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Parcel 032-1089-95-100 02/16/2007 12:06 PM
PAGE 1 OF 1
Alt. Parcel 33.31.19.431A-10 032 - TOWN OF SOMERSET
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
CHARLES R BAILEY O - BAILEY, CHARLES R
1880 45TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 6.570 Plat: 3576-CSM 13/3576
SEC 33 T31N R19W PT E1/2 NW1/4 BEING LOT Block/Condo Bldg: LOT 1
1 CSM 13/3576
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
33-31 N-1 9W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/29/1998 594574 1390/432 WD
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/05/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.570 65,800 152,400 218,200 NO
Totals for 2007:
General Property 6.570 65,800 152,400 218,200
Woodland 0.000 0 0
Totals for 2006:
General Property 6.570 65,800 152,400 218,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 133
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00
0.00
79, 70- i DEC 2 3 1998
5 g q 3 55 KATHLEEN H. WALSH
cou"Na Register of Deeds
SL Co.,
Croix WI
C E R T I F I E D S U' R.-V P
Located in part of the Northeast Quarter of the Northwest Quarter and part of the Southeast Quarter ~I
Northwest Quarter all in Section 33, Township 31 North, Range 19 West, Town of Somerset, St. Croix County;
Wisconsin.
Prepared for and at the request of: NORTH 114 CORNER
Delbert
REMAX Dodge t SEC. 33-31-19
9
(715) 246-7125 Ic0tvS (ALUM. CO. MON.)
OWNER: i/ 9$ ~00-
cn
J
1880 ulie A. Sanders ; 1~r RONALD f.
45th Street
SomerSeset, WI 54025
Somerset, Z JOHNSON
Drafted by. Kristi A. Eylandt ' AM
Y O D0'
ER.
WIS. A I
ee~ r~ ; I l
or <q O ..R~'~ _OWNER 133' t 33' I
INOr~ U R~ ~SEO ~PN~S OF / 31a•~6I iz
UNP~P~ 13.3~'1~"~ Irr
~
S89'30'00"E 180.45' °
Ir
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io
~~NE , I I ~Ln
SOUTH LINE OF 7HE NE 114 OF I n l I Z
THE NW 114 OF SEC17ON 33 I I I I
I
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NORTH LINE OF THE SE 114 OF
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IC WELL SEPTIC 0 I I I o ° o f°
y p :~10USE • d VENTS IN N I j
LOT 1 N I° I w l< Im r
lmp W d I I O i0 rt m o m
Ir Or Ihi~ WO M I- IM P P a
Z TOTAL AREA: Z I m o I M % I n I I~ o
j~ Ir = 2 m
I° 286,229 SQ. FT. / 6.57 ACRES jl I o
I (n O CJr~ l I N Z iD ~C j~ O o 0 0
i n
14 AREA EXCLUDING, R 0 W• ~w vs o I w Irn a 46
Id J 261,565 SQ. FT. / 6.00 ACR~S -4::E I o I i-' I~ ~o
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UNPLATTED LANDS OF OWNER I I i•..l a 0 N o
LEGEND: a ° °
County Section Corner Monument I J Zo 33• I p 0 a
of Record
• Set 1" x 24" Iron Pipe weighing I Pv CA. Cn I y
a minimum of 1.13 pounds per SOUTH 114 CORNER cn W I y
linear foot. SEC. 33-31-19 0'
O Found 1" Iron Pipe (ALUM. CO. MON.)
R= Recorded As
JOB #98270 too o too I. r..
t. ,
Prepared by:
A & E GRAPHIC SCALE i~
LAND SURVEYING & CIVIL ENGINEERING SCALE IN FEET: 1 inch = 100 feet NO TH
Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE NORTH-SOUTH 1/4
109 East Third Street, P.O. Box 325 LINE OF SECTION 33, TOWNSHIP 31 N., RANGE 19 W.
New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S01'31'30"E.
