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Parcel #: 161-1022-50-000 06i27i2006 10:56 AM
PAGE 1 OF 1
Alt.Parcel#: 13.29.20.415B.416.417A 161 -VILLAGE OF NORTH HUDSON
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-PIOTROWSKI, EDWARD M&BARBARA J
EDWARD M&BARBARA J PIOTROWSKI
3766 BRIGHTON WAY N
ARDEN HILLS MN 55112
Districts: SC=School SP=Special Property Address(es): "=Primary
Type Dist# Description *547 GALAHAD RD N
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 02/35-LAKESIDE ADDN 1910
N 10'LOT 3 BLK 6, LOT 4 BLK 6&S 20' Block/Condo Bldg:
LOT 5 BLK 6 LAKE-SIDE ADD VIL NH
INCLUDES PARCEL 161-1021-20(P383B) Tract(s): (Sec-Twn-Rng 40 1/4 1601/4)
13-29N-20W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/30/1999 607759 1445/427 WD
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/19/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 319,900 183,200 503,100 NO
Totals for 2006:
General Property 0.000 319,900 183,200 503,1000
Woodland 0.000 0
Totals for 2005:
General Property 0.000 319,900 183,200 503,1000
Woodland 0.000 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
Parcel #: 161-1021-20-000 06/27/2006 10:56 AM
PAGE 1 OF 1
Alt. Parcel#: 13.29.20.383B.384B 161 -VILLAGE OF NORTH HUDSON
Current �X
ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-PIOTROWSKI, EDWARD M&BARBARA J
EDWARD M&BARBARA J PIOTROWSKI
3766 BRIGHTON WAY N
ARDEN HILLS MN 55112
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description '547 GALAHAD RD N
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 02/35-LAKESIDE ADDN 1910
N 10'OF LOT 1 N 10'LOT 2, N 10'LOT 3, Block/Condo Bldg:
S 70'LOT 4, S 70'LOT 5&S 70'LOT 6
ALL IN BLK 1 ALSO PRT VAC LAKE ST Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
BETWEEN BLKS 1 &6 LAKE-SIDE ADD VIL NH 13-29N-20W
ASSESSED W/161-1022-50(P415B)
Notes: Parcel History:
Date Doc# Vol/Page Type
07/30/1999 607759 1445/427 WD
2006 SUMMARY Bill#: Fair Market Value: , Assessed with:
0
Valuations: Last Changed: 05/04/1994
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
Woodland 0.000 0
Totals for 2005:
General Property 0.000 0 0 0
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
r
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
Bed: Trench:
Width: Length: Number of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear,0 Pt .
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job: v
License Number:
3/84:mj
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER SEC. �� T 24? N-R 2-o W
ADDRESS 557 61i4-:s14Ao 4?,o, AA ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of TIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
PL E �, 7
PCo7 c C',eo�s
�czTN t�iza,oF�2a L. ,J�
A>p <P LA feoA6
N�K/ /200
o O
Irz
W6S9 P2oastT q e ( ( D,c'.i✓£yv�t 4
rJ/)
ei D P�S.o�Jc P/Z o�FC7 ,
_ t - Koy rye SAN L
/ O\ Ex; 7:)r/ I ExeS� �I T -Siz P7 7i+e�K
I S' vFC c/o�AC� R'? oC oC/<M E^)T
--
i
,<x157eay i' 0 ,
�...-. -- 70' —_
z
_ INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: ln/�/SFs � Liquid Capacity: i.2oo e7A//o Js
Number of rings used: 0�- Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,�q Side,0Rear, O 2(,S/ feet
From nearest property line Front 10 Side,(DRear,0 /L ' feet
Number of feet from: well `IDS , building: �o/
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
9'9
P.O.60X• 69 BUREAU OF PLUMBING
MADISON,WI 53707
SE',,, SEa,S14,T29N—R20W 000NVENTIONAL ❑ALTERNATIVE State Plan I.D.Number:
Ilf assigned)
Village of North Hudson El Holding Tank ❑In-Ground Pressure ❑Mound
Galahad Road
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: nn
Roger Dahl 547 Galahad Road North, Hudson, WI 54016 (je CCU
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Gary Zappa 3300 St. Croix 92545
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA EL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ONO ❑YES ONO
BEDDING: VENT DIA.: VENT MATE.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
JALARM FEET FROM LINE: AIR INLET
❑YES ❑NO ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO ❑YES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. V NT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) ❑YES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER JINSIDE CIA. #PITS LIQUID
BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH
DIMENSIONS
G RAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL NO.DISTR, NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER. ELEV.INLET.ELEV,END. PIPES: FEET FROM LINE. AIR INLET.
