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rI� $ CROIX COUNTY ZONING OFFICE
N
P. 0. Box 98 a k
Hammond, WI 54015
Telephone - (715)796-2239 or (715)425-8363 E
The St. Croix County Zoning Office offers the service of septic and water inspec-
tions to Lending Institutions, Realty Firms, and private individuals.
Completion of this form is essential so that the property can be located.
. Please provide the following informat ion,enclose appropriate fee made payable to
St. Croix County Zoning, and mail, along with form to the above address.
Testing will be done as soon as possible after fee and form are received.
WATER TESTING 0 FEE: $25.00
(For nitrates and coliform bacteria)
SEPTIC SYSTEM INSPECTION. . . . . . . . . . . . . . O FEE: $25.00
.(Determines if system is properly functioning at time of inspection)
Property owner's name
Legal Description 114 of the % of Section _, T N-R.Z 7 _W
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER ��.�• <
Color of house Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e, COPY OF PLAT BOOK, WITH LOCATION SHOWN,
AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If the home is vacant,
and has been so for some time, the water line must be purged by running the water
for several hours before the test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off,
making access to the home necessary. If this is the case, please make proper arrange-
ments with this office to ensure time when entry may be gained.
Firm or individual requesting services: f �� ,r,��( Phone No (,_- 107
REPORT TO BE SENT TO:
r
CL�O�S�ING DATE: /� J — 1? 9 ,
12/85:mj � � �� Signed -� - -
��,(� Agent or Individual Making Request
ST. CROIX COUNTY
WISCONSIN
EMERGENCY GOVERNMENT OFFICE
Y"' y ST.CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON,WI 54016
_ (715)386-4680
October 10, 1989
Carol Farrell
706 19th St. S.
Hudson, WI 54016
Dear Ms . Farrell :
An onsite investigation of the septic system of Joseph and
Karen Johnson was conducted at NE4 of the Wk of Section 21,
T29N-R19W, Town of Hammond, on October 6 , 1989 .
The Septic System was found to be failing and replacement of
the system is required. A violation has been sent to Mr. &
Mrs . Johnson.
Should you have any questions regarding this subject , please
feel free to contact this office.
Sincerely,
Mary Je k s
Asst. Zoning Administrator
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526 k4j
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227 4:0k IS&
ST. CROIX ZONING REPORT NO.: 34658/01 PAGE 1
ST, CROIX COUNTY REPORT DATE: 10/06/89
COURTHOUSE DATE RECEIVED 10105189
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
OWNER; Joseph & Karen Johnson
LOCATION; Town of Hammond
COLLECTOR: St. Croix Zoning
SOURCE OF SAMPLE. Outside faucet
COLIFORM: 0 /100 ml
INTERPRETATION! Bacteriologically SAFE
NITRATE-N: 11 ppm
Under 10 ppm is safe for human consumption,
COLIFORM + NITRATE
LAB TECHNICIAN: Pam Gane
WI Approved Lab No. 19
`�.\NOEVENpE�rG -
,i L
V
{ Means "LESS THAN" Detectable Level Approved by:
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
'COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
ST. CROIX ZONING REPORT NO.: 35216/01 PAGE 1
ST. CROIX COUNTY REPORT DATE. 10/20/89
COURTHOUSE DATE RECEIVED; 10/18/89
HUDSON, WI 54016
ATTNS THOMAS C. NELSON
OWNER! Joe 6 Karen Johnson
LOCATION: Rt. It Hammond
COLLECTOR: St. Croix Zoning
SOURCE OF SAMPLE: Kitchen tap
COLIFORM: 0 /100 mt
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 7 ppm
Under 10 ppm is safe for human consumption.
