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` - ~ 'Parcel #: 020-1057-70-000
05/23/2006 09:54 AM
PAGE 1 OF 1
Alt. Parcel #: 22.29.19.217A 020 -TOWN OF HUDSON
Gurrent X j 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 - SHIMON, RONALD J &CATHLEEN F
RONALD J & CATHLEEN F SHIMON
850 KELLY RD
HUDSON WI 54016-1000
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description ' 850 KELLY RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 24.170 Plat: N/A-NOT AVAILABLE
SEC 22 T29N R19W SE NE EXC CSM 7/1896 & Block/Condo Bldg:
CSM 7/1891 &EXC P217D &EXC CSM 7/2070
`~^ Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1037/139 WD
07/23/1997 831 /70
07/23/1997 770/522
07/23/1997 736/467
9(1(1R Sl IMMARY Bill #: Fair Market Value: Assessed with:
-- - -- -- -
Use Value Assessment
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 12.710 2,000 0 2,000 NO
OTHER G7 12.000 91,000 145,600 236,600 NO
Totals for 2006:
General Property 24.710 93,000 145,600 238,600
Woodland 0.000 0 0
Totals for 2005:
General Property 24.710 93,000 145,600 238,600
Woodland 0.000 0 0
Lottery Credit: Claim Gount: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~,~>l cJ~~ ~.1:.~ f.~~. .
Y
~11~
r
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URVEY MAP
CERTIFIED S
R19W
LOCATED IN THE SE I/4 CROIXE COUINTY~Eyy1SCONSIN 2 ~ RE P RED FOR: ~
'OWN OF HUDSON ~ ST• FARM CREDIT SERVICES
HWY "35" N WI 54022
NOTE THIS MAP IS FOR THE PURPOSE
IMF VOL.L7COFGCERTIF EOC SURVEORDED RIVER FALLS,
MAPS , PAGE IB 96.
NE CORNER SECTION 22, /~
T29N, R19W. (COUNTY -5 I
MONUMENT FOUND).
O = SET I"x 24" lRON PIPE WEIGHING
1.13 LBS. PER LINEAL FOOT.
• = I" IRON PIPE FOUND.
UNPLATTED LAN•OS•
NE CORNER OF THE SEI/4
OF THE NEI/4.
W E
NORTH LINE OF THE SE I/4 -NEI/4
11 11
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n,l O
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_ ~~ O (V
- 9.54 AC. EXCLUDING t: O W
~~, ;•.~ _~ ROAD R. b. W. l.~~ ~ '
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UNPLATTE~ LANDS
NOTE: THEREAST LRNEROFETHECNEi/4.
(RECORDED BEARING).
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Ei/4 CORNER SECTION 22,
T29N, R19W. (COUNTY (.
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MONUMENT FOUND) •,. «
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OCT 9 1987
~ a oo-+>keu
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1 CERTIF! ED SURVEY MAP ,~''~-~'~
LOCATED IN THE SE 1/4 OF THE NE I/4 OF SECTION 22, T29N, R t9W, TOWN OF
HUDSON, ST. CROIX COUNTY, W (. OWNED BY: FARM CREDIT SERVICES
HWY. "35" NORTH
RIVER FALLS, WI 54022.;
NOTE: BEARINGS ARE REFERENCED TO
THE EAST LINE OF THE NEI/4 ( REC-
ORDED BEARING.
E
s
UNPLATTED LANDS
.............. .........
NORTH LINE OF THE SE I /4 OF THE NE I/4
__~"'_ _ _ N89°42'26~~E_586.09~_ _
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NE CORNER OF SECTION 22,
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VEYOR'S MONUMENT FOUND).
~~ ~
ST. CItUIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT -~~`~ :~ ~ ~`~ ;#`~ ~ ...
