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Parcel #: 030-1015-20-003 09/11/20P AGE E I AM
P 1 OF 1
Alt. Parcel M 04.29.19.63G 030-TOWN OF SAINT JOSEPH
ST. CROIX COUNTY,WISCONSIN
Current (X
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
00 0
Tax Address: Owner(sy O=Current Owner, C=Current Co-Owner
O-KISHEL, PETER T&MAUREEN K
PETER T&MAUREEN K KISHEL
1180 SUNDANCE PASS
HUDSON WI 54016
Properly Address(es): *=Primary
* 1180 SUNDANCE PASS
Districts: SC=School SP=Special
Type Dist# Description
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC Notes:
Legal Description: Acres: 3.000
SEC 4 T29N R19W W 1/2 NW1/4 LOT 3 CSM
5/1476 Parcel History:
Date Doc# Vol/Page Type
07/23/1997 777/549
Plat: "=Primary Tract: (S-T-R 40%160%GL) Block/Condo Bldg:
* 1476-CSM 05-1476 030-84 04-29N-19W LOT 03
2014 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 05/11/2011
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 68,400 173,700 242,100 NO
Totals for 2014:
General Property 3.000 68,400 173,700 242,1000
Woodland 0.000 0
Totals for 2013:
General Property 3.000 68,400 173,700 242,1000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 205
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges 00
Total 0.00 0.00
PUMP CHAMBER
Manufacturer: Liquid Capa .
Pump Model: Pump/Siphon Ma acturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation• ons per cycle:
Alarm Manufacturer: Alarm Switch,Type:
Number of feet rom 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). 1(j-60(- 7zew a, , S�
SOIL ABSORPTION SYSTEM
Bed: Trench: CP
Width: Length: Number of Lines: 2— Area Built:
n
Fill depth to top of pipe: 14 X(�qa A L 36
1-
EA-S 7-
Number of feet from nearest property line: Front, O Side, O Rear,0 h't .��d
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 elev on:
a
Area Built:
a.
Has either a drop box O or distributes b been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings ed: Elevation of bottom of tank:
Elevation o inlet:
Numbe 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:
� Inspector
Dated: / Plumber on job:
License Number:
HOMESITE SEPTIC PLUMBING CO.
RT.3 O'NEIL RD.:HUDSON.WAS.54016
ROBERT ULBRICHT
Wl�.A*SfER PLUMBER LIC.NO.3307 MARI
3/84:mj iiv -NSTALLER&DESIGNER LIC.N0.00663
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER /��Sr1�L TOWNSHIP S7 J O SEC. T T 2 N-R W
ADDRESS R74 • 2 //U0X0,' ST. CROIX COUNTY, WISCONSIN
wi.f S�oiG
'iDIVISION Su' "l. LOT LOT SIZE S
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
CHICE
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INDICATE NORTH AFkOW
Tod dF $•YS%€�'-'1 -J z D
fps /.s F.
'tp6'0- OF S'4—^W6- , 7—
BENCHMARK: Describe the vertical reference point used S.W 4dVVICA- OF AOvS�
i
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: ��(J�1R 4 ��a� G'tls
O �T Liquid Capacity: r i
7b7`4 L CJ"✓�3 �
Number of rings used: c, `f 2f't - Tank manhole cover elevation:�j'
Tank Inlet Elevation: /e' 3i ' Tank Outlet Elevation:
E�tf
Number of feet from nearest Road: Front,0 Side,0 Rear, 0 feet
tAlr
From nearest property line Front,OSide0 Rear,0 feet
Number of feet from: well S1 building: 1 -7 '
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
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:TTaM moa; 1993 3o aagmnN
• g O `OPTS O `luoaa :auTT Alaadoad lsaasau moa3 1093 30
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:BuTPTTnq moa3 laal 10 aagmnH
:TTaM moat 1aa3 3o aagmnH
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:Odf.1 ZlTMS UUBTV
:aaanloB3nuvH maBTV
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as ingov By1 azTS d uogdTS�dmnd :TapoY1 dmna
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llagNVHO d na
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER P"5T'-'k k TOWNSHIP S7 J d� SEC. T 2I'N-R W
e T1v GC IeX
ADDRESS 474 • 2- tYuO-fov ST. CROIX COUNTY, WISCONSIN
wa SvoiG
SUBDIVISION S�'U�fiV"l, LOT LOT SIZE S
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
0-ti 1987
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O,etd/0 40X 7� r
GI Y INDICATE NORTH OW///iF-A. T.� ,� P2.0
