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Parcel #: 040-1200-10-000 02/07/2007 02:59 PM
PAGE 1 OF 1
Alt. Parcel#: 28.28.19.919 040-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): O=Current Owner, C=Current Co-Owner
LAWRENCE J&MARY J HANSON O-HANSON, LAWRENCE J&MARY J
595 SYKORA LA
RIVER FALLS WI 54022
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description *595 SYKORA LA
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.600 Plat: 2522-SUNDOWN HILLS
SEC 28 T28N R19W SUNDOWN HILLS LOT 12 Block/Condo Bldg: LOT 12
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-28N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 817/389
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.600 60,500 175,100 235,600 NO
Totals for 2007:
General Property 2.600 60,500 175,100 235,600
Woodland 0.000 0 0
Totals for 2006:
General Property 2.600 60,500 175,100 235,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 213
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER -�p,�2�' Cjc fbsa� TOWNSHIP 'roSj SEC. T c?p N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
dis -�'
SUBDIVISION _&rn dWyl i?j tLS LOT j LOT SIZE J acre
PLAN VIEW
Distances and dimensions to meet requirements of I•IHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
_ r
poap weA
1 ` �
�q5'9'
80�
r
i
INDICATE NORTH ROW
BENCHMARK: Describe the vertical reference point used I?c wf
W u)l'c'Ak�A®y iH �W
Elevation of vertical reference point: w/ Proposed slope at site: '3-
SEPTIC TANK: Manufacturer: "42L I-s. Liquid Capacity:
Number of rings used: 1,A ,,,p Tank manhole cover elevation: C29,102
X7,5/
Tank Inlet Elevation:=�� Tank Outlet Elevation: 917, zZ
Number of feet from nearest Road: Front,®Side,Q Rear, 0 2�c� ¢ feet
From nearest property line : Front,0 Side,9)Rear,0 feet
�� a� �1'� se 6V
Number of feet from: well �0 building: h0 hb�
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
1
PUMP CHAMBER •
Manufacturer: N A 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
Bed: Trench: (�
Width: Length: 2'7(0 Number of Lines: -03 Area Built: JZ60
Fill depth to top of pipe: 16 "
Number of feet from nearest property line: Front, O Side, &Rear,0 Pt . �S
Number of feet from well: N D W
Number of feet from building: G,4A)T4bk
(Include distances on plot plan).
SEEPAGE PIT 411
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 NIA
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
r
Inspector:
Dated: �S�(z1 $� Plumber on job:
License Number: 'PS
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
MADISON,WI 53707
SE' ,NE4,S28,T28N—R19W CONVENTIONAL ❑ALTERNATIVE (Itfassvgned)D.Number:
Town of Trov El Holding Tank ED In-Ground Pressure El Mound
Lot 12 Sundown Hills
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Peter Sykora Route 3, River Falls, WI 54022 ,a
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CS REF.PT.ELEV..
Name of Plumber: MP/MPRSW No.: County Sartavy Perron Number:
John P. Sykora III I 3212 St. Croix 106134
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. JLIOUIDC P CITY. TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED
DYES El NO ❑YES ONO
BEDDING. VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH
tt ALARM FEET FRO LINE AIR INLET
❑YES �NO t.' C ❑YES ONO INEARESTf--4-1
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL JPUMPISIPHONMA NUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
LINE AIR INLET
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH IDIAME TEN 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 DISTR.PIPE SPACING COVER INSIDE DIA #PITS LIQUID
BED/TRENCH T TRENCHES MA r RIAU PIT DEPTH
DIMENSIONS :5, V
GRAVEL DEPTH FILL DEPTH IDISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO. 7R NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV.INLET ELEV.END PIPE FEET FROM LINE 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
SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES 1:1 NO 1:1 YES ONO
DEPTH OVER TRENCH!BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
1:1 YES El NO DYES ONO 1:1 YES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING (TRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE JMANIIOL5 MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MAHKIN6
ELEVATION AND ELEV.. ELEV.. DIA. ELEV.. PIPES DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES ONO 1:1 YES NO
COMMENTSL - / PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY IWELL: BUILDING.
FEET FROM LINE.
DYES 0 N DYES 1:1 NO NEAREST
0
6
Sketch System on g\R. J �� L
eta)n In co unty file for and
J
Reverse Side.