()weer ~o,tJ .51J1~% D•~.> 3~1v • 3~y~
Sr]"~ ^aatlt~~s Aso X.ei y ,~ - ~ ~ zoo2
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~ City-State ~/1d SO~J /. SyOi U _ ~ •~ ' ,,,~'~/,
L,Qgal Description: ~ P~ . ~~jyl~
1_ot ~ Rlock Subdivision/CSM # y30 Jry2- ' UD~• ? ~ 7
'/~ '/, ,Sec. , T N-R W, Town of
PIN # OZC~ •%S7/.7o•~ca
(2t?~~
SEPTIC TANK -- DOSE CIiAMBER -- BOLDING TANK_INTORMATION:
~ ;~~ ~ N ~4
T'artk manufacturer ~O~G,lt-c,. ~ 'Size ST/PC ~~ Setback from: House ~ 8 Well ~ P/L ~ ~
Pump manufacturer ! Model
Alantt location
(IIOLUING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake
Meter location
Alarm location
Water Line
l3i'(,1~ r~~US~,~ CQi"S
SOIL ABSORI'~I'ION SYS'T'EM:
t
,,
Z
Type of system: Width 3 Length ~ ~ Number of Trenches
Setback from: House ,~[/' Well ~_ P/L7/~~ Vent to fresh air intake ? y0 ~
ELEVATIONS:
Description of benchmark C ~ ~ '~
Description of alternate benchmark
~~75 ~ 2
Building Sewer ~ ST/fIT Inlet
p~ LoG`~~,uli /~'I /~',v~tp
k~'SE"~S) Cov-~
yy• yo '
ST Outlet y ~ ~ ~ PC Inlet
~~.a
Elevation
Elevation /o'..
9~, o ,
I'C Bottom ~_ I~eader/Manifold / Top of ST/PC Manhole Cover ~G°~' ~~
Distribution Lines () () () -
Bottom of System ( ) l7 E~ ~ ~G T ~~~'~/ ( )
Final Grade ( ) ( ) _ _ ( )
y~o~
N/f~''
Date of installation / // ~ P,(e~rmit number State plan number
Plumber's signature ~`~~~~1 ~~ G~License number Z~.Ce~j~]5
Inspector ~~'/'I ~ vi~.y./
Date / / ~
DG-~ , Z-1- d 2
Co~kte plot plan +
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
• INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village x Township
Shimon, Ron Hudson Townshi
CST BM Elev: Insp. BM Elev: BM Description: ,q
~~
~
~'
~
~ . ~ h7
I
I
VC r
TANK INFORMATION
- ELEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic ~.
w
Dosing I~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG.
~~ Vent to Air Intake
-i ROAD
Septic
~~ ~
T /
d ~J~ I ~'
Dosing ~~ /
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
Model Number
TDH Lift riction Loss System Head TD Ft
Force Length Dia. is . o ell
SOIL ABSORPTION SYSTEM
county: St. Croix
Sanitary Permit No: 420469 0
State Plan ID No:
Parcel Tax No:
020-1057-70-000
STATION BS HI FS ELEV.
Benchmark Q~„~ ~ ~ 07 /~
AItAIt. BM
Bld~ wP,+~ ~ r~• ~ 9 •.~3
St/Ht Inlet /
v 4r ~ .