NEAREST------j01
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 R EVE RSESI DE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER TEXTURE: PERMANENT MARKERS JOBSERVATION WELLS
DYES ONO OYES —]NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER. EDGES:
❑YES ❑NO DYES ONO ❑YES ❑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
ELEVATION AND ELEV,. ELEV., DIA. ELEV.: PIPES DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
OYES 0 N DYES El No
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES 1:1 NO OYES 1:1 NO NEAREST
W
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE.
DILHR SBD 6710(R.01/82) Zoning Administrator
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 owners name and mailing address. Provide the legal description where the system is to be
installed;
If. Type of building or use served: If public is checked, ndicate 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'/z 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 .Ater
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 reasure'
is used in your building is returned to the groundwater- through your soil absorption o
system or the disposal site used by your holding tank pumper.
0
The monies collected through these surcharges are credited to the groundwater fund adminis-
ferec; by the Department of Natural Resources. These funds are used for monitoring ground- f
�-vaier, grourdwater contamination investigations and establishment of standards Groundwater,
i':s worth protecting.
SANITARY PERMIT APPLICATION COUNTY
DILHR In accord with ILHR 83.05,Wis.Adm. Code � • if X
ST E SANITARY PERMIT#
as vs
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8'/2 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 N NO
PROPERTY OWNER PROPERTY LOCATION
'/a St '/a, S T N, R Lb E (or)W
0ROPEVTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY,STATE ZIP CODE I PHONE NUMBER 7 CITY NEAREST ROAD,LAKE OR L NDMARK
Q
yC 6 d_ yv� f9 VILLAGE
,'
II. TYPE OF BUILDING OR USE SERVED:
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. ❑ New b. ❑ Replacement c. V 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. ❑ seepage Bed b. ❑Seepage Trench c. ❑See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
Feet ®Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total ##of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
a
Septic Tank or Holding Tank .`CC D t, - c,
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
n ��U
Plumber' Address(SttA0,City,State,Zip Code): Name of Designer:
Ill. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST##
�^ C f A . ti
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
t` Or✓
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
®Approved ❑ Owner Given Initial tkD} S rcharge Fee
Adverse Determination
X. CO M NTS/RE ONS FOR DIS PPROVA : -kk/ ���
Ill &Jenat no SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
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.
.�
L�:Z -S � J Owner of Property �a J
.41 X"Aw—i .1,� rig 1 ca✓K %�— .,�'7 /�"r � -, i _.!'
Location of Property 114, Section /` , T -f N-R G W
Township IV----'7`L /7"
Mailing Address
v�s<n.x/ �,
Address of Site
Subdivision Name <9�.�' S/ �C '� 2') ' ' °'Jr
Lot Number i' C .s ��<• c l= S- %` %�
.' Previous Owner of Property
Total Size of Parcel y 4/4®
Date Parcel was Created (/ems�i "� ��3 i�~s' 7�
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes /` No
Volume and Page Number Z as recorded with the Register of Deeds.
,rJT Al- /-2 Y_
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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTV OWNER CERTIFICATION
I (We) ee ti.by that aU statements on thi.6 bonm cite true to the best ob my (oun)
knowledge; that I (we) am (are) the owner(.6) o6 the pnopen ty described in thiA
inbonmation bonm, by vi tue ob a wa4Aanty deed tecotded in the Obbice ob the
County Reg.i,6ten c Deeds as Document No. 7 ; and that I (We) puzentey
own the pnopoaed site bon the .sewage dispozat dyss em (on 1 (we) have obtained an
easement, to nun with the above deselribed pnopenty, bon the constnucti.on ob eaid
.system, and the .same ha6 been duty keco&ded in the Obbiee ob the County Reg"ten ob
Deeds, as Document No 2 1 1 •
a
SIGNATURE Ot OWNER SIGNATURE CO-OWNER (IF APPLICABLE)
j—
DATE SIGNED DAT SIGNED
►corm ..o. ., .