SIGNATURE. TITLE
Zoning Administrator
DI LHR SBD 6710(R.01/82) I
SANITARY PERMIT APPLICATION CO
C;�dr x
T DILHR In accord with ILHR 83.05,Wis.Adm. Code
. STAT SANITARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than STATE PL(AAN I.D.NUMBER
8%x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO
PROPERTY OWNER PROPERTY LOCATION
ex- '/4 r '/e, S TZ8 , N, R /'I E(or W
PROPfftTY OWNER'S MA NG ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 1d////-.
�itk�Lkly -
CITY,STATE , ••`` ZI PHONE NUMBER 7 CITY NEAREST ROAD,LAKE OR LANDMARK
/(re'r W 7j �1�ZS-E+ VILLAGE: �✓`D W t r wf
II. TYPE OF BUILDING OR USE SERVED: o �yikas� Nam
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check#2,3 or 4,if applicable)
1. a. Vv 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.X 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. ❑ seepage Bed b. Seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
�� / pU / zoo q� l/ .� Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total ##of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank / ""' eoo , ❑
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): PI ber's Signature:(No Stamps) M P SW Phone Number:
3:1-' 1? -71s 568 f-T
Plumber's Address( et,City,State,Zip Cod Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
` C.- 5
C 's ADDRESS(Street,Cityjtate,Zip Code) Phone Number:
Z 42 a Y, -7 5- (7/5"
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved nitary Permit Fee Groundwater ate IssuiSignature(No Stamps
Approved ❑ Owner Given Initial I Sy(charge 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;
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'/2 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.
--------------------------------------------------------1-1--------------------------------------------------------------------------------------------
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 afar
included the creation of surcharges (fees) for a number of regulated practices which Wisco in S.
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasurQ
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- f
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 _A_tP C s k D cap
I
Location of Property Elr= J Section Z , T 219 N-R W
Township ZMM
Hailing Address #
T i
Address of Site
Subdivision Name S„�,�, pt gnu;!a
. Lot Number
Previous Amer of Property
Total Size of Parcel (,d cL CV e
Date Parcel was Created 6:3 I/A4 1 7
Are all corners and lot lines identifiable? Yes / No
Is this property being developed for resale (spec house) ? V Yes No
Volume J��Z and Page Number 7`i� as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
i (toe) cVW6y that a t statements on this ah.e tkue to the best o6 my (ouh)
knowtedg e; -that 1 (we) am (cute) .the owner(s for the phopeAt y des cni.bed in this
.in6o4mat.ion 6o4m, by viAtue o6 a WaAAanty deed kecotded in the 066.ice o6 the
County RegAhten o6 Deeds as Document No. 4-A ; and that I (We) pnebentey
own the proposed site bon the sewage d hposat system (on I (we) have obtained an
easement, t nun with the above dedchi,bed pnopehty, bon the conatnuction 06 said
syat , an same ha,e beetj duty %ecokde..,d in the 066.ice o6 the County Re i,6ten o
Ve as ent No. 9 6
I A OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DOCUMENT NO. S''ATE BAR OF WISCONSIN-FORM 1
WARRANTY DEED
, , 32458
BOOK 512 ?AGE334 '_" SPACE RESERVED FOR RECORDING DATA
TMS DEED, made between Richard F. Lewinski and Ruth B. REGISTERS OFFI A
Lewinski, husband and vifg ST. CROIX CO.. WIS.
Reo'd for Record this__a"o
and Sykora Land Company, Inc. a Wisconsin Corporation Grantor
day of---Jme_____A.D.19_?!t
t------8_QU_ A•, M.
Grantee,
W i t n e It a e t h, That the said Grantor for a valuable consideration -- `lttlr-;w > *
X17,070.00
conveys to Grantee the following described real estate in St• Croix County, RETURN TO
State of Wisconsin:
A parcel of land located in the SW4 of the NW4 of Section
27, T28N, R19W, Town of Troy, St., Croix County, Wisconsin
Tax Key a _
Described as follows: Commencing at the A corner of said This property.
