HomeMy WebLinkAbout040-1209-20-000 ti a O
Q ~ 0
y
N CO
@ 0
.y N
N N In
b o U
ry Cl) O)
x E c
C o0 w w O
O m Q
y 3wv
c y o n
II, t5 w o
Q N N N
-Its I! N 3
N (6 .5 0) !
I', O O �`-
O Z O L
C
7
LL
c N L p
N
O O a
a c m 7
Q O m 9
3 CO
v a)
0 U
Z E
., O
_ a
m m
(O N w II' d m
N H Z
O Z C
to F-
C
a
N_ N O
O CL c
N
N
H O O O
•'V �II I d (/� L p U N
U
a)
Z Z O p o
Z 0
O p
z
c c
x E
X N N N
O o O Q a a ca
U ~ H H m
U) N d N
• w _ 0 0 0
R
a I m CL
g w
:., CO 00 (n
� o U)
a)
> W a O N M LO (0 n 00 0) O M (O O M
v III 1� a O) O O 0) O m 01 0 0 0 0 0 0 0
O N O O 0) m O O O O 0 0 0 0 0 0 0
... \ N N N N N N
0 0 0 p N N � N N M N n
d O Q1 p) 0) O W 00 00 0)
d
w+ 0 1 (O N C O M (D n o0 01 O N M V O W N O
O CC Oi N V d p 0 0) 0) O (SR, O O) 0 0 0 0 0 0 0
o n o a) c c () a M 0' a) p) rn MM 0 0 0 0 0 C. 0 0 0
N 05 C j O O
i„ T 3 m N N N R N n n 6) -q W O V (O O) '7 C N m
O O O O d C N N = 7 N N N N N M N a)
Z Z to O O) W 00
0.0 N T (0 a0+ 7 - t
N I Y O Z `2 F- h
O y a+
V y ° ` 0..
0 CL
r A u CML 0 u
02/26/2014 08:29 AM
Parcel #: 040-1209-20-000 PAGE 1 OF 1
Alt. Parcel#: 25.28.20.987 040-TOWN OF TROY
ST. CROIX COUNTY,WISCONSIN
Current [X]
Area A lication# Permit# Permit Type #of Units
Creation Date Historical Date Map# Sales pp
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
0- KUJAK, PAUL A& BARBARA J
PAUL A&BARBARA J KUJAK
236 GLEN CIR
RIVER FALLS WI 54022 Property Address(es): *= Primary
*236 GLEN CIR
Districts: SC=School SP = Special
Type Dist# Description
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH Notes:
Legal Description: Acres: 4.610
SEC 25 T28N R20W NE SW LOT 2 OF ST CRIOX Parcel History:
HIGHLANDS
Date Doc# Vol/Page Type
07/23/1997 832/268
Plat: *=Primary Tract: (S-T-R 40%1601/.) Block/Condo Bldg:
*04-094-ST CROIX HIGHLANDS 25-28N-20W LOT 02
2013 SUMMARY Bill#: Fair Market Value: Assessed with:
235980 253,000
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.610 91,100 197,100 288,200 NO
Totals for 2013:
General Property 4.610 91,100 197,100 288,200
Woodland 0.000 0
Totals for 2012:
General Property 4.610 91,100 197,100 28$200
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 117
Specials:
User Special Code Category Amount
Special Assessments Special Charges 00 Delinquent Charges 00
Total 0.00
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER AtjZ 47-Al< TOWNSHIP SEC. oCS TN-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION, ri2orx �d�,rt�,ti,as LOT o s LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
IAJ
1
1 -
i
2�
ez
s � �
\L'
cj�c1 r hl
I
IN RROW
L Z;7AJ R,0.
