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030-2000-30-000
4 0 e o � I is E a� O U y'D C CO N is _ C C C L U i GL y t4 RCN M O O) N M f0 j c O O O O O Z a O�INf1 c E to lL c c.Y-.,(n W o a«. oat C -°r m c o E ¢ cal-L M � I Z ~ O` _ V M M W a m M F- Z 0 c 0 o z Z :t c ,� OS r 3 N t% H �= � O c E v v E M �ww N a in c •� O N L Or I O o a°i ¢ z m z o z N N co d E co N V f0 R a °v a '`' c O Lo W d O C O c a a bap Z > ', FL 0 ° 000 Z •N a a a u, CL _ N 2 v co 00 J U ° m rn o mil Z Q� -CIO, N N O 0 ^I O E ml a lILm in m Z 0 Lo y H O U! C O O m 0 N O y � C d ♦♦♦ O' H U N C c M V a 0 l \ M L 2 N a°i 10 v C O N = N c 7 N • iC N M E O 4) v Z C_ N O M M ', O di O O R U • O M U) 0 O Z N Z F- 2 <n Ul r d a • c. m d E 0 �1 A ciaa2 ', o3in (1 I • Parcel #: 030-2000-30-000 04/07/2006 01:03 PM PAGE 1 OF 1 Alt. Parcel#: 33.30.19.360B 030-TOWN OF SAINT JOSEPH Current [—XI ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-PONCE DE LEON, HECTOR A&MARY E HECTOR A&MARY E PONCE DE LEON 520 PERCH LAKE RD HUDSON Wl 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *520 PERCH LAKE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.900 Plat: N/A-NOT AVAILABLE SEC 33 T30N R19W PRT NE NW LYING N OF TN Block/Condo Bldg: RD ALSO A PARCEL LOCATED IN PT GL 3 SE SW SEC 28 DESC AS; COM S1/4 COR SEC 28; Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH N 89 DEG W 1042.69'TO POB;TH N 09 33-30N-19W DEG E 17.83';TH N 32 DEG W 344.38'TO MEANDER LN PERCH LAKE;TH S 26 DEG W more Notes: Parcel History: Date Doc# Vol/Page Type 12/31/2001 666865 1804/343 WD 07/23/1997 976/529 WD 07/23/1997 660/373 07/23/1997 442/338 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.900 123,500 148,400 271,900 NO Totals for 2006: General Property 3.900 123,500 148,400 271,900 Woodland 0.000 0 0 Totals for 2005: General Property 3.900 123,500 148,400 271,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �� c %�ili�� �rr✓1 .- � � ��D� FILE® NOV 16 1992► JAMES, O'Cot ELL J', �',u,;� (- StgC ouot Oeods 4:�1.63 ./Lo7L,2 , � � � 1 �1 Qe�hC� /�O 7� vs Croix Co.,WI J �4 CERTIFIED SURVEY MAP w Located in part of Government Lot 3 in the SEh of the SWk of Section 28, T30N, R19W, Town of St. Joseph, St. Croix County, o Wisconsin. co NOTE: Areas shown on this map u do not include portion of ho SMA L TRACT Z land between meander line �Y1 and the waters edge. S830301 00 11W o 159.78' x o OWNER 41'.f a o Central Bank H o z7 3670 East County Line m y ® White Bear Lake, MN 55110 / a � A S N L + N LL. N O T o LEGEND t- 4J — Aluminum County Section Monument Found d o �'V/ o"' • — 1" Iron Pipe Found Meander Line 4J o — 1" x 2411 Iron Pipe Set, weighing o v/ 1.68 lbs. per linear foot y L- 41 .., d 4- co ;► — Water's Edge of Perch Lake s m o .•Oe� Existing Roadway Cc) co LOT 2 / °'• 82,255 Sq. Ft. 1.89 Acres n0 NOTE: N 'n 04' This survey was established from found monumentation and existing occupation lines' to A They do not agree with existing deeds in Vo1..451, Page 638; Volume 600, Page 373; Vol. 497, Page 189 and Vol. 174, Page 631. PIPE FOUND FOUND N030 16'36"W, 0.95' FROM/ POSITION MPUTEO NOTE: The lots on this map y are to be deeded to adjoining owners; no Town or County approval is required. ' LOT O M `li 39,171 Sq. Ft. F, 0.90 Acres SCALE IN FEET 25 50 100 1300.85' co V/ 1042.69' 90 18'42"E S8901814 1:SW Corner of South line of vw � `'Section 28 N89°18'.42"W Section 28 SMALL TRACT St Corner of Section 28 VOLUME`-- T---nGE 2564 a''S�0 . 1 Form - STC - 104 .» � AS BUILT .SANITARY SYSTEM REPORT 3 OWNER M'I TOWNSHIP , IOSe' I SEC. T y N-R ja W ADDRESS (� , H u G m ST. CROIX COUNTY, WISCONSIN Vol n k !! � cwq 2 SUBDIVISION %jZe LA e LOT LOT SI E PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l 3 13��Roo r� L)A I I ho rrLe, Ir � CemeN-t I to - - — - 31 - - - Qx5a lci) INDICATE NORTH ARROW BENCHMARK Describe the vertical reference point used Mom c Elevation�.gf vertical reference point: ��,0 Proposed slope at site: SEPTIC 'TAK: Manufacturer: Liquid Capacity: 14009AI Number of r .ngs used: , 0 Tank manhole cover elevation: 9 9,)5 , I QQ Q'7 Tank',Inlet Ilevation:_ ,pj Tank Outlet Elevation: Numbs r of Poet from nearest Road: Front,O Side Rear, 0)Q feet :iear O est property line Front, Side,ORear,® � Q!S feet Number of feet from:, well 501 building: 31 (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE . 1 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).Shot• y- NeADe� . 96•$� — �a�a$ 100.00 �Na 9`.�► -Qc�.'7r SOIL ABSORBTION SYSTEM 10 / 195 5500 Bed: V Trench: 9755 3.1t61►&D Width: I a Length: 5 Number of Lines: Area Built: Fill depth to top of pipe: 1 U,r 3V �1 Number of feet from nearest property line: Fronts .Side, O Rear, Ft ._�__^ Number of feet from well: (p 5 Number of feet from building: �1 (Include uistances on plot plau) . 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: I Alarm Manufacturer: • Inspector. 5P 5 3�// Dated: C)(± • S �jB Plumber on job: I License Number: 3/84:mJ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING M.QDftSON,WI°53707 SE% SA- S28 T30N-R19W (7 CONVENTIONAL 1:1 ALTERNATIVE State Plan I.D.Number: 4� 4� � (if assignedl Town a� S Ja�SerJh ❑Holding Tank ❑ In-Ground Pressure ❑Mound ch Lake Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION MTE: Mtichae2 Unman Raute 2, Hudson, WI 54016 I`b -216- 11,30 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber-. IMP/MPRSW No [F7� Sanitary Permit Number. Richa&d Hapk inz 1059 t-cuix 112790 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER tJ � pp � �y P VICED PROVIDED f�(,IyJ YES ONO DYES S640 BEDDING: VENT DIA.: VENT MAlI HI(SH WATER NUMBER OF ROAD: 1PROPERTI? WELL. BUILDING: (VENT TO FRESH GGALARM FEET FROM 70 LINE � AIR INLET DYES NO OYES NO NEAREST-11H DOSING CHAMBER: MANUFACTURER. BEDDING- ILIQUIDCAPACITY PUMPM(1DEL JPUMP SIPHON M ANUF ACTUHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO QYES IONO DYES ONO GALLONS PER CYCLE: 77ND CONTROLS OPERATIONAL ( (,' OF' :P WELL BUILDING I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1:1 YES ❑NO NEAREST-- SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 1 N(,TH IDIArof TEL ATE IA RKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORC1= 1 the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH IN ODF DISTR PIPE SPACIN(; COVER IINSIOL MA -PITS LIQUID BED/TRENCH 1 �— TRENCHES % MATERIAL PIT DEPTH DIMENSIONS. `�+ RAVEL DEPTH - FILL DEPTH 14,6,91 STH PIPE UISTH PIPE DISTR.PIPE MATERIAL NO DIS NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EV.INLE T EEL�EV ENO PIPE: FE . FROM LINE AI RIN ET.IZL LAO �� '7(,R31 � NEAREST 1� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER ITEXTURE PFHMANENTNaAHKEHS 1111 SEHVATTONw1LLs _ DYES ❑NO _❑YES 1-1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH REU DEPTH OF TOPSOIL SODDED SEf UFD MULCHED CENTER EDGES 1:1 YES ONO ❑YES 11 NO El YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: st WIDTH. LENGTH NO.OF LATERAL SPACING GHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER 0ED/TRr:NCH' TRENCHES. DIMENSIONS '.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING 'ELEV.. ELEV. DIA. ELEV V. PIPES DIA: ELEVATION AND DISTRIBUTION IIID(MATIDN HOLE SIZE HOLE SPACING DRILLED CORRECT L Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBRCIh PROPERTY WELL: BUILDING: p FEET FROM. LINE 4O ❑YES El NO ❑YES ❑NO NEgf1:ST (1.4 6 Sketch System on }� Retain in county file for audit. Reverse Side. SI TURE TITLE'. Zoning Adm iwus ttaton DILHR SBD6710 (R.01/82) �f161+ SANITARY PERMIT APPLICATION COUNTY TY C DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PROPERTY OWN R PROPERTY LOCATION 5�, '/as %, S T30 N, R E(or) PRO EFITY OWNER'S MAILING ADDRESS LOT NUMBER BLO K NUMBER SUBDIVIS ON NAME NA WA CIT ST TE011 . ZIP CODE PHONE NU ER CITY NE EST R AD,LAK OR LA RK S.u ( r U ❑ VILLAGE: S �� { L II. TYPE OF BUILDING OR USE SERVED: - : — �_� Number of