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Parcel #: 030-2008-30-000 02/09/2007 04:39 PM
PAGE 1 OF 1
Alt. Parcel#: 34.30.19.377B4 030-TOWN OF SAINT JOSEPH
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
O- RADTKE, LINDA A
LINDA A RADTKE
1279 60TH ST
HUDSON WI 54016
Districts: SC = School SP=Special Property Address(es): '=Primary
Type Dist# Description " 1279 60TH ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 8.050 Plat: N/A-NOT AVAILABLE
SEC 34 T30N R19W NW NW LOT 4 OF CSM Block/Condo Bldg:
3/758 ALSO THAT PART OF NE NE SEC 33
T30N R1 9W DESC AS FOLLOWS COM NW COR LOT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
4 CSM 3/758 W ON EXT N LINE LOT 4 32'TO 34-30N-19W
CL TN RD, SLY ON CL TO S LINE NE NE
ESTLY TO SE COR NE NE, NTHLY ON E LINE
more...
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1228/106 QC
07/23/1997 825/102
07/23/1997 818/588
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 8.050 90,100 206,900 297,000 NO
Totals for 2007:
General Property 8.050 90,100 206,900 297,000
Woodland 0.000 0 0
Totals for 2006:
General Property 8.050 90,100 206,900 297,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 212
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Form - S T C 104
AS BUILT SANITARY SYSTEM REPORT
OWNER !1!!_I ��p TOWNSHIP o SEC. TU N-R ( / W
ADDRESS �p ST. CROIX COUNTY, WISCONSIN
•
SUBDIVISION LOT fV1 LOT SIZE rJ A
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3
39' 9
d food 9 A
10
100' ►
v)
a
R
I
u- - 4
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used G(Z6U1JD POS
Elevation of vertical reference point: X60'U Proposed slope at site: 3 ho
SEPTIC TANK: Manufacturer: wp't K-5 Liquid Capacity: �10DO (4 4
Number of rings used: Tank manhole cover elevation: Q
Tank Inlet Elevation: 9). 8 9 Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side 0 Rear, O feet
From nearest property. line Front,OSide,ORear,� ���� feet
J 1
Number of feet from: well y building: 191
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
f
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,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distance on plot plan). HcpDQ9 ;
Skot: 3
SOIL ABSORPTION SYSTEM r(J 0.) B9
�.. .
r103.' -? ENS g9•ya — u �a
S ,k
Bed: ✓ T�Ubf :
Width: Length: Number of Lines: Built: /
Fill depth to top of pipe: a �
Number of feet from nearest property line: Front, OSd�e, O Rear,P't .
Number of feet from well: 86'
Number of feet from building:
v'
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or 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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: a Plumber on job:
License Number:
3/84:mj
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 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan). HIAOQf
SOIL ABSORPTION SYSTEM
Bed: T�g
Width: Length: . Number of Lines: � Area Built:
Fill depth to top of pipe: - L
Number of feet from nearest property line: Fro/rn��t, O Side, O Rear Pt . 7
Number of feet from well: �V
Number of feet from building: I—to ?
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or 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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
q
Inspector:
Dated: � ► (n � Plumber on job: Q,�y, Q#,►lYr; 1G
—j� License Number:
3/84:mj
DEPARTMENT OF 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
NW,-,NW,,c+ State Plan I.D.Number:
LVW,-,NW y,,S34,T30N-Rl9u1 )TI CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town Q St. Joseph ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
LDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE.
Bill Radke 4 bT L-, 516 Hunter Hill Road No. 3, Hudson, WI 5 016
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
i
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Richard Hopkins 1059 St. Croix 119448
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: )QUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
W l�l J� `�1 I 1 Q ( f ' (o PROVIDED YES ❑NO P❑YES A NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: �P.(ROPERTY WELL BUILDING: VENT TO F ESH
ALARM: FEET FROM OuW AIR INLET:
El YES NO —4 LZ DYES-4U NO NEAREST—► d
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
P OVIDE ' PROVIDED:
E]YES ❑NO YE D ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PRO E Y W LL BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: V4A T RIAL ND 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:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: ( MATERIAL: PIT DEPTH:
DIMENSIONS .� `�
GRAVEL DEPTH FILL DEP DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: I r � ; _ PIPESf`'' FEET FROM LINE: Q� AIR INLET:
II �-JS NEAREST V�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
[DYES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
[--]YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED I 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: HOLESPACING: 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:
I
[--]YES ❑NO ❑YES ❑NO INEAREST-
� '2
/3.