Sheet 1 of 2
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DEPARTMEWPOF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O.'BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707
State NUI%, Section 33 (If signed) Number
T31 N-R19W ®CONVENTIONAL El ALTERATIVE
El Tam Holding Tank 1:1 In-Ground Pressure ❑ Mound
A O R: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
45 S;fteet Thotc Sandeu Rt. 1, Sometusex, W1 54025
C~/a 9
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. V
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Donavin Schmitt 3205 St. Ckoix. 135530
SEPTIC TANKA of S} M e Cloacr = /a/, 44 MANUFACTURER: LIQUID CAPACITY: TANK INLET TANK OUTLET WARNING LABEL LOCKING COV R
PROVIDED: PROVIDED:
GcJPP S Gp 9 9 YES ❑ NO ❑ YES NOS
BEDDING: A/b _4lk: Al HIGH WATE NUMBER OF ROAD: PROPERTY' WELL: BUILDING: VENT -pb FRESH
e ' , C-6 ALARM: FEET FROM LINE: /f. AIR IN ET'
❑ YES NO 41 ❑ YES NO NEAR
EST-~ I ~Q
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ~ I I ~ ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST -1►
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 SYSTEM 8
BED/TRENCH WIDTH: LENGTFF NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
C,2J TRENCHES: / E a ~ PIT DEPTH:
DIMENSIONS d J
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: N DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVEWV ELEV.. INLEA~ ELEV. ENDV ,J-S7h L) ~7~ PIPES: FEET FROM LINE: / AIR INLET: /
/ - / Uv :5 ` l~?VG NEAREST E,
MOUND SYSTEM S
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.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED JDEPTH 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: NO. 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
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
Rplaf~ in county file for audit.
Sketch System on
Reverse Side. SIGNAT E: TITLE: 5S f
Zoning A&ni s7 tt tat
SBD-6710 (R. 06/88)
n
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~J' w"
-^..~,.,..~,,....~.,~..,e. 1
-Attach complete plans (t0 the county c0PY only) for the system, on not less than STAT~EVS--ANITARY PERMIT #
paper / 5'S3 ej
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 OWNER PROPERTY LOCATION
5LC 4''/4,S T ' /,N,R E(or W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
A
CITY, STATE J ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLLLAGE : NEAREST ROAD
❑ Public1 or 2 Fam. Dwellin s
g # of bedrooms PARCEL AX . UM )
III. BUILDING USE: (If building type is public, check all that apply) ~ / 032 1 El Apt/Condo r ,6
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1 O r Recreational Facility
3 El Campground 7 El Merchandise: Sales/Repairs 11 Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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) ELEVATION
Feet 100,z) Feet
VII. TANK CAPACITY Site
in allons Total Prefab. Fiber- Exper.
INFORMATION New rTan stin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks k s structed
Septic Tank or Hold! n Tank
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.
Plumber's Name (Print): Plum r' Signature- (NO St s) PRSW No.: Business Phone Number:
lu D ber' Address (Street, City, State, Zip Code).
IX. COU TY/DEPA TMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing gent Signature (No Sta
Approved ❑ Owner Given Initial yS.~ d Surcharge Fee)
Adverse Determination (v
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-8398 (formerly Plb-87) (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
submitted to the county prior to installation.
5. Onsite sewage systems must be properfy'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; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
' APPLICATION FOR SANITARY PERMIT
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 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.
Owner of property I. ~ ~ /4 ry+,r F
Location of property AI 1/4 8 ►s1/9, Section, T N-R W
Township y-►~_„r~.=r-3 tf'
Mailing address L I od)
Address of site
Subdivision name
Lot number
Previous owner of property C
Total size of parcel (7 ~C y es
Date parcel was created
Are all corners and lot lines identifiable? Yes _ No
Is this property being developed for resale (spec house)? Yes No
Volume !Z23 and Page Number _ as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, 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. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the.County Register of Deeds as Document No. 4-53j~ 9Z)• ; and that I (We)
presently own the proposed site.for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
Counts' Regi, er of Deeds, as Document No.