COLIFORM + NITRATE
LAB TECHNICIAN. Pam Gane
WI Approved Lab No. 19
OE.\NDEPENpE�
V
0
v s
d ti. S Means "LESS THAN" Detectable Level Approved by1
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
DITTLOFF ENGINEERING GO
Civil Engineers & land Surveyors
Eau Claire and River falls, Wisconsin
f
"Name John R La it ;
f
I` Address Red Lodge, Montana 59068
I s
I Description A parcel of land located in the NJ of the 6f. Section 210,
T29N, R17W, Town of Hammond, St, Croix County, Ifisconsin described as
follows: Commencing at the NW corner of said Section 21; thence S8901619
(assumed `bearing) 1317,18' along the conteyrlifiaa of presont U.S. Highway
12 to the oint of beginning; thence 50°44 N"" .4G5,5' along the West line
of said IM of the N;V thence S89016'E i008 0 t • o ' 5' •
f , thence t�0 44 E 465. ,
thenco M89 161W 1008,0' along said cpnterlino of prosont U.S.91abway 12
;., to the point of beginning; except the Northerly 3311 . 90W U.S., KILatswS7 12
right-of-way,
19.7 FROM CENTERLINE
".OF CULVERT.
BEARING)
POINT OF BEGINNING
� ��ASSC1MEb. + ,;
{ •, t
S89016'E 33{ C NTERNE U.S. HIGHWAY 19---=V,° 33{
LI
1317.18 1008.00{ + , 309.18'
A�W CORNER N 89-164 W N 1/4 CORNER
W .
10 ACRES EXCLUDING HIGHWAY RI, F,F WAY t[in f
At
W15tT' LINE, OF �
NE 1/4 OF'THE NW 1/4
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x SCALt OF MQP 1 INCH � 200 1 Feet Y. 4 IRON• STAKES:FOUN1?
State of Wisconsin )
Ai
0 IRON STAKES;ORIV£N;
h County of Pierce ) ss.
Frnnci.s H. Ogden registered Wisconsin, Land Surveyor, do hereby certify that,'
On IToyom ar 6 19 1 surveyed the`above described and h•tap6ed property according, jo
f the official records and that the accompanying map is a correctly dimensioned representation, to schle of the boundaries, that
all buildings and improvements lie wholly within the boundary lines, and that no enroachments by adjoining owners appear'
i0G9G196i��Q
from' said survey. °
d.a'�'�
Detailed by D,, Halverson �,,+ A,
i FRANCIS H. '�
OGDEN t ,
' Traced by. s 8132 E f}"CAP
R RIVER FALLS,
i, .,Field Book Page �� °^..• O�►°. i` t . � Map No 70-102-CBs:
AAA L _
Form - S T C - 104
AS BUILT SANITARY SYSTEH REPORT
OWNER r oe Flo 14 04 _ T014NSHIP ~Qrr~~Yld SEC. ZI T2 N-R 17 w
ADDRESS ST. CROIX COUNT, WISCONSIN
ommci'IL~'~ ~~'Yl(SYI~ s l D , S
SUBDIVISION LOr V14 _ LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
S11(7W EVERY) II ING WITHIN 100 FEET OF SYSTEM
6
GJe l l
Ews~°
> ✓ent
-
~ ~ iz X8o Bed
zo '
o /ooo a~. , Se ~ 2'71~
/73~ / /.ZOO I
~yr~~Fi•om Ro% f"o
SeP~/c /an9~
INDICATE NORTH ARROW
11<E11CtQ{ARKI Describe the verticnl reference rr,tilt t+sed -1-lo"p of ; (opDG'Y A/A2 / nee
Elevation of vertical reference point: /00,0 Proposed slope at site: ~10
SEPTIC TANKI Manufacturer: _ Cc~ei~er- l,Jgidd Capacity: /000 alp
Number of rings used: f-i've-__._. Tank mnnhui.e cover elevation: /0 Z-35~
Tank Inlet Elevation: •/~o_ Tank Out.t.-.A. Llevation: 95%g/
Number of feet from nearr, ..:~0Rear, 0 feet
From ncsieat ptol,cA. ; i.Llie : 1'r~nl,t, L 1~ Rear,
0 /00 -f fee[
PUMP CILOSER
Manufacturer: Liqui% Cnpsci y:
Pump/Siphon Man actus-sr: r Pump Size
pump Model:
Elevation of inlets }30 0 of to k / e ations -
Cnll s e yclas
pump off switch elevation:
Alarm Manufacturer: Al itC Typal
cone. 0 Sides oRaars O
Number of feet from nearest property line.
