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Parcel #: 040-1113-70-000 02/22/2007 01:08 PM
PAGE 1 OF 1
Alt. Parcel M 30.28.19.468C 040-TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-NELSON, SCOTT T
SCOTT T NELSON
337 PLAINVIEW DR
RIVER FALLS WI 54022
Districts: SC = School SP=Special Property Address(es): "=Primary
Type Dist# Description *337 PLAINVIEW DR
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 30 T28N R19W 5 AC IN NE NW COM 426.5 Block/Condo Bldg:
FT E OF NW COR,TH E 426 112 FT, S 510.7
FT, W 426 1/2 FT, TH N TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
30-28N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
11/11/2002 697819 2041/414 WD
12/07/2001 664483 1784/493 WD
07/23/1997 840/257
07/23/1997 779/371
more...
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 60,000 151,900 211,900 NO
Totals for 2007:
General Property 5.000 60,000 151,900 211,900
Woodland 0.000 0 0
Totals for 2006:
General Property 5.000 60,000 151,900 211,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 308
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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: .2 Length: Number of Lines:_ Area Built:
Fill depth to top of pipe: 412--
Number of feet from nearest property line: Front, O Side, &Rear,0 Ft . 5S�
Number of feet from well: 50
Number of feet from building: /03
(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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
i
Inspector:
Plumber j :
Dated: � K. lber on ob
License Number:
3/84:mj
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER � o, /Fs TOWNSHIP SEC. 30 T z8 N-R /9 W
ADDRESS -R 3 Pip„J V,a£vA/ Q,z ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
I
i
Distances and dimensions to meet requirements of I.IHR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
VV
ExiS� L7 Y
EX t-_�)d L7
:Zs'
/ 30 55,
I o
/D3
J.
jj �
�P,KS i J oe�l,..nrz iva� �t/h SCI 1 �< Ex,,sZ,Je? Ou-r
--'F-XiSTuy�j N1fi l�
1-'21-VAT16o = /,0a. Oa 71
{�- -2 V•1�i
I 70 6A%-I
Pti'opFs27 h L,r��
INDICATE NORTH ARROW
sS' 70 J$ou-w
BENCHMARK: Describe the vertical reference point used 01L,Jf',"6,y7.4e- &�Vm
Elevation of vertical reference point: /00,'60/ Proposed slope at site: 171
SEPTIC TANK: Manufacturer: C/5rp, Liquid Capacity: /aoo
Number of rings used: D Tank manhole cover elevation: Q-7,�,/
Tank Inlet Elevation: q!' ,q Tank Outlet Elevation: '70
Number of feet from nearest Road: Front, S-ide 0 Rear, O 97•s / feet
From nearest property line Front,orls,�ide10Rear,O q7.S feet
Number of feet from: well S�' , building: 22 ,S" 30.00
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
YEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
NE4,NW4 �p1,S30,T28N—R19W 1I CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number:
111f assigned)
Town of Troy Holding Tank El In-Ground Pressure El Mound .
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER IINSPECTION DATE-
George Foss Route 3, Plainview Dr. River Falls, WE 54022 S-)a-87 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:
Gary Zappa 3300 St. Croix 92550
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER
PROVIDED: PROVIDED:
-a� �(�,�07 P5.YES ONO DYES 9NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
rr��ii�� /� ALARM LINE: ^n AIR INLET
FEET DYES 6NO 0-,z ❑YES �NO NEARESTTM Q�
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES ❑NO 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) DYES 1-1 NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moistureat the depth of plowing FORCE LENGTH: DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA. 7t PITS LIQUID
BED/TRENCH TRENCHES / MATERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEP DISTR. IPF DISTR.PIPE DISTR.PIPE MATERIAL: NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH
BE OW PIPES'. ABOVE COVER. ELEV.INLET ELEV.END. PIPES' LINE: 'p AInRINLET.
41 FEET NEARESTT--► nn
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 NO
meets the criteria for medium sand. TIONS MEASURED.
❑
OIL COVER TEXTURE JPERIVIANENT MARKERS JOBSIRVATION WELLS
1:1 YES 1:1 NO DYES 1:1 NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED IMULCHED
CENTER: EDGES'.