SUHt Outlet ~ , I a
/ .Z
Dt Inlet / ~_
Dt Bottom / r/
eader/Man. ---~ i~ ~~ • ,3 r~
/ ~a • 93
3
Dist. Pipe / _ _ II -~
Bot. ystem ~ ~
- 7i
Final Grade
.b
St Cover ~ ~~ G 2- g r)
s
BED/TRENCH Width /
~ Length No. Of Trenches PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ I
SETBACK SYSTEM TO P/L>~ BLDG WEL LAKE/STREAM LEACHIN Man user: ,. 1
/I
INFORMATION CHAMBER '
~
l
Typ Of System: (,.~,\
w / /~ / UNIT r7
Mode um r 1 ~-~J ~_
t a-J~a
DISTRIBUTION SYSTEM .f-p.E-~.~.t~~ ~,,,N~ ~~ ~~(/~ ~G
Header/Manifold Distribution ( x Hole Size x Hole S VeM to it Intake
6t Pipe(s) ~ ~ /
~
Length Dia Length~
Dia ~3pacing J
SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv
Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
BedlTrench Center ~ 5
3. Bed/'1'rench Edges Topsoil -
I ; Yes [~~ No -
(;~, Yes ~ No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 850 Kelly Road Hudson,~Wpl 54016 (SE 1/4 NE 1/4 22 T29N R19W) NA Lot Parcel No: 22.29.19.217A
1.) Alt BM Description = ~'r'~/C"" ~ .Q~1J ~~-~-mot N~i~..~~~„~Q, ./~, ,
2.) Bldg sewer length = ~ ~ ~ /_ - a__ /mss (/~"t/
- amount of cover = ~//
18~ - , >z-e r'LO'NC~-
Plan revision Required? ~ Yes [ No ' I ~ I ~® I
Use other side for additional information. ~,_~L ~-----ID__--- . ~,__ --_ G~~~~t ~~~~~ ~-_--
SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No.
Safety and Buildings Division County
201 W
Wa
hi
S T C/E~d1
A
.
s
ngton
vc., P.O. Box 7162
/S~OtIS/f1
Madison, WI '53707 - 7162 Site Address, ~s D ~ ~iJ
Department of Commerce /0 -~/_ d ~ ,3YU/3 "(tee / ~ •
Sanitary Permit Application Sa,ti~ry Perm, m~
~
In accord with Comm 83.21, Wis. Adm. Code, personal information yon provide ~ l
rna be used for second ses Pd
^ Check if Revision
vac w, a13. I m
I. Application Information -Please Print All Informatl n " ~ ~ State Dian I.D. Number
P
'
~~~
roperty Owner
s Name .,
lCO/~ S~1 M~~ i Parcel Number
d2D • lOS7 • 70 • ~
Property Owner's Mailing Address r- ~'~ e~l ~'
Property Location
8 ~~,~/Y ~~ ' ~
~ ZD
S t~ l ,,p
s~ ~ B ~i,A' S T N
Ci
St
R `7
~~
ty,
ate
,
E
Zip Code
phi. Lot Number Block Number
/v /
(
f
/
~,
~
Ql
~ / ubdivision Name CSM Number
II. Type, of Building (check all that apply)
~_ ^City
~.1 or 2 Family Dwelling -Number of Bedrooms
,
OVillage
^ Public/Commercial -Describe Use
v O
^ State Owned ~'°wnshtp
n n Nearest R~~ ~ ~~ •
2 } 3 t ~ 6$.~' ` ct~ S ~ ,j`A°,.14~ i_ J\ OI~i
Ill. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A' t~New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use
S stem Tank Onl F.aistia S stem
B• ^ Check if Sanitary Permit Previously Issued Perntit Numlxr bate Issued
IV. Type of Permit: (Check ail that apply)(numbering scheme is for internal use) ~ t~
44 Non -Pressurized In-Ground 21^ Mound 41 ^ Sand Filter SO ^ Constructed Weiland ,
22 ^ Pressurized In-Ground 4t ^ holding Tahk 48 ^ Single Pass Si ^ Drip Line
45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ~ Other
V. Dis ersal/Treatment Area Information:
benign Flow (gpd) Dispersal Area Dispersal Area Soti Appticadon Percolation Rate Syst LE~iS~vatio]1nt~~1 Final Grade
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min
/Inch)
~•O
.
I
J Elevation
3~ tiz~
•
~
~~-
.7
s
~ s.
~g
~~~
VI. Tank Info Capacity in .Total Numtxr Manufacturer Prefab Site Steel Fiber
Gallons Gallons of Tanks P195tic
Concrete Cons tied Glass
New Existing r
•
Tanks Tanks ~~
Septic or Holding Tank ~ ~ ~~~
Dosing Chamber
Vll. Responsibility Statement- I, the undersigned, assume responstbtllty for htstallallon of the POWT3 shown on the attached plans.