BENCHMARK: Describe the vertical reference point used s1t „ _i/yd) )O/pZ-
Elevation of vertical reference point: /pV ' Proposed slope at site:
SEPTIC TANK: Manufacturer: L-)rLS Cf Liquid Capacity: /OOQ C1214L,
Number of rings used: J Tank manhole cover elevation: �d/� ��J�
Tank Inlet Elevation: Q , 02 Tank Outlet Elevation: 421 42
Number of feet from nearest Road: Front,O Side,aRear, O � feet
From nearest property line Front 10 Side, ear,O / �/�/ � feet
i
Number of feet from: well Wo building: a Q
Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
r
Bed: C 4-J. Trench:
Width: /� ' Length: `?� ' Number of Lines:—3 Area Built;A�/
Fill depth to top of pipe: 3-S pr (17/-?
Number of feet from nearest property line: Front, O Side, O Rear,O Ft .
Number of feet from well: �$
Number of feet from building: f '
(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, 0 Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated1 �T� Plumber on job:.
License Number:
3/84:mj
DEPAR fMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
NEk,SW',4,S25,T28N—R20W I)EONVENTIONAL ❑ALTERNATIVE (Hassglann1.0.Number
Town of Troy ❑Holding Tank El In-Ground Pressure El Mound
Lot 2 Glen Circle
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Paul Kujak 1700 Aspen Apt. 3, Hudson, WI 54016 -3
BENCH MARK(Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.
Name of Plumber'. JMPIMPRSW No.: County'. Sanitary Permit Number:
Gary Zappa 3300 St Croix 106137
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV: WARNING LABEL LOCKING COVER
/ PROOV{IDEDI PROVIDED.
I fs ju ,DYES ❑NO ❑YES NO
BEDDING. VENT DIA. VENT MATE. HIGH WATER NM OF ROAD: PROPERTY WELL: B� /� . VENT TO FRESH
JI T ALARM FEOM LI /� y (AIR INLET
EYES O EYES ONO NEAREST GI{�I/
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES NO i ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF VROPE TV WE BUILDING VENT TO E FRESH
(DIFFERENCE BETWEEN FEET FROM LIN AIR INLET
PUMP ON AND OFF) El YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH D JMAA ERfLAND 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 DISTR.PIPE SPACING COVER INSIDE CIA aPITS LIQUID
BED/TRENCH TRENCHES ) MATERIAL: PIT DEPTH
I
DIMENSIONS I "" /
GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR.PIPE DISTR.PIPE MATERIAL, NO;DI'NR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END'. PIPE, FEET FROM LINE AIR INLET
J+ 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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
SOIL COVER TEXTURE JPIRMANENT MARKERS OBSEHVATION WE LLS
1:1 YES 1:1 NO ❑YES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED =11OIL SODDED ISEIDID HED MULC
CENTER EDGES.
❑YES El NO 1:1 YES ❑NO DYES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW P I P E. F I L L DEPTH ABOVE CO VEH
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATEHIAL&MARKIN/�
ELEVATION AND ELEV.'. ELEV.'. DIA.. ELEV. PIPES DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVE D
PLANS
1:1 YES El NO DYES 1:1 NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE:
DYES ❑NO ❑YES 1:1 NO NEAREST lip
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE �+I
DILHR SBD 6710(R.01/82) 1 IZOning Arli_ 1
lnlstrator
DILHR SANITARY PERMIT APPLICATION COUNTY /�
In accord with ILHR 83.05,Wis.Adm.Code • `�
°�... ..,<. STATE SANITARY PERMIT##
`
/010 /L3 7
—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 IX NO
7 PR PERTY OWNER PROPERTY LOCATION
'/ '/a, S T Z, , N, R 2-0 E (or) W
PROPERTY OW R'S N44LING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER EJ CITY NEAREST ROAD,LAKE OR LANDMA K
VILLAGE
J"
II. TYPE dF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family 2 OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1.. a. VNI 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. X Seepage Bed b. ❑seepage Trench c. ❑ See age 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):
A Feet ®Private ❑Joint [I Public
CAPACITY
VI. TANK Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank b F-1 Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ El ❑
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 'gnatura:(No Stamps) /MPRSW No.: Business Phone Number:
Plumb 's A res reef,City,State,Zip Code): Name of Designer:
N
VIII. SOIL TEST INFORMATION rr
Certified Soil Tester(CST)Name CST##
0�
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
F-1 Disapproved S Hilary Permit Fee Groundwater ate Issu g Agent Signature(No Stamps)
charge Fee
L4 Approved ❑ Owner Given Initial s `,
Adverse Determination / t—).go �
X. CO MENTS/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;
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 it
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 'ter
included the creation of surcharges (fees) for a number of regulated practices which WisCO !F1'S
a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasura
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- 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 1 vL— %»w.44 4Q J A.V...