Number of feet from well:
.Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION 9YSTEH
Bed: Ye S _ Trench:
Widths LeniEh: Number of Lines: z Area Built:
Fill depth to top of pipe:
Front, ®Side, RearsO 0Yt . /Z57
Number of feet from neareat property line:
Number of feet from well.:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Number of pits: Di star:
Size:
1 *vat ions
i t,
pit
Bottom of epn6
Liquid depths
Area Built:
Has ait~se= a drop box O or distribut n x be n u'tad on any of the above soil
absorbtion sytems4 (Check one).
HOLDING TANK
Capacity: ~
Manufacturer:
n of tank:
Number of rings used: _ E1 'Pdng
Elevation of inlet:
Number of feet from nearest prop r nt, O SidesOAaars OFt.
Number of fe t f Number of feet rom bNumber of feet from nearest road
:
Alarm Manufacturer:..
Inspector:..
,<~z" f✓""`-~`~
Plumber on job:
lI -7-~9
Dated:
License Number: NI h G~79
3/86smj
II~
MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
DIVISION
L
11 ABOR & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
P.O. BOX 7969
ADl State Plan I.D. Number:
N.'gSp~l, , e C7 21, t29 - R 17W (If assigned)
Town of `,Hammond ❑ CONVENTIONAL El ALTERATIVE
Ct Y. Hw . 12 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
NAME OF PERMIT HOLDER:
Joe Johnson t.l Hammond WI 54015 11- q
REF. PT. ELEV.: CST REF. PT. ELEV.:
BEJJCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLA r
~",~t ^ ~ 6
Name Plum r: MP/MPRSW No. County: Sanitary Permit Number:
Dale E. Hudson 6629 St. Croix 135359
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
n PROVD~ED: PROVIDED:
o vl ~p . ~ 2"YES ❑ NO ❑ YES NO
BEDDING: , VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL, BUILDING: VENT TO FRESH
ell M: FEET FA > LINE So 2 AIR INLET:
E__1 YES ~10 /I lALAI
❑ YES ~NO NEAR S~-~ f U O I U
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPAC Y: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WAHN EDLABEL pROVIDED:OVER
IN" ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PU A C TROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: AER NLET:RESH
FEET FROM LINE:
(DIFFERENCE BETWEEN
PUMP ON AND OFF YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the oil m stur at he depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
EPTHf°
BED/TRENCH TRENCHES: ( TERIAL: PIT / BUILDING: VENTDTO F RESH
DIMENSIONS ' V 1
LL
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: F PE R. NUMBER OF LINE: PROPERTY WE AIR INLET
BELOW PIPES: ABOVE COVER: L V. INLET: ELEV. END: ^ q FEET FROM / 1/0
!W_ t of NEAREST /gs o f J
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.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ 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:
WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
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:
[11 YES ❑ NO ES ❑ NO NEAREST-♦
Retajn in county file for au it.