DYES ❑NO I DYES ONO DYES 1-1 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
PLANS
❑YES ❑NO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATIONW Ls: FEET FROM OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
Z�
DYES E1 NO ❑YE El NO NEAREST
Z
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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, 608-266-381:5.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
IE. 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 morer �y
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 Grounau�atet
included the creation of surcharges (fees) for a number of regulated practices which Wisconi�in`S o
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that bur,ed treasure
is used in you., building is returned tc the groundwater through your soil absorption k"
system or the disposal site used by your holding tank pumper.
0
The monies collerteo thr )ugh these surcharges are credited to the groundwater fund adminis-
th ren' by !-he -Department of Natural R^sources. These funds are used for monitoring ground..t
v ate , groundwater contamination in\,estigations and establishment of standards roundwater,
='s vvcrt`' protecting.
3 D-6-398 1 R.03/36)
=WSILn SANITARY PERMIT APPLICATION COU► r
In accord with ILHR 83.05,Wis.Adm. Code R ol'`
STATE ANITARYPERMIT#
—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 PROPERTY LOCATION
Nc '/a '/4, S .., T,&, N, R Y E (or)
PROPERT WNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR L
❑ VILLAGE
II. TYPE OF BU DING OR USE SERVED: 12411f,'- /a '
Number of Bedrooms if 1 or 2 Family _ — OR ❑ Public(Specify): `
111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. ❑ New b. X 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. 0 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 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
- br �,5 60 20 Feet XPrivate ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xisting Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holding Tank F 7 •7 A
Lift Pump Tank/Siphon Chamber ❑
VII. RESPONSIBILITY STATEMENT
1,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) /MPRSW No.: Business Phone Number:
?Fop/AL �s 3�6 JoP6 4)
Plumbqfs AddressF(Street,City,State,Zip Code): Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name EPhone
ST's ADDR S(Street,City,State,Zip Code) ber:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved STon.ry Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial urcharge/Feeee'e Adverse Determination on � W S � �. /� •� ^
l�U
X. COMMENTS/REASONS FOR DISAPPROVAL:
le)lun l�e(Ji .lC.Jgd h S `I e ,1, ` ns
SBD-6398(formerly Plb-67)(R.03186) 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 _ C�l D . r-16 S S
Location of Property 1 E_ ;4 Section 3 , T N-R�_ W
Township G.Q� Y ( W.c- 5 rj"l
Mailing Address R p t&_.(.._� -:k � rz � 3
r „_
Fa 11 , 111 k ..1S 4 6
Address of Site �S A M c
. Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel eE Q C_A,Qo
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No -�
Is this property being developed for resale (spec house) ? Yes o 1
Volume and Page Number It 2- 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 (We) ce U6y that att Statem ntd on this 6onm cute tAue to the best o6 my (oun)
know.eedge; that I C(w i am Me the owner(�) o6 the pnope�r ty du cAu bed in th i,s
n6ohmation 6onm, by vi tue o6 a wa Aawty deed recorded in the 066 o6 the
County Reg.is.ten o6 Deed6ad Document No. / rho ; and that I W pnedentty
own the pnopos ed d.cte bon the a ewag a dis poi s y4 em (on I (we) have obtained an
easement, to nun with the above d6cAibed pnopeAty, bon the constnucti.on o6 said
system, and the .same had been duty %eco&ded in the 065.ice o6 the County Register o6
Veeda, as Document No. ) ,
SIGNAT Old OWN SIGNATURE OF CO-OWNER (IF APPLICABLE)
Zk-*7
DATE SIGNED DATE SIGNED -
i
FORM 339—WARRANTY DEED—TO JOINT TENANTS
(Section 230.45 Wisconsin Statutesi
311850
This Indenture, Made this...... ... .31st..._.. Jul
....day of..............:........ ..Y ......................... A. D., 19..72. ..
between........ ......Dean.P.....AXtnbxu.$.t er..aod._Diane..K.,,Armbruster,,..husband and wife and each.
...... .........._........An-his-and-her.ow
u...right....._............................................................I....parties...of the first part,
........... ........... D. Foss and Bette Lu Foss, husband and wife
..►......
`.............. ............ ... as joint tenants, parties bf the second part.
Witnesseth, That the said part....iea..,..of the first part, for and in consideration of the sum of
I
...... s - - ....- -
-..- - - - - -...'.- ($32p000.00)
.. ...... .... . ... ...... . .... .