Section 27; thence N0017140t1B (True bearing) 26.00 feet along j
the West line of said kk to o t 11 i'
the point po of be thence NO 17 40 E 1289.37 feet along �
0 1 u
8�g, ng i,
said West line; thence N89 18 20 E 769.62 feet along the North line of said SWt of the 1
NW4; thence 300171401IW 775.61 feet to the centerline of an existing town road; thence I
Southwesterly along said centerline of town road to a point which is N8902013011E 23.45 feet
of the point of beginning; thence S89020130t1W 23.45 feet to the point of beginning;
subject to a town road easement across all of the above described parcel lying radially
at right angles 331 Northwesterly of the above described centerline of town road; and
subject to a Wisconsin - Minnesota Power and Light Company easement across all of the
above described parcel lying within the Southerly 33 feet of said SW} of the NW4
TRANSFER
Together with all and sin lar the hereditaments and appurtenances thereunto belonging or in any wise appertaining±L +
And Richard F. Tewinski and Ruth B• Lewinski, husband and wife
warrantasthat the title is good, indefeasible in fee simple and free and clear of encumbrances except existing easements
and will warrant and defend the same.
Executed at___ River Falls, Wisconsin this 10th day of Maps Jvne , 19--14
SIGNED AND SEALED IN PRESENCE OF (SEAL)
Richard F. Lewinski
(SEAL)
(SEAL)
Ruth B. Lewinski
(SEAL)
Signatures of Richard F. Lewinski and Ruth B. Lewinski
authenticated this 10th day of June i9 74
I
Ralph E. Senn II
Title: Member State Bar of Wisconsin
�i
STATE OF WISCONSIN
County. as.
Personally came before me, this day of 19-,
the above named
jl
to me known to be the person_ who executed the foregoing instrument and acknowledged the same. Ii
li
This instrument was drafted by
Ralph E. Senn, Attorney Notary Public County, Wis.
River Falls, Wisconsin (j
The use of witnesses is optional. My Commission(Expires)(Is)
Names of persons signing in any capacity should be typed or printed below their signatures.
HCMilbrCarpry
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. I - 1971
DOCUMENT NO. I STATE BAR OF WISCONSIN-FORM 1
+ ,., WARRANTY DEED
322080 " HIS SPACE RESERVED FOR RECORDING DATA
REGISTERS OFFICE
Earl Cernohous, Bernard Cernohous, 3
THIS DEED, made between ST. CROIX CO., WIS.
Rosella Cernohous Hendrickson, Margaret Cernohous Ahrens,
Lilliam Cernohous Blake Recd for Record this___ dtli
and _ _Sykora Land Company, Inc., a scona Grantor day 0f__Xy-------A.D.197L
Corporation at____$3 �___A:, M.
Grantee, '
W i t n e s s e t h, That the said Grantor for a valuable consideratiorf TwentY— Rig sill of Deeds
One Thousand and No/100-_-_($21,000.x_ ----------Dollars
conveys to Grantee the following described real estate in St-SroiX County, RETURN TO
State of Wisconsin:
The Southeast Quarter of the Northeast Quarter of
Section 28, Tomship 28 North, Range Nineteen West. Tax Key #
This is not homestead property.
'TRANSFER g
S
FEE
Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;
And said five grantors and each of them
warrantSthat the title Is good, indefeasible in fee simple and free and clear of encumbrances except Aasemnnta of rertnrd
and will warrant and defend the same.
Executed at giver Falls, Wisconsin and s 2nd day of may Ig 74 i
St. Paul, Minnesota ` ` ? ��✓ )
SIGNED AND SEALED IN PRESENCE OF k1_1 0 1ls 4c 1
HO
ern0 O en C On
(SEAL)
�jernard Cernohous
1
Lillian Cernohous Blake
' j$F
Mirgaret Cernohous Ahrens
r,
Signatures of Earl Cernohous, and Rosella Cernohous Hendrickson
authegtit:'afeif thfs day of__ 31123CUX Ma7 T, Ig
Jae X. -Banta'
L 1 l' Title:
r� Other Party Authorized under Sec.
Minnesota 706.06
STATE OFD viz. Notary Public , State of Wisconsin
Ramsey County. ss My coamission expires: 6/6/76
Personally came before me, this 3th day of may I974
the above named Beiti+ard Cernohou8, Lillian Cernohous Blake, rgare Brno ous Ahrens
to melknQwn to be the person 8 who executed the foregoing instrument and acknowledged the same. v
VI"_*tr..pnt was drafted by Earl H. Plante
g+ S Notary Public Ramsey County,Am.
Rive Falls, Wisconsin pl.AriTE
The'bse of witnesses is optional. My Commission (Expires?FF §) CAi'r,
V
Notary F'ut,l,,
rsiuni,usswr, t.�►n,as AU' 1"
Names of persons signing in any capacity should be typed or printed below then t res. �l
BOOK t NGMiJLrCon,prr —
WARRANTY DEED—STATE PAR OF WISCONSIN, FORM NO. I — 1971 BOOK PA�E��� �'
1
cn
• H
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r
ST C - 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
a
j H
OWNER/ U Y E R 7,Q C n.