26258f
194i.S Inbrnfur>e, made by Ella M. Linder
grantor , of St. Crodx County, Wisconsin, hereby conveys and warrants to
Roger J. Dahl and Floy S. Dahl* husband and wife as joint tenants
grantee , of C,ount y,
Wisconsin, for the sum of One dollar and other good and valuable consideration
1 the following tract of land in St. Croix County, State of Wisconsin:
4
N 10 feet of Lots 19 29 & 3; S 70 feet
of Lots 46 59 & 6; all in Block 011.
S 20 feet of Lot 5;• All of Lot 4; N 10
-fset.ofqLot, 3s .all is Bloch."6a. r..,,,� „T .<,, �- .. ..• .f,.�:wrt � g. .-
' v .., *. erg•„.��� ,
And part of Vacated Lake Street between
Blocks "1" and "6" as described in the
Caption.
All in Lakeside Addition to the village of
T` North Hudson.
. '
"t 61STERS OFFeIdlk;
ST. C%PIX CO.. WIS.
•Rec'd for Record this-2r .-_ yd'
1 r
day of---�iugug1-_A.D.19_6A ' t 5
at_�9;.�1�-------A►M.
n
Re st r Deeds 5 n
r
t
� t
r /
'
in IMUness IM4ereaf,The said grantor ha s hereunto set her hand and seal this
29th day of July - ✓1. l
SIGNED AND SEALED IN PRESENCE Of
a
* Nlla M. Linder
Robert L. Bauer SE.1L)
Bauer
w
Mate of Marlinght,
Croix
County
Coun
Per§yna�lycame efore me, this 29th day of July
A D;aTg.ea.• �:; tj6,abo s named Nlla M. Linder
Eto >'i{.e46o;rn to be e�erson who executed the foregoing instrument and acknowledged the same.
. n0
',,etrt,0 uu Robert T., Bauer
.Notary Public, St. Croix County, Wis.
MY commission expires aly 7 , .4. D. 1963
*Typewrite Name under each Signature
Bon 370 PRE137
Orlando G. Holvray phone
Registered 724 St., Croix Street DU6-3922
p's`A surMor Hudson, Wisconsin
Hudson, St. Croix County. Wisconsin
Due to numerous surveys of our property. along Galahad Road, in the Village of
North Hudsone Wisconsin, none of which agreee we the eundersigned owners#
Dennis Hollerudo and Roger Dahl# stipulate and agree that .the proP$rty line.
between our respective properties in Lakeside Addition, to the Village of
North Hudson shall be as follows a to Wit: at a point 844.37 toot
South of the East corner of aeotion 14 T 29 No R 20 N, the j. section line
biirt .z
TINS da lot hl
thence Westerly at right anglee ,to the }last line of acid Gov. Lot 1 in said F
Section 14# and running to Lake St. Croix from the Bash line of said (k)v- trot 1.
Dated this L� day of 1961
Witness
4
J1 l t
State of Wisconsin
Ste Croix County. Wisconsin
On this Jat dally of 1961, before me the undersigned. a Notary
Public, within and for said o and State, personally q)jmaared the above
named Grantors and Grantees, known to cue to be the persons deeoribed herein
_ . and who exeouted the foregoing instruuent and acknowledged the hare.
St. Croix County, Win.
�- - R#y► CossaissIon a vires
JAMES J.GREEII
• Notary Public -St:Croix Co., Wis.
My Commission Expires Sept.13,1964
Abstraot of Title
and �., .,.
P L"-A' T
To:.
Desoriptions as in
Deed 7Book <298 page 235
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STC - 105 a
ti H
SEPTIC TANK MAINTENANCE AGREEMENT c
St . Croix County x
tv
a
OWNER/BUYER-
ROUTE/BOX NUMBER'`) -/- G� Fire Number
.CITY/STATE t�����Gi� (�/�5� ` ZIP mac'
PROPERTY LOCATION: ]%, it, Section , T N, R W,
Town of 1✓a" �� /�� Y°'r St . Croix County,
Subdivision li Lot number,57.14
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 pdt into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
• E
I/WE, the undersigned , have read the above requirements and agree tz„
to maintain the private sewage disposal system in accordance with x
M
the standards set forth, herein, as set by the Wisconsin Depart- do
ment of Natural Resources. Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date.
S I G ED
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.