Location of property L\ C- 1/4 t&--" 1/4, Section Z5 , T Z ?, N-R Zo W
Township 'j I?=o`t
Mailing address
Address of site
Subdivision name ST, Gt2-0%N(I L4%,61"1 .A.e10S
Lot number Z
Previous owner of property �`ti�r=o w Pte_ t�Fr��zso�-c } a 1,)L- T. f.=-3f>-L-j1A ►
Total size of parcel
Date parcel was created l
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for resale (spec house)? Yes _N0
Volume �� �R
and Page Number as recorded with the Register f .
eed o 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 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 the County Register of Deeds, as Document No. 3 �c � ) •
i R
Signature of Owner Signature of Co-Owner (If Applicable)
S12o/8'-0,
Date of Signature Date of Signature
—, DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS *PACE RESERVED FOR RECORDING DATA
WARRANTY DEED
:VOL 668 PACE bu
REGISTERS OFFICE
This Deed, made between
Del H. Einess n CROIX CO., W16.
_______________________________
-__-Lance Norderhus, William S My_ez ,_ ..............._......... Rec'd. for Reoord ibis 15
�liffo d..A,__PetersQnx--Paul-_ Fj e-lmtan _____________ day July A.D. 19 83
................... - - ----------- --- -----------------------------. Grantor,
and--------------Paul---`---'--------Kujak, single at 3:00 P.
------
---------------------------- -------------- ------------------------------------------------------
--------. ---------------------•-•------------ -------------------------------------, Grantee,
witnesseth, That the said Grantor, for a valuable consideration_-_-_-
conveys to Grantee the following described real estate in _._St.-__Croix - RETURN To
County, State of Wisconsin:
Tax Parcel No:
Lot 2, St. Croix Highlands
in the Town of Troy
I ,
i
SF
i I
1
I
I
This .....i-s--riot--------- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And.....the---above-__named---Cxantc)x.g------------------------ ---------------------------•--------._....-----•----•--------------
warrants that the title is good, indefeasible in fee simple and free and.clear of encumbrances except
i
i
and will warrant and defeJend the same. pp��
Datedthis ------------------/_3 --------- day of -------------------- ----------•---•- ----------•---r
----•------------------------------- -(SEAL) ? // %ri --- G ✓- - )
* .
----------------•- -------------- $-�
-----------------•----------•----------------------------------------(SEAL)
j * --•-•---•-------------------------•------------------------------- =_ ,*-`'¢--- -w--.--
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN
ss.
---------•-------•-------------------------------------------------------------
✓NEB------------------County.
authenticated this --------day of___________________________ 19------ Personally came before me this ____/3 ____day of
_.------•-- u ,z--------------------- 19_ifd-- the above named
�!/- -r�2-- ._1�1�(yrS _ij/11C?! i R_N ----------
*-------------------------------------------- -------------------------------- ��,�_6!.. t'N__F 5 5� ✓__1i4�fs4i_. i E 5
TITLE: MEMBER STATE BAR OF WISCONSINA!/�k_Np�� �,{�us_,__ �y_f�FA!__/t�0(�' _f��y�/____•_
-------------- nl 7
(If not- --------------•--•--------------------- FJ.-CKs�.f�•--1�----E€�-�-o---�-..[_h�JI�-S--T--��f���Q�!.----
authorized by § 706.06, Wis. Stats.) l��l u ti T l rh y'v" S U I'oZ r F I/n
to me known to a the person .___.__._.._ w o ecuW the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
,• S ---°------ ----------'--- -
-x------------------------------------------------
Z/V'e-- fp----------------------------------
.J -
��P11 ��!I/ !�%���ST�R[/ .. �U •-------%_ I� l!fl / Eby ------County, ale M {.
