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032-2059-20-025
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YAL~SA-"- Si. C;3(1;X COUNTY REGISTER OF DEEDS SLR+~YORST. CROIX CO., MI ED SURVEY MAP 11/14/2200930R03E15PM LOCATED IN PART OF THE NW1/4 OF THE SW1/4 OF SECTION 17, T30N, R19W, CERTIFIED SURVEY MAP TQWN..OF SOMERSET, ST. CROIX COUNTY, WISCONSIN, BEING PART OF PARCEL 1 REC FEE: 13.00 OF AZERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 331, AT THE ST. COPY FEE: 3.00 CROIX` AUNTY REGISTER OF DEEDS OFFICE. PAGES: 2 SURVEYOR: PREPARED FOR: NOTES: NO ADDITIONAL LOTS ARE BEING CREATED'BY THIS MINOR DOUGLAS J. ZAHLEFI DAVID LINDSTROM SUBDIVISION. THE REMAINING PORTION OF PARCEL 1 OF CSM VOL. 2, S & N LAND SURVEYING. INC. 2055 WHITE BEAR AVE. NO. PG. 331 IS BEING ATTACHED TO THE PLATTER'SADJOINING PROPERTY 2920 ENLOE STREET SUITE C VIA AFFIDAVIT. HUDSON, WI 54016 ST. PAUL, MN 55109 ALL CONDITIONS, RESTRICTIONS, NOTES, ETC. LISTED ON THE PREVIOUS CERTIFIED SURVEY MAP ARE APPLICABLE UNLESS OTHERWISE INDICATED. W114 COR. E1/4 COR. SEC. 17 SEC. 17 ~9j S89°3929"E 5181.92' 1313.40' 3868.52' LEAST-WEST 1/4 LINE i w V d©4 ~ @A.m. 0R-1 Y It P@~ 1663 j rA OO'~M~D C7~[nIGG?~ I (S89°47'E) I _ S89°45'01 "E 410.64' 37.06' ` 367.8 5.77'-, 40487'__- ; 616' 0 33' 33' p OF W/$c e y t Z~ DOUGLAS J. ~i ZAHLER Z I Q zm S-2145 EXISTING I ~n H DS 1 I SHED_~'% ° C I m Z 1. $ I 0 I LOT 1 N w m m Ti t Ul 3.622 ACRES Ut m 1 C0 t o Ln l I (157,786 SO. FT.) INC. R/W Y A 3.546 ACRES 9 ~ I ~XI N : STS G c~ W I C i m (154,475 SO. FT.) EXC. R/W m t 000 ? ~EWA y ODD I IO EXISTING SEPTIC TANK / 1 TL-P. EXISTING}-.i^'_' TANK I w I HOUSE I c~ 1 C Z'_ 1 1 l 11 DRAIN FIELDS I r------I 103.22' 3 1, tt tt ; I I 1 ~t71 616 m m L------~ t1 Q ~J 404.71' U 36.24' 368.47' 11.58'- N c y N N89°45'01 "W 416.29' M-m o o 1 a s m pQG3~~d mm 4 ir°m a m CU LSD o Qd(a44G3 m M LEGEND I I ~ O+ o FOUND ALUMINUM COUNTY SECTION Z O CORNER MONUMENT _ m' v m • FOUND 1.OUTSIDE DIAMETER IRON PIPE SCALE IN FEET 1" = 80' O SET 1"OUTSIDE DIAMETER BY 18" LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT 80 0 80 ROADWAY SETBACK LINE (100' FROM RIGHT-OF-WAY) THIS INSTRUMENT DRAFTED BY: WILLIAM KANE ln~ SEPTIC VENT JOB NO.6332.01 DATE: 11114/2003 SHEET 1 OF 2 SHEETS Vol 18 Page 4652 ' s r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430239 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Lindstrom, Dave Somerset Township 032-2059-20-000 CST BM Elev: Insp. BM Elev: BM Description: _ Sectionlrown/Range/Map No: / 0 0 - a /0 0 0 54j*u2_ A -j_ 17.30.19.7336 TANK INFORMATION •-7,3 d a-r~- VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept 17-4 5 ic r -M i Igo Benchmark 75 I ob 00 d Alt. BM 11(0• ~S A c Bldg. Sewer m G / Holding tt Inlet -74 7 ' TANK SETBACK INFORMATION St/Ht Outle ~Gj-1 D 6k,~ KI) TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Q4a ac-- Septic ~l Dt Bottom f ~ Header/Man s.2~ l/,C S i Aeration Dist. Pipe o le~✓ gp 1/ Holding Bot. System I S~ q q- Final Grade 014 L) PUMP/SIPHON INFORMATION sYf Manufacturer Demand St ver - GPM ~ K~ S (6• .35_ Model Numb TDH Lift riction Loss System Head TDH ' & ` 5` /0~ 3 For ain Length Dist. to Well d7lu SOIL ABSORPTION SYSTEM - j 0 G ..QXC,& BED/TRENCH Width Length 11o. Of Trenches PIT DIME NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM LEACHING cture . INFORMATION Ty//GG Of System: Q {~7y~~ y~/q ' CHAMBER ffo t `~~~~LL~ 0 rl~• ~ 6J6/ ~ 1DV 1 J~ Model Number. DISTRIBUTION SYSTEM Header/Man' Id Distribution x Ho ize x Hole Spacing Vent to Air Intake `d Pipe(s) Length is Length Dia acing- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only h -Ag",ds Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedrrrench Center Or Bed/Trench Edges Topsoil Yes No J Yes ] No COMMENTS: (Inc ude code discrepencies, persons present, etc.) Inspection #1:%o//0 /b3 Inspection #2: / / Location: 1538 42nd Street Somerset, WI 54025 (NW 1/4 SW 1/4 17 T30N R19W)~ !gyp /L/ot,I P Parcel Nom: 17.30.19.7/333,B 1.) Alt BM Description Ate t t~~ ~t~(K ~ fig ,Tu 2.) Bldg sewer length lro -amount of cover 431 a Plan revision Required? Yes No `O Use other side for additional informs Xin. SBD-6710 (R.3/97) Date lasepctor's Sin t re a Cert. No. (5 ~i~~ r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ff , d tseonSln Madison, WI 53707 - 7162 Site Address L~ Department of Commerce ` ' ~3 6 Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21. Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes 1. Application Information - Please Print All Info ati r__ U State Plan I.D. Number ~J Property Owner's Name AU G 0 6 2003 Parcel Numbe~X_2,~_g 7 131/0 3 L p3 Z - 743S9 - Zc-3 - aao Property Owner's Mailing Address ST. C1 C',X COON' 1 Property Location '7 3`515 OFFICL_ tk:tJ A; S T 3 N, R / City, State Zip Code Phone Number Lot Number BlockYWNumber Subdivision Name CSM Number ~~~d C3/~'l 7 II. Type of Building (check all that apply) ❑Ciry I or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe. Use NTownship %_S40_?n.0 r Sy ❑ State Owned W Nearest ad 1 J4,t~ 3,D 46;~,+O_e I 9~? .1,Z( V/ M. Type of Permit: (C ck only one box online A (numbering scheme for internal use). Complete line B if applicable) For County use I ❑ New 2~Replacement System 3 El Replacement of 6 El Additi7_~ p S t Tank Onl Existin S B. Check if Sanitary Permit Previously Issued Permit Number Date Issued IVZoe of Permit: (Check all that apply) (numbering scheme is for internal use) 44 -Pressurized In-Ground 21D Mound 47 ❑ Sand Filter 50 ❑ Constructed wetland 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft. (Min./inch) ( 7. (o Elevation ~o Irv 6 - Tz If 7. CaZ . _ 7-3 Y6 . a/• VI. Tank Info Capacity in Total Number Manufac rer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks~~~ oncrete Constructed Glass New Existing Tanks Tanks dQZyO~ Septic or Holding Tank Z~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number 4--1 -77 Z Plumbe's Address (Street, City, State, Zip Code) 2 PI r.l-_1 uJ , Y1 County /De artment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater D to Issued JasTing-ftent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse _ a~SV 0lt) Determination V 1X. Conditions of Approval/Reasons for Disapproval AffvA complete plane (to the County only) the system on paper not less)pn 8101:11 inches in size ~3 . SZ. SAD-6398( 0 %41) JOB L ~l2ds t-ro~,, TIMM EXCAVATING Route 1 Box, 192 SHEET NO. OF Q WILSON, WISCONSIN 54027 CALCULATED BY&-,Oil LL0251 DATE d, '5 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MP" #696 MN CHECKED BY DATE SCALE i ; i i : i I ........t .........i .........f .......j ...........j ...........i.......... d..... ...i f i i I t ! a........... ;...........f........... ........i.......... . I. r..........: i Y i i i ........i..........e.......... i.......... .......i. r..........r..........r..........,...........a........... .........s ..........i ........j... - ! i 1 . f..........is . : . i ' 3........ i... i i j i i..........F. ........j.............. ..q. .....i i..........j........... ........j.................. .......q............ i 19 i j I sit „~+v i , i 1 r~ I v3 ` 7r_ i : . s D z 5a ; -t' i : .3 r........ :....r... : © i r o o .P . ....u . 1P d. . At . s;. . . . • 3.. s~ c V . L p Y~ - - Svc., ,i G........%~Jc No La rv~':~/~ts . 