UEPARTIVIEN70F REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND P.O. BOX 7969
LABORL
PERCOLATION TESTS (115)' MADISON,WI 53707
RELATIONS
(H63.09(1 r&Chapter 145.045)
LOCATION: i N: TOWNSHIP/MUNICIPALITY: , OT NOBLK.NO.: SUB DIVISION NAME:
1/4 1 TZ4 So — — �rns f'OUN
s S C Y, � �1/4
COUNTY: WNE R S NAME: MAT N ADDRESS:
Sr Gory G,X+2'. ANL- s 47 GaLn"ai, h N
USE DATES OBSERVATIONS MADE
NO.BE COMMERCIAL DESCRIPTION: L DESCRIPTIONS: PER A I NTESTS:
Residence u� ENew Replace Ape IL
50,is &4 d 41E - sD 'SOILS- 14s is- 1-1 v86A,lZ�
RATING:S=Site suitable for system U=Site unsuitable for system
ONVEN VEAL: MOUND, IN-G D- :S T M-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)
os a sau Esau . sou ou
If Percolation Tests are NOT required DESIGN RATE: (lf any portion of the tested area is in the
under s.H63.09W(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
El.
BORING TOTAL GROU ND ATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER DEPrH'iBi. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- 9�,f$4 J
7,50 io"Bees=�U�eCo�Co,� 3Z"$�r\tSL 4� $Qgm*M S*6�
e-
B
8-
e-
B-
PERCOLATION TESTS
DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. ISE RI o D 1 P RI D! PERIOD 3 PER INCH
P-
P c DES s oNr — IS /MLf So L C I to / df TLr Pre A
P-
P. _ cbSS 1 E�RC
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
i
i
1- . _
ousc
F�A4, :OLCr; LEV>LT lob id O'CIO
AL
=20
m.4.06 __t:oti.1C�BTLr _
l
I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME pri t : TESTS WERE COMPLETED ON:
AIMY 30+4►,,jS0kV R�s�u Su r'vi;Yin/�, �N� ' � 1 L 2$ �0(7i 7
ADDR S �/ CERTIFICATION NUMBER: PHONE NUMBER(optional):
4 2 SEco1s q S7 /`(ulcer l � t4%4- 3Fs6-4o�0
CST SI TURE:
C:l
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
DIVISION
INDUSTFY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707
HUMAN RED ATIONB (1-163.090T& Chapter 145.045)
OINAME:
LOCATION: TOWNSHIP/MUNICIPALITY: T KO VSl
�50 —'/4 VILtd ' I�x 4cs
COUNTY: WNE UYE NAME MAILINU
USE — DATES OBSERVATIONS MADE
NO.B DRMS.: COMM IPTI ON: _ PROFILE DESC OEATIONTES71
Residence _ u� K - C]New t<Replace /(pk IL
SOILS
OILS &,3 A�� ' n���
RATING:Ss Site suitable for system U-Site unsuitable for system
ONVEN AL: MOUND: IN-GRCSUN� -FILL OLD NG TANK:RECOMMENDED SYSTEM:(optional)
El OU os flu Ej S U Z S C1U CIS C7U
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(6)(b),Indh I I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL raRQU ND ATER INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH AQ, ELEVATION OgSERV D TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B f �C� / ('�Z f 7, U /���Cnj s`tC>R�o�Chr� �Zp�knl`JL ��J$a►�M � SgG�
Cab covr.
B-
B-
B-
fB
I
B
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME A LEVEL-INCHES RAT MINUTES
I NUMBER INCHES AFTER SWELLING INTERVAL-MIN, p I PERBHE= PER INCH
P-
P- f Q.0 'ES s __NCIT bONE AT T/<1 /n2tf . 'ScoL C Id Isic Te Pie
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
�ontal 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
±
FtnE,i>oc� CLEVn�torQ loo TALC
pp /' 2-6,
pt?MCNI't+l1�2>A - Cd�N�R , p�' 1'CA�S t�d1.t �ruN4.l�4 7`Cr ,
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,
NAM (prigt �� " -`— —.--- --- — —TESTS WERE COMPLETED^ON: �
�drtf k,rd►�I`���n/ RuuSuQr:Y/n,c,.. ���5
J �
ADDR CERTIFICATION NUMBER: PHONE NUMBER(opt ional):
-- CST SI TURE
;OT 4111
DISTRIBUTION:Original and one,copy to Local Authotity,Pinpetty Owner and Sail Tester.