Sketch System on TITLE;
Reverse Side. SIG E: t)"
SBD-6710 (R. 06/88)
1
SANITARY PERMIT APPLICATION
(ZY,0ILHR COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
4ttach complete plans (to the county copy only) for the system, on paper not less than ❑ f 7
8% x 11 inches in size. hec i revis 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
cToe- ,n<' %a'/a,S 2/ T q,N,R 17 1(or W
/
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
r7 , f / !A / ~t/
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
xn an 1Z)V- 1511015 911Z6$
II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD
Z
( ❑ State Owned ❑ VILLAGE ~,~,Q,l~ ~
C
N OF:
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(5)
111. BUILDING USE: (If building type is public, check Z11 that apply) Z
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
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) 1.0 New 2. Z 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 N 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) D ELEVATION
T -1 -115 D /3 z u ` 11o 9 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Hold In Tank GOO /~00 S Pd I F1 Q
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
PO O A2 a,'»
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No Stamps)
Approved ❑ Owner Given Initial d Surcharge Fee) O
I , Avers Determination -OUf1
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly PI15-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber
I
INSTRUCTIONS r=,Y
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; 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 sloe- CJoAnSoI9
Location of property N~ 1/4 Alld 1/4, Section 2 , T N-R
Township _W
Mailing address l~fAddress of site ,,Sarni
Subdivision name
Lot number
Previous owner of property (Jo/71~ GQ/~
Total size of parcel /0 A'C,rte,S
Date parcel was created ~eCefi2 e,- Zf /912J
Are all corners and lot lines identifiable? X Yes No v
Is this property being developed for resale (spec house)? Yes No
Volume -.5-0 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.
---------------------------------------------------------7---------------------
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. -3/ 994 ~ ; 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
of the Count Register of Deeds, as Document No.
i nat e 0 er Signature of Owner (If Applicable)
9-1
'44 /R- q X9
Date f Si nat re Date of Signature
6.
DOCUMENT NO. STATE BAR OF, WISCONSIN-FORM 1
ME44$ WARRANTY DEED
} 319964 BooK 50 PA THIS SPACE RESERVED FOR RECORDING DATA
REGISTERS OFFICE
THIS DEED, made between J ohn R. Lair and Karen J Lair,
ST. CROIX co., Wlta.
husband and wife.
Recd for Record this_ 26th.
Grantor day of-Pj gelnb4r _A.D.19_?3
and ...J-os.eph J. Johnson and Karen A Johnson husband anel
wife; as jgjnt tenants,
t----~0:~0---- A'M.
Grantee, C.
W i to e e a e t h, That the said Grantor for a valuable consideration Re fatal of Deeds
Twenty Two Thousand-and no/100 ($22,000.00 T~Q lara__
conveys to Grantee the following described real estate in St, t iroix County, RETURN TO
State of Wisconsin:
I.
West 1008. 0 feet of North 465.5 feet of Northeast
i 1
Quarter of Northwest Quarter (NE 1/4 NW 1/4) of Tax Key a
I
Section 21, Township 29 North, Range 17 West. This is _-homestead property.
I~
I
This deed is
~j ( given in fulfillment of a certain land contract between the
above parties, dated December 28, 1970, and recorded on January 5, 1971,
It
r in Volume 468 on page 192 as Document No. 303443 in the office of the Register
of Deeds for St. Croix County, Wisconsin).
I
I
FEE
w I'
#A 0
EXEMPT
Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;
,I And John
R,__Laix-and-Kax-en_J-Lair, hushar,d and u,-ife_, - it
I) warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances
'I If
and will warrant and defend the same.
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Executed at 1LP J - l' /t%~j.~_ -,na--------- this ? _ - day of
.
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19-7-1
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SiGNE AND SEALED )N P ESENCE OF (SEAL) ii
t John R. Lair I
_ ~aL f Ct<'i (SEAL) 11
Karon J. Lair
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' (SEAL) j'
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(SEAL) ;I
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Signatures of--,-.
III
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authenticated this day of 19
_ Title: Member State Bar of Wisconsin or Other Party
Authorized under Sec. 706.06 viz.