Signature of Owner Signature of Co-Owner (If Applicable)
Date of Signature Date of Signature
' Form - S T'C - 104
• _ • AS BUILT SANIT/1RY' SYSTEM REPORT i
• • Nil
OMER o / AJ
f s7~~ C TOWNSHIP c Yjme
~y mf~~. SEC. _ 33 T
ADDRESS I •oC
ST. CROIX COUNTY] WISCONSIN
00
i SUBDIVISION _ LOT _
LOT SIZE
• _ PLAN VIEW
Dig, teacee and dimensions to 'j1`'rt•
meet requirements of IyNt:%83'.
SHOW EVERYTHING WITHIN '100 FEET OF SYSTEM
• 4111.11.•.,, ,
001
fie'sf~ 111 I~s',11
rd lot
• ~ dc'. ~ ' a C 1. - - _ t vim'
• i✓ :'Its. . • V
INDICATE NORTH ARROW .
BENCHt Describe the vertical reference point used
• Elevation of vertical referencepoints
Proposed elope at site:
' 8LT'rIC ?ANICs ~
Manufacturers •
Liquid Capacityt //0,1-V)
• `•'••'•NumbsE of rings usedt
--I- -Tank manhole cover elevation:
' Tank Inlet Elevationt
Tank Outlet Blevationt
Number of feat from nearest Roads ,
• 1 • . Front,Q Side,o Rear, 0----Lg,5:
-
-From naarest• property line i -Front, Side Rear feet
O •Qtest
Number of feat fromt well
• (Include this information of ..the above plot iplan)(y re O / •
• Terence dimensions to septic tank)
SFR Rump srDE
1
PUMP CHAMBER
Ma facturer: Liquid Capacity:
Pump Mode Pump/siphon Manufacturer: Pump•Sise
Elevation of inlet: Bottom of-tank evation:
pump off switch elevations C one per cycle:
Alarm Manufacturerx Switch Type:
.i•.. •Number of feet fiom;nearest roperty lineff'• Fron Side*ORurs0 Ft.,~-
`Nu r of feet from wells
umber of feet from building:
lude distances .on plot plan).
SOIL ABSORPTION -SYSTEM'
Bdd:• • yL=S ; • Trench s
r t Lengths
Width: Number 'of Lines:_ • , Area Built: -JI Fill depth to to of pipe: ^_A6= 716~
'7 40
Number of feet f fim nearest property line: Fronts O Sides Rearjo 1t.
Number of feet from well:
N or of feet from buildings
(Include di Lances on plot plan). '
S ACE PIT
g = Number of pits: Diameter:
Liquid the Bottom of seepage pit elevation:
Area Built:
Has either a drop box r distribution box O been use n any of the above soil
absorbtion sytems? (C eck one
HOLDING TANK
Manufacturers Capacity: _
t
Number of'.rings 6sed:• levation o bottom of tanks
• Elevation of inlets
Number of feet from crest property lines Fronts Side, O Roars 0ft.-
Number of feet from well:
Number of feet from building:
Number of fast from.nearest roads
arm Manufacturer:
Inspector:.
Dated: ak Plumber on jobs
License Numbers
t I.:
.
3/84:i j
1 '
DOCUMENT No• ~ISTATE BAIL OF" WISCONSIN FORM 1-18n8 P 70116 &F^I;E RE$ERVEO FOR RECORDING DA1A
I WARRANTY DEED
• 459390 vrl I1
II 8l73 PAGE 53
GLEN BRAE, REGISTER'S This Deed, mado between ....a Partnership ~F~~~~
coxis.1a.til)g. -~:...];.r...BakeK , In1i,~liam M. ~ ST. CRAIX ~O.;~
Bakex...and .He.nry....`.....Ru.tj.Qdg.Q . l Reed for Reeord
an(] ..............TH:OR..SANDERS............................:.................., Grantor, ~ JUN 081990
. at it 10:55 A. M
. Grantee, 'I Regiaterpfp °
witnOSSeth. That the said Grantor, for A valuable consideration....,. I~
conveys to Grantee the followinx described rool estate in ...,~~.....Cx.Ai.~c....... If nnuhN To
" 'I
County, State of Wl■consin: ~I
Tax Parcel No
NE 1/4 of NW 1/4 EXCEPT the North.10 acres
thereof and N 1/2 of SE 1/4 of NW 1/4, ALL
in Section 33-31-19.
