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Parcel 020-1159-63-000 03/06/2006 12:52 PM
PAGE 1 OF 1
Alt. Parcel M 16.29.19.906 020 - TOWN OF HUDSON
Current [Xj 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
O - LORENZ, JAMES & CAREY E
JAMES & CAREY E LORENZ
578 SPURLINE CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 578 SPURLINE CIR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 4.370 Plat: 2216-NORTH LINE STATION II
SEC 16 T29N R19W NORTH LINE STATION II Block/Condo Bldg: LOT 15
LOT 15
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
16-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 786/301
07/23/1997 771/246
2005 SUMMARY Bill M Fair Market Value: Assessed with:
92771 415,000
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.370 78,500 344,800 423,300 NO 05
Totals for 2005:
General Property 4.370 78,500 344,800 423,300
Woodland 0.000 0 0
Totals for 2004:
General Property 4.370 53,900 259,900 313,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 139
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
v '
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
I
OWNER Sim LoRz -NJ( TOWNSHIP HLAD50N SEC. T~LN-R-LLW
ADDRESS ~ U. cZ } ril C1RS.Ie ST. CROIX COUNTY, WISCONSIN
SUBDIVISION I ) N LOT V15-
LOT SIZE
5+-A ION
PLAN VIEW
Distances and dimensions to meet requirements of IM 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
$x43_ 1L
~0'
z
%Mc~ MARk)4011~ 11a" ROp
a
lY' ° ~d 005,E
BF-DKOorv\ R01ykF
INDICATE NORT ARROW
BENCHMARK: Describe the vertical reference point used III, St~e,l ~Ob
rr~~ c
Elevation of vertical reference point: too. V Proposed slope at site: I o
SEPTIC TANK: Manufacturer: ee ks Liquid Capacity: V V
5Aot 6A5cmod
Number of rings used: - I Tank manhole cover elevation: I\I~• ~p
~~002 6K Mrd?-~ Tank Inlet Elevation: 7.7(p Tank Outlet Elevation: (l 3C~
p Number of feet from nearest Road: Front,O Side, Rear, 0
Sh~>''• y.3~ feet
jo o,bo
I Vy 3 6, From nearest property line 'Front,O Side,O Rear, 135 feet
Number of feet. from: well , building:____] - 77 y
(Include this information of the above plot plan)( 2 reference dimensions to septic tank) J
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan). 5 1*{,-, .7) HehoEZ a e~00 a C
SOIL ABSORPTION SYSTEM too, 7-5
~N9 0 018 _ t/
10~13err 1
/ i_-.
Bed: Trench: 9.$0 6eo
Width:_ 1SL Lens'th: Number of Lines: Area Built: O
Fill depth to top of pipe: ~ - l
Number of
feet from nearest property line: Front, Side Rear Pt.
O O
Number of feet from well:
Number of feet from building: 8 8
(Include distances on plot plan).
I~ SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: v~I ' 9 Plumber on job:
License Number: TTRS 037(9-?)
3/84:mj
l
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR HUMAN RELATIONS DIVISION
' 'P.O: BOx17969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
Vk,'x7k,S16,T29N-R19T,%T -'CONVENTIONAL ❑ ALTERATIVE (Ifassigned)
Town o-l" Hudson
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
E ADDRESS OF PERMIT HOLDER: INSPECTION D T :
James Lorenz Spurline Circle, Hudson, TdI 54016 2-A7- 9 60
BEN H MAR K (Permanent reference point) DESCRIBE IF DIFFERENT F OM PLAN:. REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber P/MPRSW No.: unty: Sanitary Permit Number:
dff 1059 St. Croix 119425
SEPTIC TANK/HOLDING TANK:
MANUFAC URER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
-7 PROVIDED: PROVIDED: j
7- ~ 97/ -7 ! t 3, 6, YES ❑ NO ❑ YES 21q0
g'rv `
BEDDING: VENT IA.: VENT MAIL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE' AIR INLET:
❑ YES NO C ❑ YES ❑ NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/ PHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI NA NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES N NEAREST 111111-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of pl in FORC LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall ceas u t' MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WI TH: LENGTH: NO. OF-/ DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
TRENCHS': L' I MATERf PIT j DEP
DIMENSIONS /
BER OF PROPERTY BUILDING: VENT TO FRESH
GRAVEL DEPTH FILL DEPTH ;ELEV. ST I E DISTR. PIP DISTRPIPE MATERIAL: nrzREST
BELOW PIPES: ABOVE COVER: INLET: ELEV. EN LINEAIR INT FROM
Z, 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:
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
S3Y
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS:
q9 ?i FEET FROM LINE:
❑ YES ❑ NO ❑ YES F-1 NO NEAREST
Retain in county file for audit.