... ,......... ..
to..............them'
......An hand paid by the said parties of the second part, the receipt whereof is hereby confessed and
acknowledged, have.......given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by
these presents do.._....:... ive
g , grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of
the second part, in joint tenancy, their heirs and assigns forever, the following described real estate, situated in the
County of........... ......St. Croix.. ...and State of Wisconsin, to-wit:
it
Ij
i
A parcel of land of approximately 5 acres which comprises
the E' of a certain 10 acre parcel located in the NE'k of NW!y,
Section 30-28-19; said parcel hereby conveyed being more
�i particularly described as follows: Commencing at the NW
corner of said NE'k of N104, thence E along the N line of said
NE'z of N04 a distance of 426.5 feet to the point of beginning;
thence E along the N line of said NEk of NW a distance of
426.5 feet, thence S parallel with the W line of said NE'z of
I!, NW14 a distance of 510.7 feet, thence W parallel with said N
line a distance of 426.5 feet, thence N a distance of 510.7
feet to the point of beginning.
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TRANSFER
FEE
i
Together, with all and singular the hereditaments and appurtenances thereunto belonging`or in any wise !
appertaining; and-all,the estate, right, title, interest, claim or demand whatsoever, of the said part.les....of the first
part, either in•la*6r equity, either in possession or expectancy of, in and to the above bargained premises, and their
I
hereditaments and appurtenances.
To have and to hold the said premises as above described with the hereditaments and appurtenances, unto ;I
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the said parties of the second part, in joint tenancy, and not as tenants in common, and to their respective heirs and
assigns FOREVER.
f7 ,
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State of Wb m*
Cotntty of St. Croix
I hereby comfy that this imtKumt ji a l
true and coned copy of the doour wtf an No
and of reowd in my office and hay bom
compared by me.
Attest_ May 19 1 g 87
James O'Connell
lames O' Conneq Register of Died
Deputy
p Y
And the said. ....:Dean P. Armbrustem snd Disma K.` Armbruster
........ .... ....,
........ .........
............I
for....,. �m elves,and.. ...................heirs, executors and administrators, do .........covenant, grant, bargain and
agree to and with the said parties of the second part, and their respective heirs and assigns, that.at-the time of the
ensealing and delivery of these presents.....they..are,,,_.„well seized of the premises above described, bs`of:a good,
sure, perfects absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are:free and
li ',.
clear from all encumbrances whatever........................................................................... ....................................:.........:....:..:.........
i
................................. ..................................................................................................................................
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I' and that the above bargained premises in the quiet and peaceable possession of the said parties of the second part,
I
as joint tenants, and their respective heirs and assigns, against all and every person or persons lawfully claiming the
whole or an art thereof the
i
y p a eof............... ....y.......will forever WARRANT. AND DEFEND. I r
1
11 In Witness Whereof, the said partes....of the first part ha.Ye......hereunto set.......their . - .........hands....
and seal.s..this.................31s.t..................day of...........July.................................... A. D., 19...7.2....
SIGNED AND SEALED IN PRESENCE OF Dean P. Armbruster
Diane K. Armbrust r
............... . ..........................................................._.....(SEAL)
j
...........................................................................
..................................................................:...:............... SEAL
STATE OF WISCONSIN,
ss.
... ....... ...... ...........Pierce.........County.
Personally came before me, this.................31at....................day of.....................JulY...........................A. D., 19...72..,
above named............ . .....Dean_P_...Armbruster..and..Diane..K. Armbruster
the abo ................ .......... ..,............... :., ...............
1
..,...� ,,..,..�. ,... . -
to me known to be the person...A who executed the foregoing instr t and ackno � tdi:t ame. „od
. .... .. . ... ... .. . ..... ... ...- ... '
uth R. Her ers'rr C-1 11> ,
Pierce �� `<� '
Notary Public t��f Wis.
My Commission expires............11r2... ...... D., 19.....ZS.
'i Drafted by C. L. Gaylord, Attorney.
River Falls, Wisconsin.
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SEPTIC TANK MAINTENANCE AGREEMENT c
St . Croix County x
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OWNER BUYER nn Y` S M
ROUTE/BOX NUMBER ILO k L° 4 � oX �� Fire NumberAa
.CITY/STATE IC ya r P Is [,A-)1. ZIP
PROPERTY LOCATION:_, If J _ , Section_, TqN, R �9 W,
Town of -r klNy WP=) , St . Croix County,
Subdivision , Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed , by a licensed septic tank pumper. What you 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-
essar y the se tic 'tank is less than 1/3 full of sludge and scum.
