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03/17/2005 09:43 AM
Parcel #: 030-1015-40-005 PAGE 1 OF 1
Alt.Parcel#: 04.29.19.64G 030-TOWN OF SAINT JOSEPH
ST. CROIX COUNTY,WISCONSIN
Current X
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): *=Current Owner
*LANPHEAR, MARK G&DIANE J
MARK G&DIANE J LANPHEAR
514 RIVER RD
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es):
*=Primary
Type Dist# Description *514 RIVER RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 4 T29N R19W NW SW LOT 9 CSM 5/1477 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 843/99
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
4821 223,200
Last Changed: 07/07/2004
Valuations:
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 75,500 144,100 219,600 NO
Totals for 2004: General Property 0 0
3.000 75,500 144,100 219,600
Woodland 0.000
Totals for 2003:
General Property 3.000 44,300 110,300 154,600
Woodland 0.000 0
Lottery Credit: Batch#: 135
Claim Count: 1 Certification Date:
Specials:
Category Amount
User Special Code
Special Assessments Special Charges Delinquent Char 0 00
Total
0.00 0.00
F
O gRCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 -962 - 5227
ST. CROIX ZONING REPORT NO.S 06853/01 PAM 1
ST. CROIX COUNTY REPORT DATES 6/21/91
COURTHOUSE DATE RECEIVED, 6/20/91
HUDSON# WI 54016
ATTNS THOMAS Co NELSON
i3
OWNERS 4 :Mark & :Dianne La y,
LOCATIONS 514 River Rd.# Hudson
LD I q ICIM 5 /f41-77
COLLECTORS FI. Jenkins
SOURCE OF SAMPLE# Kitchen faucet
COLIFORM40 0 /100 mi.
INTERPRETATIONS Bacteriologically SAFE g 9
NITRATE-NS 2 ppe !�
Above 10 ppm exceeds the recommended Publ' G
Drinking Water Standard. r+ y
Coliform Bacteria/100 ml � A A, tj
LO
Nitrate-Nitrogen# mg/l o i p V O
r . .
�O
LAB TECHNICIANS Pam Ganes
WI Approved Lab No. 19 ,
,.1
y.Of• Pe
t
Means "LESS THAN" Detectable Level Approved by'
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
c� C�\
xo ST. CROIX COUNTY ZONING OFFICE
i
911 4th Street
Hudson, WI 54016
,l C Telephone - (715)386-4680
The St. Croix Co. Zoning Office offers the service of septic and
water inspection to Lending Institution, Realty Firms , and
private individuals.
COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE
LOCATED. .
Please provide the following information, enclose appropriate fee
made payable to ST. CROIX CO. 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-------
-------------------------FEE:$ 25.00 ✓
(For nitrates and coliform bacteria) -
FEE:$175.00
WATER TESTING----------------------------
(VOC'S) --
---FEE:$ 25.00 ✓
SEPTIC SYSTEM INSPECTION----------------
PROPERTY OWNERS NAME: cln cC�I(' 1 *T;1� e-c
PROPERTY OWNERS ADDRESS:5) 7���C� 6CAJ CITY Legal Description 5b3 1/4, �Li1/4 , SeC. N-R W,
Town of )v5 C p 1-` Lot No. ,Subdivision
FIRE NO. I LOCK BOX N Ala!-
Color of house ire- h Realty sign? , ,, 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 arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: nik)cufs
Telephone No._ 3L( IS 7S
REPORT TO BE SENT TO:
CLOSING DATE: q I
Signature:
• - ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST.CROIX COUNTY COURTHOUSE
bad 911 FOURTH STREET • HUDSON,WI 54016
(715)386-4680
June 20, 1991
Mark & Diane Lamphear
514 River Rd.
Hudson, WI 54016
Dear Mr. & Mrs. Lanphear:
An inspection of the septic system on the property
of Mark & Diane Lamphear, located at 514 River Rd. , Hudson, WI
was conducted on June 20, 1991 . 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.