Sketch System on -
Reverse Side. ATURE: TITLE:
SBD-6710 (R. 06/88)2C , Zoning Administra.tOr
61
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
FAX - 715 - 962 4030
ST. CROIX ZONING REPORT NO.: 42658/01 PAGE 1 j
ST. CROIX COUNTY REPORT DATE: 6/10/93 a
COURTHOUSE DATE RECEIVED: 6/04/93
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
I
OWNER: James 6 Lorey Lornez
LOCATION: 5T8 Spurline Circle, Hudson
COLLECTOR: Jim Thompson
DATE COLLECTED: 6-02-93
TIME COLLECTED: 1:15pm
SOURCE OF SAMPLE: Outside tap
DATE ANALYZED:6-04-93
TIME ANALYZED:11:00am
COLIFORM: 0 /100 ml
INTERP'R'ETATION: Bacteriologically SAFE
NITRATE-N: 7 m
PP
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
9 10
vG oc
l y f
VGr9 . ~y r
LAB TECHNICIAN: Pam Gane ;
OF.%DEPE DEN 19 tell
~pp WI Approved Lab No. 19
y
< Means "LESS THAN" Detectable Level Approved by:
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
ti 11 12 CQ ~ N~
RECEIVED T. CROIX COUNTY ZONING OFFICE ,
St. Croix County Courthouse
MAY 8 1993 911 4th Street g
cp ST CROIX co Hudson, WI 54016
COUNTY ~ ~
ZONINGOFFICE Telephone - (715)386-4680
The . C County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form i Pssential aQ that tbe property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, 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--------------- --FEE: $ 35.00 V
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 lv~
(Determines if system is properly functioning at time of
inspection)
PROPERTY OWNER'S NAME:
PROP. ADDRESS: 5- IS `_.n- U .C t h Q G fCA CITY SOIL
Legal Descri tion 1/4 of the 1/4 of Section , T N-R
Town of - l {GC~Sbh Lot Number Subdivision:NO• 75-,k S L)Y\ ,U
FIRE NUMBER LOCK BOX NUMBER r2-0-11'5_q -6,5
-/Om-.111
C
olor of house Realty sign by house?V If so, list fi n
PLEASE INCLUDE, IF AT ALL POSSIBLE, A ,i.e,COPY OF PLAT BOOR,
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 arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:
Telephone Number
REPORT TO BE SENT TO: ON M"JIM C4 ME
somw sG-tpv~d~~ I
HU&N. VA 508
CLOSING DATE: It r"s seem
Signature
J
s ,
• ST. CROIX COUNTY
r WISCONSIN
r - ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
June 3, 1993
Michelle Dunckel
MidAmerica Bank
600 - 2nd St.
Hudson, WI 54016
Dear Ms. Dunckel:
An inspection of the septic system on the property of James & Carey
Lorenz at 578 Spurline Circle, Hudson, WI was conducted on June 2,
1993. At the same time a water sample was obtained for testing.
The results of that testing will be sent to you as soon as we
receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Should you have any questions, please contact this office.
Sincerely,
v
ames K. Thompson
Assistant Zoning Administrator
cj
NOTE: Ponding was evident in the vent pipe, but is functioning
alright.
I
SANITARY PERMIT APPLICATION
'
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
DILHR Y
1. sk.
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than / / 1~1 jet ?L'5_
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.
