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Parcel #: 036-1069-10-000 01/09/2007 09:57 AM
PAGE IOF1
Alt.Parcel#: 29.31.17.447A 036-TOWN OF STANTON
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-RAPPLEY, LAWRENCE A&KATHRYN L
LAWRENCE A&KATHRYN L RAPPLEY
1520 HWY 64
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description " 1520 HWY 64
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 28.000 Plat: N/A-NOT AVAILABLE
SEC 29 T31 N RI 7W 28A E3/4 SW SW EXC E Block/Condo Bldg:
33'&EXCS290'OFW150'OFE183'OF
SW SW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
29-31 N-1 7W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1238/628 WD
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
166902 Use Value Assessment
Valuations: Last Changed: 05/27/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 17,000 165,600 182,600 NO
AGRICULTURAL G4 25.000 3,700 0 3,700 NO
UNDEVELOPED G5 1.000 500 0 500 NO
Totals for 2006:
General Property 28.000 21,200 165,600 186,800
Woodland 0.000 0 0
Totals for 2005:
General Property 28.000 21,200 165,600 186,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 214
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTM NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
DIVISION
ABOR&tIUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
P.O.BOX 7969
MADISON,WI 53707
CONVENTIONAL ❑ALTERNATIVE State assigned)
Number
SW SW14,S 2 9,T 31N-1g117W "'asigned1
Town of Stanton ❑Holding Tank ❑In-Ground Pressure ❑Mound
HWY 64
ZZE
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DA E:
Carl Crosby Route 3, Box 279H, New Richmond, WI 54 17 C9 13 ,?f 9`a
BENCH MARK(Permanent reference pomt)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
Name"1 Plumber MP/MPRSW No.: County. Samlary Permu Number:
Byyon Bird 1309 St. Croix T106130
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. ILIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER
PR VI ED. PROVIDED.
YES El No DYES NO
BEDDING: VENT DIA.. VENT MATE. HIGH WATER ROAD: PROPERTY WELL. BUILDING. VENT T FRESH
ALARM. NUMBER OF LINE n LAIR INLET
LINE 7
❑YES NO C ❑YES ❑NO NEARESOM �7
DOSING CH BER:
MANUFACTURER BE DDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANU CT IRER PROVIDED PR
pROVI DED OVER
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATE N MBER OF PROPERTY WELL BUILDING VENT TO FRESH .
LINE AIR INLET
(DIFFERENCE BETWEEN ET FROM
PUMP ON AND OFF) ❑YES N EAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth ofplgovvg V LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall ceas&Atil FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO.OF DISTR.PIPE SPACING COVER INSIUE DIA -PI15 LIQUIH
D
BED/TRENCH /) TRENCHES MAT AL PIT DEPT
DIMENSIONS
GRAVEL DEPTH FILL DEPTH IDISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO DI NUMBER OF PROPERTY WELL BUILDING VENT TO FRES/+
BELOW P�r/ ABOVE COVER ELEV.INLET ELEV.END. PIPES FEET FROM LI/NE / AIR INLET
NEAREST
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.
DYES 1:1 NO PERMANENT MARKERS OBSERVATION WE LLS
SOIL COVER TEXTURE
DYES ❑NO DYES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
DYES 0 N ❑YES El 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 M DISTR OISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKINI;
ELEV.' ELEV. DIA.. ELEV.. PIPES DIA..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS 70 APPROVE U
PLANS
DYES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PRIOE ERTV WELL: BUILDING.
FEET FROM
f �a
El YES El NO DYES 1:1 NO / NEAREST
0 25 Q
j 2-
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE
DILHR SBD 6710(R.01/82) Zoning Administcrator
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm.Code 6:�- f✓iolr
�.�.;w.,,,.a.,.....,.�.,.o� STATE SANITARY PERMIT#
&/ v
—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
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 5d NO
PROPERTY OWNER PROPERTY LOCATION
1 S\A1/a .S , S T N, R l E(or W
PROPERTY OWNER'S MAILING ADDRESS c LOT N}�MBER BLOCK N MBER SUBDIVISION NAME
r� er l /Vk J\ f;C
LW,STATE AP CpDff PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
/9 Al ❑ VILLAGE: "�lh
rn
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 9= OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. 0 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. DO Conventional 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. R See a e Bed b. ❑seepage Trench c. ❑ See page it
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): / Jet
3 Ted if 6, Private ❑Joint ❑ Public
VI. TANK CAPACITY Site Fiber- Exp
Manufacturer's Name Con- Steel Plastic App
in gallons Total #of Prefab. p.