t 1~
This deed is given in satisfaction of a Land Contract dated April 1, 1989
and recorded April 3, 1989 in Volume "837", page 87 as Document No. 446570.
Thin . ••.,i.s riot homestead property.
1i}O (16 not)
Together with all and ■ingulur the hereditaments and appurtenances thereunto belonglnn;
And:......... GLEN BRAE
warranut that the title 1■
good, indefeasible In fee ■irnple and free and clear of eneumbranree except
recorded easements and rights.of way.
and will warrl4nt and defend the .anlo.
Dated thin ..........21st day of 1!m..................................... 19.90 ,
GLEN B:
By . Roaker (PEAL) k3y (SEAL)
,Partner Henry T. Rutledge, Partner
By.:..
...4.4"......... (SEAL) . .......................(SEAL)
William M. Baker, Partner
• .
AUTHRNTICATION ACKNOWLHDGMRNT
Signatufe(e) STATE OF MINNESOTA
......Hennepin County.
.
authentlcated.thle ........day of... 19...... Personally came before me tills ...cl,~ day of
19=1.Q.._ the above named
Roger...L..._Bakerc, William M. Baker
& Henry _T ! Rutledge, pa rtners o_ f
TITLE: MEMBER STATIr FAR OF WISCONSIN GLEN BRAT' Partnership
(lf not,
aull~nrtzed by •
700,08, WIS. Stuta.)
to me known to be the person .5....... , who okecuted the
forogoing instrumont and ac to led a the same.
THIS INATkuMF.NT WAD DRAFTED UY 1•
James W. Peter
. j .....,"l~.l c.............. ~
Notary Yubllc in
....C.ounty, . MN
(Signatures may be authenticul.ed or aeltnowledged. Both Afy C'onlmiiidon Is permanent. (lf not, state expiration
are not nocYtmary.) rCh 2 3 9 5
date:........ ,r
Woonts of penona dxnlnIr In any eapaoity vhuuld hr lyprd ur printed ht-low thdr alanatnrm JAMW.PM
NOTARY pUSI l y~~ ~1J
N'AnnANTY DEEP NTATx IlAlt of WIHl ~hni 1 0. Inc.
NORhi N~t No. ! - t942 9g4 My -f
M
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
'c~g~
ROUTE/BOX NUMBER" FIRE NO.
CITY/STATE- ZIP
PROPERTY LOCATION: 1/4, Section 13
T 31 N RW
Town of St. Croix County,
Subdivision , 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 for a MAXIMUM of
$3000 of the cost of replacement of a failing system, which was in operation
prior to July 1, 1978. St. Croix County accepted this program in August of
1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their
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 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 form 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 Department 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 date.
SIGNS
DATE S "
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
DEPARTMENT OF REPORT ON SO"1I+ 6~k ANA S~t~1~tTY&BUILDINGS
INDU` 'rR Y, REP
LABOR AT~JD " y~ ~ DIM Mill)
IRIP0rr,N RELATIONS ~ PERCO
LATIOf~.w~~l TS (115) P.O. BOX 79ill-,R
(1-163,03(i) & ChApilltrf.149,048) 414 MADISON, WI 5:tiw
` TOWNS I / UNICIPAL , _ LOT NO.: SU
`E.__t/ A41 33 731 14/0 196rt'W north part Somot~~C ~;t >rr n/a _
r,all.)N i r: OWNER'S ~ 2 .
