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Parcel #: 040-1035-80-100 06/06/2005 09:40 AM
PAGE IOF1
Alt. Parcel#: 8.28.19.115C-10 040-TOWN OF TROY
Current !X ST.CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): "=Current Owner
KENNETH RAU HOLT SUSAN MH
HOLT SUSAN M
431 RED BRICK RD
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description "431 RED BRICK RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.390 Plat: 1763-CSM 17-4583 040/03
SEC 8 T28N R19W PT NE NW&PT SE NW Block/Condo Bldg: LOT 07
BEING LOT 5 OF CSM 10/2734(13.150AC)
NKA CSM 17-4583 LOT 7(3.390AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
08-28N-19W NW
Notes: Parcel History:
Date Doc# Vol/Page Type
08/11/2003 734951 17/4583 CSM
07/23/1997 1083/37 WD
07/23/1997 817/543
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/19/2004
i
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.390 63,000 163,400 226,400 NO
Totals for 2005:
General Property 3.390 63,000 163,400 226,400
Woodland 0.000 0 0
Totals for 2004:
General Property 3.390 63,000 163,400 226,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY
WISCONSIN
- ; €i� ZONING OFFICE
r r r r■r■■■ .,■� X COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
1,(J, �c (715) 386-4680
A
SEPTIC INSPECTION REQUEST FORM
i
A a specify desired test(s) & remit appropriate fee with
11' plication. Outside water lines are often turned off during
winter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained.
vV❑ Water (VOC's) $185. 00 ,n. Septic $50. 00
Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria
` retest $15.00
` Owner: 'I Requested.by:
Address:!M/ Address: / _0
ZIP ZIP�_�j
Telephone N°: ('�) A I Telephone N4: S3 --So?,3(p
Property address Fire W & Street) : 5( 4104*14k A,AO
Location:J4 '., ) Sec. , T N, Roza W, Town of_-Noe
Realty firm: /A)A Lock Box Combo: Closing Date: f000'-t5=W
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
I
Water sample tap location: &.) 71-4
Is the dwelling currently occupied? A Yes ❑ No
If vacant, date last occupied: AM
Age of septic system: "
Septic tank last pumped by: Date:
Previous Owner's Name(s) :
Have any of the following been observed?
❑Y V Slow drainage from house.
❑Y 1513 Sewage Back-up into dwelling.
❑Y 439 Sewage discharge to ground surface or road ditch.
❑Y hir Foul odors.
Other comments relative to system operation:
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: DATE: ,
1/94
OWNERS DRAWING OF HOUSE & S T C STEM LOCATION
} � (� �i
d
S
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? OYes ONo
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: OBelow grd ❑At-Grd ❑Mound
Approx. size ' X I OGravity ❑Dose OPressurized
Ft. 2 ❑Bed OTrench ❑Dry Well
Molding Tank OOutfall pipe
OBSERVED DEFICIENCIES OOther OUnknown
Septic tank
Setbacks: ❑House ❑Well OProp. line OOther
Dose tank
Setbacks: ❑House ❑Well ❑Prop. line OOther
OLocking cover OWarning label OPump/Floats
OAlarm OElec. wiring
Soil Absorption System
Setbacks: ❑House Dwell ❑Prop. line ❑Other
OPonding: ODischarge:
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
• 44
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
ONN ER TOWNSHIP SEC. Tp y p
N-R 1T _W
ADDRESS � 2 �k ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/Jre.
XI t
�
I i O Q
Lj
T
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used S'.}�/ CO/1,F/L_ Or- '&_Lm ( �W Ate.:
Elevation of vertical reference point: lluo,yy Proposed slope at site:
SEPTIC TANK: Manufacturer: L Xis no A.)& Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation: 9$,
Number of feet from nearest Road: Front,O Side,aear, O f feet
From nearest property line Front,OSide,0Rear,a feet
Number of feet from: well (, building: 0 3 '
(Include this information of the above plot plan)( 2 reference,dimensions to septic tank)
" SEE REVERSE SIDE.
pp-
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,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: eL G V. �',3 Trench:
Width: IT Len the 34 Number of Lines: Area Built:/
Fill depth to top of pipe:
Number of feet from nearest property line: Front,, O Side, O Rear,
Number of feet from well: w? .