Bedrooms if 1 or 2 Family. OR ❑ Public(Specify : e Q PJp I e III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. .:' New b.XReplacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Xconventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. J�ee a e Bed b. ❑seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(S_quare Feet): PROPS(Square Feet): 3 )6 JC' OFeet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strructed Steel glass Plastic App Tanks Tanks Septic Tank or Holdina Tank 1600 WksKS ❑ El ❑ ❑ Lift Pump Tank/Siphon Chamber L+—,—. . VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage syst shown on the attached plans. Plumber's Name(Print): Plumb ' Signat re:(No St mps) MP/MPRSW No.: Business Phone Number: �hP k' Ns 0.51 7�s 3900.)o Plumber's Address(Mks,City, F Beate, ip Code): Name of Designer: j ' 10 jl�"L l�1 L N t C. SY01 * L 40 VIII. SOIL TEST INFORMATION Certified Soi Tester CST)N e 1f CST# O ^ ° < A A U CST's AD`�ESS�tre t,City,State,Zip Code��C b U ���C ��� t� Phone Number: ��-� IX. COUNTY/DEPARTMENT USE ONLY J l/ ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Fa Approved ❑ Owner Given Initial ��� urchaarrge Fee LP [�}��(� (/y���/ Adverse Determination �' — ��" O�CCChh >� J 'v X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFQRMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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 permii mustbe'approvbd by the permit issuing authority, A new permit may be needed if there is a change in your building plans, system location, estimated wastewatVr flow (number'of bed= rooms, etc.), depth pf system, or;type of system;. 4. Changes in owh�rship or plumber requires a Sa6it'ary Permit Transfer/Renewal Form (SBD 6399) to be ) submitted to the county prior to installation; 5. Private sewage syStemms must'be proparlymaintained:The septic tannk(s) should be pbmped by.ar licensed I pumper whenever necessary, usually every 2 to.3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the state of.Wisconsin, Bureau of Plumbing, 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 where the system�is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified-soil.terer's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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, drlwn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tangs; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1'984,°1983, Wisconsin Act 410 was signed into law. This legislation is more' commonly known.as the groundwater protection law. This'.change iti statutes was the result of overt years of stelady negotiation and public 'debate. The groundwater bill 'Ground titer included the creation of surcharges (fees) for a number of regulated practices which, Wisco ik 'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rig 'asre. a is used in your building is returned to the groundwater through your soil absorption .u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered b the Department e e a tment of Natural Resources. These funds are e used for monitoring Y p 9 i water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 1 APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property i�1�C.i�().� � G- +MctV-1 Location of property � 1/9 <5 0 1/4, Section 074 , T N •C -R � W Township f jo alb Mailing address 13 0-3 S 3 r.l S- : Address of site / 3 - Subdivision name Lot number Previous owner of property J)nnald F N/eh oh'i AQ/`cl{Ay Affil en i Total size of parcel -� L v.Cr Date parcel was created $-g3 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house)? Yes X No Volume (_oto U and Page Number 3"73"73 as recorded with the Register of Deeds. I 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. -�9S11 Z✓ • ; 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 dul ecorded in the Office of the County Register of Deeds, as Document No. Y Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature side ...A ........... .... ..... h .......... ........... Ree'd. 1w► t� ........ ...... .. ....... ................................. (iraaMr. �day Of err1..» 1�..QElt1.................... .......................................... air 3:45 r 11 ,.....,..�. . ........... ..... ... .................................... 4* ...._.» ................................ ................ .... ._._........... !}roatesr k1 1.Trnt the MM Oegar.ter a nlWb aSewwndiea.-•-•- ... ..................... ............................ --TO -- " aeMNal�i.titastee tte tdkwiaX dreribed real oete/e iS w To The South One-half (S 1/2) of that part of the Northalst Quarter of the Northwest Quarter Ta:ParesiNe: (NE 1/4 of NW 1/4) of Section Thirty-three (33), Township Thirty (30) North, Range Nineteen (19) West, lying north of the Town Road running through said Northeast Quarter of the t+lorthwest Qua rte r. { 7 . and Y d` The North One-half(N 1/2) of that part of the Northeast Quarter of the Northwest Quarter (NE 1/4 of NW 1/4) of Section Thirty-three (W ,Tonshi P Thirty (30) North, Range Nineteen (19) West, Lyin g ' :,- north of the Town Road running through said Northeast Quarter of tW Northwest Quarter. -v.7i Tk& ....WW bomesteed property. tb� boreditaments and appurtenances thersnnto belonging; i otaaaw�. ea and Doroth P. Alen, husband and wife, - wwraale that i tkie i. ft . iadeteaeibk in fee simple and free and clear of encumbrances except j, and will warrea t Said AetaA the same. Dated this ........... .............. ...:..... . day of . . . _ Q 1. 19 4; 2 ' t .... ................. ............ ..(SEAL) 1C. �u� it '(.&AL) • ............................................... Do atd F.,.Allen- ..... . ......... ........ t: (SEAL) X �L6 t.t � r .-,1✓ ! ..`rlJl.L.J .........(SICAL) ...... . ....... j 4 Dorothy P. Allen AUTURNTICATION ACHNOWLRDOURNT Minnesota STATE OF WKSOM3 ---•• -----------•-••----••....................•-•-•--•••--•.....•---•--••- Ramse 1 -•• •-y ..........co unty. autbaotier d this ........day of_____________ ____________ 19..... Personally came before me this .. .......day at March ---------••---•-- 19.0,3.._ the above panted -...--•...............••-•--•--------------•-•-•••-•...........-- ------ .................................. ......................................... ..husband and wife,--•••-•• --......••---•-...._.._.......... .: . . TITLE: MEMBER STATE BAR OF WISCONSIN - ',' (If not.................................................. _. - authorized by 1706.06.Wis. State.) to me known,to be the person s_ who executed the foregoing instrument d ledge the name. THIS INSTRUMENT WAS DRAFTED BY Thomas, Kind, Swenson & Collatz, P. A. 'Ni""' infra1 T_______.__;- •445--Nlinfiesbta bti tauT nnesofa _. ..._ _ _ . . e ....�.......... .............•---_--•-• ............----...._. Notary Public fiam-sey County.._Nsmlirfpearre (Signatures may be authenticated or acknowledged. Both Vv Copimission-is permanent.(If not state axpji*"" art•not necessary.) - date: - -. -- grazes d passes aleaft in say espeeitr douM be typed or primed Allow tAeir s isaasurrR ,.,v.' _ n wtlanMll d)1~a1 81aat V STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER `''`�Lh0.C. I D 044w-Av-, ROUTE/BOX NUMBER 1303 S3 r4 S I , FIRE NO. 130"S CITY/STATE �4uAz-@*, , Uf . ZIp Sgdl6 PROPERTY LOCATION: SE 1/4 1/4, Section Zb , T j0 N, R %`i W Town of St: Jas ph , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE Z C 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 INDUS T Y, OF REPORT ON SOIL BORINGS AND SAFETY&rBUIL VISION INDUSTRY, 'DIVISION LABOR AND PERCOLATION TESTS (115) P.O. W WI 7969 MADISON, HUMAN,REL'ATIONS �, SON, 53707. (1-163.090)&Chapter 145.045) W ' TOWNSHIP/MUNICIPALIT . OT :BLK : SUBO NAME: /�f �►(or 3TT10,10 t W r"'S/W M :!/ Qn R Epa USE DATES OBIPERVAVIONS MADE NO.B : CO T O : T �esidence .3 New �eplace RATING:S-Site suitable for system U-Site unsuitable for system IrsT�NA_ : MS.