ROUTE/BOX NUMBER R43 Fire Number 6p"o- y2�
r�^ 'I. I P rj"AJv Z Z
CITY/STATE �'��,� /'��: �5 � �
PROPERTY LOCATION : �5& 14, NG, �4, Section ZS , T 2S N , R/__W,
Town of -7—v6 V1 , St . Croix County ,
Subdivision _&w%A,6.j�A Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper . What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix . County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
H
three year expiration . 0
z
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein , as set by the Wisconsin Depart-
ment of Natural Resources . Certification form u t be completed
and returned to the St . Croix County 'l.o g 0 f '_ within 30 days
of the three year expiration date .
SIGNE
DATE
St . Croix County Zoning Office
P . O . Box 9S
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
P.O. BOX 7969
MADISON,WI 53707
LABOR AND PERCOLATION TESTS (115)
HUMAN RELATIONS (H63.090)(H63.090)&Chapter 145.045)oc
L% ION:u SEC ION: �OWNSHIP MUNICIP ALITY: LOT NO.:BLK�NO.: SUBDIVISION NAME:
�/ q a TOON/1169 E l r �I. G /a. Su+tdelCOUNTY: WNER' BUYER'S NAME: MA ADDRESS:
USE Al `per DATES OBSERVATIONS MADE
NO.BED RMS : COMMERCIAL DESCRIPTION: PROFI E DE CRIP 11 1PERCOLATION TESTS:
KIResidence , IA ANew ❑Replace I � 2'�� S/�.A��g
RATING:S=Site suitable for system U=Site unsuitable for system * o f f 110 Ck V
ONVENTIOaNAL: MOUND:�� IN-GROUND-�URE: SYSTEM-I®ILLHO❑LDING®NK:R�E�CO��M��D SYSTEM:(o tional)
SS UU S S U S U S U ��u -0.1/ s
S'
If Percolation Tests are NOT required DESIGN RAT If any portion oft rea 3J
under s.H63.09(5)(b),indicate: indicate Floodplain ele tion:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
y - r p�-1"IS 11 y— i& P9H P;I I
B-
3 e c �S
D=14"Pk Re.,N s�
B- 2. 9y S y � at- o `. s
'.e> Cp 776-76- 6(P y,c S '
B-
13- '`7� �p(r� ��0'9" > fe wa ] cq. g Q
Re ZE"
sctf e
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PS RI D 1 PERT D 2 PERIOD PER INCH
P- %A / o
P-2 a If 70 0
P- r 3p f
P
P- Z' r ! if
P_,9_ fl d(
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION "
3
.` i
< < I
1
7
1
—0-4t ,...... y(..� ..-. -GJ�- ��1 -..�.., -..T-.2.. 'a.._,...... .�y`yy.,....._�„ ..... I _... _..-----
je ex 99 � t t
tN
... .. I
j
� . � — �.....�..._._ ....-:._._. ---..-._�... ,,.....d3_....-..- ,...._^ ........_....... -a — _ _gym._..,,.,.,' F
j €
w+M# `
I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME(print): TESTS WERE COMPLETED ON:
/48 49
AD SS: CERTIFICATION NUMBER: [PHONE NUMBER(optional):
F$
CS SIGNA RE-
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
J
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 `
To be a complete and acctdrate soil test,your report must include:
1. Complete legal description;
2, The use section must clearly indicate whether this is a residence or commercial project;
S, MAXIMUM number of bedrooms or commercial use Manned;
4° Is this a new or replacement system,
B- Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MADE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
t:eparate street may be used if desired;
S° Nh)kO SlMt VOW benchmark and vertical elevation reference point are clearly shown,and are permanent;
B. Complete all appropriate boxes as to dates, narnes,addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10, If the ir;for in,'firm (such as flood [)fail),elevation)does riot apply, place, N.A. in the appropriate box;
11. Sign the form arid palace your current address and your certification number;
1`, iJakc legible copies and distribute as requires}. ALL SOIL_ TESTS MUST BE FILED VVITH THE
L_OC:AL AUTHORITY INITHiN BQ DAYS OF COMPLETION.