Tap
3o-ffOM �'pGE' of SrD,w(r �1•T
BENCHMARK: Describe the vertical reference point used CbevS2 Of Adore-
Elevation of vertical reference point: Proposed slope at site: �_
SEPTIC TANK: Manufacturer: 600Q�k Liquid Capacity:
Number of rings used: f 4f- Tank manhole cover elevation:
g 2 t '
Tank Inlet Elevation: /�' 3i Tank Outlet Elevation:
Orr
Number of feet from nearest Road: Front 10 Side, Rear,O feet
j From nearest property line Front,OSide,�Rear,O feet
I �
Number of feet from: well ( , building: 7
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
IM'ON*31183NDIM 18311U1SW*m;.-
s'8av Lon'ON'on 83owllld 83lsW-*s'im `
MOW 183808
1[o1S SW'NOSMH''08113N,0£'18
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:pvoa asaasau moa; aOa; ;o aagmnK
:guTpTTnq moa; 199; 30 aagmnK
:TTOM moa3 jaa; ;o
.,3 aag>luo
IaTUT 3o agmnK 0 `IBag O`OPTS O `:1UO3A :aulT �laadoad Isaasa uoTsnH O T;o amr2UT:xus2 ;o mo]loq ;o uoTIsnaTH agnK
:� lTasduo :aaanjos;nuv
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tTos anoga age ;o eCus uo pasn uaaq q jngTaasTP ao O xoq doap E aagpia sVH
:2TTng Baay
:uo na o :11 aSBdaas ;o mo��og :g2dap PTnbT'1
:aaaamgTQ :slTd ;o aagmnK -- aZTS
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7 n :SuTplTnq moa3 29a; 3o aagmnK
c" :TTaM moa3 2aa; 3o aagmnK
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A 1�
:ITTng vaay :sauT'l 3o aagmnK :giPuaZ :gIPTM
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rtY-�AY1 1 707 �
' WHISI,S KOI1aHOSgV 110S
•(usTd joTd uo saouslsTP apnTaul)
:$uTPTTnq moa; 2991 ;o aagmnK
:TTom moa; aaa; ;o aagmnK
• 0 `OPTS O `4uoa3 :OuTT Aiaadoad isaasau moa jaa; ;o aagmnK
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Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
' • 4I
OWNER TOWNSHIP S7 �IOE- SEC. 4' T 2T - l
N R�W
ADDRESS AA Z 11uDdo v ST. CROIX COUNTY, WISCONSIN
WIT S4'o/G
SUBDIVISION 'Su'U�fiV� LOT LOT SIZE S
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ufkT-
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NcvSE
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by
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76 T
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I D.QV� r.�bX T, er y
=fZ•o' INDICATE NORTH UkOW
�' DJ
If 7—. �2 q prp b''2
BENCHMARK: Describe the vertical reference point used S,W �iw�i Of /ydvSg
r
Elevation of vertical reference point: 'Q Proposed slope at site: �� 0
W FEES
SEPTIC TANK: Manufacturer: rptJ�n k Liquid Capacity: �
Totg4 y,3• 3 '
Number of rings used:qq f 1"t- Tank manhole cover elevation:
} Tank Inlet Elevation: '0' 3i
Tank Outlet Elevation: / •Z• '
Number of feet from nearest Road: Front 10 Side, Rear, O feet
i
j From nearest property line Front,OSiL Rear feet
feet
Number of feet from: well building: 7
(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
P.O.BOX,7969 BUREAU OF PLUMBING
AADISON,WI 53707 State Plan I.D.Number:
W2, NW%,54,T29N—R19W CONVENTIONAL ❑ALTERNATIVE (Ifassigned)
Town of St. Joseph ❑Holding Tank ❑ In-Ground Pressure ❑Mound
Lot 3 Sundance, River Road
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTQON DA E:
Pe to Kishel 1360 Furness Parkway, St. Paul, MN 5511 8 ������ �J '
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:
Robert Ulbricht 3307 St. Croix 99033
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO I DYES ONO
BEDDING: VENT DIA.: VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT LE FRESH
ALARM. LINE: AIR INLET:
FEET FROM
EYES ENO DYES ONO NEAREST;
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING OVER
❑YES
NO OYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF .PROPERTY WELL. BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN
FEET FROM LINE: AIR INLET
PUMP ON AND OFF) ❑YES El NO 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:
BEDIIRECH WIDTH: LENGTH NO OF DISTR PIPE SPACING COVER —INSIDE DIA #PITS DEPTIH:
TRENCHES: MATERIAL PITT
DIMENSIONS
GRAVEL 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
MOUND SYSTEM: I i ____
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.