'z : . -L' T f Fl Gb . . . PRODLICT M14 1m. &aim, MuL 0101. To O1dn PHONE TOLL FREE 1-M2254= JOB OC..U ? L iL(clS t~'cs-~-F TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE - $-°3 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE 1 y ....................................................i........... ./~!S a I ~k > j o 'F z4 . ~>5 ice" A i ~o ` ...m . . . r 3 r i y~ {e, j l p f ~Lt ° CL....~ T.... PRODUCT 20.5-1 ~~Inc., Groton, Mass. 01471, To Order PHONE TOLL FREE 1-800225.0380 l PAID Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must v l~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. v 32 ~yiZ CY ~~v percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ed by Date Personal information you provide may be used for secondary purposes ( ivacy L}W,c5 (f h(3 ""p V 9 U r Property Owner ; i Property Location Povt. Lot 1/4 4 T N R E (o 4w Property Owner's Mail,' Address lot # 1 Subd. Na or CSM# 3-31 -7 V- A12 Nearest Road City State, Zip Code Phone Number 0 City ❑ Villagti jig-Town S S Da c ) o2 ❑ New Construction Use Residential I Number of bedrooms., Code derived design flow rate J GPD Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable eft. ---z6 - ~E - General andrecommendations:j~~X~, Q L P/V~ l v [ Cj . cJ~ H/~ ' Y Boring a Boring # pit Ground surface elev. • ~ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r Cam-- Z 6A 46a. z1a rn- /0 L In r sl-O "g # Boring la"Z Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfrf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 p 'ZD o , 3 Z- s - N„- , s Z , l O ' Effluent #1 = BOD > 30:5 220 mg(L and TSS >30:5 150 MOV ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 7 715-246-4516 Property Owner _ Parcel y I Page 2 of E] Boring l ~ - 4° Boring # lr~ © Pit Ground surface elev.l Depth to limiting factor - in. Soil Application Rate '14V C Horizon Depth Dominant Color Redox Description fixture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 -3 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~eplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fi= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil icetion Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD3 130 mg/l_ and TSS 130 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-8330 (8.6/00) { Soil Test Plot Plan Project Name Steve Johnson Sh rd Address 1538 42nd St. Somerset Wi 54025 STM #226900 Lot 1 Subdivision Date 7/18/03 N W 1 /4 S W 1/4S 17 T 30 N/1319 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Vent Pipe System Elevation 97.6/97.0/96.4 HRPSame as Benchmark Alt. BM Top of 1/2" pipe @ 100.0' Scale is 1" = 40' unless otherwise noted 80' T 50' 150' Existing 3 40' Bedroom House B-1 Drainfield is slow 7% draining, no above Slope ground effluent found ' 35' 5 15' * -2 B.M. 4' 0 -3 10 1 ' 30' 10' Alt 103' .M. 101' 99' Y -d N 250 660' Property Line System Management management of this system is critical. As a condition of approval of these plans this system management section must be rep ie~~ed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715-772-3214, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the ocher and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I I f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water-saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. t Never pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. o No paper products other than tissue should go into the system. - `o chemicals should go into the system. S Avoid surge flows of water, try to spread laundry throughout the week. Maintenance The septic tank must be inspected every three years by a properly licensed person. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption I cell If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve ~apacin to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or !~"U da`s should pass before any necessary repairs can be made. .A oid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8 A~ oid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 0 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. Contingency Plan wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer &A f)f litr~~'1y'~Lt Mailing Address ` 2 ay1 ~(,lrYLaJ d Property Address 3 ne,!! (Verification required from Planning Department for new construction) r-T" City/State ~rrs~ r Parcel Identification'Number zo-66D LEGAL DESCRIPTION Property Location d& '/4, 5 W '/4, Sec. T,3_N-R-ILW, Town of .Sd ,arSs~.~ Subdivision Lot # Certified Survey Map #Cog , Volume '2-- . Page # 331 Warranty Deed # 3 Z~3S Volume -=4335 , Page # 361 Spec house; yes ❑ no Lot lines identifiableA yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of 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 into 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 St. 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 wastewater disposal 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. I/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 that your septic s m has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o the three year lion date. a / 3 / 03 IGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described a v , by virtue of a warranty deed recorded in Register of Deeds Office. C-)3 SIGNATURE O ICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 7- - ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: 1., Sec. /7 , T 345 N, R--j W, Town of 50-t-Ler V -0-A St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced D 3 Did flow back occur from absorption system? Yes Nom (if no, skip next line. Approximate volume or length of time: gallons minute's Capacity: Construction: Prefab Concrete X Steel Other Manufacturer (if known) : L4 h r. zaa Age of Tank (if known) : Sj (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name 4.~ Signa e MP PRS Z 6 2 I J 2 3 3 9 P 361 732935 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. NALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI This Deed, made-between Steven E. Johnson and Gloria J. RECEIYED FOR RECORD Johnson, husband and wife. 07/31/2003 08:30Am Grantor, and D.J.L. Trust WARRANTY DEED Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 1014.00 COPY FEE: (if more space is needed, please attach addendum): CC FEE: That part of NWI/4 SWIM Sec. 17-T30N-R19W described as follows: PAGES: 1 Lot 1 of Certified Survey Map recorded in Volume 2 of Certified Survey Maps, page 331, as Document No. 336897, St. Croix County, Wisconsin. Recording Area Name and Return Address ~h ,.-.e- L , r-i p S'f-Qot.H /S ;Z. "7 HF_RoN I- AIV Sowt eiLre7` (,✓itc- Sy o~~ 032-2059-20-000 Parcel Identification Number (PIN) This is homestead property (is) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. - Dated this l ~f day of July 2003 * * Steven E. Johnson * * Gloria J. J on AUTHENTICATION ACKNOWLEDGMENT Signature(s) Steven E. Johnson and Gloria J. Johnson, husband STATE OF - _ ) and wife ss. 22 + l County ) authenticated this! g lay of July , 2003 Personally came before me this _ day of the above named * Kristina OgIand TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, w1 STATE BAR OF WISCONSIN 800-65..!021 WARRANTY DEED FORM No. 2 - 1999 336897 CERTIFIED SURVEY MAP SCALE IN FEET I 0 ' 100' 200' 300' 400` 600' I ♦I I DRAFTED BY D.L.H 0 UNPLATTED LANDS_ MI I p: LEGEND Z: S89°47' FO3 .00' Q: ® COUNTY SECTION CORNER MONUMENT 9o° 259.59' 217.07' 3 p; BERNSTEN CAP, FOUND. W: I- : 0 1"x24" IRON PIPE WEIGHING o W pj Q 1.68#/LINEAL FT. SET. : Z o 0 0 N. O O 0 ~I 0-: 0: O M M p Z: - N FENCE Z M co I p Q : 0 3 cod co SURVEYED FOR: PAUL FRMISTED W ; PARo 3608 N. DAKOTA AV E. F'10.00 , o NEW RICHMOND, WI. 54017 a. W INCLU J' M 9, 50 ACRES TRUE OWNED BY: MARK AND BETTY REED n- o o ~ 3 I BEARING R.R. #1 Z: Z o EXCLUDING ROADWAY J90o' SOMERSET, WI . S402S M NW-SW Cw 220.95' 406.05' '33'I Go 4:1) N89°47'W 660.00' ~,+~ES DfC UNPLATTED LANDS o o~ • I 0 R.Q,t f 01 197coNk s 0 I SC Of tae Ell SW CORNER °!x ds I av„~°,f°°'t)" SECTION 17 q0 ti T30N,R19W Z I POINT OF BEGINNING DESCRIPTION: A parcel of land located in the NW1/4 of the SW1/4 of Section 17, T30NJ% R19W, Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing at the S1 corner of said Section 17; thence N39°00'07"E 2102.58' (true bearing) to the point of beginning; thence N89°47'W 660.001; thence N00131E 660.001; thence S89°47'E 660.001; thence S00131W 660.00' along the centerline of an existing town road to the point of beginning. Subject to the existing town road right-of-way over the Easterly 33.00' of said parcel and also subject to a blanket ease- ment to Dairyland Power Cooperative to place, construct, operate, repair, maintain and replace electric transmission or distribution lines or systems of pole type structures. I certify that the above survey, description and map are correct to the best of my knowledge and belief and that I have fully complied with the provisions of Sec. 236.34 of the Wisconsin Statutes and Section 5.4.2 of St. Croix County Zo ing Ordinance. Dated: September 22, 1976. . Francis H. Ogden S-882 Jo No. 76-706 Ogden Engineering Co. ~~~"1111111#pN,123 E. Elm Street GUN•`S~~~i,4 River Falls, Wi. S4022 p summslot4l FRANCIS H. APPROVAL Of Tr11 > OGDEN 'a V A L t'~ SEL'3iC 0.1 t _ S882 Dogs , APPROVED r RIVER FALLS, (r SY JE1 r WIS. '!yam ..~`'.~o•' IN O V 1 7~ R ST. C;.OIX Cc: U..1 r COMPAVENS.W PARKS PLANNIN t QMMlTTEE M Ji ~ ✓ I COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 t, ST. CROIX ZONING REPORT NO.S 09197/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 8/23/90 COURTHOUSE HATE RECEIVED#* 8/21/90 HUDSON, WI 54016 o ATTN2 THOMAS C. NELSON 2,(f U _3 032- Z S OWNER: Steven b Gloria Johnson LOCATIONS 1538 42nd St., Somerset COLLECTORS M. Jenkins SOURCE OF SAMPLES Outside faucet COLIFORMS 0 /100 tot INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 4 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gape WI Approved Lab No. 19 i.., .OF.\NDEPEA,I. T! ' u f A < Means "LESS THAN" Detectable Level Approved by# o PROFESSIONAL LABORATORY SERVICES SINCE 1952 13, r 1.900 G 0 o ,y C ~O, r \ ST. CROIX COUNTY ZONING OFFICE p yp ` St. Croix County Courthouse o 911 4th Street ~ Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections private individuals. r-.,..W et: on of this form in annan4'- al so that the nrnngXty can be 12 tB.d • 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. TESTING----------------------------FEE: $ 25.00 MATER (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC S) FEE. $25.00 SEPTIC SYSTEM INSPECTION------- (Determines if system is properly functioning at time of inspection) o~wa C~~or~o~ SeSe~ Property owner *s name Property owner's address VS-3g, `k'Z-hJ3b U~ I E44 OZ5 Legal Description UO 1J4 of the 5oc-. _114 f Section T _N'R 19 Town of 'ssw-~rs~-'~ Lot Number ___Subdivision Name FIRE_ MMMz- X538 Color of house G3c.~tm Realty sign by house?~-If so, list firm: PLSASS INCLUDE, 1F AT ALL POSSIBLE, A HAP, .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 ~9 b23 REPORT TO BE SENT TO: • ~'o~... 