DILHRSB0-6395 (H.02/82) ... OVER
L_
UEPARTMLNT OF REPORT ON SOIL BORINGS AND SAFETY 8t BUILDiP1GS
DIVISION
INDUSTRY, PERCOLATION TESTS (115) P.O.�t�X
LABOR AND MADISON,WI 53707
HUMAN Rf I ATIONS (H63.09(1r&Chapter 145.045)
LOCATI
N._- N:T y p TOWNSHIP/MUNICIPALITY: OT NO.. LK NO.: SAU�1 DIVIS NAME
>L �� ='�� 1' 1L'. R/11Z-' for) YILLK1La c"'F NQ �JSC1 �`f s
COUNTY: WNE NAM A
Si ckoI It 11002 Al1L 5117 �7ALAi4AV% N
USE � DATES OBSERVATIONS MADE
NO. EDR CO M TIResidence u� K °�-- Apt I Z�, ���7
Sorts &3 l; 44C- 5,7 `j61LS_ Os g- 1408&w�
RATING:Sa Site suitable for system U-Site unsuitable for system
ONVENTI MOU D: IN-GRZ)UND FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)
r a s �u Mrs ❑u o s u ,�s ❑u o s au
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: I — Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL H R UND ATE -INCHES C ARACTER OF SOIL WI THI KN SS,COLOR,TEXTURE,ANO DEPTH
NUMBER DEPTH is. ELEVATION d BSE VED q TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- SrJ �`�, 3 > 7,SU io'Bea S�FG Coy Co,M 3Z"$�rvSt. 4��B +�Mtn
Ga tO cp v►. .
B-
B-
B-
B-
,+B
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TI DROP IN WATER LEVEL-INCHES RA NUTES
I NUMBER INCHES AFTER SWELLING INTERVAL-MIN. f PER INCH
P.
P- E C SE'S S NOT b6NE AT Tq/S !ME Sp C 1 b ! IS I 'r is P*6 jAdLe
P-
P.
P- M
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-
:•.rental 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
Z! _ " ILS �"'
7 6o'l' - ' N
VLAhPOLL- CLLVn sorer (3 0,CX,
26
t>tt/CFlr�+rld2� - C jZnl4 0�
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.
NAM print �� TESTS WERE COMPLETED ON:
r1�'J .v ,.��11NS���/ R�xuSu�yr.Y��lG� /^<<-• PAP+L Z$ /'�'87
ADD S: / CERTIFICATION NUMBER: PHONE NUMBER(optional):
C51"SI TURE. e �
j�1
• q
DISTRIBUTION: O,igmal and one copy to Local Authority,Propei ty Owner and Soil Testes.
DILHRSRO.6395 (H 07/62) OVER -
` • J /:z Ig V /
` �J FCT1.U n/ �Li'0 nil
fL vPx
-0 /VFV✓ IAOO �--- To J�93T "oAonFn-Ty L2►vE -�
GAL, _S�PTSG. TANIG /arvD GALAl1A/J /lQ
0p
CAL. SEPTIC 1000
CAL.SFPTZC TAlJK
//O 70 wEST� y�
B"PE&Tr LTtiE io' �OC oz- /J/ YL
o Ap• LxssrsNG SEPrsc -rArvk
1 k
J2r_rrQr_�cr
r_xurrN6 GAnAGF-b AF1oLACE177E1-r�'
_c IG
EXZIr3.rvG O Z
/300 CAL 1JnrwL�LL3 �t
LEXssrsvv WELL
y `
U
/vO SC/oLE
,_('v N TN 00A0 A5rLTY L=.4 E
Ivo7 ALyqu1.2Eo o^,l _S,E/7-. -- IAkv)<
A P PROVED 'VENT CAP
h 4C 1t,4±M 12"
ABOVE FINAL GRADE
4" CAST IRON VENT PIPE
MAXIM-IM OF 42" ABOVE
PIPE TO FINAL GRADE
SIGNED:
MARSH HAY OR SYNTHETIC: COVERING LICENSE:
MINIMJM 2"AGGREGATE DATE:
OYER PIPE T I /
DISTRIBUTION PIPE
TEE SOIL TESTING BY:
46 I �i /' �iF� i//Vr�nf OA,/.
f l
ELEVATION BED 6" AGGREGATE •
BOTTOM PER SOIL., BENEATH PIPE PERFORATED PIPE BELOW
TEST IS ` • COUPLING TERMINATING
FT. AT BOTTOM OF SYSTEM