SI.
Croix Thor Sandeta
U; c + ..r.,,. <.06 Wi~..St.: ,.Apt. #206Htfdaa>~if34 t"54016
r, f Y DATES dI§89.hvATI0N9MAt3E
NO. B s CR T O
X~Rtrsi;)nnce
3 I:1t, " I ;n/e , • ! [ ew ~ a`! RO ~ 1 . P€ ATioPTiF2 I
4-4 4j--q0
ft11TING S- Site suitable for systam it Uill' $itr tiAeultlibls forsysteltl l
t e
rOrJ~/FtJrfUNl1'l: ND: IkTliiilllljj~'~11
:c;r'rJ I i i, !
P S U : S K: RECOMMENbE ISYST~M.Ioptior1a11
(~,J u ❑i entibal l
U conv ~ 1
Ii rprcolation Tests are NOT requltlld,~,;,t 1 TE: , t v - -
r,n=tar 5.1163.09(5)(b), indicate: 111160 of the tested IIIM III IM fh#
n
11/a P►e iA,A, indicate Floodplilh'k*g!#)6M
PROFILE DESCII)PTIONS
Pr)~Ir.lr, rOT
64601110160m, ,
(iM Iv7tiLFZ DEPrii`ij j ELEVATION ATE -N S CHARACTER '
S S 70 9 OIL WITH T KC E, ANC) FEri!1
OBSERVED (SEE A 0 V. t) ill ~ACK,I
D 6.50 98.45 none >6.50'
8- 6.91 98.45 none y
>6.91 58bl"Ji 1.17bn.s.1. 6,d i
A'Agrr 4.58bn.c, `:s r
13- 3 8.00 100.65 none >8.00
.50b14i751m.sil odb~►~
8 4 8.00 102.24 none , -
>8.00 .75b ,08bn.s.sj1V -.x.14 &gr.
B-5 8.66 102.25 -
none >8.66 . .75b11.08bn.s.sil tlvbilil ►rgr. 5 151_)tt.
k
3-decimal' PtACOLATION MTO :rx Y
TF~T DEPTH WATER IN HOLE a '
NUMBER I AFT ERSWELLIN MIN
S IM VEL-IN RATE INU(EST
M ER
1
P° none ~ + ,RATE INCH
P.2 2.33 none
-P none <3
P
P
! PLAT PLAN: Show locations of percoiatlort teFlj~ toll borings and thi dimensions tit iA>iblr roil areas. Indicaft Ili th e h~' i
'Zontai and vertical elevation reference
polhtr Af1tt ihtri+il their location i~flLlFlbe What are
of land slope-
ti
6A the plot eft ~1l16W the surface elevlt1116h *41 tfifl A1" 4I►e direction and r•-r,pr,r
SYSTEM ELEVATION for orig. site 91* foiL alt. sitei~
T
_ w+e' y .V 1.
O - -
i „r rig fh
Pill
hyy IV
.
J
pt_
.J r
. ' 7! LL raw
r
ill -7
777
g
- _ a
Y
I, the undersigned, hereby certify that the toll tar(r'.i• 0ott6d on this tallith were made b h Administrative Code, and that the data reCOrdt4 Alltf the lots A adcard
ivith the pro III Ifled In the Wisconsin
tionof fhe teiti ere cotreCt host bf fny knowledge lfll 'fliitl M+r!
NAME print : rr { r 1 , `rj+ty~ a L i~,~ r r r 3f::iir~f
TESTS WERE C
Ga L. Steel :r liI
A s$ 4-4-90.
Shore Dr., New ChWhd UL 5401 CERTIFICATION Ht7N UMBERloptionall:
' 2298 X46
-6200
CST
t r,, SIGN
ISTRIBUTION: Original and one Copy to Local Authatity, Property Owner and $oll TMt~f~j,
ILHR-SBD•6395(R.02/82)
-oven=~Y F w;.~', F
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