El YES El NO
PERMANENT MARKERS OBSERVATION WELLS
SOIL COVER TEXTURE
❑YES El O 1:1 YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED.
CENTER. EDGES.
El YES 1:1 NO ❑YES NO DYES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
�) WIDTH. LENGTH: NO.OF LATERA , GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER:
" EYiM�RiTNl4.iY TRENCHES:
IESt NS
MANIFOLD PUMP MANIFOLD DISTR. MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEV.: ELEV.. DIA.: ELEV.: PIPES. DIA.:
Ei I VATIClN AW,
� ,' VERTICAL LIFT CORRESPONDS TO APPROVED
O IgFt11hAT10111 HOLE SIZE HOLE SPACING GRILLED CORRECTLY COVER MATERIAL PLANS.
EY ES ENO ❑YES NO
COMMENTS: ERMANENT MARKER S: OBSERVATION WELLS: NI;IIIpIBE 1 AF" LINE ERTV WELL: BUILDING:
� FEET.Fi� 1"
0 ❑YES ONO ❑Y E S El NO NEAREST,.,"
0 1 br� U
0
y
.k5
Sketch System on Retain in county file for audit.
Reverse Side. TITLE:
SIGNATURE:
Zoning Administrato
DILHR SBD 6710 (R.01/82)
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 bye approved b)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 San tar, Permit Transfer/Renewal Form (SBD 6399) to be '
submitted t4 the_ my prier to installation;
Y5. 'Private.,sewage system§,must be,properly maintained.The septic tank(s) should be pumped by licensed
puknpe'r*whenever tiecessae'y, usu'aq 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. Prcperty owner's name and mailing address. Provide the legal description where the system is to be
i nsta+Ied; -.
Il. Type of building or use served: If public is chedked, 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; F,) soil4est data on a 116fprm.
GROUNDWATJiR S4RCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into iaw:.This legislation is more
commonly.known as the groundwater protectjon law:This 6h nge in statutes was the
result of over 2 years of steady negotiatid6 and•public debate. The grod Beater bill. Ground
included the creation of surcharges (fees) for a number of regulated practices which Wisco irt'S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasur6
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-
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)
DIL R SANITARY PERMIT APPLICATION COUNTY„ v
ILHIn accord with ILHR 83.05,Wis.Adm.Code STAJ.�SANITARY PERMIT#
C!�9&33
—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 NO
PROPERTY OWNER �0, PROPERTY LOCATION ^
kols� W '*Y4, S T �' , N, R /r E(orl�`/Y•Y,J")
1 3&O W B's M.AILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CIT ,S TE /! 7ZrC/OD� PHONE NUMBER CITY
IL AGE : s'�, s NEARSOAD,' 4
!� J Tl�a
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. El Replacement c. ❑ Replacement of d.El Reconnection of e.❑ Repair of an
,,rr,, tt System System Septic Tank Only an Existing System Exiyting System
2.�l A Sanitary Permit was previously issued. Permit# QZ 72n? Date Issued r 00'° 7
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.kConventional b. ❑Alternative c. El 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.A 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): 82.
Feet Private ❑Joint ❑ Public
CAPACITY
VI. TANK Site
in oallons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank ❑
Lift Pump Tank/Siphon Chamber Cow
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): ' PIumbe 's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
'Z01301- Z� A, ' 4 3 �a 7 '!s 460 -elf
Plumber's Address(Street,City,State,Zip Code): Name of Designer:
0 -3 #UPSa,v 4:07,($7- Si;006I
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name HOMLSIllt S011U PLUMSIN GO. CST#
RT. 3 O'NEIL RD.,HUDSON,MS.5001f Z Y
CST's ADDRESS(Street,City,State,Zip Code) WIS.ASTER PLUMBER LIC.NO.3307 M.P.It>R Phone Number: n 6 �j
MINN MSTALLER&DESIGNER LIC.N0. d 6
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee
Adverse Determination `cd 4:�5,6rj / � � /�J / • v�- '�
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
DEPARTMENT OF �pp�w REPOT ON SOIL BORINGS AND &BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115 P.o. Box 7869
) r
HUMAN RELATIONS 1 / MADISON,WI 53707 �
(1-163.090)&Chapter 145.045)
LOC TI N: SECTION- OWNSHIP/�: OT NO.:BLK.NO.: SUBDIVISION NAME:
�/ �/ /T 1 N/R�l E( r) -T'• os E-P ff--' 3 $U j>>•9,uc�
COUNTY: OWNER'S BUYEfi'S NAME: MA FL IN ADDRESS: i
USE DATES OBSERVATIONS MADE
NO.BEDRMS,:ICOMMERCIAL DES RIPTION:
Residence ,f f New ❑Replace �_ 7_
I
i
RATING:S=Site suitable for system U-Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUNDPRESSURE:S S EM-IN-FILL OLDING TANK:RECOMMENDED$YSTEMaoptional) '
�J S EA NS Ql! C3S E1U ❑S'E3U E]S a]U cow 0C-0 7 4-- i
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: Ch/S.S
Floodplain,indicate Flood in elevation: �
PROFILE DESCRIPTIONS SCS S'C>
BORING TOTAL DEPTH T OIL GR UNDWATER-INCHES CHARACTER OF S WITH HICKNESS,COLOR,TEXTURE,AND DEPTH l
NUMBER DEPTH IN, ELEVA4�ON OBSERVED I H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B-/ /D.S� , la >/d,s
B-2-11610 / d s �CO '_-- •���,0 r •S, , '0'E se� S � �C•s a o RSA S f
1 iA.) cu7' Aka E4 _ a?n.p 'top so i
• I
B-
B- ��,if5- lf,41,eavnv 7-z/JF y
B- Ry GST G 01V Syf ,'FZ- csr--Ar- 22-M
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 D2 PER INCH
P- c L.