- � � -.�- - �. Notar, Public __-__ fJ.°?ly_
----------------
(Signatures may be authenticated or ac(� rrn Is permanent. (If not, state expiration
are not necessary.) 7`
JACK D.H&�O(�1----�� fMGN(L---�- ---------•--------------r 19. 1_..)
s� =R�ARi'�E�BE��tt+�lvEzcFiTA==.__----- -- --
.l�cCnn1�r�l1CCpplI..11��•r.��-iiTTv�/
*Names of persons signing in any capacity should or prmbe,p'8A9' Q-i5 —4T6Xtur s.
My Commission Expires Nov.9, 198 .
WARRANTY DEED x r Wisconsin Leral Blank Co. Inc.
—I Milwaukee, Wis.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER F'AQ -- Pte.
ROUTE/BOX NUMBER ( Zoo &kp-T A 3 FIRE NO.
CITY/STATE \'44 ZIP
PROPERTY LOCATION: L C 1/4 S w 1/4, Section 2 , T 2f; N, R W,
Town of T\;?-0-4 St. Croix County,
Subdivision Wl-i-"l�P} Lot No. 2
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.
SIGNEDC/�
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
102oT i0rvo C/2ois
S,--ccrzo..l A219As
p6/o To /VO/LTI4
2opE2Tv (.2n+F
i
® , /1oPOStU
0/lOPoSf/� i R�szo��
6'Anabe /2o�r,50-
&P.SEL1 WELL--��r —5' ALT NEkl D'JMrIP7 '
s--.,Tt 7wAI CIF TnOY
5A I
! o hoo GAI.
o SEPTSG TAm,�
2o72
Sal is ,
\ � 83 Ys To E.o.rr PopFnrY
A La. c
I -!'L op,,
SLopE
i
✓Elvr S?A GK
ayo �g pes
33'
WHI--&M- SS To,- 01= A00
7 , ELe% = /oo>oo rr
S�irrN PnopsnrY L7„,r
A10 -.0 CA L l_
FRESH , i_ 111` rs 8 vFRVATION PIPE
4i Y lrUVaa OF 1i?. dFt. %— _ �t# 4" _:k' T i i.t VENT F!PC
MAR-41 HAY CIR SYNTHE'l 1(' COYER ING
� �..
L i C.EMS E:
O"t ER PIPE
`ITT M PER SOIL., R � E Rr )HArED
-rtPIPE BELO!'S'
TESTIS i
Qn • _ -
OF S-Y-ITEN1
. _
, ; _
covcv �
..,� .. >.
.
i
...,,. ... .. r
�M.ir. - L
=v w UNPL �t QS QWNED. BY aTHERS
t
..� t ; .4 r r �vQ 3s„ 2 1 fi45.24' .Y,
>1 ;+� ?r f.4�v LYS O� .+' -"i� `'�i +" ice f'3' {, '4 , ss�^r�`-/. R f ;; M
V bV '..r '�` -'car' .y '�'•rc
tl!t r . ry
d� rt w r
1 a.•:-� s4r,y�2e _..c i..i° "'C ', -rw r L r;o.r'��.`<,,'*4r S' {f y�f `.t _. . i .zi t-;; + v -��
t s�`
'w- x v1.y.; ,t. i. e."tsy't ♦ �,! ,c��7,--ri 'i'f�' 7` ,.r .T ^`7;Z, L; t r t. c T i r S ..