STATE OF Wt9EONSIN
_---_.c~'b~_!C_ County. ~C
Personally came before me, this day 1973,
the above named--__- John R.--Lair-and Ka_r-en.J. Lair,_husbancLAndAuifet_ - _ _
5
to me known to be the persons - who executed the foregoing instrument and ackn~t~
k le
This
instrument was drafted bye' uOt^'c'- rd 1lis
Charles E. White, AU (D pig, Notary Public ~ ~~vanry,irts-
Diver
The use of witnesses is optional." My Commission (Expires) (Is) / r^/
Names ul pir. on.: signini; in any cap, c,ty should INl typed or printed below their signatures. HGM~i~ Corrps~®
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1' - 1971
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
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OWNER/BUYER e cl o /ISO
ROUTE/BOX NUMBER ~f Fire Number
CITY/STATE 11-Iq/I21970/Ja /.(/i ZIP
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PROPERTY LOCATION:/Vy- 14, / k) Section e_'l T 4'9N, R1_W,
Town of ~Q/yl/Ylp~~ St. Croix County,
Subdivision /f/ 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 septic tank pumper. What you put into
the system can affect the function 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% 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 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
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I/WE, the undersigned, have read the above requirements and agree z
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to maintain.the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- ro
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 date.
SIGNED
i
DATE
St. Croix County Zoning Office
P.O. Box.. 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
IIVDUS DUSTRX, DIVISION
LABOR AND PERCOLATION TESTS (115) 7969
MADP•O.ISON, WI BOX 53707
HUMAN RELATIONS 3707
HUMAN
(H63.09(1) & Chapter 145.045)
LOCAkTI ~ :N, SECTION: TOWNSHIP/MUNICIPALITY/ ILOTNO.:BLK.N(5. : SUBDIVISION NAME:
to
L / / 21 /T2 9NlR/ ,9
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
2' e' a a e ondo z,
USE DA ES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: DESCRIPTIONS: ER A ION TESTS:
Residence a ❑New Replace 1PROFILE
A5) -/Or O9
RATING: S= Site suitable for system U= Site unsuitable for system
CONVEN
12STIONAL : MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
S ❑U $ % ❑U $ ❑U ❑ S ®U ❑ S ®U
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09151(b), indicate:
A/A I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B / ,qZ V,52 r~ •'7~~alsA~ A25-~~ -7~'~ •5~&n s-3° 7Z 1~ eo
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B- 7, Z5 9Z,93~ le ~'Z~~ •3'~~ls~~/413nse/%D~ ~Lj'n~
B- 3 7-Z7 93,y~/ ~ lVnoe, 7-27
•8~ L~ls,~ Jb ~ ~ ns~ o~ f s
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER }PIGMIES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 --PERIOD 3 PER INCH
P- +33 e- /0 2 i 7- Z -5-
P- z z • o Z
P- - Z. 3' o 3 3
P
P-
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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 5201 F
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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:
/D -
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SI NATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER -
INSTRt-1CTIONS FOR COMPI-FTING FORM 11, S13D 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 systern;
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 t-. , for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
Make sure your benchmark and vertical elevation reterence point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion if appropriate;
10. If the information {such as flood plain, elevation) does riot apply, place N.A_ in the appropriate box;
1 1 . Sign the form and place your current address and your 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
coh Cobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestone
*s - Sand HGW - High Groundwater
cs Coarse Sand Pere Percolation Rate
med s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
Is - Loamy Sand > Greater Than
*sl Sandy Loam < Less Than
*I - Loam Bn - Brown
*sil - Silt Loam BI - Black
si - Silt Cry Gray
*cl - Clay Loam `r Yellow
scl - Sandy Clay Loam R Red
sicl - Silty Clay Loam mot Mottles
sc Sandy Clay vv,/ with
sic - Silty Clay f f f few, fine, faint
*c Clay cc _ common, coarse
p1. Peat r i i n Many, medium
rn Muck d - distinct.
p - prominent
HWL - High water level,
Six general soil textures surface water
for liquid waste disposal R%A - Bench Mark
VRP Vertical Reference Point
"tJ THE OWNER:
This soil test report is the first step iro secur r.t. The county or the Department l-nay request
verific:atic,n of this Soil test c c A co to s,"A of pl for the private
Sf /,We system and a p8 3ocai 111 C.rdr" {j
(Main a pcrm4, The.sanit<a€.::° St; rt c?3 3ritj C I~. lt.C:iCsi;.
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