Sketch System on Retain in county file for audit.
Reverse Side. SIGNATURE: TITLE:
SBD-6710(R.06/88) Zoning LAC minis
4 DILHR SANITARY PERMIT APPLICATION
.a....,...v......,
In accord with ILHR 83.05,Wis.Adm.Code COUNTY e
STATE��ARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than /Q (j/7/�/j(s/
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
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PROPERTY O NER PROPERTY LOCATION
1 ' N W'/a N W'/4, S T30, N, R 17 E(or nW
PROPERTY OW(VVR'S AILING A DRFSS�� �O ' � LOT# � BLOCK# �
CI �SIATTEQ Wf S ZIP CODE PHO E trMBER SUBDIVISION NA R CSM NUMBER
II. TYPE OF BUILDING: (Check one) ❑State Owned ❑ VI VILLAGE NEAR T�tPublic N 1 or 2 Fam.Dwelling—#of bedrooms PAR ELTAX N ;zs
U71�
III. BUILDING USE: (If building type is public,check all that apply) �/\ _ "1o®O
1 F1 Apt/Condo V ooCC 8
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 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
PE
A) 1. LLJ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 El Mound 30 El SpecifyType 41 El HoldingTank
12 N 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 13.ABSORP.AREA 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
53 REQUIRED(sq.ft.) PROPOSE ( q.ft.) (Gal day/sq.ft.) (Min./inct'h)) Q C.�Q ELEVATION
9`4S S - ` 7 1. S v•J U Feet Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New ling Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank d
Lift Pump Tank/Siphon 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): Plu is Signature- o Stamps) i IMP/MPRSWNo.: Business Phone Number:
. .1 �� qb ' N Ids 9 71S Sgt- M)o
Plumber's Addre s(Street,City, fate,Zip Cod ):
e c � IS c, 0 7
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee(Includes Groundwater ate Issued Issuing Agent Signature(No Stamps
Surcharge Fee)
Approved El Owner Given Initial � I ,� v0 1,^QQ
Adverse Determination J O� o
X. CONDITIONS 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 a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onshe 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:
I. 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'f 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 siding 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
S 11' C - 100
It
This application form in Co be complutud 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 duvcl.apmeut 'be intended for .resale by owner/contractgz, ("sperm
house") , then a second Form should be ruLn Lhud and completed when` the property is ;•`
sold and submitted to Lhla offIC0 With this" appropriate deed recording.
- - - - - - - - - - - - - - -I - - - - - - - - - - - - - - -
Owner of Property 1///�/// zzL �1SC9 T(C
L
f Location of Property khz� Sect:lon y , T N - R _ W
Township J IJ:S Ill
Mailing Address
i
Subdivision Name
rl
Lot Number - !
��
G�
Previous Owner of Property
1 Y
Total Size of Parcel S_1 S '`I
AS
Date Parcel was Created "'
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes E7 No
s a"M r.NANG
Volume and Page Number as recorded with chi Register of Deeds � y^';r�fl
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: �
EPA
u
1 . Warranty Deed
postal
,
2. Land Contract
3. Other record.i.ngs filed with the Register of Deeds Office
In addition, a curl l f l od aurrvuy, If avo l l al l u, would be helpful so as to avoid delsys�lc��;a� '
of the reviewing prc,cun. If thn t uod dvnerlption references to a Certified Survey, s'i�f��tt,�:
Map, Chu the CerL i f l od IIUI uoy Hnp "ho l l n l nn hu vuqui.r.ed. ii`bdi`rs no:=�O
.— —- - — — — — — — — — — — — — —
—
I.s�.