❑U I S C7U [,ITEM IN ❑S FI L S�U :RECOM47f/r ti D�dN.i op Hall UU ICX�/► C�/4_ i If Percolation Tests are NOT required DESIGN RATEn If any portion-of the tested area is in the under s.H63.09(5)(b),indicate: , 5 I Floodplain,indicate Floodplain elevation: Y' PROFILE DESCRIPTIONS j BORING TOTAL P H GROUP DWATER-INCHES CHARACTER OF SOIL WITH-THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER ELEVATION gSERVED TO BEDROCK IF OBSERVED(SEE AB�BIRV.ON BACK.) ��w I� i � <�� ails./ �f�i;d >/,;Afb >"h.S �� AA HI e«i s 1 {rj'o' s' s� 'Cy s .2, V21014 sq�yr� B- 3 � 5 > 70 �3' �s . �3B e .s•8'111041 s w 'pw1 B- B- I PERCOLATION TESTS EST DEPTH ATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES j NUMBER A .TER ELLING INTERVAL-MIN. P PER INCH / ff� r •.' j P_ 3 P-. P- i 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 T), Sj z -- — %A --- -- TN 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. i NAME(print) TESTS WRREYOMPLETED ON: i ADDRESS: CE F TION UMBER: PHONE NUMBERIoptionall: 1 i Cs-T G QIT DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. i DILHR-SBD-6395(R.02/82) —OVER— L_ - 67 1-1 0 SS R B. L PLOTA N I IJ-0 S-E C TJ 0 1\1 ±`NAME mkftel 0 _ . ....__ N A M ' .,. tL0CA IQN ..' � �, _ r- ICE NS F .j 1059 P L n I" hM A_I - t Nate fzorh 53A-erk a TANK Note. : Ad J ace J I ASI ga p45 ' aeo W.l l s ARA 'Glkkktl, - , No 100 Ir t �TbN� x _ aa' 3 BeOROQ M HoM� I I� J FA 1 O I �' 0 �f av&� 60rte�ole Sites �oaa la'---- Jul X- PCRC,61t S IftS LJ ac g' yo �,= are T1,R�s hold d� FRo"k DOOR T-L-I00.b i 0 aT 1 PA � 8e,low Pipe �' AND OBSERVATION PI-PE S._.A E AIE, INLE:C FRESH i Cno-S SECTION r Approved Vent Cap Minimum 12" Above G J Final Gr a5 Q__ tau ' MAk 4" Cast Iron Above Pipe% Vent Pipe To final Grade- Marsh Hay Or Synthetic Covering Min. 2" Aggre(JI.1 Over Pipe V �r_-3� Tee Distributii� Pipe _..._...._.l. Aggregate N Perforated Pipe Below Bcneath Pipe 4 —Coupling Terminating At r_ . Bottom of System y - Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SQ rn rl,`�I�r TOWNSHIP SEC. �_ T ,30 N-R 19 ADDRESS �o >'z Z ST. CROIX COUNTY, WISCONSIN 60Z SUBDIVISION LOT Z LOT SIZE Sf.75 PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM k� - �Jp^ 300 4s Pz" Fly -0c ` J• $,M Top o� K � P C \/ u�O�o¢( Tf G ti C I� 1�/. 9 z. 00 P'Le i 5 00.(CL ` agXSO - - [.,,�p¢r TvtgC�n Z ZNSwIa'1'�ow.�oc.lc t-0 fi [ '70 3 � ly INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 1"" /o1' Li CV lot vl� Elevation of vertical reference point: 100.0=0.377- Proposed slope at site: /g % N L SEPTIC TANK: Manufacturer: W Z, S a r Liquid Capacity: 1000 Qa( Number of rings used: �_ Tank manhole cover elevation: 9 76 5' Tank Inlet Elevation _ Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side,N Rear, O feet r From nearest property line Front,0 Side 10 Rear, Q L4 feet y! , Number of feet from: well 10 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE t PUMP CHAMBER Manufacturer: AV9— :Liquid Capacity: q P Y Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: i 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). SOIL ABSORPTION SYSTEM Bed: — Trench: ol c S X 75 Width: C" Length: ?S- Number of Lines: Z `Area Built:-7 S-0 �T Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,Ft .�l�' Number of feet from well: Z Number of feet from building: t (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: Inspector• Dated: Plumber on job: �- _1-1�7 License Number. 3/84:mj y i DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS -LABOfl BO iL X 7969 HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O.BO MADISON,WI 53707 Ip�,., SW�,SW1,S28,T30N—R19W CONVENTIONAL ❑ALTERNATIVE 'If_.gn�iD.Npmber Town of St. Joseph ❑Holding Tank ❑In-Ground Pressure ❑Mound Lot 2 Perch Lake Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: , Sam Miller Route 1, Box 282, Hudson, WI 54016 —a 7- /0. <�XU BENCH MARK(Permanent reference pomq DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber /MPRSW No.: County: Sanitary Permit Number: Dou MP�T Strohbeen 5432 St. Croix 102822 SEPTIC TANK/HOLDING TANK: MANUFACTURER. JLIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT T FRESH ALARM. FEET FRO / LI AIR INI N=.ET +�}� r��� 1�, � V c. INEAREST2---� I ��rsTI r� OYES L�hNO V LJYES il�lVO DOSING CHAMBER: MANUFACTURER BEDDING-. 