,�_- ti {+yt'yyS'r. '. S ♦y . �._i=ce,�V a K-� . , t: y f +1°kw, y<':_4 _ �i. r ..a`i: `+* ., a ,`iy i,
I.
1.-� '� 4,V:,.;,:, x T :� _�•7�Y. 'C dam' .+c} ",t, v;� ''r ,, . y':
'- -- � " <..: ..!e d.talRk -�,' '' y.Y , i-4- '�tom, 4!� '.. r �,,: y ,'Y 11 <,
y=,' �, y• ,>, iii — -`r'' " ^-w 'is rh { s.f '"'t �� �k .-1 I
ttZ fj`.,,r .e.> `'rt 7. r+ate N Yl s♦' , +, .� _ P !y a. -',+< '.
~ S \
a• - .': T` y 4 . L t .� - , '; ;,,.I-l. t� z-. •7
a., '�i stir+_$ y. w< y r S > _ "�."e'11 .
` ''s z -Z:Re s9 , YN r �' a s' S' +i > s* A, ,.r. r ' \ .7
p ., P. �+ a .,., r' e y u G-Y .' t gyp W,-1 .1;✓ t . 5
r y Al L. w 1 +.•4 !ti t<. " is b y`�` rn `: 1 � l� r�; 1� 'a ._.+. . i� '4 '1' i r t y
\ ,.'tin F �,F -,f 1H y P¢'�. - k� '.'# yy� ,c, i,M t' v[^ T'\ t 1k q s rR17 '� Sti.r 'ts. ~`��'� t'4
x fr .+_ �"" -, ,is;.y ---.ri w {.. o J:.�_ ,a. " V >.♦ t i'�.- '*'�"7rs kF•-'::�C:.. <.TY a'.• •''r a v.- -. __%i
iks' v, y 7, is a;t }r. � 3
?' r., � NF. dA :i; -•-•`o��"y�r .°.S .,.:. ., .. -* S rs -„S y; 1 t .`.zu t#._11.Y •,1{ Y< y 4kY`4 yq•iT j4 M i. y f i - r'Y 11 Y��•tw •, * 1p�,�, „- .(y
a4�^'`R t hi'n`•{'i-s-K'F5t t �' e •. `rr �' .. \_. "�c..'. � .i ..yt.t r�.:�; :{+<,i4• C r. r -, +i�t. r i'�'t p!.
F` ♦.._ }4�,3f. • .r: ,.�. :x, l+��d�s,;,r f'c^ f"' :� ,kz '9 _'q.*�?Y, :r atCw r „s ._, /T� 4 '-, _$
,r. '�"n,., .R.,,t•, ..prF. •'M1 i.W aa' .y F 3` >,G.:Cr ^w -,Z."*7.yt4' v-r e_ 7sY% ; r : ♦ "44
x- i� t. y '4., ,t;.. ,. ,.T? A- ••L�'�4 l wk'.:♦. + ys s ..4 T t K.., . 'r
y�ty�.e��rq .' *�`h• 'i. 'ms's 4. Oct` .zr� -..}iw 5.y e'k a ,'t,"74, ^ yt �%'4�,t o a _ y 6.• .,
T : � % a rr y Jrr ar' _a + 2^'c 1 +l w:+sf� ..nf,t'jw "+{X.� w �r 'f y, .^� ., tf..I.