Plumber's Name (Print) Pl
'
umber
s Sig re tv1P/MPRS Number Business Phone Number.
~. ~ll~IZ1 ~ 7' ~'-~t~'
z~ 3 ~ S. 7~s •3 ~G ~~~~5
'
Plumber
s Address (Street, City, State, Zip Code)
Vlli. Count /De artment Use Onl
Approved ^ Disapproved ' Sa~tary Permit Fee (includes Groundwater Date Issued issuing Agent Signature t1Vo Stamps)
Surcharge Fee)
^ Owner Given Initial Adverse . 2z
Detenntn
ti
~
~ ~
a
on
, aq ?~
UC. Conditions of ApprovaUReas
o
ns for Disa
nn
__
pprove ~L I_
~ __ _ ~
~u c~~. .
Attach templets plans Oo the Conch onil) for the sfatem oe paper ne! leas than tll/= x 11 tncha ht tdze
SBDyd398 (R. OS/Ol)
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' UL~CiICI-1~' & ~SSoCtATES CQ. ~~.-
655 O'Neil ~ioad • E-iudson, WI 54016
715-386-8185
PROJECT INbEX
geg..Ues-gners of E.ng--x-ering Systems
Pr-vafe Sewrrge Cvnsuh~nls
1'1,AN 1 I) ~ N~T BATE 's~~. /,3 ''O Z
OWN1?R !0/11 S1'~//yO/lf E'HONE 36 (9 ' ~/~~
.-
S~ T-~' A u~R Ess X150 /~'..e!!t/ ,~~ . ~y~so •y Cyi • ~'y6! ~
~- LEGAL UESCRIF'TION P~T ~~ ~T ~~ C`s~ ~ y3 bQ`I2-
'TOWN OC' ~UQSo~ COUNTY sI ~ ~~ ~
cs'1'M 'l ,(I,e~SD~ ~ z2-~38~
LOCAL 11UTt10RI'I'Y/ SUPERVISION s7''' ~Jej~ ~~iN /`"~/"
f ROJECT bESCRIE''I'ION:
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Ulbricht & Ass a Consultants
Privat® 8Awag
855 O'Neil Rd.
Hudson, Wis• 54018
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Pg.l INFILTRATOR SIZING WORKSHEET
Pg.2 SYSTEM PLOT PLAN
Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS.
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An observation pipe may serve as a combination observation/vent pipe providing it terminates in
the same manner as required for vent pipes. See Figure 6.
r~-Vent cap. Velum bend Cap
r'G `'~ 12" min. •.,
12" rnin, Final grade . ~~..
....... ............ _.._..~..,_._.~_. ___.w._.__......._..._...~~.._.*_
Aggregate (~ ~Istribution lateral
¢~~ I :~ . _s, gy'p' a~ l! .~ x. ~
~~ System elevation
Figure 6- Vent and combination observation vent pipes .
Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly
on the bottom of the distribution cell. The locations of leaching chambers are in accordance with
Table 3 of this manual.
Observation pipes are installed in the distribution cells and are provided with a means of
anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative
surface for stone aggregate systems or from the inside of leaching chambers to a point at or above
finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate '
systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for
leaching chamber systems are attached to the chambers in accordance with the chamber
manufacturer's printed instructions, extend from a distance ? flinches above the infiltrative surface
through the top of the leaching chamber up to or above finish grade and terminate with a
removable watertight dap. All observation piping has a nominal pipe size of 4 inches. See Figure
5. ,
Water tight cap .
`~ 4" min. dia.
~ ~-Slot •~_~_
6" min.
In8lttative surtace~
Water Closet Collar
Top of
leaching ~ Repair couplings
chamber. J
Inrin/ ~4" h. 1
Bar(3rB" min. dia.)