111OUID CAPACITY. PUMP MODEL P WARNINGLA11 LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO YES ❑ O ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY PATrVIA WELL BUILDING AIR NLO FRESH , (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER AN KING 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: WIDTH. JLENGT NO.OF DISTR.PIPE SPACING. COVER ffNUMBER INSIDE CIA -PITS LIOUIU BED/TRENCH TRENCHES { MATERIAL: DEPTH DIMENSIONS '} GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DI F PR OPERTV WELL BUILDING VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV INLET ELE^V.END PIPES L1AI�R/INLET (V II C���1 1 —► V 6 'TV MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS JOBS11VATION WELLS EYES ENO EYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDEO MULCHED ' CENTER. EDGES. ❑YES : NO DYES ❑NO DYES ❑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&MARKIN(, ELEV.. ELEV.. CIA.. ELEV.. PIPES DIA ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS OYES ONO El YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. S FEET FROM LINE: II DYES El NO ❑YES 1-1 NO NEAREST IFZ 0 Sketch System on .1 ��(,Retain in county file for audit. Reverse Side. 5 -q SIG TITLE Zoning Administrator DILHR SB D 6710(R.01/82) ;may' SANITARY PERMIT APPLICATION COUNTY L DiLHR In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT# a� DQ —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION j�. 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPERTY OWNER PROPERTY LOCATION S w'/4 S w'/4, S T N, R E (or&W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME � 1 o)c CITY,S ATE ZIP CODE PHONE NUMBER 77 CITY EAREST ROAD,LAKE OR LANDMARK 7 ❑ VILLAGE: G L. L II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. IN New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. KI Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.El Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. El seepage Bed b. ICI Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Lxf-P�Trd ,k1?2.0 G 3 LP 15- (, 4 % �°'�"'' Feef ,�Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks I Tanks structed Septic Tank or Holding Tank W a. S Iz`r Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: a� c 6 :;1-- P—S f3 � 2 �{7 32 3 3 o� hCm Plumb 's Address(Street,City,State,Zip Code): Name of Designer: e;ebi W a,- Q (__T_ 40 j 7 ac. Strd b�QH Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# y� CST's ADDRESS(Street,City,State,Zip Cod ) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) charge Fee Approved ❑ Owner Given Initial Adverse Determination X. COMMENT/S1/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber J INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION ° TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 816 x 11 inches must be submitted to the county. The plans must include the following: A) lot Ian, drawn to scale or with complete dimensions location of P P P holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground 8W. included the creation of surcharges (fees) for a number of regulated practices which Wisco fR'S a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaIstIFB is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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 r-&r1,'��r Location of Property S &(/ IC S Lt' , Section T__:�C N-R� Township Nailing Address `TA7/ �p y _-10-- ><"12 o ""T Address of Site __,ee A kc Subdivision Name Lot Number '*_ Z_ Previous Owner of Property DaL,,r'ce t,eJcr� Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number �L'?4t 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION i (Wel co-A-ti6y that aft statements on th,iA for arse trtue to the best o6 my (ouh) hnowtedge; that I (we) am (Nee) the owne&(s the pnope><,ty ducAi.bed in this .in6o4maAon 60nm, by viAtue 06 a waAAanty deed neeokded in the 066.ice 06 the Coluityy Reg.cateA o6 veeds" Voeument No. 297 ,;La'-? ; and that I (We) pnersent.ty aun the proposed kite 6oh the sewage df,6pos eys em (o)t 1 (we) have obtained an Qaeo"ent, to nun with the above de cAi.bed p>topehty, bon the eonsthucti.on o6 said systm, and the some has be-en duty neconded .in the 066.iee o6 the County Reg•i6teh o6 Vttd&, ab Doewnent No. aji '7 ,P SIG91VRZ Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) i DATE SIGNED DATE SIGNED • DOCUMENT NO. BQOr 453 Fa�E474 WARRANTY DEED --STATIC OR WISCONSIN•FORM 9 2-97 O I THIS 9PACZ Rti6RV6D FOR RBCORDIN6 DATA �I Elsie REGISTERS OFFICE IS r TH R-46M 'TIJRI,,Made by M. J. Wert __.........._......».._.._.._._.rt ._......_.._„_.............. i � 87. CROIX CO., WIS. ., � ............»_......_................. .......__........_..................... .._........................... .....»......_.._.._.._.. II Reed for Record this__24�h. grantor...._ of..._»__......_. t.�..»�roiX.._.» --_.._._.._...County, Wisconsin, day of--. July-_-__A.D.19 F hereby conveys and warrants to...Darrgl_A,-MR)EI-_-•.-•-.._�._,.__,. .._... at- 84---- A e M. ..................»......_...._.._...._..»..................»_....... .._.._......_.._.._»»_........_»_.._..»...._.. of $t. Croix .._....._...County, Wisconsin for the sum of _.._.._.._»_._t ... »Qng•-»dollar _( 1,00) and other ood and valuable » RETURN TO consideration &_.._._.._..»..__. Tr / ..................-..... ._ ..».... �.»........»...._.._.. ».._..».._..».._»........_.._..- �T✓�/i,t/ 4 7` �f ..................»......__..»............»..........»_......»................_............_..__........_................... the following tract of land in.......»...._.. ._......._........_...County, Wisconsin: .......»».._........_.._»..»..--._..__......_........__.......».._........_..__.._............. The Southeast quarter of the Northeast quarter (SEINED) of Section 32 and the Southeast quarter of the Southeast quarter (SEJSEJ) of Section 32 and the West half of the Northwest quarter (WJNWJ) of Section 33 and the West half of the South- west quarter (Wiffb of Section 33, and that part of the Southwest quarter of the Southwest quarter (SWISWI) of Section 28, lying south and west of that body of water called Perch Lake, except part conveyed to Arthur T. Kerrick and Agnes Kerrick by deed recorded in Volume 265, page 493, and subject to the buyers interests in those land contracts entered into by the grantor and grantee (and his wife, Beverly A. Wert) with Theodore L. Mackmiller and with Kenneth D. Wert and wife, all in Township 30 North, Range 19 West. In Witness Whereof, the said grantor....- ha.St..... hereunto set............ er_......_... hand...... and seal...... this day of..... .a UEle........... , A D., 19..6:.97... yy�j �! .0 -.......... RIONN AND HIDAL$D IN 9ENCE of 1 » / F.l q i at M- ,T T. lye�r,t Lr I ....... _.............._........................(SEAL) ........... ... ..... ........». `.i c'` - ......._........... ». ugh ». Gwi — ..........................._.............._............._..»..............................(SEAL) Marlys r ......................................._.........._..........................................(SEAL) S e of Wisconsin, I St. :UL•••••County. Personally came before me,this..,e ` day of.........!T11 .........A.D., 19.69., the above named ........Elsie Elsie-k. .J.,•..•W991 ............................................._._..........._.........................__».........._.................-............_..../.--.... .... ..........................._.--.. to me known to be the person...... whope�utKitie foregoing in stt t atyt3�a ow ed the same. s { F Gwin THIS INSTRUMENT WAS DRAFTED 131G{' Hugh - Ci u; NoTADRr , Ngtac Public................St.'