Number of feet from building: t16�
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
I
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:
I
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:
I
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
I
Inspector:
Dated: Plumber on job:
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
MAD ISON,W 1 53707 IS,,,,Plan I. .N er:
umb
NEt4,/ NWta,/ S8,T28N-R19W C�CONVENTIONAL ❑ALTERNATIVE
D
❑Holding Tank El In-Ground Pressure F-1 Mound (11 assigned)
Town of Troy
Red Brick Road
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
WI 16 1 91? r
Hudson 540 r1 0
Kenneth Sorensen 431 Red Brick Road, ! (�.� C)
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV,
III
I Name of Plumber MP/MPRSW No.: Coumy. Sani,ary Permit Number:
Gary Zappa 3300 St. Croix 106125
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. ILIQUID CAPACITY. TANK INLET ELEV.'. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
DYES El No ❑YES ONO
BEDDING. VENT DIA.. VENT MATIL HIGH WATE NUMBER DF IROAD: PROPERTY WELL: BUILDING. JVENTTOFRESH
ALARM. FEET OM LINE. AIR INLET
❑YES ONO Y NO REST
DOSING CHAMBER:
MANUFACTURER BEDDING: L C PAC V PUMP DEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED PROVIDED.
❑YES El NO ❑YES ED NO ❑YES ❑NO
GALLONS PER CYCLE: v PANDC ROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENT TOFHESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soi oistureat the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH. NO.OF DISTR.PIPE SPACI G COVER IN'i SPITS LIOUIU
BED/TRENCH rRE NC HES M ERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH JLIIITR f STR.PIPE DISTR.PIPE MATERIAL: NO.DI R. NUMBER OF PROPERTY WELL BUILDING IV ENT LE FRESH
BELOW PI ESf I ABOVE COVER. ELEV.INLET ELF.END'. PIPES FEET FROM LI"� AIR INLET
b U/ 2- 727 NEAREST--► ! r� 7 Z s
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 1:1 NO
SOIL COVER ITEXTURE PERMANENT MARKERS OHSEHVATION WELLS
DYES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
❑YES ONO ❑YES ONO ❑YES El 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&MARKING
ELEV.. ELEV.. DIA. ELEV.. PIPES DIA:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY COVER MATERIAL PLARITSCAL LIFT CORRESPONDS TO APPROVED
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING
FEET FROM LINE:
q ❑YES ONO ❑YES ❑NO N REST ` Ir , fI
Sketch System on file for audit.
Reverse Side.
SIGNATU .�/R TITLE
DILHR SBD 6710(R.01/82) Zoning Administrator
LHR SANITARY PERMIT APPLICATION COON -:
In accord with ILHR 83.05,Wis.Adm.Code
FW .�.,.. 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 r5kNO
PROPERTY OWNER PROPERTY LOCATION
% %, S P T , N, R � 9 E(or)o
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER B SUBDIVISION NAME
L
CITY,STATE ZIP CODE PHONE NUMBER 0 CITY NEAREST ROAD,LAKE OR LANDMARK
/ E3 VILLAGE TOWN OF* eow
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family Z? OR ❑ Public(Specify):
Ill. 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¢# 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. Z seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes er inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
Zy b Q Feet ®Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank Oa V
Lift Pump Tank/Siphon Chamber 1:1 ❑ U J I I Li I ❑
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) AMP/MPRSW No.: Business Phone Number:
cmx �o io .3:700 s- - S-0
Plumb ex's Ad res ( reef,City,State,Zip Code): Name of Designer:
r. G
III. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
t /�/
/ n �-
ZV N laercA V N
CST's ADD SS(Street,City,State,Zip Code) Phone Number:
V
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Iss 'ng Agent Signature(No Stam s)
�Aroved �q!}� urcharge Fee
pp ❑ Owner Given Initial I�a'^�`
Adverse Determination W Y
X. COL7ENTSIREASONS 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 t
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 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
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 AtBi
included the creation of surcharges (fees) for a number of regulated practices which WisCO ir!'s °
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried teeilp6
is used in your building is returned to the groundwater through your soil absorption o
I'
system or the disposal site used by
Y ou r holding tan k pumper.