P-
P- Z
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. LO tv
SYSTEM ELEVATION '1 J 9/ o
__
I —
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 COMPLETES ON:
HOMESITE SEPTIC PLUMBING G0. f — 7—419 J
ADDRESS: CERTIFIUCA I N NUMBER: P NE NUMBER(optional):
ROBERT ULIC.NO, y 7
M.P.R. . 7 O
'01NN INSTALLER&DESIGNER LIC.NO.0066 CST SI ATUR
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER—
REPORT ON S/OIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN
Project I.D.
�Qi�,- /� / 3 � LO 7� .J UN,/�i/.v�-�•-- f Q•Q
--- MOMESITE SEPTIC PLUWNG CQ
LEGr;ND 11.1YNEIL RD.,MUDW,MRS.SW
ROBERT ULBKHT
o - Ba c kh o e '.'its WIS.MASTER PLUMBER LIC.K 3311 ALP.R.t
MINN.INSTALLER Z DESIGNER UCL ND.WA
X = Perc Locations C .S.T. 2482
Q = i xisting Well *a-'
�c of Slpiv6- T A S,w•
® : Vertical Reference Point : "p
T' evation of Vertical Reference Point
-- - - - Lot Line 0
w
i
SCALE:
Ott
firs riarr
re-wE�e
I 90 0
O ---- ��,�, ryy •
I Iio c x SEp{r c T MEg��E SEPTIC o $.5R0�
R N3 p NEVI RERt UlBR1CH�.3307 Mp.R•�•
N�•
f�
� �aSTER Po�M&O�SIGNER 11C• 00
X30' w s•..•'`N�`AIIER i l j 0 \`
APFFouEp
19 3 _ I f e E- s�f'd 70 S3
---57 x�o'- - - - - -- -
.
r
L
r1�j- Q
� M
1�kj
`9 v Fresh Air Inlets And Observation Pipe
0 L - Approved Vent Cap
� Minimum 12" Above �'�` foev Final Grade ,E---- ����
(J
a •Q
• ur^ of
_ 4" Cast Iron
�2 Above Pipe Vent Pipe
-ro Final Grade
Marsh Hay Or Synthetic Covering
Min. 2'1 Aggregate
Over Pipe
Distribution Tee
Pipe 0 0 0 0 0
(e " Aggregate 0 Perforated Pipe Below
Beneath Pipe Coupling Terminating At
so,
��- Bottom Of System
vFresh Air Inlets And Observation Pipe
a h
Q� 0 ( Approved Vent Cap
Minimum 12" Above n
Final Grade
or
_ 4" Cast Iron
y-Z Above Pipe Vent Pipe
P
Io Final Grade
Marsh Hay Or Synthetic Coverit0le
Min. 2" Aggreg
Over Pipe
Distribution _ Tee
Pipe 0 0 0 0 6 " Aggrega te Perforated Pipe Below
Beneath Pipe Coupling Terminating At
Bottom Of System
REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN
Pr o j e c t I_.P
---- HOMESUE SEPTIC PLUMBING CQ
LRG? TD 11.1 WNEIL AD.,HUDSON,VU SM
INERT MAKHT
• - Ba c kh o e ''its MS.MASTER PLUMBER LIC.NQ 3317 M.P.0
MINK.IWALLEA i DESIGNER UC.N0.Qmu
X = Perc Locations C.S.T. 2482
Q = -;xisting Well Qa�far, //0
® : Vertical Reference Point �D� of P40 6- AT S,kl C�i�-G.- u
, '.evation of Vertical Reference Point
-- - - - Lot Line O
AA � I I
SCALI
P;:
.