....-----._.--.rox-...............-.County,Wis. Hugh F. Gwin ( (. permanent .......... bY3 w mission Is)............................................_......_. 4 (Sect on 59.51 (1) of the Wisconsin a(d)e%%' gqwdes that all instrumen4s to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees,, wises,ah¬ary. Section 59,513 similarly requires that the name of the person who, or govern- mental agency which, drafted such ms 4411 be printed,__tyrypewritten, stamped or writteo thereon in a legible manner WARRANTY DEED STATE OF WISCONSIN Wleeonetn Legul 81ank Cntnpany .FORM No. 9 Milwaukee,Wla, (Job 28249) H • y a ST C - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a H OWNER/BUYER�.,�, /�,���✓ ROUTE/BOX NUMBER_ Afi / '6 a'oC-11gZ�— Fire Number — CITY/STATE �uNS®y! Cr/� ZIPS7CC- /b PROPERTY LOCATION : 15 Lt/ 14, _SW k, Section--"287 , T SUN , R I W, Town of P4 , St . Croix County , Subdivisionmry' Sc,_yU. "-4 , Lot number Z 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 . 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H 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 . SIGN 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 . DE3'ARTMENT OF REPORT ON Sall BORING AND SAFETY& BUILDINGS DIVISION INDUSTVY, P.O.BOX 7 69 LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 HUMAN RELATIONS (1463,090)&Chapter 145.045! TLA 10N WNSHI MtlNif:�M�'l4:•hur': O SUBDIVISION NAME: '/�S .i ag /T N/R�9 ,- J Os t PH Vie:p—r Svxv, M 4-P Y: LING ADDRESS: USE DATSS OBSERVATIONS MADE Residence / „i P`� few ❑Replace /Z�X' `$, 2 S`4 06 50 J L. g�caCl K Z 5c �-S Co.�: G+►ec r-ram RATING:So She suibWa for VANO U0 Site u tauft"for eyatarrt NK:RECOMMENDED SYSTEM:(optional) S U S U S. . U []S NU L5t,(GHis Wirll SWOP 60;4X5 It Percolation Tests are NOT required if any portion of the tested area is in the under s.H83.0511(bl,indltcte: N, r Floodplain,indicate Floodplain elevation: NA DEPI PROFILE DESCRIPTIONS all BORING NUAABER CHARACTER B 1 S, OL R,TEXTURE,AND DEPTH ELEVATION ACK.)T B- I®•3' '�I e?? f��J/ ix� o.L9; 6N 5�0 a3 so6'5,o.4)L''DN�S; dio Dk @4S.., S.Z /t,2.7 9S'.8Z Monks > I#•Z7 BNS�L'/.3��LT.BNfs`5'MaoS;'�►. r�39s''4hra 4t ay L S�-• A. g.�$ V• S d.1' D•"1 B04 L-S RDISrl.l car /2,001 0$ Noma 40 cP. OnnorI• • 8I . 1•oq•34 sow •c0.ot -' 1Z1 N . 3.e0' 54 4; + " L > t y+.x r—WA 'M 33 RD,SDN' <i.. SOW w M4M B-¢ s+6 6 (S� i d•4 p a .LO' N B- 5' 1 �4/ w /� � �'/�r.'�►� 1.5.0. $41FS � CO.p$ 14 soNSPLpLlX&k& S cAtTBEr awl Q- C> G1Mkd. PERCOLATION TESTS TEST AT NUMBER D A I INT AL M. RATE PER INCH MINUTES P- P.az Z •G. 3 P. > � P- ui P _.. ..., P. P. / I PLOT PLAN: Show locations of percolation tests, soli borings and the dimensions of suitable soil areas. In scale or tancel, cribs what are the hori- zontal and vertical elevation rieforence points and show their location on the plot plan. Show the surface tion W,011 V h direction and percent R-!i of land slope. (J 1Z— T N C-14 C}Z, d O GGG�� SYSTEM ELEYATMNL',, W"a T'mer4CN 67.85" Aim' OVAI-k ©F m7—rL- N etc- A"0 O'I T/O N*" 1- I i I coo. I—(nIE Sash lu 7_t3 1,the unden",hereby certify that the soll bob 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. z; NAME tprint): TESTS R COMPLETED ON: JAAAff-eS a. 45/2-5- /41 G AO CERTIFICATION NUMBER: PHONE NUMBERloptional) D 7 0- D o�+ W J 5G 386-4oe o UNATURE: �• DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Teter. DiLHR-SOD-MS(R,02/82) —OVER — cri c� a, F4z cz w d � O�V O� N � r ' o O •� O k �l o e --- --7 3Y..'— J 1 J Ito ° � o 0 Id U IL a Z 4L 77 OL — Ir o Iri MO7 ap M h. • S3� � IV h- Z Q pl Cl 5 S'f�rr IV. gZ,OQ �,. �aw�` ia �a Iti � ']. 5' Low✓ "C/4�+�-� Y N©f c 5ys-tawl �.a.�,4'" lCj, aq /09 V 14,1 a„ 4 /113'"4. ((a7`�aH G qCl d ' t- i'a vi,:,I L 1/y”= 10" 'a o a.. H o la. T a 7,,,.. D �a.✓L -re-jer t),,, , %4"k ►��� .� fi ,, • A �, IM. 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