ABBREVIATIONS FOR ERTIFIED SOIL TESTERS
Soil Separates and Texture.- OtIver Symbols
st - Sto'lt' ')Ver IV) BR € edrock
3 1p,t) SS S
C r,�rl„e („- - �,anctstone
gr _ Gravel jundei S”) LS - Limestone
S,:ne1 IGVvI - High (3ioundwater
Cr .tsr: Sara t Pars, P °�t,att� Rate
I?lwi s [ diiwna sand 1=
s Fw'e Sand Bir;g - 3 3.3t1,'ng
L ca lity r,a,;c# C, e ter TIIi to
sp =r:Iy Loan-i - Lass"l'h,m
Batt --- - tr"+1€I
h Loat"I ; _ °i
t
<ty _car=te cr .__ Re'd
S.Ity,� CI ay Lt)ar p -_ [a e ,i!es
31,ti spy clay
CI t` v, fir? , (alnt
R,1"lt;ic
}-air
_ ra': s o e x,f�?°c; fc3t1E. vv tE'r
't E hglo c{ .,rsast:e dis osEal B10 - B€ r „.
I a r'; €,?nark
V R P - er ,;al Reference Poin-
t�
TO THE OWNER,
rl t.`; so!l res, '.``p•'on is he fil st sr+'r) ki"i a S<anite!"y twrmit.. The courlty or-one Department may request
1'ca n 1-4 tl.k' smj t:; i, fs€ l<[ par101, to say: tnit issuance, 'A comp kI to set of pII)nS tot the private
VnVlc- sv ,.ern 'Ind a I,IE','t1 it ap "'llicalion nnuSt ile submitted to i.hE: .ap piopariwe local authctl"Fty ill order to
, FITI "'he tarlr rCary p u'wllt rT41,.;t Lie rz?,i,dlk'`1 and posted pl ior'to the Start of construc"Jolt,
Lc IZ 'e 'ems � kaca Scle-
�s
�oe—
A-dr-
117C>.44 r !�C Cu 3�,� { e
t
zb�
$�3 s,fe, sl,�c d
Q a$�b
c�-y- Z3z-7 l opt-
t
r
/''Ape-
1
I
Vertical Horizontal
Type of Separation Separation
Animal Waste Management Practice Distance Distance _
C - Waste Transfer Systems
1 - Reception Tanks or Hoppers 3 ft 75 tt
- liquid tight concrete or steel
2 - Gravity or Pressure Transfer Pipes - 25 ft
- Cast Iron or Equivalent, PVC meeting
ASTM D-2241 , other pipes meeting
NR 110.13(5)
D : Runoff Control Systems
1 • Animal lot
- gutters and pens none 25 ft
- lot or yard none 50 f t
2 - Filter strip
- below or downslope none none
of animal lots and
stacking slabs
3 - Settling basin
- generally located in or near 3 ft 100 f t
the animal lot
- liouid tight concrete
Motes:
1. When the above horizontal distances are exceeded, SCS standards may allow
lesser vertical separation distances where increased material
specifications are met.
2. While the current draft of NR 112 does not contain specific vertical or
horizontal separation distances for filter strips, the DNR encourages
inclusion of appropriate separation distances in the design of filter
strips.
3. SCS standards do contain vertical separation distances for runoft -control
systems.
�Is-
..
c�osc Se x�®� csf AF
Cr�-,a�, 44�i
A F,A4
14 -So,weA
ak -f v�e� �`J''�►
� weG1
O G'
a Cs2a C, wo�� e,4 & _
i
pot
cAl
A 5,De 60' r�wi�aw
ob
5` 5�
i
WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM:
Design a mound sy em for a
The site character tics are: '
Depth to groun ter or bedrock _ in.
Landslope %
Percolation rate min./in.
Distance from dose ch r to distribution system ft.
Elevation difference be en pump and distribu on system ft.
Step I. WASTEWATER LOAD = _� gal .
Step 2. SIZE THE ABSORPTION AREA
A) Area required sq, ft.
B) Bed or trench length (B = ft.
C) Bed or trench width ) _ ft.
D) Trench spacing ) _
Wastewater oad i .24 gal/ft2/ B = ft. �
tren s e
Step 3. MOUND HEIGHT
A) Fill d pth (D) _ ft.
B) Fill epth (E) = D + % slope (A) _ ft.
C) or trench depth (F) _ , ft.
D Cap and topsoil depth (G) = ft.
E) Cap and topsoil depth (H) = ft.