INFORMATION New Existing Gallons Tanks Concrete glass structed
Septic Tank or Holding Tanks Tanks Tank ❑
Lift Pump Tank/Siphon Chamber 1-1
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sew e system shown on the attached plans.
Plumber's Name(Print): Plu is Signature:(No Stamps) MP/MPR�SW la. Business Phone Number:
n nt cl V 9 �-�
Plum eP9 ress(Street,City,State,Zip Co e): Nam igner:
VIII. SOIL TEST FORMATION
Certified Soil Tester(CST)Name CST#
W {A- W, a 6 70
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
�'y L715' 321
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Is ping Agent Signature(No Stamps)
Approved ❑ Owner Given Initial S rcharge Fee
Adverse Determination ����
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
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;
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;
if yo., h.=ve question=s co�icerr,inc your pi ivaf., sewage syster: , contact your local code adr,ninistrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
". 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;
ill. Purpose of application: Check only one in ##1. Compete ##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 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; 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
Can 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 ateC
included the creation of surcharges (fees) for a number of regulated practices which Wisco*WS
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ire 946
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
a
The monies collected through these surcharges are cred'ted to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
vlater, groundwater contamination investigations and establishment of standards. Groundwater,
i 's worth protecting.
SBD-6398(R.03/86)
SANITARY PERMIT APPLICATION C77"4
� DILHR In accord with ILHR 83.05,Wis.Adm.Code
C.a,.;. .��......o STATE SANITARY PERMIT##
iv 6/3
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
Z x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO
PROP TY OWNER PROPERTY LOCATION
t�J+/4 /4, S v� T �, N, R /7 #(or)W
PROPERTY OWNER'S MAILING ADD S // LOTNUMBER IBLOCKNUMBER SUBDIVISION NAME
t , j �''' v�7 , E'er E!? .y►00�C�
/V+4 A , '4
CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEA T ROAD,LAKE OR LANDMARK
VILLAGE:
11. TYPE OF BUILDING OR USE SERVED: n
Number of Bedrooms if 1 or 2 Family /r OR ❑ Public(Specify):
IIL PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. �§ 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# 1 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. Conventional 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. D9 seepage Bed b. ❑seepage Trench c. ❑seepage Pit
2. PE OLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
C Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gal l0ns Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank �e k f
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): Plumb s Signature:(No t ps) MP/MPRSW No.: Business Phone Number:
lumbe 's Address(Street,City,State,Zip Code): V Name of De
Vlll. SOIL TEST INFORMATION
Certified oil Tester(CST)Nam2 CST## 6
&L)A
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Qcliz l 2d,c)c� charge Fee
Adverse Determination �5
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
PFP,8MATION & 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 revi*ns to this permit must be approved by the permit issuing authority. A new permit maybe 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
F 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 a//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 8'/h 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; 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 lltier
included the creation of surcharges (fees) for a number of regulated practices which Wisco [#>EzS
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried
is used in your building is returned to the groundwater through your soil absorption
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-
.. f
water, groundwater contamination investigations and establishment of standards. Groundwater,
....... .................
it's worth protecting.
SBD-6398(R.03/86)
W`l1
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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 properrrty 1 �)
Location of of off/ 1 9 �'�� 1/9 Section �`
P P y / � l , T �N-RW
Township
Mailing address 9
Address of site
Subdivision name
Lot number
Previous owner of property
Total size of parcel C;,- G'GG�Lti4�
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 11.and Page Number as recorded with the Register of Deeds.
-------------------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warrant deed recorded in the Office of
the County Register of Deeds as Document No. and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorded in the Office
of a Count ister of Deeds, as Document No. ) .