) . P g
Certification form will be sent approximately 30 days prior to
three year expiration.
0
I/WE, the undersigned, have read the above requirements nd agree N
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- v
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Off:Lre within 30 days
of the three year expiration date.
SIGNED
DATE _ f 7Tz
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 .
DFPARTM �F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, , P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON,WI 5370/
HUMAN RELATIONS (1-163.0911)& Chapter 145.045)
LOCATION:N, ION: J v TUWNSHI UNICIPALITY: -O'r NO.:BLK.NO.1: SUBDIVISION NA E:
/4 /4 o Tze N/Rr9 �(o TROY
COUNTY: OWNER' B j 'S NAME: MAILING ADDR SS- _>R1
r -T��<�IX _ ��t*�RC�E Y�SS FAT 3 �Lr4/NV1 EW %j k L(_S ;QOZZ
-- --" DATES OBSERVATIONS MADE
USE
DE�f NIPI tON. �
TLEgmTpTiO1�_
NO.BEDfifvlS.: COMM�R i�
Residence N K I -7
INCW Replace -- AY 1419V 1 MQY /S 19IS7
Nc - +JtcrlN
RATING:Si Site suitable for system U=Site unsuitable for system -Ch t- ._.EMM�. .._
CONY NTTONAL: MOUND: —� IN-GROUNDPRESSI E SYSTEM IN FILL IOLDING IANK FIECOMMENDED SYSTEM:(opt nal)
U S EU "$ U I E$ IOfU to$ [IS AlU I co anrr�o
DE..SIGN RATE:------- --..------_. --.—.
If Percolation Tests are NOT re4uued II any poi unn nt the tustarl araa is in the
under s,H63.09(511b1,indicate CL/yS5 Floodhl aiu, indn ua Flondplain elevation: /�//�
C- _ ---- --- --------- _ ---
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T N
R UDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
7"$tRNSt L ze>dst4 I�S46*- IZ"tit NCStbt
B- ! 8,Sb 9GZ on([ X8.50 43°Be�IFS z'A !S+GRJ�cob p
� /O�gt_LTS 1'q'�$t2n1S1L It$�/gQNS'��'R 3+�fCT8Qh�7SrttaQ
B- 27 74�„Ro84NFS 1� C,K
_ — 9"$ALT� �A"BaN51 C t7�8RN F-M5 6R
B- �3 4s,l-] 9% 3` r4a" >8_1? zo"-rakyMSt4it 3WRARNF",-* k
B-
B
PERCOLATION TESTS
c
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WA Eli LEVEL INCHES RATE MINUTES
NUMBER IMCMtS AFTERSWELLING INTERVAL-MIN. P�RIDD t PERInD2 —__- P PER INCI1
—. / _ 3 f
P_ z 4t-s o 9�3.15 3 0 —1-/ 4 - ---- —!-14----- —- --- 24
--a 1 --
P-
pUS
PLOT PLAN: Show locations of percolation tests, soil horintts and the. dimensions of suitable so I Ira as Induate! s<:ale or distances. Ur!scril a what are the hori
iontal and vertical elevation reference points and show their location on the plot plan. Show th• surface elevation al all horin(Is and the direction and percent
of land slope.
SYSTEM ELEVATION 9330 —
f .w • ` L � IV EST�AC C ��
i+� � cTomt-s t ro/. D pED
R:�re 2�ye�et� z
{aen.Lr. 000f"�f/ / 1
TIlAGTS !�_.•
/Jrj 1+91 "• C�� tf ,tl� —t r pENGF►MAQT"S�I•kli 11�/
Fff /n,>!„r.•„r �emine.� l.~j I f�Z GJ�NAMCNTAL ELM
f/eii/ r Jo4.,•z /bu
60 �
I E[_EvanoN IOO.OU/
Cafe tN
"all
q��
?!v7 .•/4♦ rTh a Fed I
rZ e
My
,JO z g"3 i
Elf
r +
�v q C ^ice. `.-d.,/..r•A +� P-3
fit 1
(.