Sincerely
P
Mary Jen •
Assistant Zoning Administrator
cj I.
i
7/,A)
47*
NJr
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SW 1/4 OF THE NW 1/4 OF SECTION 4, T29N, R19W,
Nt
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
OWNER LEGEND ri' ALLEN C
WILLIAM 8 MARILYN FEYEREISEN NYHAGEN
RT. 2, BOX 250 1" IRON PIPE FOUND. '>
S-1407
BLUEBIRD DRIVE
HUDSON, WI. 54016 1" x 24" IRON PIPE WEIGHING, HUDSON,
1.68 LBS/LIN. FT. SET '. wis f
ILE" < ,
CURVE DATA TABLE
CURVE LOT CENTRAL RADIUS CURVE CHORD CHORD
NO. N0. ANGLE LENGTH LENGTH LENGTH BEARING
1-2 74 030100" 217.11' 279.77' 262.83' S31 015100"E
12 43 047105" 165.91' 161.91' S46036'27.5"E
11 30 042'55" 116.39' 115.00' S09 021!27.5 11E
N 3-4 45 010'46" 165.20' 130.27' 126.92' S16 035'23"E
11 24 050'05" 71.61' 71.05' S06 025'02.5"E
10 20 020'41" 58.66' 58.35' S29 000'25.5"E
5-6 40 030'59" 233.00' 163.48' 161.35' S18 055'16.5"E
7-8 40 030159" 167.00' 118.09' 115.65' N18 055116.5"W
9-10 17 027132" 231.20' 70.45' 70.18' N30 027'00 11W
BEARINGS REFERENCED TO THE
WEST LINE OF THE NW 1/4
ASSUMED N00 049'14"E.
M SCALE IN FEET
,y ea I.
100 0 200 9 6�
X05,
w
5°2ro �5aV1 0
56 LOT 12 0
NW CORNER SECTION 4 i 'I� 36,715 sq.ft.
CO. MON. 3.14 acres
n 524.
` N81°48'5E 48'5 z
° C>
Ln
I
r0 °sed CSM N Cn y ��
_ LOT 11 i�
P 66.00 �\` 139,312 sq.ft. 0 � H
S06°00'00"W 2 3.20 acres 0° &s
i
CCLI to ' S89°39'47 1�
En
N89 013 04 W E 492.70'
r 331.05' a S39°10'46"E iv
H
o p ' S50°49'14"W s 120.11' cn
1O- i
1,, 00 w w 66.00'
a otQ N LOT 9 -10 5, LOT 105/2 W
t, a i3O N ' 130,680 sq.ft. \
_
N-, f i` - 1 3.00 acres 130,967 sq.ft. 0
SO1°20'13"E 3.01 acres
S89013,04--E 483.35' 45.95' 7 , 6
66 331.76'
435.43'
S89 013104 11E 881.04'
W 1/4 CORNER SOUTH LINE - NW 1/4 TOWN-ROAD
�S SECTION 4 Ln
/ CO. MON. v S88 039147 11E
881.11'
° DEDICATED TO THE PUBLIC •�
_°
THIS INSTRUMENT DRAFTED BY DOUGLAS 2.AHLER JOB NO. 84-31
r
Form - S T - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER /�/�`� L� F.R/? TOWNSHIP , r D� he SEC. T
ADDRESS /f/�? ST. CROIX COUNTY, WISCONSIN
SUBDIVISION Gl LOT
9 LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
00P Yoe
a
55' 71
Aocerco-
,235'
w.
225'
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
T Q(
Elevation of vertical reference point: Q p �l
__�___1O Proposed slope at site:
SEPTIC TANK: Manufacturer: /«&4ZA- � Liquid Capacity:
Number of rings used: ---L— Tank manhole cover elevation:
Tank Inlet Elevation:--?-?,_o Tank Outlet Elevation: 179
Number of feet from nearest Road.: Front33 Side,o Rear, O
.2 6 feet
From nearest property line Front,O Side,Rear,O /�/� feet
Number of feet from: well building: i---;--_
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Ma facturer: Liquid Capacity:
Pump Mo 1:
pump/Siphon Manufacturer: Pump Size
Elevation of i t• Bottom of tan evation:
Pump off switch elevatio llons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from neare property line: Front, O Side, O Rear,0 Ft•
N er of feet from well:
umber of feet from building:
clude distances on plot plan) .