OWNER's MAINTAINCE OE SEPTIC SYSTEM
POWTS (landowner) is reponsible 'for proper operation and
maintenance of this system. Regular periodic inspections and
servicing is necessary for the safe healthy operation of.thie
system. The owner is required by code to submit all necessary
maintenance/inspection reports to the controlling ,authorities.
SPECIFIC CONTACT AGENTS S ~ ~U~ X Ga`y'. ZD~~,v(,.-
* Govdrnmental authority/ inspectors: ~~
3 ~~~ ~ ~~~o '~
* Licensed installer, responsible for providing an operation/
maintenance "Users" manual:
3 ~ G ~ ~/ ~ s ~ ~ ~~~~~ G~ ~~~ s z Z ~ 3 -~ S
* Licensed serv~Lce / inspection
J~3 ~~,v /~o/~G-~,v
agent other than installer:
* Electrician, for pump, electric controls, wiring units:
~.
IMPORTANT OWNER MAINTENANCE RE UIREMENTS
i• Winter traffic (sledding, shove~rin
area shall not be permitted, or frostecan/willopenetrate into
the cell, freezing up the system. Discontinuos use in the
winter.(a vacaction trip, resulting in no water use) can also
lead to freeze ups.
2• Water conservation needs to be exercised! Or system can be
irydrolically overloaded and desl:royed. This svs$em was
designed for a maximum wastewater flow of
y5 ~ gals. daily.
3• POWTS are not designed to accomodate waste a garbage..
disposal unit, or any other unnatural sources of waste.
Any introduction of such waste materials will overload.and
destroy this system.
~ • If a power Iorttage occurs, or a
in a temporary overload of effluen~~beins/ it may result
cell, which may adversely impact the cell (leak~ge)tolthis
recommendec9 that a licensed pumper empty the dosing tank,
allowing the pump to return to dosing the correct amounts.
Consult your installer immediately for advice.
5• Neglect of the vegetative cover
erosion preventive (the cells insulation &
can lead to failure. Compaction or heavy
traffic also can destroy t he system. It IS NECESSARX TO
REGULARLY WATER 'I'FIE VEGETATION OVER A SYS'PEM! ! Effluent in
the system beneath IS NOT sufficient alone t0 maintain a
grass cover.
6• Periodic inspections by the owner, or hie agents, is
intostheys Inspection pipes and ports have been incornorafa.~
__ _ _ ystem: on FhA m.,....a L_ _ _
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
n~ acw~uancx w~ui ~.vmm oa, vvis. riarn. ~.vue
~_.~.~
Cou"ty
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size
Plan mu ..,. _:. _...d.
'
.
include, but not limited to: vertical and horizontal reference point (BM), direction and ~ `~ I tq... ~ s+~ D
~
4 ,,Q S' ? * 7~ ~
percent slope, scale ordimensions, north arrow, and location and distance to neare t road. •
Please print all information. , , Re~ie~ed, b Date
Personal information you provide may lte used for secondary purposes (Privacy Law, s. 15.04 ( } (m}}. ~ li;
Property Owner Prope LocatioTn ~
^
Ron Shimon Govt. ~ - ~/4 ~1~.~~;,$ 22 29 N R W .
19 ®)
Property Owner's Mailing Address Lot #
~ Block # Subd. Name or CS
y30 9 g ~ ~
~
'a~
Q `
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850 Kelly Road - 10 I - 1
j
City State Zip Code Phone Number dy ~ Vili3ge ^ Town Nearest Road
Hudson WI 54016 ( 7~5r386-3196 Kelly Road
__ _-_--
a New Construction Use>~ Residential / Number of bedrooms 2 ~ Code derived design flow rate 30p GPD
Replacement ®Public or commensal-Describe:
Parent material T WPCs pvPr n» twagh candc Flood Piain elevation ff applicable N~. ft.