PROPERTPROPERTY LOCATION
L® it~R hi -e- S z,, Y., S TQ 9 , N, R 9 E (or)
PROPERTY PNER'S MAIIrING A DRESS LOT # BLOCK #
S >;P_ fie I's- I
C
CI TATE ZIP CODE PH MA MBER S IVIS NAME OR CSM N011 liog ~lso,~ l sc. Q61 CITY NEAREST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : S 1i~y C 4
ja TOWN OF: ❑ Public LINJ 1 or 2 Fam. Dwelling-# of bedrooms ~ PAR ELTAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) 1 I 1 _
1 ❑ Apt/Condo 1
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 120 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. ERNew 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 El Mound 30 ❑ Specify Type 41 El Holdin9Tank
12 ❑ Seepage Trench 220 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
r1 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) rJ~ 4 ELEVATION
V d I no ?;t 9 f i < 3 J. 1Q Feet Feet
V1111. TANK 1.0 CAPACITY Prefab. Site Fiber- Exper.
in allons Total # of Manufacturer's Name Con.. Steel lass Plastic App
INFORMATION New istin Gallons Tanks Concrete strutted g
Tanks Tanks
Septic Tank or Holding Tank y OO Q
Lift Pump Tank/Si hon Chamber H D F] I El F1
Vlll. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plum 's Signature: ( Stamps) ` MP/MPRSW No.: Business Phone Number:
" C- Ord "uS 6r~ c~S9~ ~S 3~ ~ 4aa0
Plumber's A dre m(street, City Stite, ip cod
L
IX. COUNTYIDEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued Issuing Agent Signature (No S mps)
Surcharge Fee)
Approved ❑ Owner Given Initial & i 4S. oc
Adverse Det rmination 1
X. CONDITIONS OF APPROVALIREASONS 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. 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 onsit+e 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.
ll. 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 (8.11/88)
APPLICATION FOR SANITARY PERMIT
S T C -.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 , iC :E •
Location of property 5' 1/4 NC 1/4, Section T 2'77' N-R !_W
Township t,,4 So'v
Mailing address
Address of site VA, WL
Subdivision name 4~dem2 o ,J
Lot number
Previous owner of property 1,,-)qN A-I6( r G r #e k) S
s i
Total size of parcel ;4t?2t5
Date parcel was created JR (rl r~fd~SfiE A~ t 1'{, ►ygo
Are all corners and lot lines identifiable? _,~--Yes No
Is this property being developed for resale (spec house)? Yes No
Volume -?~(o and Page Number 3c)(_ 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. y Z 8L(Q D ; 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 County Rego ter of Deeds, as Document No.
Sign re of Owner Signat a of Co-Owner (If pplicable)
Z-7
Date of Signature Date of Signature
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
H STATE BQt. OF WISCONSIN FORM 2 -1982
428490 786PAGE@1
~V~'.
RE ;ISTERS OFFICE
ST. CROIX CO., WIS.
Donald Stephens and Lori Stephens, husband and Recd. for Record this 27th
wife, as survivorship property
d~ of July A.D.1987
bfN 12:20FMa
conveys and warrants to -._James Lorenz and Carey. r Lorenz
. 'AAA >ft
_husban --a d._w fe,...as__marital-_property,...with-_..... s ee9taoc.o066 1!
._rights_._of_ survivorship,~.................. I
I
RETURN TO
I
- - - ~.__-m_
the following described real estate in S_t_--_CrQiX .......................County,
State of Wisconsin:
Tax Parcel No: !
Lot Fifteen (15) of Northline Station II in the Town of Hudson.
I
1
This is not
homestead property.
(is) (is not)
Exception to warranties:
Dated this 15th-------------------------- day of July- 19--87...
I
~^wq ----------------------------------------(SEAL) A S w~«- ----------------------(SEAL)
Donald tephens * Lori Stephens
I
--(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT If
Signature (a) STATE OF WISCONSIN
ss.
'i
St.__ CroiX- County.
authenticated this day of___________________________ 19 Personally came before me this 15th-------- day of
July_________________________ 1~7-... the above named
Donald Stephens and Lori Stephens
TITLE: MEMBER STATE BAR OF WISCONSIN
; f?... t-------
(If not- - 4
authorized by § 706.06, Wis. Stats.) S -
to me known to be the person who eibcutQ4 the
fore oing instrume t a acknowledge the ,time
THIS INSTRUMENT WAS DRAFTED BY •
Reinstra, Van Dyk & Needham, S.C. - -
~a L. Glaser
Attorneys at ..Law ' - ~
New__Richmond- Wisconsin 54017-0127 St. Croix
-
Notary Public ---------------------J----- >tpu vbZWla:' i!
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, stale e~i;wtfon
are not necessary.) date: 3- 3l- 91
19- )
-Names of persons signing in any capacity should be typed or printed below their signatures.