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Length: ,�� ,w Number of Lines: Area Built: (0.29-11
Width:
Fill depth to top of pipe:
/r
Number of feet from nearest property line: Front, Side, O Rear,O Ft .42Z-5-
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Li d depth: Bottom of seepage pit elevation:
Area Buil
Has either a drop bo or distribution box O been used on an of the above soil
absorbtion sytems? (Check e) .
HOLDING TANK
Manufacturer: C city:
Number of rings used: __ Elev i of bottom of tank:
Elevation of inlet:
line: Front, Side, O Rear, OFt.
Number of feet from near t property
tuber of feet from well:
umber of feet from building:
Number of feet from nearest road:
A rm Manufacturer:
Inspector:
Dated: _z Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR&HUMAN RELATIONS SAFETY&BUILDING
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS DIVISION
MADI WI 3707 OFFICE OF DIVISION CODES&APPLICATION
SW, 1, 29, 19W
TOWnt of St. Joseph CONVENTIONAL State Plan I.D.Number
Lot 9, River Road ALTERATIVE (If assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑
NAM OF E PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: Mound
Mark Lanphear --II Rd 7 INSPECTI E:
BENCH MARK(Permanent reference point)DESCRIBE IF DI FEREN�FROM PL Hudson, `� 54016
REF.PT. LEV.: CS I REF.PT.ELEV.:
Name of Plumber:
MP/MPRSW No.: County:
Donavin Schmitt 3205 Sanitary Permit Number:
SEPTIC TANK/HOLDING TANK: t. Croix 119534
MANUFACTURER:
LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER ❑YES ❑NO ❑YES ❑NO
ALARM: NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
❑YES Q NO FEET FROM LINE: AIR INLET:
❑YES ❑NO NEAREST—�
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER:
WARNING LABEL LOCKING COVER
❑YES ❑NO PROVIDED: PROVIDED:
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: ❑YES ❑NO ❑YES ❑NO
(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
PUMP ON AND OFF) ❑YES ❑NO FEET FROM LINE: AIR INLET:
SOIL ABSORPTION SYSTEM. Check the soil moisture at the de th of Plowing —♦DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF
/ DISTR.PIPE SPACING: COVER
DIMENSIONS TRENCHES: MATERIAL: INSIDE DIA.: #PITS: LIQUID
PIT DEPTH:
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END:
DID FROM LINE:
NEARES � AIR INLET
MOUND SYSTEM: T ♦
Mound site plowed perpendicular to
slope and furrows thrown unslope: Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
mound systems to make certain that it ON REVERSE SIDE. SHOW
SOIL COVER
❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
TEXTURE:
PERMANENT MARKERS: OBSERVATION WELLS;
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: YES ❑NO ❑YES ❑NO
CENTER: EDGES: SEEDED:
�MULCHEI:
P RESSURIZED DISTRIBUTION SYSTEM: O ES ❑NO
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE:
DIMENSIONS TRENCHES: FILL DEPTH ABOVE COVER:
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.:
ELEV: PIPES: DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY:
COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
❑YES ❑NO APPROVED PLANS
COMMENTS: PERMANENT MARKERS: ❑YES ❑NO
OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM
❑YES ❑NO ❑YES ❑NO NEAREST----** LINE:
n
� s -
-�-� ~ y
o +I
2s
Sketch System on
Reverse Side. Retain in county file for audit.
SIGNATURE:
TITLE:
SBD-6710(R.06/88) Zoning Administrator
Thomas C. Nelson
SANITARY PERMIT APPLICATION 7SK�TDILHR In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PER #
El Chec
–Attach complete plans(to the county copy only)for the system,on paper not less than k if revision to pre IJ ous application
8%x 11 inches in size.