General commerrts Suitable for a conventional below grade system
and recommendations:
spirit@frontiernet.net '
1^ Boring # 0 Boring ~
Q Pit Ground surface elev. 101.02 ft. Depth to limiting factor >9U in.
Soil ication Rate
Horizon Depth Dominant Cglor Redox Description Texture Structure Consistence Boundary Roots OP D/fP
in. Munsell ~ " Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2
1 0-11 10yr3/2 - sil 2tnsbk mfr cw 2f .5 ..8
2 11-90 7.5 4/6 s ml - - .7 1.2
•0'
2 Boring # ~ Boring 101.08 >90't
Pit Ground surface elev. ft. Depth to Jimiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots OP D/fF
in. Munsell Qu. Sz. Cont. Cobr ~ Gr. Sz. Sh. *Eff#1 `Eff#2
1 0-42 10yr3/2 - sit 2tngbk mfr cw 2f .5 .8
2 42-90 7.5 4/6 s Osg ml - - .7 1.2
•
S. a .2 '
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Efliue - D < 30 mglL arts TS < 30 mglL
CST Name (Please Print) Si - -~~ CST Number
Thomas C Nelson 2273$7
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 6/28f02 715.246-2454
~ Z_
,.
ORIGINAL
Property owner Shitriori Parcel Ib # Page 2 of 3
.~
3 Borin # U Boring
9 ~ 109.0'2 >96
pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Colw Redox Description Texture Structure Consistence Boundary Roots GPD/fP
In. Munsell Qu. Sz. Cont. Color Grr Sz. Sh. 'Eff#1 *Eff#2
1 0-1,2' 10yr3/2 - sil 2msbk mfr cw 2f .5 ,8
2 12-22 1 5/b - sil 2msbk •mfr cw if .5 .8
3 22-53 1Qyr5/6 f2d5yr5/8 cl lmsbk mfi cw - •2 .3
4 53-96 7.Syr5/6 ` - s Osg ~ - - .7 1.2
Bori # ~ Boring
~ ~ Pit Ground surface elev. 105.12 ft Depth to limiting factor >92 in• Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'REff#1 'Efl#2
1 p_lp 10yr3/2 - sil 2msbk mfr cw 2f .5 :8
2 10-24 10 4/6 sil 2msbk mfr cw 1 f .5 .8
3 24-92 7.Syr5/6 - s Osg tnl - - .7 1.2
y
~- 4~. or
^ Boring # ~ Bonng
pit Ground surtace elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Colw Retlox Description Texture Struoture Consistence Boundary Ro0tS GP Dlff
In. Munsell Qu: Sz: Cont: Color Gr: Sz: Sh: *Eff#1 'Eff#2
* Effluent #1 = BODs > 30 < 220 mg/L and T33 >30 < 150 mg/L * Effluent #2 = BODg < 30 mglL and T3S < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-833tlTesi(R.07/00)
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• S'1' C1ftU1X CUUN'I'Y
SEI''I'IC 'L'ANK MAINTENANCE AGREEMENT ..-~ '
AND .--
OWNERSHIP CERTIFICATION FORM .
. t
Owner/Buyer ~oN ~ c~~ ~~~,~ s~/~,~6iv 3 ~ C~ 3~ y~ (P
5> >~ Mailing Address 2S 5 ~ /~~~~t ~~
/ 5~_ , .
Property Address
(Verification required from Planning Departrnenl for new construction)
Cit /State ~v~SO ~/ ~/
y Parcel Identification Number
LEGAL llESCR1C'I'lUN eZo - ~ar~--~ - ~
Property Location ~~ '/,, N~ '/~, Sec. 2Z , T ~~ N-R 1 y W, Town of ~ UQS~
a.~~ `
Subdivision ~'' l~ ~ ~i ~~ ~ ,.....~~ 1
_~
Lot #
.~ ._._ -
Cetli(ied Survey Map , Volwne ~ ,Page #
~0 37
WArrnnly lleed # _ ~a~/~3 ,Volume ,Page #
!3 ~ ~.