�,n>tpJ rM � v9 y •' 'YgAC'r$ Z.•t^ G]�
r P/.l�r <iirf� ru h j1{S� I A r
9- 1
1,the undersigned, hereby certify that the soil tests reported on Iles lorm ware made by nu-in arcs I with the pooclulcaes.nil noalhods specihad ua tba Wisconsin
Administrative Corte,and that the data recorded and the location of the tests are corntcl to the hest of any knowledge;nut la'hel
--....-_.__. IFSIS WERF(()MPI I,II I)ON:
NAME(�pri_nT=_,___,__,___,__,__ p
I�ARJ / �1oNr./S6ry IPu",c IS `'jLA1&riNt`, INC- 'MAy __ _--
_____.__ CE14TIFICA110N NUMBEH(optJnnal).
ADDRESS: r � 3�tf�_��TS
A o7 3'�t -
- - -
CSI
DISTRIBUTION:Ori(lowl tend oua copy I(, I.oc:al Auahnc 11Y.Pcopc'a ty Owrtcc and.`roil I c".Un
DIL.HR 9606395(R.02/82) OVFH
REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DEPARTMENT OF DIVISION
INDUSTRY, PERCOLATION TESTS (115) MADISON WI 537
LABOR AND- 07
HUMAN RELATIONS (1-163.090)& Chapter 145.045)
LOCATION! SECTION:' TOW/ UNICIPALITY: OT NO.:BLK.NO,: SUBDIVISION NAME:
�4 Tze N/R19 to 1 ROY �� $ �
`� / ----r MAILING DDR SS.
COUNTY: OWNER BUYER'S NAME:
rCkolx _..--C�tr�?f <,t �os5 PIT 3 PLA/NyfLw IVEIe 11Ct.S 4oZ�-
-- - '- -'— DATES OBSERVATIONS MADE
USE -. _-- -- -' -- -' -° - ---- r"-alnL-Er-DUCE!�n-fffp-r,-MFMCOL I E S:
DIAL DE CRI _ w Mp 9TH Residence I.-JNew Replace My —�9FS7 / r Y IS 1
°M,twt, l �sK f AFL �� SOILS
-Nc NI�k►N
RATING:S=Site suitable for system U=Site unsuitable for system _ _ - �✓�L __ZMM
- -- - C ENDED SYSTEM:{o nal)
-ONVS-O�N?�: MO�U SEX NGCIS lY U I EIS I fUL IEISGOU RC4N '-I 7 AL p
DESIGN RATE:- II an tirUnn of till)tested areal Is in the
If Percolation Tests are NOT rcyuired Y p
under s,H63.09{511b1,indicate: �L/4'j5 Z --- I Floodplam, indicate Floodplain elevation: �/�
L�- -
PROFILE DESCRIPTIONS
BORING TOTAL P H T R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, DEPTH
NUMBER DEPTH gg ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.)
/O gC L7-S, 7"Rk S i L 2B'/BR1J 6+�
B- .`_b 951 ,6Z 47 Cole,
- /o'���-TS �g"BervSil, r8"BeNS�C,�e 3f"4r8QN1hStG2
B- Z .Zti 9Ss.0 > 8.Z5 ?b"RI>,aRtn�FS
_ — 9„Q��T� i4"BRNSt� 17"6�N F-MS GR
B- 45.1-7 �)� . 1�(oNL 8 ,/7 zo"Cr8R1J MSt4tt 385�'Q�$QN F5�'�SP.
B-
B-
�F1 PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN W I Elt LFVEL IN H S RAT MINU-f ES
NUMBER IBS AFTER SWELLING INTERVAL-MIN. 7- P _Rlpp 1-. -_ P1 �eion z- _- __ ) -_-_ PER.INCrI
P- Z 4-6<_ a 3 7 4
P- --�- ---- ---------- ---.. ------ - - --_�-
p --- ------- ------- --- - - - 4 - — ---- —
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable so I i was. indicate scale or distances. Describe whist are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show tit. surface elevation a1 all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 93.30
I
t: DQ`
All
>? /�,♦ clnnets t F/e � SEA
naAU. trot t ' �puS 4 T�1
rRncT•
VAMP LL 000d off /
era. AO /3y 1
Tunes 4 NMr1I�
eo
r9as C'o[�e/re � J•t4• —t / $EnK �'SQI�G tn/
v ss (irr,.,,nc%• EL.EV4T1nN
• HF I I t N
rCile� r Nn I
P/a 7 s •'J4 J Rad e
•�'-_ J1 d Fe/, I
All, I
-32 -
r s� y Z !v /Fs ��/; • zd 7a
Tj
4.