–See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
IF 11111 4el '�a '�4,S T N, R E�o
B
PROPERTY OWNER'S MAILING A RESS
LOT#
BLOCK IF
CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
` CITY NEAREST ROAD
11. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE
❑ Public 1 or 2 Fam.Dwelling–#of bedrooms Sl A—ARCEL TAX NUMBER
III. BUILDING USE: (If building type is public,check all that apply)
1 ❑ Apt/Condo 10 ❑ Outdoor Recreational Facility
2 ❑ Assembly Hall 6 El Medical Facility/Nursing Home 11 ❑ Restaurant/Bar/Dining
3 ❑ Campground 8 El 1-1 Mobile Home Park Merchandise: Sales/Repairs 12 ❑ Service Station/Car Wash
4 ❑ Church/School 8 13 ❑ Other: Specify
5 El Hotel/Motel 9 ❑ Office/Factory
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. KV New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Existing Reconnection of
System 5 ❑ Existing System
System System Tank Only g y
Date Issued
B) ❑ A Sanitary Permit was previously issued. Permit# —
V. TYPE OF SYSTEM: (Check only one)
Other
Non-Pressurized Distribution Pressurized Distribution Experimental
21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
11 Seepage Bed 42 ❑ Pit Privy
12 Seepage Trench 22 ❑ Pressure 43 ❑ Vault Privy
13 ❑ Seepage Pit Pressure
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. M(Min./inch)
RAE 6. SYSTEM ELEV. 7• ELEVATION GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.)
?a Feet Feet
CAPACITY Site Fiber- Exper.
VII. TANK Prefab.
in as Total #of Manufacturer's Name oncret Con- Steel glass Plastic App
INFORMATION New istin Gallons Tanks structed
Tanks Tanks
Se tic Tank or Holdin Tank
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on th ttached plans.
(No Sta
Plumber's Name(Print): Plum Signature:
M PRSW No- Business Phone Number:
um er s Ad ress(Street, ity,State, ip ode:
3
r
IX. COUNTY/DEPARTMENT USE ONLY Iss 'n Agent Signature(No Stamps)
S Permit Fee(Iucha Groundwater �e-
Issued
Lj DisapproiDeterminatl, (Includes ee
pproved ❑ Owner GInitial
Adve
n
X. CO NDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to county,One Copy To:Safety&Buildings Division,Owner,Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years. '
2. 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,&-licensed >
pumper whenever necessary, usually every Z.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:
x
I. -Property owner's name and mailing address. Provide the legal description and parcel tax numbers) 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 tbe`county; E) siail test data on a' '151orm; and F) all sizing information:
GROUND'WAirER 140RCHARGE
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 ( _
Location of Property �� —N W._h-• Section T 'Pa N-R W
t
Township
Meiling Address
Address of Site
Subdivision llama
Lot Number
Previous Owner of Property A A •
an ��►� � r i�_ r�
Total Size of Parcel a s.Q S
Date Parcel was Created
Are all corners and lot lines identifiable?
_.� Yes No
Is this property being developed for resale (spec house) ? Yes �/
�C No
Volume 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 vane 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
CCAV6y that att A.ta.tement6 on .thi.6 ane tAue to the but o m
hnowtedge; that 1 (we) am (ah.e) -the owneh.(�sfor the pnopehty ducAi.bed6.inythiA �
in601ma-ti.on 6ohm, by viAtue o6 a waAAanty deed Aecoh.ded in the 066ice 06 the
Coltnty RegiA teh. 06 Deaths ah Document No.
gun the phoposed 4c.te bon .the Aewage o4AsP0.5 by'st ems that phebent,Ey
ead o�^e►Lt, �o hun with the above dens cJc i ed n0 � a obtained an
ayd.tun, and the came had been duty heconded .tn fihe�066iceh06 the County nReg.i.e eA 06
Veedd, ae VOemen t No. ) ,
SIGNATURE OWN SIGNATURE OF CO-OWNE
(IF APPLICABLE)
DATE SIGNED DATE SIGNED
i
Gnster J.M>
t .