firsriatr
S�wE�
js F/�U =9o0
/o 0O plU '
i L io c r SEp f r c 7- ME$IZE SEPTIC IA�IDSQO, G 540
R N3 p NER060 ULRRICHO.3307 Mp.Rs•
N
ASTER P�UMgER lIC• UC•�'��
W1S. 'fNSSAI"ER&DESIGNER
150
,tiiNN 1
X
0
Mrr 190 +
AFFOwEn
_._-..r fife,
S-x IS
L
i
p
O M
Fresh Air Inlets And Observation Pipe
a h
00 L Approved Vent Cap
` Minimum 12" Above �
Final Grade Ao—
/I
0 •Q
4" Cast Iron
�2 Above Pipe
Vent Pipe
-ro Final Grade
Marsh Hay Or Synthetic Covering
Min. 2" Aggregate
Over Pipe
Distribution Tee
Pipe —'" 0 0 0 0 0
(Q " Aggregate 0 Perforated Pipe Below
Beneath Pipe Coupling Terminating At
spi� 0
T Bottom Of System
vFresh Air Inlets And Observation Pipe
h
• Approved Vent Cap
Minimum 12" Above n
Final Grade
or
4" Cast Iron
y•z '' Above Pipe —
'Po Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
Min. 2" Aggrjed
Over Pipe
Distribution Tee
Pipe 0 0 0 Aggrega Perforated Pipe Below
Beneath Pip Coupling Terminating At
Bottom Of System
REPORT ON SOIL BORINGS & PERCOLATION TESTS 115 PLOT PLAN
Project I.D.
L:EGTTTD MOMESIiE SEPNC PLUM9ING M
AT.i OWEIL RD.,HUMN,M&rjpy
ROBERT ULARICHT
• = Ba c kh o e ''its WAS.MASTER PLUMOER LIC.N0.3317 M.P.0
MINN.IN9TAUER i DESIGNER UC.N0.a"
X = Perc Locations
Q = Existing Well C .S.T. 2482
® = Vertical Reference Point ; F SlDi.�7lr AT '57W' Cd�P,v.G1 J'�ov
TI.evation of Vertical Reference Point /0101.10 0
--- . -
- Lot Line 0
W
3
SCALE:
I � .
FMiST/.vGr
9o•D
/3a
0
�3
f�IPf
_ 9s
L
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&,HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.130 7969 BUREAU OF PLUMBING
MAO SON,IWl,53707
W2j NW4, S4,T29NR19W IICONVENTIONAL 1:1 ALTERNATIVE IState Plan l.D.Number:
Town of St. Joseph E]Holding Tank ❑In-Ground Pressure 1:1 Mound Ilf assigned)
Lot 3 Sundance
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Peter & Maureen Kishel
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:
Robert Ulbricht 3307 St. Croix 92528
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA L LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO DYES ❑NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATE IN UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. FEET FROM LINE AIR INLET
DYES ❑NO DYES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: 7y",G: LIQUID CAPACIT Y. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
ES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moistureat 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:
BED/TRENCH WIDTH: LENGTH IND.OF DISTR.PIPE SPACING COVER INSIDE CIA "PITS LIQUID
TRENCHES. MATERIAL: PIT DEPTH.
DIMENSIONS
GRAVEL 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 ►
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-
❑YES ❑
meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER ITEXTURE PERMANENT MARKERS JOBSERVATION WELLS
❑YES 1:1 NO DYES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER. EDGES.
1:1 YES ❑NO 1:1 YES ❑NO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR,PIPE MANIFOLD HPI'PES.DISTR. fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.'. ELEV.: DIA.: ELEV.. A.'.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY AL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES NO ❑YES NO
COMMENTS: EMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
1:1 YES ONO 1DYES 1:1 NC NEAREST
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;
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 tanks) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your privat 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 appliuilion must include.
I. Property owners name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: li public ;y 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. Compiete ##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'h x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement
system areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form.
------------------------------------------------------------------------------------°-------
GROUNDWATE?R 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}elater—
included the creation of surcharges (fees) for a number of regulated practices which Wisco iWl a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried � e.asure
is used in your building is returned tc the groundwater through your soil absorption << o
system or the disposal site used by your holding tank pumper. a
The monies collected through these surcharges are credited to the groundwater fund adminis-
e Department of Natural Resources. These fends are used for monitoring ground- 1
undwater contamination investigations and establishment of standards. Groundwater,
protecting.