inGN>v rM f J9/b. �YMaC t3 ~•t�
�.. 0r—
1,the undersigned, hereby certify that the soil tests reported till this loan were mmle t Y me ill accilicl will) the 1)roar lilt es.Ind niollwocls sperilled in the Wiccu+csin
Administrative Code,and that the data recorded and the location oI the tests are correct to Ihn best of Illy knowledge and 1whel
_-
__.._-.___ 1 FST5 WERF COMP1 t•T LI)ON.
I�ARJG"/ ,JnN�/�a�iry �u",ct Sc�RJEY/nIC, /,SIG MAY
_ __ •--- NUMI3LR: lYHONE NUMHER{n urnrd):
ADORES (,ENrIFII Al ION
S: ' / 3"t��,• 3�fb-4QTs cJ
407
5--�
DISTRIBUTION:Origln)rl and ogle c:npy to Local Aull-111Y,Plot"•)ly I)wne) and Sall I c°.0 c
1 OVER
REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DEPARTMENT OF DIVISION
INDUSTRY, P.O.BOX 7969
LABOR AND.- PERCOLATION TESTS (115) MADISON,WI 5370/
HUMAN RELATIONS (1-163.090)& Chapter 145.045)
_ _.--_--- ---•-- _ - -_._. _- -- - -i)T NO BLK.IVO.: SUADIVISION AME:
I.
l_OCATION:N SECTION: IOWNSHI UNICIPAIITY:
COUNTY. OWNER': BIJYER'S NAMF: _ MAILING ADDR SS
tVE� AfLS S4oz�-
- -- DATES OBSERVATIONS MADE
USE A 1 :
It,�. NCO/.BEI)ftIVIS.: COMMER(9AL I]FSC(Ilf))16 M
If�lRrsirlrnce l INrwReplu.e MAy �Q �9�7 ! IdY /�7 19TS7
L `6 9 S 0 LS K I N
RATING:S-Site suitable for system U-Site unsuitable for system_ MMt,RT _ _--_-- --- ---
-— _ - -- - -
ONV -Nl'IONAL: MOUND: IN-GHOUNDPRESSl1RE: SYSTEM-IN F II L.I IOL DING I ANK HFC.OMMFND[O SYSTEM:Iopt n,il)
, S ❑U I 0$_OU [ . . EIS Wu --l_o$ ,Wu.-_l_EIS 9 - Cdv v !„114NA L p�
DESIGN RATE If an o0o urno of Iho t tsterl area is in the
If Percolation Tests are NOT recluned v I //�
under s,H63.09(5)(b),indicate: CL/4_�� Floodplano, nuho:ur. FloorqpFain elevation: �V K
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO R UNDWATER•INCHES CHARACT[ii OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH
NUMBER DEPTH FA ELEVATION OBSERVED EST.HIGWE—ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
IC�T[ l TS 7r$JtN t (_ Zee I-z"Aktit CIS tGk
B' ft. Ci k ,GZ �.(�ntL > `3 >« 43,,gQrJF _Z'$QFS FGI��coh
/U r(>'>Lr✓T' /g//�ervs 1�. 18'/B2NS�U�e 3 f'/LrBQrr/`�SfGe
B- �s. J i� r t��r'4L > , 1? zo"[Tt3et� MSie k 3VR&$aN
B-
PERCOLATION TESTS
TEST DEPTH WATER IN 1101-E -TEST TIMF DROP IN WA 1 I-H t F VFt INCI)ES HATE MINLffFS
NUMBER II�MfS AFTEFTSWELLING INTERVAL MIN_ PERIOD ...- "-V PMOD 2 __. I'__._I(t_____ .—__._PER INCH
U
P_ _ �,�� __. Nom-- `��-•`'- ---�-- - - I_1� , 3,c _ �j z(,
P. z 4_Ys IyoN yE3 i`>- - --°- 1_�4- -- _ �.�4 '� 4 Z4
3 -
P 3y X14
____N- ----
PLOT PLAN: Show locations of percolation tests, soil horauts and the ifnnensions of suitable so I ,f1'': Indi ate s< de or distancis. DPSCrilxt what are• the bolo
zontal and vertical elevation reference points and show their location on the plot Flan. Show III, surface elevation at all hotmgs and the direction and percent
of land slope,
SYSTEM ELEVATION _ 9330
1
2 per 11 - IA�EST�ae C OE'
p 1 p�bELIN�
Mir R' 'or z �oUS 7�n1
owns rs /
v000d'rrff / �V
,f TMACTS !/,{r 1
r,iy
1975 rTamer 4 i �
�o//r//C ,l. Z r �E,n]CNMAI��.�SQIyt.Lt !•�/
;7 r(��lrrrs.�Ae _-, �' jO p'RNAMcrVrAL ELM
s As („ ......, I ELEVATION IOO.OU
Co% '
rsrtn .•/.,r../ �� .