,
II'r:►�'� R I V t 110111 N Q R..1.I FICATION
! k >I
I (we) cexV6y that a ( b•ticteme is can ( ts' 6onm axe taue, to the best o6 my Ioux) � � ��itk :.
knowZedle; Biat I (we I run (aAel) •t.he, ow"eA Q ) o6 the pupehty dedcki.bed in -this
in6onmati.on 1604m, by VIAtue OK a u!a!!hantu deed aecoatded in the 066ice o6 the
a jr
County Reg:i.s.tex o6 Uevdh R.5 Document Nt�.�Y�2S'l and that I (we) ,{L�r
pmentty oun the pn.opo6cr.! 4.(t bon 1hr se1,J(_T jc r.c.a pot a system A I (we) have
obtAned an easement, to hu" with the above ducai.bed pnopexty, bon the
conatauati.or, o6 said 4l/tzm, and the same haA been My xecoaded in the 066ice
o6 the Coun7 y Reg.is.t:en o6 Deeds, as Uunume.nt No. 1
r ,
1 Y
SIGNATURE CAF OWNER I ' A' UiZE Or CO-OWNL'R (IF APPLICABLE)
VIA KAK
DATE SIGNED DATE SIDED
i4
ii �I
OCUMENT NO. I, STATE BAR OF WISCONSIN FORM 1—1982 ! THIS SPACE RESERVED FOR RECORDING
DATA
A
p.1QfA.RRjANTY DEED
44225 BOOT( 02 P i'
�l A,E_ 0 _
� l REGISTERS OFFICE
UM
DDeed„ made between CATHERINE M__ BAUER �I SRec d�cX CO., W�
f k a Catherine M. Schultz
l ------- ----- Record
-_- . _.. .._______________ .---.---- _--- �I
-- --- Grantor, I O C t 1 41986
and -.WILLIAM .E. RADTKE AND LINDA A R_ ADT$E I at 10:00 A.M
husband and wife---------------------s survivors hi marital
---
prop_erty --- --------
---------------------------------------------
Register of 0ee6
Catherine------- ------ -------- -, Grantee,
Witnes 'eth That the said Grantor, for a valuable consideration......
---herine Sauer
---- -- -- ..........
conveys to Grantee the following described real estate in st•
County, State of Wisconsin:
F yr'
F Part of the NWJ of the NW} o!" $eao
described as follows$ Lot 4 of Certified
25, 1979 in Vol. 3, Page 758, as Document
TOGETHER WITH that part of the NE-Z' of the NE4 of Section 33-30« $ ;
described as follows: Beginning at the NW corner of Lot 4 of the
above-described Certified Survey Map ; thence Westerly on an extension
of the North line of said Lot 4 of said C . S.M; 32 feet more or less
to the centerline of the town road; thence Southerly on said centerline
to the South line of said NE4 of NET' ; thence Easterly on said South
line to the SE corner of said NE4 of NET' ; thence Northerly on the East
line of said NE4 of NET' , being also the West line of said Lot 4 of said
C • S.M• , 500 feet more or less to the point of beginning. Subject to
the right-of-way of said town road. I�
NSF
7.
FES
is not
This -------------------------_ homestead property.
(is) (is not)
Together ith all ai3d sin lar he hereditaments and appurtenances thereunto belonging;
eatherine Bauer
i,
And--------------------------------------------------------------------•--------------------------------------- --------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
is
easements , restrictions and rights-of-way of record, if any.
and will warrant and defend the same.
---------- --------------- - --.--, 19-88
Dated this - day of
September
•----------- --•-• --------------- -_----------------(SEAL) _ (SEAL)
* - * _Cather Catherine M:.-..Bauer,--f/k/a_:Catherine
M. Schultz
-----(SEAL) -------•------ ........................... (SEAL)
* * - - - --------------------------------------------------- ...
AUTHENTICATION ACKNOWLEDGr4BM,T;.P�q ; CA
Signatures) STATE OF Arizon
---
�?r
-------- --------- -------- -------- --•- ------------------------- Yava i
1
...- - • a -County.
------------
authenticated this ........day of___________________________ 19_-____ Personally came before me this ___2....`h_.....82Y of
S p Vim----- -- ------------- 19.88_- the above named
-
Catherine M. Bauer A/a Catherine
---------------------- ---- ...........................................
