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Parcel #: 030-1017-20-000 04/04/2005 08:43 AM
PAGE 1 OF 1
Alt. Parcel M 05.29.19.74B 030-TOWN OF SAINT JOSEPH
Current X ST.CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): *=Current Owner
GILBERTSON, LORI A
LORI A GILBERTSON
497 BLUEBIRD DR
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description *497 BLUEBIRD DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R19W NW NW SEC 4&PT NE NE Block/Condo Bldg:
SEC 5 LOT 1 CSM 2/421
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
05-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
01/16/2004 751995 2493/447 QC
07/23/1997 729/106
07/23/1997 559/354
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
4834 216,700
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 75,500 137,700 213,200 NO
Totals for 2004:
General Property 3.000 75,500 137,700 213,200
Woodland 0.000 0 0
Totals for 2003:
General Property 3.000 44,300 110,400 154,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 217
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
•COMMERCIAL TESTING LABORATORY, INC.
�14in Street, P.O. Box 526
Colfax, Wisconsin 54730 0�
715 - 962 - 3121
800 - 962- 5227
ST. CROIX ZONING REPORT NO.'* 20725/01 PAGE 1
ST, CROIX COMITY REPORT DATE! 4/09/92
COURTHOUSE DATE RECEIVED; 4/08/92
HUDSON, WI 54016
C ATTN: THOMAS C. NELSON
j OWNERS Steven Getty & Lori GiLbertson
LOCATION' 497 Bluebird D►., Hudson
COLLECTOR' M. Jenkins
DATE COLLECTED'* 4-06-92
TIME COLLECTED' 34'45pm
SOURCE OF SAMPLE' Yard Spigot
DATE ANALYZED'4-08-92
TIME ANALYZED.2'00pm
COLIFORM' 0 /100 mt
INTERPRETATION: BacteriologicaLLy SAFE
f NITRATE-N'* 3 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
CoLiform Bacteria/100 ml
k Nitrate-Nitrogen, mg/L
PQ
$ 9
� r
0c+'Z
LAB TECHNICIAN' Pam Gane S' r
OE .. WI Approved Lab No. 19
< Means "LESS THAN" Detectable Level Approved by!
PROFESSIONAL LABORATORY SERVICES SINCE 1952
1
nn ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - ( 715) 386-4680
he St . Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals .
Completion of this form is essential so that the property can be
located .
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address . Testing will be done as
soon as possible after fee and form are received .
WATER TESTING----------------------------FEE: $ 35. 00 LZ
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127 . 00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25. 00
(Determines if system is properly functioning at time of
inspection)
Property owner 's name J r f UL&) / a- LO�4 V(L&mod \/
Property owner 's address _ `1`'1� LULL
Legal Description 1/4 of the 1/4 of Section S` , T ZLj _N-R _
Town of HbA:So,,j Lot Number l Subdivision Name
02>U — (U 1-7—Zv-ca�rJ � ��B
FIRE NUMBER LOCK BOX NUMBER
Color of house 0Hi--J7-_ Realty sign by house? If so, list firm:
G IL(T I 1-12-1 Plk-
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained .
Firm or individual requesting services :
Telephone Number - --- .::• tai t,:.
307,��-,�''j .-L 1,"1
REPORT TO BE SE
Closing date - C1 Zr
Signature
i
w 4
ST. CROIX COUNTY
WISCONSIN
"Js
ha } ZONING OFFICE
•: ST.CROIX COUNTY COURTHOUSE
- 911 FOURTH STREET • HUDSON,WI 54016
(715)386-4680
April 6, 1992
Peg Starke
First National Bank/Hudson
307 2nd St.
Hudson, WI 54016
Dear Ms. Starke:
An inspection of the septic system on the property of Steven
Getty & Lori Gilberson, located at 497 Bluebird Dr. , Hudson, WI was
conducted on Apr. 6, 1992. At the same time a water sample was
obtained for testing. The results of that testing will be sent to
you as soon as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Sin rely,
r
Ma Ws
Assistant Zoning Administrator
cj
PUMP CHAMBER #
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
I
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: '!5� Length: 52:> Number of Lines: Area Built
Fill depth to top of piper
Number of feet from nearest property line: Front, O Side, Q Rear,0 Pt ._�
Number of feet from well: Zj;gn '�
Number of feet from building: 11'711
(Include distances on plot plan).