:.03/86)
DILHR SANITARY PERMIT APPLICATION co
7: :°�.... ...o,. In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT#
-Attach complete plans(to the county copy only}for the system,on paper not less than °?
8%x 11 inches in size. STATE PLAN I.D.NUMBER
-See reverse side for instructions for completing this application.
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PETITION {{��
❑ 4J
PROPERTY OWNER If r PROPERTY LOCATION FOR VARIANCE YES NO
J,CreA ,¢v/Z��✓ �/ Sf�EL w yam.1V 4i4, S T 2 , N, R !p E (or w
PROPERTY
13&6 OW NFV4vFf ADDRESS A;e ,L �/ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
CITY,S ATE,Ip �J ZIP CODE PHONE NUMBER CITY NEAREST ROAD,L
X:a /fv ,�j r�� 13 TOWN OR 1 VILLAGE: S4• jos %IJE-�
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. K 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. El 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. 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. ABSORPTIQN SYSTEM INFORMATION: (Check one)
1. a. See a e 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): PROPOSE (Square F et):
< // 1117 '/ fOZ �Z� fZ r Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY
in allons Total Site Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank Iny 91 ❑
Lift Pump Tank/Siphon Chamber ❑
VII. RESPONSIBILITY STATEMENT 1 11 1:1
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): �u��� JWR/MPRSW No.: Business Phone Number:
`R0 6E�T Wb'l 3�0 7 7l3- 3&n?1f'-
Plumber's Address(—Street,City,State,Zip Code): Name of Designer:
At-3 ff-vpra, wi 5 Yvo/� 7e. h 1 40,0% 7'
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
CST's ADDRE S(Street,City,State,Zip Code) Phone Number: IV
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee =er e jissu—in Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Ad verse Determinati on /�o. v6 i
X. COMMENTS/REASONS FOR DISAPPROVAL:
Eby 7A6AnC s
S13D-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.
Owner of Property �CT�V2 iS��/ A, �Y1►4 I cZry �isLt�
Location of Property Lt))�Z- LL) It, Section , T Z�J N-R �(y W
Township
Mailing Address 1 3�o o 7�4 e-►J e ss V AL2 s-t4
Address of Site
so Uj SL
Subdivision Name Sill V�c (P
: Lot Number
Previous Owner of Property Lk-), I I,,,A VGA A ��4.�Le-e o-e f-j
Total Size of Parcel 3 ►�CIQo�
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes X No
volume_ and Page Number S / 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
1 (We) ceAti6y that att statement on this 601m are true to the beat o6 my (our)
knowledge; that I (we) am (ate) the owner(s) o6 the pnopehty des cA i.bed in th,i d
.in6o4mation 6oAm, by viAtue o6 a waAAanty, ee �ecotded in the 066ice o6 the
County RegiAten o6 Veeds ad Document No. Vj l s and that I (we) pheeentey
own the pnopod ed site bon the s ewage dial pos s ys em (on I (we) have obtained an
easement, to nun with the above deacztbed pnopenty, bon the cond-tAuation o6 said
system, and a same had been duty %ecokded in the 066.ice o6 the County Regizten o6
Heeds, o ent No. ) .
S GNATURE OIL OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
------------------
I?OCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2—1982
425415 7_l7pArE54.9
................... ------------------
REGISTERS OFFICE
ST. CROIX CO., WIS.
William A. Feyereisen and Marilyn F . Feyereiser Rec'd. for Record this 7th
----------- ------------------------ .......................... ................................................
.....h.u..s.b...a..n..d.....a...n..d.....w...i..f..e...,..................... y Of May A.D. 19-17
.......................................................................................... ......................
t 2: 15 P
-----------------------------------------------------------------------------------------------------------------
conveys and warrants to _Peter T . Kishel and Maureen K . ?��
---*------ ---------------------------- ............*--------------*.......
....Yi-s-he.L,...hu.sb-an.d....a.ad---wl.f ---------------
m ......•.•.•........................
-----------------------------*------------------------- ----------- --------------*--------------
RETURN TO
.................................................................................................................
-----------------------------------------------------------------------------------------------------------
----------------------*1--------------------*----------------------------------I----------- --------
the following described real estate in ...S.t..-...C.r-o.i.x........................County,
State of Wisconsin:
Tax Parcel No: ..............................
Part of W-2 of NWk of Section 4-29- 19 described as follows :
Lot 3 of Certified Survey Map filed October 8 , 1984 in Vol .