I --- ----- --=------ ----------------------------- --------------- M= chulz
TITLE: MEMBER STATE BAR OF WISCONSIN
I (If not- ------------
authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the
foregoing 'nstrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
----------------------------
Kristina_.Ogland_Lundeen
Attorney at Law ••----.
------------------------------------------------------------ ................... lie Notary Pub ....Yava 1 County, ` AZ
(Signatures may be authenticated or acknowledged. Both My. Commission is permanent. (if not, state expiration
are not necessary.) date 11yCommissi n UpiresOct 21,1991
---- ------ --- - 19 )
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 1-1982 Diilwaukee. Wis.
'k,
`H
Y
STC
- 105< r
r
SI PTIC 'TANK -MA INTENANC'L :A(:REHMLN''" o :y
St Croix Co'untY x
d
OWNER/BUYER- m
ROUTE/BOX "NUMBER S_1. r ,�,/�. /6 Fire Number
CITY/STATE i-C.0,PI ZI P
PROP.Elm LOCA1'TUN : 4, A1,01 W,
'Down of e47 St . Croix Co.,unty ,"
Subdivision Lot dumber ;, .
f.
Improper use and ma'intenatice of your- septic system mould result in
its premature' f.ailuxe ;t'o handle wastes Pru1)er ma.intenance�, c�n f
s i s t s 'of um in oust .the . e tic 'tank: ev"ur '
pump >; P y three ;year"s of `sb�iner ,
if need"ed , by d lic`.ensed sejitic tank's �uucher What yv°u put inG°a ;. x
the system can. afEe`ct ;the :f`unction "o'f `"tlie sr.1)Lic tank; as a treat
meat stage in the waste disposal sy's'tem .
f
M R
St . ,.Croix Eounty presidents 'ifiu� be r6ligtble Cu r,ecely>� a branCfor `' }
a maximum of 60% Hof." the'; cost ;of replacrnicnL of .'a" faiaing �syst,"e in, ,.
r which `was ,."'in operation ,prior to :Julys 1 , 1078 '' St' ('roii. Gour►:tyE' r `
accepted this 'lrogr'�m iii`aAu U'S t ``of198U ;t°witlF
;t e rc}quhtC. a't' *r �
uwners of rll "dew systeiisfa� ree !to�keep ' th6 ir sys_teiis praoperly' I. ,a
mallltallltd
1'he property owner, agrees;, t6 submit , to St . Croix° C0uii'ty l,onzn`
certificationform; signed by ' the "o'wn"e r" and ` by a ;'master plum6;er ,
Journeyman "plumber ,= res ricted plumber ur "a ,licensed pumper vyeri �k'
fy'ing that > (1)" :Che, on-site .wastewaCe°r disposal system is n �ro.per=
operating cbndi,ti6n'-and (2) , after +lns ect1on an u►n 'in ��"(�f nee `
P P P.. b
essary) , the septic'.'. 'tank is, less than"."1/-3 full' of sludge.,'andVscum. a,
Certification form=,will . be sent""'approximately 30 daysr prior toy
three year expirat"ion . '?
I/WE, the unders"ign'ed ,. " have-, read the; above requirements and abree a'
to maintain the private se`wag; disposal System in acc;oidance ewitzh x 3
the- standards set." forth , herein as" "set b y the Wisconsin D,e :r
A- ::►d
ment" of Natural. Resources Certificationform must be completYed
and returned to' the: St . =Croix County "Zoning Off ire within30 days
0f""the three yearsexpiration dat'"e
{
St . Ctloix County Zoning Office
P. 0 fox 98
Hammor�d ,'.WI 54015
715-7S:6-2239 or 715-425-8363
r .
Sign , date and return to above address -'
• , `' � '•t V a_t" _;,�] ��� K �'�, Y-F,'f4rWp�.x:�➢'"�, �4`.T}a"z Ft ?���`.. A F '
DEPA51TWENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(H63.09(1)&Chapter 145.045)
LO T1'/ �'/ SECTI_Q%
VY'No.: SUB[I ISION NAME:
C�f�/T�n u OWIR�� BRf R' GAME: MAILING A SD�4
Ael.