( (/Signature of wner Signature of Co-Owner (If Applicable)
Date ooegn-#4re Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN — FORM 2
VOL 611 PA U E 5 WARRANTY DEED
3 JL THIS SPACE RESERVED FOR RECORDING DATA
�J REGISTERS OffiCE
Nora F. Sandmann ST. CROIx Co., WIS.
Rec'd. for R:.cCord this 12
day of June A.D. 19 80
conveys and warrants to Carl J. Crosby and at _ 1 .50 P , M,,.
Mary M. Crosby, husband and wife, J"James 00"Connell
as joint tenants ---.-._„
�,� �• De put
RETURN T TO
the following described real estate in St. Croix County,
State of Wisconsin:
Tax Key No.
The East Half of the Southwest Quarter of the Southwest Quarter
(Ez of SW4 of SW4) of Section Twenty-nine (29) , Township Thirty-
one (31) North, Range Seventeen (17) West.
This Warranty Deed is given in satisfaction of that Land Contract
between Grantor and Grantees dated May 22 , 1969 , and recorded in
the St. Croix County Register of Deeds office on June 2 , 1969 in
Volume 451 of Records on Page 628 and 629 as Document No. 296462.
FEE
EX 1TT I
ThisiL4omestead property.
(is)(is not)
Exception to warranties:
Dated this v� day of May ' 19 80 .
(SEAL) (SEAL) f
i
Nora F. Sandmann
(SEAL) (SEAL)
4
f • i
AUTHENTICATION ACKNOWLEDGEMENT
Signatures authenticated this day of STATE OF WISCONSIN
May ' 19 -80. �SS.
S �) t N/A County. is
Personally came before me, this NZA day of
Cherrill Hirst N/A , 1s ,
TITLE: ME14BE-R-6-TA4T-E-BAR OF 9NSIW I
the above named
(If not, Notary_ptthl
authorized by§706.06,Wis. Stats.) CHERRILL HIRST
Notary Public-State of Wis onsId N/A
This instrument was drafted by B-PueB —
DOAR, DRILL, NORMAN,
BAKKE, BELL & SKOW
New Richmond, WI 54017 to me known to be the person_who executed the foregoing i n-
strument and acknowledged the same.
I(
(Signatures may be authenticated or acknowledged. Both are not !
necessary.) • N/A
Notary Public County,Wis. I
*Names of persons signing in any capacity must be typed or printed below their signatures.
My Commission is permanent. (If not, state expiration date: II
-
-WARRANTY DEED=STATE BAR OF WISCONSIN FROM N0.2—19773
L
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER 3 0& --2 /�} FIRE NO. T
CITY/STATE_L /A��/'L� �-� ZIP 7
PROPERTY L AT?TN: .1 0 1/4 W 1/4, Section of- ! , T_&_?/ N, R_J7 W,
Town of , 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
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680 '
Sign, Date, and Return to above address 1,
V
DEPAH I MEN OF REFUK I UN EVIL BUKIIVI_a_S ANU , OHI L_1 1 « UUILUIIVU0
INDUSTRY, _ DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145) sage 1 of 2
LOCATION: ECTION: TOWNSHIP/ P*PW*Y: LOT NO.:BLK.NO.: SUBDIVISION NAME:
SW 1/4 SW 1/4 29 /T31 0170641 STANTON N./lo N.A. N.A.
COUNTY: OWNER'S 'S NAME: MAILING ADDRESS:
St. Croix Carl Crosby ht. 3 Box 2796 New Richmond, Wis, 54017
USE DATES OBSERVATIONS MADE
R NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: AT O TESTS:
laResidence 2 N.A. New ❑Replace I U5-10-88 05-11-88
RATING:S-Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL11S DING TANK: RECOMMENDED SYSTEM:loptional)
US ❑U HS ❑U @I S ❑U ❑S ®U ❑U I Convenbional
E
DESIGN RAT :
If Percolation Tests are NOT required DES If any portion of the tested area is in the
under s. ILHR 83.09(5)(b),indicate: N.A. I I Floodplain,indicate Floodplain elevation: 14.A.
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
0-13 TS Drk(,yBn I, si , p ,m r,as,no mot.
B- 1 118 97.42 None None 13-361'ir1cYBn(10`CR4/4)1,lfbk,rnfr,dw,no mot.
o- .r Us y me sw Agr, sg,aw,no Mot.