1`. .�(C��ys�Y �! t4y G dCYt Y Y ypk NCe {Apl s F
,••y -a,f . iZ+�,,y •:ta iN� ,/► yi1�+t. 4a �yyPf.7' 't "j.,\ 'iw��'Mhi 'te�"'+1•�xA' O�Y_,,� ._a.. e �± v. ^
X c.'^ 2•AF { s'Q a 3,,.r s M r a'� ,q f1i J.. .h�,��:,� ,e.�� ,y�+c f._•_ y _;�,,yS
X: +'} 'wu ;S �y "�d� .' 'c�.Ki• { rt' `�'.af F ^r. 'lys }t�'�1.. „b' .f i -h Tc •'e-+:i
.✓z? .�Y^ `{ ri,+iSa,. 1'� �;� .t 4 "may; �S+ P �' l a r .�w3.� %L p� M _ t)eW y^1.rlY:.r ♦:
'�' ,.r mot""" ��+y t r ' a+r3'�� - �G i_. +e s.,�:.v a ,5!".=s'jt '[ Sc ti '...- S�
fix♦ `yM°7+s5f, ..iv�. 2 +i' - Y.�"'r .�x°'< *,, �i�. 4,:,a,•e'•F' l' i'_-x a s' -n ..< t .v
�•.� .r.. : y �',..q+7£ ....'-7-1.4 L. 1_•4 1 z:1 •, x .+r 'J R' i 7.a. yr a -it 1.
V sEr .,, S -. r r P t y r ys• L ,k,�.' _'. 44� a. T S•
riy3 €- .t r.t)' r .� r< .,t.,� •� £ K,.t -.,,- '^ 1 .ti•z '� ,y ,'.•.;A r.y "; v ♦ s - M 1 t
q� tee• '^ : SL`i-1 "L -.-. .,+• , -t 1 S+ a't' i S 'f ,� ..'! y" ,e i 6
C '',SOt, s r'Kr = e e.co ti -`"'� .. .� `'+ ti':S• :Zw >v ,�.• �''` 1. '_r4 .:-� _ a _.aye v
, _s.o a .r:' '7 J -�+ s .+\. x �_ ...a. 'y -+t .r5. n.; .7Y- +5, , f„�-_ F ,_ � Y� r w < �• '- F"+.-' _» \:]�l . •.
„��" z'r'�r'ti_� �%s'. '.; '�'" ''.'�w"'rc�ty .,.,y,+Y .;N., .'�c.:j �x� __---._ � . .�E +••*�l'3'bY �' ? f 1. t't t- �`
r'.q-� �db ,i• a S w` _4':+!" 7'_ " --—- Nw ''[a�' q t 'i. Y' 'T f_. t T er''r.1� � '►o �'' "e +r•,+ '' d fi,' ••.t.., '"hy, a? ._ ,y 4 P . '•'t�..r �a� �N s °'I 7;9a ' �„ ,:,'• .e -; .' `'nr. spy, ti"1 �� �?,a � _ 't: � �{•�. .�: , ' " 1 ryt..J � ._ n;t G',sr'" * #,i.ryR 15t v�c ri.•LY"'i x cs �'x'� ..f ,.. L6�• `"' s~ ` 7k1
'' •Z t-!'"r-<-`f:• °a'rrrY4 ''_- ` '�°7 .,k Y 'i s / hi ..�.{•:t V. �e At"c �L`, r- "♦ka t.
s - .7 A""'" r '.d-- `--t 3 p S;'Z+'"'T'.+ t > ', a e..�H c.�a Fr.. ' Rw'Y" �y.�••a `� .t,�}
r
:: ,�.. b?. fit- e '' '. .�' r r ,.}r
s.,,, ` Yt'i ,.y, b .Ler 1 �n H.4. ::�.- :y5► -w,►h ,,.I"r+7, L .
s z mss"?� �p Jr s .. i a C ,+ w-,, r s y + / g.."-pmt.` 'i.