USE f(J( S DATES OBSERVATIONS MADE
NO.BEDRMS.:ICOMME LDESCRIPTION: PROFIL D S TIONS: ER O ESTS:
Residence ✓ lew ❑Replace 3 '
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
�S E10 aS ®S ❑U 0S 0S 2i!
If Percolation Tests are NOT required DESIGN RA E: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: / Floodplain,indicate Floodplain elevation: __J
PROFILE DESCRIPTIONS
BORING TOTAL D PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXT ND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
.L 0/3 Z, .S ,199
B- � 9s '
PERCOLATION TESTS aJilg �^►
TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P PER INCH
P
5- D .2 -95', �.
P-_
E 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 12
tN
i � d
a
1 {
r�
I
G
E
t
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 • k TESTS WE C PL ETED ON:
ADDRESS: CERTIFI AT N NUMBER: PH NE NUMB ER Ep R(optio/nal
):
Si
CST IG TU
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) OVER —
M
INSTRUCTIONS FOR COMPLETING; FORM 115- S6O - 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 bedrodlvs or commercial use planned;
4. Is this a new or, replacement gsteni;
5= Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheen may be used if desired;
B, Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9, Corplete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (surf as flood plain,elevation)does not apply, place N.A. in the appropriate box;
11. Sian the form and place your current address and your certification number,
,,*j2, Make legihlr> copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETIO=N.
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 Perc — Percolation Rate
need s -- Medium Sand W — Well
I's — Fine Sand Bl(.Ig -- Building
Is Loamy Sand > -- Greater Than
'sl - Sandy Loam < -- Less Thai)
'I Loarn Bn - Brown
*sil --. Silt Loam BI -- Black
si — Silt Gy — Gray
'cl — Clay Loam Y .. Yellow
sci -. Sandy Clay Loam R Red
sicl - Silty Clay Loarn mot — Mottles
sip; — Sandy Clay veil with
sic — Silty Clay fff — few, fin;, faint }'
C' Clay cc — common, course
P t — Peat corn — Many, medium
rn — Muck d — distinct
p - prominent
HWL - High water level,
Six general sail textures surface water
for lictuid waste disposal BM — Bench Mark
VRP -.. Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a saniluiry permit. The county orthe Depar'tn'ient may request
verification of this soil test in the field prior t_r> Perrnil issu'-ince, A complete set of glans for the private
�3 axle system,and a perm; application must be sLv,nrdtlwl to the appropriate local authority in order to
obi a Peii nit. The saniI.ary permit must. he ohlIirrerl and posted prior to th st=art of arry construct i<:rri.
p E . L. - 7 PLOT ANo CROSS SECTION
' PROJECT P L Uj M-B ER
NAME NAME v rz. K.',tv
LOCATION (0t" St L I C E N S E4 t- .
st . D A E Vill
I PLOT MAP
&&tom E L=I Oo.b
Os [3owz- )e Safes
X? pe�c,hafe saes 3eURUur
i ayi IS
/do o
k lots RF- 9Al
I ILSo�e. o H ' r c.e►,�
ARP_ ore K
f rR0M Sy stz►y 3o'
0 1
Tbn" 50 qt 1�rKor�
Sea
0I 3 I
18x53 I O
3�b -Lip LLU � _ _ j y 391
30
i
I SyStem 'Is Uetp, pRea !'dust Qen►cl. MA�k
Be Cut �'o t�ect r'1r�x CoVCIZ
I Re ulvee ryt:
AIN
FRESH AIR INLETS AND OBSERVATION PIPE
CROSS SECTION
Approved Vent Cap
Minimum 12" Above
r� O� 11NAI Gepok
Final Grade
1ar �'1 x 4" Cast Iron
Above Pipe -::,I Vent Pipe
To Final Grad
Marsh Hay Or Synthetic Coveri g 7"
Min. 2" Aggreg� e
Over Pipe
Distribution �► �— Tee
Pipe
Aggregate Perforated Pipe Below
Beneath Pipe �-- Coupling Terminating At
(j�t{ar & "'may Bottom of System