; a
:................ ......................
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- t
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 J S 6 r e V\ s &- h.
Location of property 1/4 AJ 1/4, Section g , T_,Z3N-R W
Township. �� o
Mailing address '4 3 1`SL
Address of site M
Subdivision name
Lot number \ I
Previous owner of property (,J i �, w"•� �r C� Yr C�" 1
Total size of parcel C c. e s
Date parcel was created le? 7 3
Are all corners and lot lines identifiable? Yes No
Is this erty being developed r resale (spec house)? Yes �_N0
pr 1Z
Volume y and Page Numberv� as recorded with the Register of Deeds.
-------------------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed r corded in the Office of
the County Register of Deeds as Document No. 3 I (O 1 (O 4 ; 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 �jc Lde d in the Office
of the County Reg i ter of Deeds, as Document No. _ / (o ) .,
Si ature of Owner Signatu a of Co-Owner (If Applicable)
Date ofQ Signature t Date oW Signature
a
I�
i
J " DOCUMENT NO, �.. WARRANTY alm=
w r
STATIC OF W19CONOtN—FORM 0
8OU PH�nF A LQ
THIS SPACE RESERVED FOR RECORDING DATA
THIS INDENTiJ M Made by...wTUI ...ti7. M.CEWMA...i n
.......PATRICIA„M. CRAM,DALLY...htsbd...MA”. k (i�t._................. REGISTERS OFFICE
_..
.................................................................................._............................... ...._................. ST.CROIX CO., Wisa
grantor..s of_ St. CrOx Coup , Wisconsin,
hereby conveys and.warrants to.. KENNETH,;E,� SOI;EN�S N 0.10.. Recd for Re=d this Oth
JOAN L..„SORENSEN.r..,.husband _and�w fet„ as„joint day of____AV_ _A.D.1973
_tanants t_ _k:�. _ P
_.. .._....-... _........................................................•.............grantee...A.. of �_ _
.................................._.........................................County, Wisconsin for the sum of
RaRistter o
r'
5t. Croix
,One„ 01.00) _Dollar and other_^good.and valuable fiTURN D
consideration
............................................................................................................................................
.................................................................................................
the following tract of land in ..........................................'
St Croi;x..............................County
....................
Wisconsin: ..........................................................................................................
A parcel of 'twenty (20) acres located in the East one—half (E�) of North—
west Quarter (NW4) of Section Eight (8) , Township Twenty-eight (28) North
Range Nineteen (19) West, described as follows: From the Southwest (SW) .
corner of said East one-half (E�) of Northwest Quarter (NW;.,-) of Section
Eight (8) as the point of beginning, go East along the South line of said
Northwest Quarter (NW4) a distance of 468.0 feet, thence North parallel
with the West line of said East one-half (Eh) of Northwest Quarter (NW 34,
)
a distance of 1748.0 feet, more or less to the center of the town road,
thence N630551W along the centerline of the town road a distance of 521.0
feet to the West line of said East one-half (Eh) . of Northwest Quarter (NW )�
{ thence South along said West line a distance of 1977..0 feet, more or less
to point of .beginning.
t
TRANSFER
r
a i
FEE
f �
f
V
I
i
3014 Witness Whereof, the said grantor.-S.. ha..V.P... hereunto set....... heir........... hand..S.. and seaLs. this
............ day of......_..............I may.:.......-•---......... A. D., 19..._
Ilia
..........(SEAL)
$IONED AND SEALED IN PRESENCE OF 11
i
`/
• YR�I(/ Gc
!f�CCI _... .....::...............(SEAL)
na S. tufty .............................. raudall
(SEAL)
Bruce L. Benedimt
.(SEAL)
State of Wisconsin,.GB.tM County. Perso ally came before me,this.....30th day of...............My.......A.D., 19...7.3,
the above named ........lolil ndall..and..P.atriaia..M.....Crandallf...his...wife,
................................................. • `............................................................................................................