Q i� �yC yae 1� b _ �o ,
'�'�'" `Y.' .,` .A, .�.���" 'raw, �ri ti.r,�,. 1 y Sy,_ 'S 4
. _ . (•a - Y, 3�� j. ��i „vt'•sg' ''Y.t•Lc?�3 ;C- t K^"• r3.t�,i• x •++�'r'^. r L'.F OX ev
l Y; +^# - Rr. j`t'7�r4 .Yw<.,+ 'd•-Ks,.n` .•: ,t wb, , ,n• / uk.,' :� - '�yn"• 4 J._• •t.Q,L
a. _.f` 3.' :., v t ':5..� ft"•• z+:. wXr �c, a fiI• t R•;'^ •y.. •�>
.. '°fix IS i.J• --.` 1_ ,+- �F�r �<'-_&V sr y^-t�
., y 4' c.• a � t r.F" "a7`6t fks-•L ,L Y�. '=a 1' Z• - . GC ,'jnS. 's7Y";i• �'t' r
Y '� S r
Y♦'.° P+iy F*"1?(y ►C w7a C.,"" x+-"ti �:. '.r- �'"i, or - y_ .. _ nt�a,,, s
Z'Y {y,,. ,i,t; r �� �'�}R�kw��'�'.i.fJw '- 1 '�'� .Hi. ltiiv .."', r �„ !� t"`'V' ♦ °.s�',.4`, 'R`,i';9}Z.
�7.. ', q"• T 'u 0f, r-� E _ ' #' .tr" �"_w,;•' ^s 6 ^'? �s, ` c . � .♦ -;sr ._. s.:.sr. , r ,� :a,,t.-..:
s` �I' sue- 't`_ �i£' �. :rr ,,.,SS`�'a'G & r._ Lf' r • ';'+ '1 4.y4" a *...: r} ".'. : .
c-.F♦ ice" 'F.: •a•�"w•' l '. 1♦ s a ` �i.. n.A - ..raY �}H.' •'Ye' e�`l R' y
�! 1f'�'"y_t�Y ,ri fY�� '. v ti "+k •t �`. ,..ft rW1*�`L •IJ .y T� YT�WKti I. �' Y'r�Mt.;,fit ..l N+f, '•il..
tip { t L-
�. .` �t `- a '' :< l •`t:t r -`t a �,1•••\ r,S >tr '• t w z :�.r?J+� �.Y
va� `Y u L+nla. f . r f a ,ij-''� ` s r Y ♦ ,ti.`t � a a�" '� n:.
..w•M r'� `..•,li(e .%;. R.,.r- 'c i -.r '7�.e �{^4 '-� J'Ck:j r �-�,� �.. �r 1 y r ♦ ., '.:
.'r +y 'Ki,t. ." _ y �- .R a ti,E •;,f 1 j •�_�f ". . '- 'I liar `. - -., '�' y♦ r'!i�;
• �' C" \ i .�{.- M+ - l'y. KM�' 9t1 iiR' e,� �. �.w� ywr ..� +a.: ;j 1 'y'W Cyy �l' 'r�.
ia' r `",.?., h !''a.+ iy'^ ^► ,�,,,'Frf ..` W .,ra,m� t ..,,y,1A�w�
1, 41• ex:.i..�, +>r�.., - 11 .At;N •s ak.w �r ,Y� •, '' ae e .w. ✓' .ic:A.
fii, o t 1 Y..v i QR.. .... 't ;..r *„c.,
_,,,:,•,i , ;. kE ORT ON 50JL 0 II'hNJ S JAND
II�IUUbTFiY,
LABOR AND PERCOLATION TESTS (115) � BOX 7969
HUMA14 RELAf IONS O ') MADISON WI 530
4e1 (1-163.090)& Chapter 145.045)
LOCATION: SECTION: p TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: Sj 8131VISI fi NAME / S
,/ ,/ ��/T2d N/I�ZEE for ��or Z. 5 Ci #1;a,
CO?(ITY: • OWNERS BUYER'S NAME: • MAILING ADDRESS:
•l ei X L, le U 3 k ,�15" GrMoo .Sf• IV. 1},OT -7 /l uAro.J 4)15 .
USE DATES OBSERVATIONS MADE
NO.BED MS. OMMERCIAL DESCRIPTION: PROFILE DENCIU17IONS: TS:
F�
Residence , / New ❑Replace f� ?
RATING:Sn Site suitable for system U-Site unsuitable for system
CONVE TI NAL: MOUND: IN-GROUND.PR CY TEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:loptional)tas oU s aU s 0as �U as aU le4pE-11Ti -Y4 FT.