It*0*said Gwadar,Eor a Valuable CONOWMatiae t
ra UM To
� thR psi dsrteribsd rat estate in St. erti.i:
Tas Key!fo
1/4 ,p t3oi.ldf 1/4 of Section 4, T*VWhip 29.11orth, Range 19
joeepbo St. Croix County! Wisconsin, described as follow:. � 1
k
tIt"d $ttsvey-Map, recorded October 8, 1984, .in Vol. "5", page h ,
No. 393852. �
tAe'protective covenants as recorded in Volume 697, Page ' .
t No. 39M53, recorded in the office of the ,Register of
Ow-of Croft, Cotaity.
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SEPTIC TANK MAINTENANCE AGREEMENT z
St . Croix County
a
9
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,c/BUYER
C Fire Number_
x0UTE/BOX NUMBER
CITY/STATE ZIP "-::3 IP
�{Ot
1 1 Section s T Qq R tq __W,
PROPERTY LOCATION :��4� ����
Town of �bS2D� St . Croix County ,
Subdivision �(,.h 0.u`CL Lot number q___•
stem could result in I
Improper use and maintenance of your septic system
its premature failure to handle wastes . Proper ma �turesooner ,
sists of pumping out the septic tank every three years
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 re suiremerlythat
owners of all new systems agree to keep their
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
eri-
journeyman plumber , restricted plumber or a licensed pumper proper
fying that (1) the on-site wastewater disposal system
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 H
three year expiration . °
f:
I/WE, the undersigned,, have read the above requirements and agree x
to maintain the private sewage disposal system in accordance with b
the standards set forth , herein, as set by the Wisconsin Depart-
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Off. i, i n 0 days
of the three year expiration date .
SIGNED
D ATE
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 .
r)USTRY, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
"a�IUSTRY DIVISION
P.O. BOX 7969
,.,.80R AND PERCOLATION TESTS (115)
-ihhlAti F�tLATIONS MADISON,WI 53707
(1-16,J.09(1)&Chapter 145.045)
i0�-'ATTON: SECTION: -� TOWNSHIP/MIdNIefPPtITY: OT NO.: LK.NO.: SUBDIVISION NAME:
/T:z5N/R/qJ( r C?
;';IOUNTK: OW ER NAME IWAI LING ADDRESS:
t A"t"J,4)j
DATES OBSERVATIONS MADE
Y 3 DO I fT—rul LE DESCRIPTIONS: PERCOLATION TEST
1psidnce g
New ❑Replace,� i 12—BATING:S-Sita suitable for system U-Site unsuitable for system O
ONVE.. NAL: MOUND: IN-GROUND -FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)
NS au M ou Is ❑u EIS zu Ds Zu
If Percolation Tests 3rs NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
ALIX
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROU N WATER-INCHE HARACTER OF SOIL WFTK THICKNESS,COLOR,TEXTURE,TND DEPTH
NUMBER pYTYfN, ELEVATIQN OBSERVED
E: TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK,)
B- f � --- )Q > $J8 eSi l. 33 $
G°
13- 9� 7 q 33 AL2
B-
►rl�a If PERCOLATION T9STS
TEST DEPTH . WATER IN HOLE TEST TIM IIY�Vk!--NL�=- RAT INUTES
NUMBER r@S A."TERSWELLING INTERVAL-MI _ PER INCH
P r 4� A90 A) _ <
P. z. 3 z; Ae o 3
P-
P-
P-
P
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
!ontai and vertical slavation reference points and''tsbow their location on the plot plan. Show the surface elevation at all borings and ;he direction and percent
of land slope.
7d
SYSTEM ELEVATION _.. 113 -
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-ne undersigoud,hereby certify that the soil tests reported on this form were made by me in•iccord wits+the procedures and methods specified in the Wisconsin
Admi.iistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
TESTS WERE COMPLETED ON:
pC:E'
CERTIFICATION NUMBER: PHONE NUMBER(optional)-
wma
CS"SI N�U
. Ic'N:Original and one copy to Local Authority,Property(*caner and Soil Testar.
-95 (R.02132) —OVER—
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