ero f rr�gqe F�� '
r J76e
Fos u*/ YI [v rfis +vh • 7d7_o 1
114flQ . ♦ Cr�O
4l,,.lA7
27
y IYtAC'fb j
•' e �q4k
•
I,the undersigned, hereby (-Prtify that the soil tests reported on Ihls folio were rroadc by not-oil,u cooll mill IIu•pl ocedows.11111 clhnds sper;ilocd nr the Wisconsin
Administrative Code,and that the data recorded and the location of the! Tests are curler.] to Ihr hest of Illy knowledge and hehef
NAME tPrin]1t \r /� - t 7
/,1dY
_ - 0 H P
-.__.
(:[-It I IFICA11ON NUMI PHONE NIJMBEH(u linnall:
ADDRESS:
�:a -
_ - t.t;l ;:Iii _lDlff -
DISTRIBUTION;Orirlucif.outonecopy In fol.,ll Aulh000ly.l'lopo'oly tbvnl•1 and:ioll le.l o
1)fl"HR SR)6395 (R.0?/8?I OVt 1f
on �1.l3 o
—' ivo..Trl A-toP1cATY L t"Er
"GvT A rv0 )L/Z o.fS
f ' Exzs71Nv i yo/
DavEWAY
I
i
k7�257S�G � /_=XrsT2ivG
GA/W CE NbTE L'J�L ST2N C> FiaSLEO Aozr4c7-
1ZEszoF1vcF- SEPT.ZL T/D^,n Arv0,.1,1
S -- �Dn.Ywol-L To VE
3 � G�oZG� �orJ'
-- DES7/zorc0 �J
O 1 /�25 A4 AGFf11E n.T
O , 7o wi✓ or Trtu y
/VCW /bob GAL O
'---' sr CnosX Cou►.,T"Y
SCPTIC. 7Arv1L ° Sa Exzra.�G ou-r BLDG
�' �/ � fd tnzrTSv6 L✓cLL
w.EST PA-PErtTY 13/'1=SPXI<_-' On vl,A,7r✓vTIOL
L.=r->: -Ts ov£2 X33 ELV, = /00, oo'
oZ OD'f'r+�r+ l�i�oPvs r'a
,d/LO2vF2iL�0 �O� A1,0 ,�'Gi4L�
yo, ' 6 6 6 s
ovL=n /oa To SST--�
CjcmSn G O U'r �/to Pk2TY �iv E
'OES ' Stites <-I /o J' oPE 12LuFF Z-rvE
pES TwYEa `
s VENT s-MCK
6�uoE Ss To J O�t1N 4ii�ppat , LINE
FRESH AIR INLET AND OBSERVATION PIPE
APPROVED 'VENT CAP
MAX IMIJM 12"
ABOVE FINAL GRADE
4" CAST IRON VENT PIPE
h+4XIMJM OF 42" ABOVE
P 1 PE TO FINAL GRADE
SIGNED:
MARSH HAY OR SYNTHETIC COVERING LICENSE: r�/�J'
MINIMUM 2" AGGREGATE DATE:
OYER PIPE ol
DISTRIBUTION PIPE TEE
SOIL TESTING BY:
ELEVATION BED 6" AGGREGATE
BOTTOM PER SOIL. BENEATH PIPE PERFORATED PIPE BELOW
TESTIS * COUPLING TERMINATING
7. 3o FT. AT BOTTOM OF SYSTEM