War i
to me known to be the per's r1�7 tit fhb► tote g instrum t and a wledged the same. j
.........................................
.....
i
•4 Richard J Kinne
THIS INSTRUMENT WAS DRAFTED J ,' A ' st. Cr�.X..•._.•_.._, ___County, W1S.
� -
G '•
Notary Public,
.......
C. A. RICHARDS /
M commission (expires) ZU1.1 25. 1973
Attorney at Law r ( a ) �)....... a...
(Sect(on 39•5I (1) of the Wirco at all Instruments to be recorded shall have plainly printed or typewritten thereon
the Dames of the grantors,grwtta, Diary. Section 59.51}similarly requires that the name of the penoa who, or govern•
mental agency which, drafted such instrument, shall be printed, typewritten, stamped or written thereon in a legible manner,)
WARRANTY DEED STATE OF WISCONSIN Wisconsin Legal Stank Company
FORM No. 8 Milwaukee,Wis. (Job 88808)
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER 1<7Z # 5 P;Eb !�CKK GAL FIRE NO.
CITY/STATE t'I Ut SC)ti Lc) t't ZIP
PROPERTY LOCATION: NE 1/4 N Cd 1/4, Section , T z? N, R W,
Town of T r C Lf 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.
9 P Y
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 lumber or a licensed pumper verifying that (1) the on-site
P P P Y 9
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 t ei � ,Y
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
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
, UMAN'RELATIONS l / MADISON,WI 53707
(1463.090)&Chapter 145.045)
e UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME:
1/4 N� Z8 NIN �lor Tleo
COUNTY: AM n T k pp D:
S-r C.4.0 1 &
X �Q�N`�o 9l—r& KIC NOGMS /JijDSO'N W/1 54016
JSE DATES OBSERVATIONS MADE
DESCRIPTION: TESTS:
Residence ?' ❑New �eplace /V IL Z7 /gam QP*1� 27 /9wt
7%14 S ,y4-.0 74 S ICS- 'Sig - sATTRd
RATING.,Sri Ske suitMde for sy*om U.She umuitablle'fm system Q j RECOMMENDED
NV �� Q� S ❑Y S ❑u L ❑JG96Y : t.NV�.NT-/dkU ALMxr,ional)
If Percolation Tests are NOT r uired DESIGN RATE:
tQ If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: C�l�Ss I Floodplain,indicate Floodplain elevation: d
PROFILE DESCRIPTIONS
BORING ALA ELEVATION AT -INCHES A A R O SOIL I THICKNESS,COLOR,TEXTURE, AND DEPTH
V TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- k,_7 9 7Xhr r4 aNC 9.67 2-Z)kcT5 zd-"& ,L 2*7 R SSl4 41"Lrig MS
B-
B-Z S �1;d 9TV? Nola > H.SO /g"Bc�Ts Z ' a z "B ��GR 42"cTS st >e
B-
B- 3 -7.1-7 %7.9 t4C*4 tl >7.17 /4"P>t s L 44S
B-
PERCOLATION TESTS
DEPT WATER L T I RAT MINUTES
i NUMBER S AFTER SINELLIN INTERVAL-MIN. 1015111100 1 PER PERID PER INCH
P. o 3 >? Z <
P- Z .3 O 9*7.30 7 Z
P_ 0 Z L c
P-. AY
P-
�'LOT 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 9 3.00
opop FILL PIPE
5n1�►IC_Y&nrrc� �L� /01,04
' j ToP E► Y= 98.94 P
-2 ! l444EItT Y6 ,NFL w s 95• o
&qS&LIkJ�� E�9'r'E�'s�3 � ��p•-� -
C Tkk1QX TAAL of ABLY&
,,tt tN
0 N w-Y.IE
p-� — Zf;'
o
9
23
I . .