BAR OF
KC 11 rCcrrgmM~ STATFOR
M No. 2 1 82 WISCONSIN Stock No. 13002
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CA
S T C - 105
SE' PT IC TANK MAINTLNANCE AGREH*MEN'1' r~
St Croix County
- v
Z'. ~vRE~z
OWNER/BUYER mcs P, %2
m
ROU'1'L/BOX NUMBER v A, l Lt Fire Number
CITY/SPATE 1'VGedoAl ZIP
Sw
PROPERTY LOCATION: Sectii,n )s, T. 21 M,. R~ W,
'town of •14 d~ Al St. Croix County,
Subdivision ~6 t~u1f A,',c,.Y>~ Lot number /
Improper use and maintenance of your septic" system. could result "in
its premature failure to handle -wastes.Proper maintenance. can
sists of pumping out the septic tank every" tl,ree••years>or sooner
if needed, by a licensed septic tank i.mLer. WitaL you (gut 1n.tuf;
the system can affeet `the function of Lhe-Sujltic tank as `a tr`eat-
meii t stage in the waste disposal system.
St. Croix. Cuunty_res'idents Ilia be eligible" Lu receive a,'granL' lur,
"a maximum of 60% of the ::cost .of '-,'replacumen't;~.offailing; syytein
which was in operation;prYur--t`o July 1, L9.78 ~ St Croix COUnty
acce1) te'd this pyubram.,-, in Aul;ust °'of .198U.,` wi;tl„the' requlremc►iC`.chae 1 Y
owners of all new syst`ems;ahree CO keel th"~:''Ir~'°Systems properly y }
all -
maintained. ,
'1'1►e property owner agrees to sub"mit to St. Croix'`"-County-7.oning a`
certification form, -signed by the owner and by a ilia ster`;pluin be r,
Journeyman plumber, ,restricLed_ plumber or a,licensed pumper veri-
fying that (1) the on-site wastewater disposal 'system";is in,:fprupi er.
operating condition AInd 2) after inspection and pumping (if nec--
essary), the septic 'tank is less than 1/3 full. of sludgeand. scum..
.Certification form will be sent approxiu,ately 30 days prior to`
three year expiration.
O
I/WE,'the undersigned, have read the above requirements and `agree N
to maintain the'private sewage disposal system :in accordance with
the-standards set forth, herein, as set by.,the' Wisconsin `Uepart i
ment-of Natural Resources. Certification form must be completed:
and returned to the.St: Croix County ZoningOffi,ce within 30=days
of the> three year expiration date
SIGNED ,
DA'Z'E -
C/3- Z-7-
St. Ciloix- C,)unty Zoning Office
P.-O. f•ox 98
Hammond, WI 54015
715-7S`6-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LA9bR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
(H63.0911) & Chapter 145.045)
P/ ~ Y: LOT NO.: BL Zog ME: / d ~
LOCATi SECTI N:T^qN/R/~(or TOWNS
. d,,15Z, j I
OUNTY: /NER'S BUYER'S NAME. MAILING ADDRE S: S
rO m Z o
USE DATES OBSERVA IONS MADE
NO.BEDRMS.: Comm ER ESCRIPTION: PROFIL E TIONS: ER 10 ESTS:
Residence Nlew ❑Replace
RATING: S= Site suitable for system U= Site unsuitable for system
C OINV_ENTIONAL: M UND: IN-GROUND-PRESSURE: ISYSTEM-IN-FILLIHOLDING TANK: RECOMMEN ED SYS E :(o 'onaq
1s au ~s ❑u as osw MI P;,- 4"
xi I -1 6 s ❑u
If Percolation Tests are NOT required DESIGN QATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
tj- BORING TOTAL DEPTH TO ROUNDWATER-IN HES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH[ ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OB ERVED (SEE ABB!►R~V. ON BACK.)