SEEPAGE PIT
Size: 4%w Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box'a or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: l�lJ 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, OFt.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job: "Gw 7✓ --
License Number: IWS 3z-7-51
3/84:mj
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER �� ` U TOWNSHIP Sy �j SEC. TZ N-R ' W
ADDRESS Z ST. CROIX COUNTY, WISCONSIN
a
SUB7!7--- — LOT SIZE
�z/
PL VIEW
Distances and dimensions to meet requirements of I•I.HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
of
Q K5
a9f/U��
o/ 5x 40 ks
co
q 'I
I�y
a � ,
Rt
MAY 0 Q
ST GAQIx
owicE
INDICATE NORTH OW
BENCHMARK: Describe the vertical reference point used �..
Elevation of vertical reference point: /D Proposed slope at site:
SEPTIC TANK: Manufacturer: iquid Capacity: je77-0
Number of rings used: 2) Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,O Rear, 0 /4�V feet
From nearest property line Front 10 Side,O Rear,O -70 feet
Number of feet from: well 1,: V 7 , building: 7y
(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
BUREAU OF PLUMBING
P.C.BOX 7369
MADISON,WI 53707
NW4NW4j ,S4,T29N—R19W State Plan I.D.Number:CONVENTIONAL ALTERNATIVE (If assigned)
Town of St. Joseph ❑Holding Tank ❑In-Ground Pressure ❑Mound
Bluebird Road
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION AT
Steve Getty Route 2, Hudson WI 54016
~- (� -gt -
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.:V.: CST REF.PT.ELE V..
Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number:
,Roger Timm 3224 Ste Croix 102853
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
nl 2 PRQ VD: PROVIDED
✓-��/J%� �/V ,L!JYES El NO ❑YESNO
BEDDING'. VENT DIA.. V L ROAD'. PROPERTY WELL BUILDING. VENT TO FRESH
UMBER OF LINE -7 IAIR INLET
G� J ET FROM �j ; ,J I❑YES NO ( AREST
DOSING CHAMBER:
MANUFACTURER BEDD ING'. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON flMANUFACTURER pROVIDEDLABEL PROVIDED OVER
❑YES ❑NO ❑YES ❑NO ❑YES NO
GALLONS PER CYCLE: PUMP AND CONTO . UMBER OF PROPERTY WELL BUILDING VENT LE FHE SH
LINE AIR INLET
(DIFFERENCE BETWEEN EET FROM
PUMP ON AND OFF) ❑YES ❑NO EAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing NGTH 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 INSIDE DIA LIQUIU
BED/TRENCH S S` TRENCHES J / MATERIAL: PIT DEPTH
DIMENSIONS /
GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PR OPERTV WELL. BUILDING VENT 70 FRESH
BELOW PI / / ABOVE fj� ER E EV I �E7 ELE /J 2 �] C� PIPES FEET FROM LINE
AIR y.�LET
�I ?a G.. G / 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-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TEXTURE PERMANENT MARKERS OBSEH NATION WELLS
❑YES ONO ❑YES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERALSPING. (TRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER
AC
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE OISTHIBUTION PIPE MATEHIAI&MAHKINC�
ELEV.. ELEV.: DIA. ELEV.. PIPES DIA..
ELEVATION AND
DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL
PLANS
❑YES ONO OYES ❑NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING.
COMMENTS: 3 I LINE
FEET FROM
DYES 1:1 NO DYES 1:1 NO NEAREST
o -7
�1
Sketch System on Retain in county file for audit.
Reverse Side.
SIG TITLE
Zoning Administrator i
DILHR SBD 6710(R.01/82)
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT F
APPLICATION y
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
%r 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. Prcaerty owners name and mailing address. Provide the legal description where the system is to be
installed;
ll. 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.
-----------------------------------------------------------------------------------------------------------------------------------------------------------
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 ate
included the creation of surcharges (fees) for a number of regulated practices which disco lira e
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Te85tttB!
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- 1
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
DILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05,Wis.Adm.Code STATE'�SANITARY PERMIT#
/o a863
—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 Z NO
PROPERTY OWNER PROPERTY LOCATION
.51t pvle C'e 0)tj 1/4 /1141'/4, S T 2 , N, R /y (or)0,
PROP RTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
a7ik Z CSm o z
CITY,STATE ZIP CODE PHONE NUMBER CITY
❑ VILLAGE : NE
/S0� -eaw
/.c� ✓oL
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. ❑ New b. W 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. 9 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. See a e Trench c. F-1 See a e Pit
2. PERCOLATION RATE 3. ABSO PTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
60h 3,3a Feet Jg Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in al Ions 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 !D �2 5
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/MP SF SW No.: Business Phone Number:
rry 2 -7 7L
Plum is Address(Street,City,State,Zip Code): Nam:r'A'9�
igner:
/�
VII I. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
rr 3,4WX
CST's ADDRESS treet ity,State,Zip ode) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
Approved urcharge Fee
❑ Owner Given Initial I ZC).cc 'Ma'r 1/0— ?7. n
Adverse Determination
X. COMMENTS/REASONS FOR DISAPPROVAL:
PIoh M,�.o .. rJ�.(sOh
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
t .