"5" , page 1476 TOGETHER WITH 66 foot road dedicated to the
public as shown on said Certified Survey Map and on Certified
Survey Map in Vol . "5" , page 1477 and Vol . "5" , page 1478 .
{% Subject to the protective covenants as recorded in Volume 697 , Page
541, Document No. 396853 , recorded in the office of the Register of
Deeds for St. Croix County.
TRANSFU
FEE
is not
This .............. ....... homestead property.
(is) (is not)
Exception to warranties:
Subject to easements , reservations , and restrictions of record .
14r
... --- ----------------------------- day of .............T.......
Dated this - -----------q ........... 1q..87
Y---------------------
.........(SEAL) .............. ..............n. ............... .....
. ....................................... ....................
III William A. Fevereisen. .
............... .................................. ...........
............................................................
.........(SEAL) i--- ...............
-------------------- ........ .............................. :\.......
a ..y��k..IF ...Tey_�.r-e..i-s.e.n.... ..I Mil .
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) ------------------------------------------------------------ STATE OF �iN
ss.
................................................................................
.... 0AICOU.......County.
0'a
authenticated this ___.__..day of........................... 19.._... I this ..._......_.....day day of
Persona y came before me ....
MMCL�--------------------- 19�I- the above named
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TITLE: MEMBER STATE BAR OF WISCONSIN
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(If not- ------------------------
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authorized by § 706.06, Wis. Stats.)
to me known to be the person ............ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
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......5 tq.pben J . Dunl_ai)..........................
- - ---------------- -- . .....
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Hudson, Wisconsin
................................................................................ Notar c ........ . -----------._County, IUL/7Z.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.) date: ._.__MgCommission
ppiT.March 31, 1991
.1 19.........
..................•..
•Names of persons signing in any capacity should be typed or printed below their signatures.
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':.... ....... ......................
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KC. dle CoffWWW STATE W N
ORM No. 2 BAR OF 98ISCOSIN Stock No. 13002
F — 12
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OD V
..._LLIAP�I S b1ARILYN r-EYER&ISEN
130,680 sq.ft.
rto 3.00 acres �i RT. 2, BOX 250 t
BLUEBI$D DRIVE 1
1 sA mfr HUDSON, Vil. 54016
`n N88 042'44"vl o
H3
ri 307.05'_ Q; o° ;
EG END .
L
w,
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V
. PIPE FOU11D.I�
x 2�4" IHOR\PIPI
sd ,o'' v is 1.68 LBS/LIN. FT. ' SET.
.,�
1j,
N Im
} o w .6S 66 FOOT ROAD DEDICATED TO THE PUBLIC ;
LOT
130,680 sq.ft. ���•,�- S�, 'e t
CD 3.00 acres
CO AC 7LE
tea,
` 458.15' a '
SOO 06-5911E,
1 7 88,.47'
LOT-5, ��. �
` uwt .. 1.30,680 sq.ft."
N89°53'Ol"E .1 g` l � t
� , :• ?+
66.00
3.00 acres } �. ' 026` ' c)
o LOT 12
o e S6)8°30' -
- .. - 136,715 sq.ft. :
3.14 acres F
lzt
4
A 51�• 2 3yi31°48'S5„E 524• 8 = k a
RN LOT 6 .��,,
�
�r> 130,680 sq.ft.
3:00 acres `�w `� 3: LOT 11
LOT 7
t - w 0 `� 139,312 sq.ft.
1 0 4�JLO�. 130,680 sq.ft. 2 3.20 acres r•: M ia.
o `� 3.00 acres =i; s 1 1
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a N irk 1n
Im
S89°39147"E 492.70' IR
�0 192.00' 243.43' N89013'0,41#W 10.
- N89 013104"W 435.431 £ 331.051 �, a S39010146"E " 3
1 t
S50°49'141-w a 120.11'
n3 w LOT $ 66.001 3
c N s LOT 10 �.
130,682 sq.ft. N N LOT 9 ,�, �.
o o 3.00 acres .
r oo N to 130,680 sq.ft. ,
N x.00 ` • 130,967 sq.ft.
F.
71,K --4 j r 46)3.3° :' .5 :' �. .:.
.. --- ' 6 331.76' >~
"tit 45. 3 0R S89013 411E 881.04' ROAD LINE - Ni 1/4 SOUTH L)NE NW 1/4 ---- :-
TOWN � #:
o v S013°39!47"E
un lstted lands CO - '- DEDICATED TO THE PUBLIC
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
I a
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
CITY/STATE ZIP y�!�
i � / I l
PROPERTY LOCATION : (+VIZ. , /� W !4, Section "/ T Z`) N , R W,
Town of ST St . Croix County ,
Subdivision Ls- � Lot number
I
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
three year expiration . o
V.