I'Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
If
s.H63.09(5)Ib),indicate: Flondplain,indicate Floodplain elevations-
PROFILE DESCRIPTIONS
BORING TOTAL P H T R UNOWAT R CHARACTER IL WITH ,COLOR.TEXTURE. AND DEPTH
NUMBER DEPTH ELEVATION OBS RV D E .-H HET TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- / ..� , 93'1 -7 qtC > 7 .S r '7S'44-6y. Si/, .G7'hAt--Si L, /./7' 11604-s,L .91 • CJ/. TAJ
5,14 1 Y. d. C'S .
y7' '7?,'7?, >/o, a ' /�s ' L�.�,�. s,�, .P,? ate. SG, 6 7 " Ali CS
B-
3 > 9 S AV W. s ' - ' 8,v• v ens
.33 ' BO- s
> - � ./67' 1,1'4.). c , .67 ' c�• N.'4S.
roj .v cor
B- ' 9, 0' 97zz' -- > . a ' .s• 4A) "6y.
s�, .�.� ' �. s`, ,,�,• a� sue,
. /-7 ,v C
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-INCHES RATE MIND rES
NUMBER JAJ JI I AFTER SWELLING INTERVAL•MIN. -----T-ERIOD t PEF1100 2 P 100 2 PERIOE53 PER INCH
P-
P-
P-
?- o r sz
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what ere the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the urface elevation at all borings and the direction and percent
of land slope. 0 ;;C G/e` �,Y c rc y lo. 75-
/� TTo� o/� �Fv �,YC���4T7o•J
SYSTEM ELEVATION R ezow 11 T• 11 pT. ,gl- �'/�U�► /a-v__ 93.-_.a 5 F'-.
I J II f I 1
I I -A- i _H
I, the undersigned,hereby certify that thes�tj'��� form were made by me In accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data n in ron of lhs-tests are correct to the best of my knowledge and belief.
NAME(print)- ��t' TESTS WERE COMPLETED ON:
HOMISM TO ' O COO p - ���3
ADDRESS: RT. , o9wi ` CERTIF CATION NUMBER: PHONE NUMBERloptionall:
Ss=oLyd 3P
C GNATURE-
Of
DISTRIBUTION:Original and one copy to Local Authority Property Owner and Soil Tester. y t y
DILHR SBD-6395 18.02/82) 5 h e -.OVER 3,t a r'
- REPORT ON SOIL. 13ORiN &S ; PERCOLATION TESTS IIS+
PLo r PLAN PROTEc i r. D. zo t z S1- i(m 111 L4-dS
DA rE g-p3 -7)e 6 y n�-v
HOMESITE TESTING CO.
11T.3, O'NEIL ROAD BOB ULI;lidG;►.
HUUSON, WIS. ...- 54016 e S.S— 02 Yee
i
PROPOSED HOUSE mosr LIE 2� Fr at o4otc "v,4f 4il. TEfT ^er.45.
PlZo Pw o wee M usr LIE ,Sp FT o,� tiORE' hiPor/ i9cc TEST i9�E�l S,
I
zx/ST/,v(r 40 0le G
#AvP Rdyc- W aw 5411EL /,34er5
o
H e;z . B M. V ic � PEFER � c� Po� r /°
a, Ur • , PT 3/y" pl-pE SST C's 7-
/ s Z FiQo"► ��• °�
1
LEGEND
�'lEV�lrio, of vfPr, iQEF r- .
U�'T•i2rT, P/
J3,
P l
°c f1"G�'tii'N•fT� • x 3 )
PC-
t3 Z
• •�� •
yp ' v
, �o y
oar
to
� i}ott�si f� • �
•
n
G�FS?- �o T Gi.uE
. �+ �+V 1' ., S Yl.:� OM• 'T�Y� ���i.� ICY _ .. •d.