III
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 2t'1 &S: L-Q /6U 2l L'—I
Location of Property k , Section ;,Z�, T -R / 9 W
r 44
Township A :s 4%
Nailing Address
Address of Site
Subdivision Name
Lot Number �c�+
Previous Amer of Property T)e-n 115 ES . .c� C K,
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Vea- Yes No
Is this property being developed for resale (spec house) ? Yes _ /X _ No
volume ]L. and Page Number %Q 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 (wel cutti6y that dtt etatemente on thi4 tponm ane t�tue to the but o6 my (oun.)
hnowtedge; that I (we) am (ahe) the ownert(e l o6 the phopenty dmc i.bed in thiA
in6onmati.on 6onm, by viAtue o6 a waAAanty deed hecoitded in the 066.tce o6 the
Count yy Reg4Aten o6 Deeds ah Uoeument No. Q 5 and that i (We) pneeentey
own the pnopoaed site bon the sewage a"poe 6y-stem (on I (we) have obtained an --
eaeement, to nun with the above deachi.bed pnopeAtty, 6ort the eonatnucti.on o6 eai.d
aystem, and the name has f,een duty n.eeohded in the 066tee o6 the County Regi6tc
Veede, as Document No. f0 A 6 6, ) .
SIGNATURE OIL R SIGNATURE OF -OWNER (IF APPL7
DATE SIGNED . . DATE SIGNED
#40 al 'A'l'16 BAB OF ! 1...
n . WAOLWY
alt
-
' t i araie Mtwesn
....Ilautia.-M...-Black and--KathsYn r
r.�taitl ego► yiLfe.Amd-individually .
. .. .... ... ..... ................ ................. ftec'd. kr �eoat;d ,
OeC.
.........................................P. . t.St.. .. ..A._. ilhsicxsnn..__- ----- day�f �
h fe,..s15._�nil11_t..team-ts-....._..-•.....................•-••----•-- 3:45 P
a.... ........ . ._..._.-----.....------------.__...-----------------••-••--....------•--•-- ��.
K ...::_.......................................................................................... Graatss, .
witne Wth, Tbat the said Grantor,for a Yalu"consideration------ °s
•....>. . ............ . .........._....- •----
St: ........
TO
*+l'to Grantee the following drreribed real estate in .....
fi CwaRf, Scat• of Wisconsin:
'`- Part of Northwest Quarter of Northwest Quarter of
me
Section 4 and Part of Northeast Quarter of Northeast Tai Pared .-----------�-----
Quarter of Section 5, All in 29-19 .described as follows: . `.
Lot 1 of Certified Survey Map filed July 25, 1977 in Vol. "2", r
�:
K '
V
,^ NSFW
;,
f
This homestead(is) property.
F k 3,Y
TogetAsr with all and singular the herWiramentr and appurtenances tbemnts belonging:
Aad....t• # R Blah 8 pti<Std-hr�n--E- ec .............
go S . .................... ._ :..
warruts that, title is �ooieau�le m se sin an and c r o eacneobrancw eieapt
easeatents, covenants and restrictions of record
" and will warrant and defend the same. ?,
Dated this .. day of December .............................: .......... 1!8'S..
__...-(SEAL) '�/!
-__.. _ )1..._. __ -... t k .
• ...... ... iN _.
.. . .. . ...................:.... ......_ --•--- --------------(SEAL) _
• -:;'..,. •---- ...... ----• - --.-.. • -NATHR13I.1 -$LACK-• ...... - -;r
- -- -
f
AUTHANTICATION ACKNOWLBDGUX397
.. g ► (s) Dennis M. Black and STATZ OF WISCONSIN ,
.. "
:__.... &1thrYn..• Black.
- ra.
s aathont ated day ember---__ lg85_ Personally came before sa tbtI.--.........
.......... ..... .....•- �:. :- •....