iyy~ J .33 6h S, .IJD AlSfa' 5/7'Blil✓1-S
B- ~7 i 61,
P koxt ff F I
B-2 Q' 1/a~ 05 , 1 s,, hS ,~Z,9ZB.1,cs~; 336►~nS
/ / • / O ' 811J J3Y~I~' J ~r IVh ~f SY Il/s0+SA/C Z 01 aft I►1s
4~
B- y ,o Qr 9Z r0 40 Bn/, Ail 6ti es' ; 3 93 6A ~s
~s~y~ y s~ - s
B-,s 7 /7 / 08' > 7J17, ; y~ 61 s , r BA
B- L asp y,~ue a~ ~lu~iRjL, Ars o~ {►ar~'lo ~,J
PERCOLATION TESTS r~
TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERS ELLING INTERVAL-MIN. PER OD 1 PERIOD 2 PERIOD PER INCH
P_ 1 , So'
P_ 16 ~ 3
P_ 2- IL <3
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 Bin z`~
i F I , ~ ,L ,2
F i s I ! ~ ~ a ~ -
IT
,
G ~ ~ ~ ~ ~ yep
45
3 ~IrQV
i P
Y TH
I
s
E ~ r
I
a
I _ u I 1 w(
{
r• rC ~0 S (,~4 ib 1 -
I, the undersigned, hereby certify that the soil es to on this form were made by me in accord with the procedures and me5ods ified in the Wisconsin
Administrative Code, and that the data recorded n the loca ion of the tests are correct to the best of my knowledge and belief.
NAME (pr' f TESTS RE MPLETED ON:
4e./ 13 Un-, I)e
ADDRESS' CE IFI A ION UMBER: PHONE NUMBER (optional):
tj~ 5,,C10
CST SIG
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395
To be a complete _I accurate soil test, your rel include:
1. Complete legal ':ion;
2. The use section r indicate whether this is a residence or commercial project;
1 MAXIMUM numl e{? 3oms or commercial use planned;
4, is this a new system;
5. Complete ting boxes. A SITE IS SUITABLE FOR A N TANK ONLY IF ALL
OTHER vY- RULED OUT BASED I SOIL CONDITIONS;
6. PLEASE use ''le it:ions shown here for - profile descriptioe apicting the plot plan;
7. MAKE A LEGIE --lm accurately lordw, raur test location- scale is preferred. A
3 : --hee' rr a ] desire(.];
8. M :;e sure your i -k and vertical eleva'tio ference poir r sf own, and are permanent;
. Complete all a:;p boxes as to dates, n addresses, floor <rcolation test exemp-
ti( n, if appropri_
10 If inform< i flood plain, elevation) does not apply, p' in the appropriate box;
11. _ 1 ° he form aw. /our current address and your certification
12. ~ ible I distrihUte as require. ALL SOIL TESTS UST BE FILED WITH THE
LC. ~L AUTHO Y WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR IFIED SOIL TES-_.m-
Soil Separates and Textures ➢r Symbols
st - Stone (over 10") BR - Bedrock
coh - Cobble (3 - 10") SS - Sandstone
gr vel (under 3") L~ - Limestone
s " - Nigh Grou _
cs Sand Percolat.~n
med s r °.nd Nall
Cs - - Building
Is Loamy Id > greater Than
sl - Sandy Loam < Less Thai r
`I - L( let Bn - Brown
i1 tnt BI Black
si Gy - Gray
Cl - C Y Yellow
SO - Loam R - Red
sicl Loarn root Mottles
fff - f vv,
cc ~.z
- rnm - Man
m - d - disth
p - prorr,
HWL - I-wi
Siv !axtures
p c? >posal B(y9
VRP F
NER;
r
o
ntr. on.
PB.L. 67 PLOTAND CROSS SECTION
PROJECT PLUMBER
NAME s Log-pwz_ NAME J c. 2
LOCATION L IC ENS E do"
A E 311
PLOT MAP
R+ 51oPe
b h1 ~d " 5tcc I Roo 10
9Rd ~~=>~o•0 30,
O = Bor~}~~~~ 54e; 50 1
~ S ~ 1
,
x ; hole 5eS
La GC1Q,NeR YS*
S~oP
6
x ~gx~ Ca B~
job's,t',#, W~}~s 04 s`D
N e ~ IboffiWRY JFu2?rktr s~AN iJ 60' Sp' d
~'ti~rn Sc~4 ~ ~ .J
1 00
Room
AV
® '",leld `(hush
FRESH AIR INLETS AND OBSERVATION PIPE
CROSS SECTION
-77 Approved Vent Cap
IS 7e~ I FNAI GI~1~~
Minimum 12" Above
Final-Grade
4" Cast Iron
Above Pipe Vent Pipe
To Final Grad
Marsh Hay Or Synthetic Covering
Min. 2" Aggre
e Tee
Distribution Pipe
OEi!
q Aggregate Perforated Pipe Below
~0•/a Beneath Pipe l9 Coupling Terminating At
Bottom of System
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