Spec house U yes ~ no Lot lines identifiable ~ yes O nv
SYS'!'EM MA.IN'I'ENANCE
Improper use and nrainlenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put info the system
can affect the function of the septic tank as a treatment stage in the waste disposal system. "
The property owner agrees to submit to SL Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site waslewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating tlrat yourr septic system Iras been nrairulained must be completed and returned to flue Sl. Croix County Zoning Office within 30
days of the tluee year expiration date.
~-
9/ a~~~
SI~NAIURE OC APPLICAN"1' DAZE
UWNER CEItTIrICA'I'IUN
I (we) certify that all statements on this form are true to fire best of my (our) knowledge.
the ro eNy desct' d above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIVNA'f UR. • OC APPLICAN"1' '
I (we) Am (are) the owner(s) of
~//o/n~
DATE
****** Any information that is rrris-represented rrray result in flue sanitary permit being revoked by the Zoning Department. ******
** include with lhls application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the wanranly deed
nR~GINAL
sos~.93
Pye l d 2
r.~CtST~;2'~ ~r:~CE
Zec'd Ibr Rib
SEP 2 7 1993
afi f : t 54- ,,P' ~~~
'/ ~ ~~,
afl~.e- ~ ; ~-ts
ttecadi~ labrnuriaa
voc 1~7-i-GE 139
LIMITED WA,RRAN1'Y DEED
THIS INDENTURE, made this .~~ day d September
19 ~_, betwvxn ~~ank FCB f/k/a Farm Credit Sank.
~ St Paul --.
a federally charoerod corporation, with a poet office sddtess d
375 Jackson Street
St taut Minnesota 55101
pay d ~ first lam. ~ Rnn_w_1 d .T_ Rhimnn and CA_thl een P.
Shitoon, husband and wife as marital aurvivnrahip_.
wlaee p~ ofBoa ~~ ~ 553 Omaha Road
Hudson Wiscon in 54016 ,
party d the soa;nd part, (lrereitntter referred eo as party whether singular or
plural). WTTNESSETH, that the said ptuty of the flrat part, for and in
cortsideration d the sum d _Zwenty-eight t ousand and no/1COts-
-------------- ------------ ----------- DOLLARS,
(~, 28 , 000.00----------~, ~ g p~ by the said party d the aecoad part, the reixipt whored is hereby sxknowledged, does Qrsot,
bargain, se11, and convey unto the said party of the second part, his/her/their heirs, successors and assigns forever, the following described real
estate, situated in the County d St. Croix , and S~ of Wisconsin , oo-wit:
***SEE ATTACHED FOR LEGAL DESCRIPTION***
} i __.-
~_
1
. 1 { / / ~ ~
~ ~ It }~. ~
wbject to all cxistins easeateats sad ruts d way; also subject m aU taxes on said premises for the year 19 93 and followio` Yeah: ahw
subject m all unpaid puts snd inst~•:ments d special asseasn+des oa said premises which have failea due, or will 6tl due ItereaRet
EXCLUDING therefrom and excepting sad reserving b said puty d the foal put all mineral sad rvyalry rights, iaoerea4, estates and titles
heretofore reserved or excepted d record by The Federal Laod Back d Saint Paul prior oo January 22, 1986~ if arty, with atrch easements for
ingress, egress and use d sur6ce ore ntay be incidental or r-euesaary to use d such rights. The bregoiag exchuioa, exc:eptioo and reaervatioo
shall include, but not be limited m, all oil, gas, hydrocarboru, coal and other minerals d whaboever amine lying is a under the abovo-
descrbed lands and aB rayalry irtteresti as o0 oil, iu and other minerals produced sad sated therdrom. 1t u expressly underseood dot the acid
parry d the first part will make ao warranty as b the extent d its ownership d minerals, or ss to its title thereon.