..... ............................. ' 19 the aM �
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tbosaised by 706.06.Wis. States) to me known>to be the prase, ,. ...wtri►'
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�..-TM S INSTRUMENT
WAS�[1J2AltTEQ BY
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...... ------__....: Notary Public ..........
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{ ma{ tloated ir. My. Commissim in
Pe,an ackaov►ledged. Both
date: ............... k
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SEPTIC TANK MAINTENANCE AGREEMENT 00
St . Croix County z
d
a
OWNER/BUYER � C hU
ROUTE/BOX NUMBER� Fire Number--7
CITY/STATE C� Son 'J l ZIP
PROPERTY LOCATION : _Z, ��4, Section _, T S>2 R�W,
r to Town ofd St . Croix County,
Subdivision Lot number
17. O
�e.�-�-• S��e�w�.-� ..s�� asp 14-rNo v3�g q�
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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 . o
z
I/WE, the undersigned , have read the above requirements and agree E,
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein, as set by the Wisconsin Depart- 'b
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County 7.onin Office ith 'n 0 days (�
of the three year expiration date . C-/
SIGNED
DATE C
St . Croix County Zoning Office
P . O. Box 98-
Hammond , WI 54015
715-796-2239 or 715-425-8363
Sign , date and return to above address .
DEPARTMENT DUST Y, OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, �✓ DIVISION
-LABOR-AND PERCOLATION TESTS (115) MADISON WOX 7969
HUMAN RELATIONS
H 3.09(1)St Chapter 145.045)
UNICIPALITY: OT N .. NO.: SUBDI VISION NAME
� �/ Z9 N/RJ4 (or ST J 5 SM - V.--Z 4Z 1
COUNTY: NAME:
'S,C12o lx -1417 t E G r-rr'y
USE DATES OBSERVATHM MADE
NO.BENW: OMMERCIAL DESCRIPTION: FILE DESCRIFITION9. PERCOLATION TESTS:
rj�Rsi ,ce ruN� �_. .r ❑New Replace Mac z� �9�7 ��� z4 /9�7
RATING:S-Site suitable for system U-Site unsuitable for system $rC%- a CO "--INCTEIG
NV� �V. M jV�.Q� 1 � �� � - �L O DI A K:RECOMMENb€D SYSTEM:(optional)
C�pp�,�jY+J�IU E 1 S &.1)l
If Percolation Tests are NOT r uired bESIG HATE:
e9 /� if any portion of the tested area is in the
under s.H63.09(5)(b),indicate: l-1-•ASS I Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL B -1 A SOIL K OR, F TUBE,AND DEPTH
ELEVATION V
TO BEDROCK IF OBSERVED EE ABBRV.ON BACK.)
B- gip.)? q9."7 > /d.t7 1i 411- jZjJ&4SL 20" S►c c•
13- > 8.06 tt.TS��' srL i3`� SL 'Sa�gaNc-Ms
le > 7.58 ZAICLTS 10"S"st /221AAFS 40"86,x-MS
B-
B-
B-
PERCOLATION TESTS
TEST q PTH . WATER IN HOLE TEST TIME I S
NUMBER fi AFTERSWELLING INTERVAL-MIN. PER INCH
P- 'Z io '
P- 3 A21
P»
P• AT I O
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori•
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION R 3.3a
_ t
i t NMIQ�k•?PIi(k+
?4" -M#61b END
tr
k
f
i yr -
33' 3
y) fjvr3LC0J
3-A
I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
INAME print : nn n/� TESTS WERE OMPLETED
HAAVd JON�Sdn/ KUScN SU B7l�/4 ` V -'b6c4E✓h$Ea
ADDRIESS: CERTIFICATION NUMBER
40? Sc��oN1 sr- u�ih ti ► X4 0 ►ei 3A 4
i
CST SI URE
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DISTRIBUTION: Original and one copy to Local Authority,Pro grty Owner and Soil Tester.
L
DILHR-SBD•6395(R.02!82) -OVER-
Timm JOB
SHEET NO. OF Z
Excavating Co. ' CALCULATED BY �/ �'^ DATE V,4 -r 32 Z
• R I, Box 192, Wilson, WI 51027
CHE.OKED BY DATE_ 2 57—cT 7
— SCALE
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SHEET NO-
Excavating OF
xcavat�'ng Co.
• • R (, BOX 192, Wilson, W1 5'17 CALCULATED BY� DATE
CHECKED BY
DATE_ 2--
SCALE
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- Gwlai.PI 01471.