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein , as set by the Wisconsin Depart- w
ment of Natural Resources . Certification for u t be completed
and returned to the St . Croix County l.onin Off. i. e wi hin days
r year expiration of the three r a y xp on date .i
SIGNED
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 .
/N
IS/0/v GS
7969
3707 INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395
To be a complete and accurate soil test,your report must il)CIU('-Ie:
1. Complete legal description;
2- The use section must clearly indicate whether this is a residence or cornmercial project;
3, MAXIMUM number of bedrooms or Cou)rnerCiai Use planned;
4. Is this a new or replacement system;
5. 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. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
sepal-ate sheet may be used if desired;
8, Make, Sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9- Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp-
tion,, if appropriate;
10. if the information (such as flood plain,elevation)does riot apply, place N.A.in the appropriate box;
11. Sign the form and place. your Current address and Your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures other Symbols
st Stone (over 10") BR Bedrock
cot) Cobble (3- 10") SS Sandstone
gr Gravel (under 3") LS Limestone
*S Sand HGW High Groundwater
cs Coarse Sand perc Percolation Rate
reed s — Medium Sand W Well
fs Fine Sand Bldg Building
is — Loamy Sand > Greater Than
*sl Sandy Loam < Less Than
'I Loam Bn Brown
*sil Silt Loam Bi Black
si Silt Gy Gray
*CI Clay Loam Y Yellow
Sci Sandy Clay Loam R Red
icl Silty Clay Learn mot Mottles
se, Sandy Clay w/ with
si(, Silty Clay fff few, fine,faint
�c Clay cc common, coarse
Or. Peat [TIM many, medium
Muck d distinct
p — prominent
HWL — High water level,
Six general Soil UIXWN'S Surface Water
for liquid waste disposal BM Bench Mark
VRP Vertical Reference Point
TO THE OWNEW
is the first sl(, -nit. Th(� county or the Department I'llay McLJOST
"ol rest lepoll it,securim.)a saf6,ary pvr�
of rhiS �.,,ill test in "'M? field prior lo p'emni" A conlf& so! 01 lslans for the private
-su!�Ertstt ci t. the elpptc)priate local authority in order to
The sa nusl A'be ohtained a� posted p6w to tho stmt of arly constmcla(ll)'
-ta-!
1014
ti
DEPARTMENT OF
INDUSTRY, REPORT ON SOIL BORINGS AND
` SAFETY& BUIL
FtU,MA AND PERCOLATION TESTS 115 DI
HUMAN F3E'LATIONS ( � P.O. BO
` % (H63.090)&Chapter 145.045) ` MADISON,WI
LLOCATION:A/ SE TION: TOWNSHIP/
�� /Tz9 N/R/ �,(or)W OT NO.:BLK.NO.: SUBDIVISION NAME:
OIN ER' NA MEE• AILING A DRESS:
F0 56P7
USE
NO.BEDRMS.: COMME CIAL DESCRIPTION: DATES OBSERVATIONS MADE
,Residence Z
104 New ❑Replace. PROFILE DE RIPTIONS: E O AT10N TEST
RATING:S=Site suitable for system U=Site unsuitable for system
CO�TIO❑NAL: MOUND: IN_ -GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
UU ❑U (7S CCU 0 S (�.lL. 0 S Cell ,�
If Percolation Tests are NOT required DESIGN RATE:
under s.H63.09(51(b),indicate: If any portion of the tested area is in the
Floodplain,indicate Floodplain elevation:
�✓ Im'a l° PROFILE DESCRIPTIONS �Z
BORING TOTAL D PTH TO GROUNDWATER-INCHES HARACTER OF SOIL WIT THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER BEPIIiJ�I, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- �Z 2� A) 0 A.7�' z
zS zs ,5 '
/Z/ IS p Cry B3
83 as
S.�, 3
Yz 3s
B- /z J— ? �lZ i5 a� S8
B 7 NNE > ?r
B-
1 / Sln)q PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES
NUMBER AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERI D 2 P R RATE ER INCH ES
P- r 3
P- � >,N� 3
P- 3 o N 3
P-- 3
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the h
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 per
of land slope.
SYSTEM ELEVATION
31 - - _
Oil
E �
10 --
`2
A__ _ z
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 W P�/ERE COMPLE I F:I)ON:
ADD[iESS: — -7 '9 y4
e CERTIFICCATIGON NUMBER: PHONE NUMBER(optional):
CST SIGNA U
i
RIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
-SBD-6395 (R.02/82) —OVER —
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