B- 56-118 same as 36-56w/pockets of med 5�2.5YT?4/3)
0-12 T3 -�rkCzyl3n lOYFt4 2 sil, fpl,mfr,as,no mot.
B- 2 118 97.19 None None 12-24GyBn(10YR5/2)sil,lfbk,mvfr,as,no mot.
2 - YR o s , cpr,m r,as,no mo ..
B- 44-118YR(5YR5/8)med s, 0sg,mvfr,N.A.,w/5%'gr.
-12 TS i,rkGyBn 10YR4 2 sil,lfnl,mvfr,as,no mot.
B- 3 120 97.75 None None 12-:'8hrricYBn 10vR 1 lfabk mTi dw no mot„
28-58Str•ongBn(7.5YR5 6)ls,lfcr,mfr,db,no mot.
B- 8- 20r` 6/ m d s Os R,ml, A.,w/20%gr,no mo
Bores 4 thru 7 on page 2 PERCOLATION TESTS
EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 __EE R OD 2 PERIOD 3 PER INCH
P_ o g�- I y 1
P- 3-7 JV0&a_ VIA
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-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surfac Vation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
I
4,1 Ipor+d &,oraF w%r Fo 51'
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;
,SdAr.a /"��-o'
I f
AC �� 1I►
AV
°� UlI bile
44 We-
rap of r-i fIv a 5 r_5 re
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of 8'
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T- h .Tt ? iTZI
!oo
the undersigned,hereby certl y that the soil tests reported on this form were made by mein accord with the procedures and meth ds specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME print): TESTS WERE COMPLETED ON:
W,kL C ' �✓
ADDRESS: CERTIFICATION NUMBER: PHO E NUMBER(optional):
4 uc GUS t �r
CST SIGNATUR
s
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395(R. 10/83)_ —OVER —
J
Carl Crosby ?age 2 of 2 r7IN n� G✓ fT�/VroN Two/' ,.Z d =r1 3
re # Total. 0eDth Elevation Depth to Charater of soil
in Inchs Groundwater
in inchs
Observed Est.
88 96.53 None 51 0-24('I'S)LrkGyBn(10YR4/2)sil,lf,?l,mfr,aw,no mot.
24-33GyBn(10YR5/2)sil,lfcpr,mfi,as,no mot.
3-51YR(5YR4/6)1,2mabk,mfi,gw,no mot.
51-59YR(5YR4/6)1,2mabk,mfi,cw,w/c3dYR(5`_R5/8)mot.
59-88R(lOR4/6)ls,lfgr,mfi,w/c2dv-R(57-R5/8)mot.(no horizor
5 84 97.48 None 50 0-8(TS)%rkGyBn(lO 4/2)sil,lfol,mfr,aw,no mot.
8-23GyBn(10YR5/2)sil,lfcor,mfi,as,no mot.
23-50RY(5YR6/6)1,2mabk,mfi,cw,no mot.
50-64RY(5YR6/6)1,2 mabk,mfi,ci,w/cldYR(5YR5/8)mot.
64-84RBn(5M4/4)ls,lf-,-r,mfi,N.A.,w/fldYR(5YR5/8)mot.
S 84 99.90 None 27 0-9(TS)DrkGyBn(10YP 4/2)sil,lfpl,mvfr,cw,w/l0�dogr,no mot.
9-27UrkR-Bn(5YR3/3)sl,lmp1,mfr,N.A.,no mot.
27-84TrkRBn(5YR3/3)sl,lmpl,mfr,N.A.,w/lOinch Dockets of
cs,BnY(l0YR6/8),w/c3dYR(5YR5/8)mot.
7 77 aprox. None 39 0-7(TS):-rkGyBn(10YR4/2)sil,lfol,mfr,as,no mot.
115.0 7-201rkYBn(lOM4/4)1,lmbk,mfr,cw,no mot.
20-29R3n(53R4/4)sl,2mbk,mfr,gw,no mot.
29-39YR(5-?4/6)meds,lcbk,mvfr,as,no mot.
39-41YR(5Y.R4/6)meds,lcbk,mvfr,as,w/f2dYR(5YR5/8)mot.
