P- G
AiiiH P-
P-
PLOT T 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-Y-Z 4--957 I-eZ
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4_ 14YM
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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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
~ ~ e~ G~f S o o ? Tl,
CST SIGN TU E J
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
t
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 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
'1 - Loam Bn - Brown
'sit - 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.
9
PLOT PLAN
.-PAOJECT_ e1--ez, 101~5~ ,fM ADDRESS 15--6, ~S Gro~x daJymec^Sel,~tj~1.
1/4/S,7 /T~3/ N/R/ W TOWN COUNTY-:5tC,•-r s ~
PRS Byron Bird Jr. 3318 DATE
BEDR06M- CLASS PERC_, CONVENTIONAL KM-GROU PRESSURE
CONVENTIONAL LIFT- MOUND_H0LDI
G TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA ERC RATE 7 BED SIZE f ~X ',4,5
1116 Benchmark V.R.P. Assum Elevation 100'
Location of Benchmark '
* H.R.P. .ciJ't
0 Borehole Well Scale = Feet
O Perc Hole System Elevation
Uent
12"
Grade
TYPAR COVERING
2"
12" 3' 4 s' 4O 3' 3' 0 3'
6 " Sewer Rock
12' 18'
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