TOGETHER with all and singular the Itereditameds and appurteaarras therctrolo belonging ar in arty wise apper~iniag; and a0 eetaee, right,
title, interest, claim a demand wbataaever, d the said party d the first pert, either in law or ctptity, either is posaeseioa or eapecttmry d, in
and to the above bargained premises, sad their heredinmerw and apptrrtemaces.
7~0 HAVE AND TO HOLD the said premises as above ducribed, with the hereditarrreatf sad appurteoaoces unoo the said party d the
f
uwo tct
r~2dt
o ' 137-~ 1~0
1N WITNESS WHEREOF, the said party d the fast put, has caused rhea pteaerKa to be executed in b ~rorpotate ttatne the day and year
flat above written.
WITNESSESS:
„•~. ,
L:.
'y ',yam `. -
•~ ~"
, * .r . ~
` ' - 11~ '
. ....
I
3TATE OF WISCONSIN
' lsa,
COUNTY OF ST. CROI% }}
AgriBank,~PCB~K/k/a
~AARRMM
Ji nder Regional Vice President
d Farm Credit Services of Northwest WI.
FLCA
asA~r~y m-fact for Farm Credit Bank d St. Paul,
n k a AgriBank,FCB.
~~
(N.i~
trw.-
71ts)brcgoing uutrNmtnt -Has aubtorvfidgtd bc)brc me on (dau) September 22. 1993
by (nano) Jim Render , (ptl~) Regional Vice President
of Farm Credit Services of Northwest Wisconsin. FLCA
as Attonuy-in fact, on behalf of Farm Credit Bank ajSt. Pool, n/k/8 AgriBank, FCB.
O~. F -
Peter E. Stern
Notary Public, Pierce County, WISCONSIN - A!y conrrnission upins March 6, 1i ~,~
STATE OF
COUNTY OF
~~
7lre )6trgoing instrunKnt Nas acbowledged beJ6rc me atr (date) -
by (name) -(title)
of
on behalf of said corpomtion.
Notary Public, Cawh,
This instrument was drafted by:
L.A. Woltmaa
Farm Credit Services of Northwest WI
Y.0. Box 199
A/y coeawissiow apircs - 19
1
River Falls, Wisconsin 54011
a.; r,~s"~t' $ ~' +1 ; ,'`~2 .~ioS ?IC'a+T~. nv " ....n,:eex~:.R -, , . _ -
' and the SF~NE~, including part of ti:s
~~~, ~ ,~ paYcel of land located in the NE~SE~
~ Certified Survey Map recorded in Vol. 7 of Certified Survey l~i~896~ ¢]~1
in Sec. 22 T29N-R19W more fully described ea follows: ~7tAK 4~
Commencing at the East quarter corner os~tion a 22~~~o s40 feet~o Zthe7Po~t
along the East line of the NFh of said
of beginning; thence North 89°57'16" West, 750 feet; thence ~whoasylong~chord t
~•.•.,~ ~~TM:a~e Southerly
along the arc of a 905.17 foot radius ....-.-
bears South 75°47`19" ~•lest, 1+1+5.83 feet; thence South 61°31'54" West, 135.86 feet;
thence North 00°16'46" k1est 129.94 feet to: the Southwest corner of th~SEr~~
said Sec' of~Certified Surveys~pege 1891, a distance of 690dfeet;ethence lr'orth
in Vol.
68°U9'21" East along said Certified Survey a dista~so bein8~ arctof a 227 foot
Northerly 53.5 feet along said Certified Survey, ° ~
radius curve concave East~rl Weat allon~sa dCertified Sur ey a6dis'tan etof346~83
feet; thence North 00 11 1~~ g int ~ the East 2is~e of the
feet; thence South 89°57'16 East 1104.01 feet to a po
SE~tv'~t of said Sec. 22; thence South 00°02'57" West along the Fast line of than
NEB a distance of 828.2 feet to the point of beginning.
Subject to existing highways, easements and rights of way of record.
~e above described premises contain 24 acres, more or less.
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