41-51 rkRBn(5YR3/4)lcsw/„r,lcbk,mfr,as,w/f1fYR(5n5/8)m<
51-77R(2.5-YR+/6)sl,lm.r,mfi,N.A.,w/m3p7F(5YR5/8)mot.
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CIEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
DIVISION
LABOR&RUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
P.O.BOX 7969
MAD( N,WI 53707 �yy State Plan I.D.Number:
SW% y,S29,T31N-R17W [(CONVENTIONAL ❑ALTERNATIVE „f assigned)
Town of Stanton ❑Holding Tank ❑ In-Ground Pressure ❑Mound
HWY 64
NAME OF PERMIT HOLDER'. JADDRESS OF PERMIT HOLDER: INSPECTION DATE'.
Carl Crosby Route 3, Box 279H, New Richmond, WI 54017
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN'. REF.PT.ELEV.: CST REF.PT.ELEV.
Name of Plumber. IMPRSW No.'. County: Sanitary Permit Number:
Ray MP
W. Shern 4343 St. Croix 1 106130
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIEE. TY. TANK INLET ELEV.: TANK OUTLET ELEV.- P AFV NG LAB L PROVIDED OVER
DYES.. ONO DYES ONO
BEDDING. VENT DIA. VENT MATL. HIGH WAT ROAD: IPROPERTY WELL: BUILDING. T TOFRESH
NUMBER OF LINE jVtN
AIR INLET
ALARM FEET FROM
DYES ❑NO ❑YE NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
DYES ONO ❑YES ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT T E FRESH
LINE AIR INLET
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ❑YES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH 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:
WIDTH. LENGTH. NO.OF DI STR.PIPE SPACING COVER INSIDE DIA 1t PITS LIQUID
BED/TRENCH TRENCHES. MATERIAL( PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPERTY WELL BUILDING VENT T E FRESH
BELOW PIPES. ABOVE COVER ELEV.INLET ELEV.END. PIPES. LINE AIR INLET
FEET FROM
NEAREST
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-
meets the criteria for medium sand. TIONS MEASURED.
OYES ONO PERMANENT MARKERS OBSERVATION WE LL
SOIL COVER TEXTURE
❑YES ONO E YES ONO
DEPTH OVER TRENCH/BED rEDGES F"'DYES
EPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED MULCHED
CENTER .
DYES 0 N ONO OYES ONO
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 MNO DISTR DISTR PIPE UISTHIBUT ION PIPE MATERIAL ELEV.'. ELEV.. DIA.. ELEV.'. PIPES DIAELEVATION AND
DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY ERIAL
PLANS
❑YES ❑NO OYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE ERTV WELL: BUILDING.
DYES ❑NO OYES ❑NO FEET FROM NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE.
Zoning Administrator
DILHR SBD 6710(R.01/82)
SANITARY PERMIT 0 COUNTY
a a E ao TRANSFER/RENEWAL UNIFORM PERMIT#
� DILHR (PLB 67-T) /V U y
PERMIT RENEWAL DATE: PER�MIQT TRANSFER DATE: ORIGINAL PERMIT IS�ANCE DATE: STE� AN I.D.NUMBER:
CITY: I/'�i
PROPERTY LOCATION: V
t/4 �' '/4,SC) ,T c3 1 N,R f`] E (or OWN OF: v
LOT UMBER: BLOCK f�UMBER: SUBD_I 71ON NAME:
N T ROAD, LAKE OR LANDMARK:
IIJ SANITARY PERMIT TRANSFERRED TO:
PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED):
PHONE NUMBER:
NAME:
SIGNATURE: NAME:
ADDRESS: PHONE NUMBER: ADDRESS:
I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this
property. PREIOUS PLUMBER'S NAME (IF CHANGED):
PLUMB SIGNATURE:
Q,
PL PREVIOUS UMBER'S ADDRESS:
A M,�� (,JZ I I I tuc.s�.
MP/MPRSW NUMBER: PHONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER:
!'1 43 l 7,c�) gasr3/9
DATE APPROVED: DISTRIBUTION: Original-County
SIG TURF OF ISSUING AG NT: Copy-Bureau of Plumbing
�a Copy-Owner
Copy-Plumber