+b 0P-3
B- BM ISW (2,oRw�.k oT FIRST
ARe-►ow 000b S-r*P ELLV' 1C)6-C6
Sff�TIC..S'(STE�±
1,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.
rint : TESTS WERE COMPLETED ON:
�tR1/hy o feJ�Su'2�/�Y I�V& I NC- 401L _Z� /1W
A CERTIFICATION NUMBER: PHONE NUMBER(optional):
Aa7 SE-►v 11 Sr 0 S-4o I 34 4 3�G 4080
CST S1GNA RE:
DISTRIBUTION: Of and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER --
RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 BOX 796
�UMAH RELATIONS
H 09(1)& Chapter 145.045)
UNICIPALITY: OT NO.: LK.NO.: SUBDIVISION NAME:
��N 1� . ZIR N�RIg �lor 7-4(5 — — —
COUNT): NAME: MAILING ADDRESS:
SIR-r DR tck j-r
�DA� �Sa�, WI `�`%b►�
USE DATES OBSERVATIONS MADE NO. MERCIAL DESCRIPTION: STS:
F.esidence 3 ❑New grReplace I 4RIL Z7 /98$ I AP*,,. V� 9'k
L s �a� 7� SalLs- 'Sig - S4T-4T
RATING:S•Site sukabla fors em a
system W Site unsuitable forsystem
MN- IN- S : YSTE -111-1- OLDI�NG(TTAAN�K:RECOMMENDED SYSTEM:( py t`nal)S ❑u 0S ❑u ]U ISMS Flu ❑ J Cb^NtNT/Grs1L l
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: CLASS ' Floodplain,indicate Floodplain elevation:
C PROFILE DESCRIPTIONS
BORING A AL H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
ELEVATION —OBSERVED_ TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK,)
B- 1 9 67 97,84 14014C >9.67 zz"$Lf rS 2&"APP L Z7'e eRNCS44le 41"L-r.P--eAjMS
B-
B-Z 8S 97.27 NIi Q.S� ��"�cfrS Zo" Q x ''8a CS�6GR 42"rr8 !� +f
B-
B- 7.17 �6.Z4 NC*4 k > 7.1�7 /8A'9«rs 14" R L S4"LT Qom; MS
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 12=11IIES AFTERSWELL)NG INTERVAL-MIN. PERIOD t PER PER INCH
P- 141.0.0 3 1Z
P- '� 30 K9�-3 0 P. 3. o 30
P
P-
P-
"LOT 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
$rti-ToPoF Fig PIPE
SaFTIC T �L� -101,04
r. , tJr'
-TOP 9B•'74 Tpt
Q ,! /'ly"-Ckc rd ,uFl.bW : 95.E 0
23'-
j 1b NJ
_.
g-3
z8M SW C,eR,,44-_R arc FIRST
AQtA ov Or_b CONC RiT� STrP E��tr- IC -06 '
r Sc.PrTic.. <�TE�-F-
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.
rint : TESTS WERE COMPLETED ON: G
A%QVlJ' o T.UXN��yCY nvc. rl N�- 401L Z7 1 9 WD
A CERTIFICATION NUMBER: PHONE NUMBER(opt iunaq:
467 SEc'Otiis Sr 14 ubso w S�oI ��g4 ��c 4o80
p14 CST SIGNA RE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SSD-6395 (R.02/82) - OVER -
IJ26
2 n/1'
l-✓rs-r �iwPE�—Y LzNE �
1-11101,E-Y LZIE
aJ,,P-rcT'
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/i 6 J a,z%oTzovv
�vL✓.✓ of %il.oy
WL ST. C/O-TX COU.N7Y
---
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3� Ex�ssr L�zA�
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lonoFE/L7Y L7NF r Aizt ��
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ADADXE0 / XELt7 t=XYS7ING S�TZG TAY,�K
�XZlrs.�C7 �A2tep /O.l3.PD,QPTZON 13E� AREA
n.�w .ovc sna 3S EFfluF.vr L= 1� /1ia SC/9L�
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AnEA, ra,3-6,zAol: of Z5i,e1-U6,vT Lrn,e To /✓AvE' Com1°ACTE,0 G-2A^WLA2 /tiLL
FRESH AIR INLET AND OBSERVATION PIPE
I
4' i_A T iRf_`N Y E3" ! PIPE
M,k" 10,4-►tA Of— 42" AF,=;