5 ►r. 3 w~ closing date 2 O signature - i i v ~ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE x' 911 FOURTH STREET • HUDSON, WI 54016 - - (715) 386-4680 DOW Aug. 21, 1990 Steven Johnson 1538 42nd St. Somerset, WI 54025 Dear Mr. Johnson: An inspection of the septic system of the Steve & Gloria Johnson property located at 1538 42nd St., Somerset, WI was done on Aug. 20, 1990. At the same time I also obtained a water sample for testing. The results of that test will be sent to your 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 inspections. This not not in any way warrant or guarantee the continued proper functioning or operations of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J;! JeTi ins Assistant Zoning Administrator cj r o y o' 0 ti O 3 m o C7 r~ I °c ~ I = ~ ~ ~ ~ B ~ r1 co ~ X O D=i UOi O? O C- C- c hi p3j O N 0 O O~ 0! co O V N -4 =r 3 OD CD en CD d N w A CL Z a fOb COiI o N NO d 0.4 cA 1l I cD N 7 1 N CD CD !n L" D7i to W 7 ? C 1 N a O W N N C,) N r,J O N n < O C N 7 n < O W O 0. 0) CD E; CD K) C W a 1 Of C W C lY 00 o a e cn Z D cn < D c0 O ca c N m co (D y a N C CD h o a l c a c o o O O A V CD N ` m l~ CD I ~1 O CO CO CD CD (D CO C/) 0 or ch O m 00 CO O CO) C lr Q CD CD M 000`~I O 000 !1• CD @ 3 1 N 3 C A 7 O N z N z c O D a l O D a l o CD v N v (n l~~l CD , 7 m 7 `iy C CD N C CD N CL W a 3 7 a 3 7 jCD co Z CD co y I N B I u7"i c .gyn. CL z 1 a 1 A o Z -4 A W m o -4 CL C 3 z O " O " C) co CD CD a C4 co I I y a 0 (A a o a o 3 a co n "n o 2 c (7 0 c =r o a I ~C n o a Cl) N CD o? U) w y a ~N r 7 a CL 0_0 co I ~ m I o a c N 0 O I ~ y a N CD ti O O N b CD CD a En O cs O o g o g °o °o i in I It.. MAY I 12004` 746674 L VOL 18 PAGE 4652 ~ KATHLBE'A H. w1LM S'• CR7, C0 REGISTER OF DEEDS S(.f ~',~FYOR'S PUt .TY ST. CROIX CO., MI CER ED SURVEY MAP 11/141 003 R03:155PH LOCATED IN PART OF THE NW1/4 OF THE SW1/4 OF SECTION 17, T30N, R19W, CERTIFIED SURVEY MAP TQWN..OF SOMERSET, ST, CROIX COUNTY, WISCONSIN, BEING PART OF PARCEL i REC FEE: 13.00 OF A:I&RTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 331, AT THE ST. COPY FEE: 3.00 CROIXtQUNTY REGISTER OF DEEDS OFFICE. PAGES: 2 SURVEYOR: PREPARED FOR: NOTES: NO ADDITIONAL LOTS ARE BEING CREATED'BY THIS MINOR DOUGLAS J. ZAHLER DAVID LINDSTROM SUBDIVISION. THE REMAINING PORTION OF PARCEL 1 OF CSM VOL. 2, S & N LAND SURVEYING, INC. 2055 WHITE BEAR AVE. NO, PG. 331 IS BEING ATTACHED TO THE PLATTER'S ADJOINING PROPERTY 2920 ENLOE STREET SUITE C VIA AFFIDAVIT. HUDSON, WI 54016 ST. PAUL, MN 55109 ALL CONDITIONS, RESTRICTIONS, NOTES, ETC. LISTED ON THE PREVIOUS CERTIFIED SURVEY MAP ARE APPLICABLE UNLESS OTHERWISE INDICATED. W114 COR. El 14 COR. SEC. 17 SEC. 17 ` S89°39'29"E 5181.92' 1313.40' LEAST-WEST 1/4 LINE 3868.52 V N dc4 ~a~o o OR y@_ 9. p(2. 4~M J (S89°47'E) I _ S89°45'01 "E 410.64' j 37.06' 367.81' 5.77'_ 404.87' ; 6I6 OF WIS 33 33 e ~ DOUGLAS J. ?ipi Z W Fill, ZAHLER I v !I-' S-2145 EXISTING ~n t i ~ H OS SHED_ I~ jn VV Z Om LOT 1 ; N 0 0 ~ m 3.622 ACRES Ln j m Ln I (157,766 $O. FT.) INC. R/W y O 00 A 3.546 ACRES i m (154,475 SO. FT.) EXC. R/W Fk~SrjH fil W 7 R~~W G F 00 co I G EXISTING Ay IV SEPTIC TANK 0) i . TL EXISTING}-,r--1' TANK HOUSE c 1 Q~G 11 DRAIN FIELDS I r-----, 1 103.22' 33 33 p II 1 i I 1 ELI 616- a) L------ i 11 L IJ 404.71' MT 36.24' 368.47' 11.58'- -4 22 N N m N N89°45'01 "W 416.29' m t m o y o 0 2 0 0; A pQf~~~d ml, m m„ © 9L~ ED 5-I' C~f~ICTUM ° z Om (nn n LEGEND I FOUND ALUMINUM COUNTY SECTION (000 CORNER MONUMENT Z, waftm v m FOUND 1' OUTSIDE DIAMETER IRON PIPE SCALE IN FEET 1" = 80' SET 1" OUTSIDE DIAMETER BY 18' LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT 80 0 80 ROADWAY SETBACK LINE (100' FROM RIGHT-OF-WAY) THIS INSTRUMENT DRAFTED BY: WILLIAM KANE 0 SEPTIC VENT JOB NO. 6332.01 DATE: 11/14/2003 SHEET 1 OF 2 SHEETS Vol 18 Page 4652 ' Parcel 032-2059-20-025 11/14/2006 12:12 PM PAGE 1 OF 1 Alt. Parcel 17.30.19.733B-10 032 - TOWN OF SOMERSET 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 - LINDSTROM, DANIEL R DANIEL R LINDSTROM 1538 42ND ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1538 42ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.622 Plat: 4652-CSM 18-4652 032-03 SEC 17 T30N R1 9W PT NW SW PT LOT 1 CSM Block/Condo Bldg: LOT 01 VOL 2/331(9.5AC BEING CSM 18-4652 LOT 1 (3.622 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-30N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 02/27/2006 819302 EZ-U 11/21/2003 747200 2460/478 AFF 11/21/2003 747199 2460/477 TD 11/14/2003 746674 18/4652 CSM more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.620 51,100 145,500 196,600 NO Totals for 2006: General Property 3.620 51,100 145,500 196,600 Woodland 0.000 0 0 Totals for 2005: General Property 3.620 51,100 145,500 196,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/16/2005 Batch 05-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . Parcel 032-2059-20-025 11/14/2006 12:17 PM PAGE 1 OF 1 Alt. Parcel 17.30.19.733B-10 032 - TOWN OF SOMERSET 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 DANIEL R LINDSTROM O - LINDSTROM, DANIEL R 1538 42ND ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1538 42ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.622 Plat: 4652-CSM 18-4652 032-03 SEC 17 T30N R19W PT NW SW PT LOT 1 CSM Block/Condo Bldg: LOT 01 VOL 2/331(9.5AC BEING CSM 18-4652 LOT 1 (3.622 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-30N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 02/27/2006 819302 EZ-U 11/21/2003 747200 2460/478 AFF 11/21/2003 747199 2460/477 TD 11/14/2003 746674 18/4652 CSM more... 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.620 51,100 145,500 196,600 NO Totals for 2006: General Property 3.620 51,100 145,500 196,600 Woodland 0.000 0 0 Totals for 2005: General Property 3.620 51,100 145,500 196,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/16/2005 Batch 05-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 S I ~~illNTy 336897 CERTIFIED SURVEY MAP SCALE IN FEET I 0 ' 100' 200' 300' 400' 600' •~II DRAFTED BY D.L.H MI UNPLATTED LANDS p LEGEND MI I I Z: S89-47'E 660.00' COUNTY SECTION CORNER MONUMENT 900 259.59 150.34' 217.07' ° 33' 33 0: BERNSTEN CAP, FOUND. o w: w o Q C) 1"x24" IRON PIPE WEIGHING `o ~ 1.68#/LINEAL FT. SET. C! Z o 00 J: • -O O J 6 OR 4: 0: O M M O z' FENCE z . M I Q ; Q (01 J : c0 SURVEYED FOR: PAUL FRM4STED W: PARCEL I 1 z 608 N. DAKOTA AVE. 10.00 ACRES of NEW RICHMOND, WI. 54017 a. w INCLUDING ROADWAY F- F' I OWNED BY: MARK AND BETTY REED a M o 9.50 ACRES ~ TRUE R.R. #1 z Z o EXCLUDING ROADWAY 8-" 01 BEARING SOMERSET, WI. 54025 M J M ° to NW-SW W MN~ e•- 8 W ; w 220.95' 406.05' ?-'90..P3_3"33' V N 89 ° 47'W 660.00 D£C~ UNPLATTED LANDS oo~ fs 97s 0 0 Rep/at O Cot ft 'St. Go •a, rxc ost1 SW CORNER ori,~ wr,C,,,,;n ^tn SECTION 17 q,` I ~c+ Z ti T30N,R19W I 1 POINT OF BEGINNING DESCRIPTION: A parcel of land located in the NW1/4 of the SW1/4 of Section 17, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin, described as follows: Commencing at the SW corner of said Section 17; thence N39°00'07"E 2102.58' (true bearing) to the point of beginning; thence N89°47'W 660.001; thence N0°13'E 660.001; thence S89°47'E 660.001; thence S0°13'W 660.00' along the centerline of an existing town road to the point of beginning. Subject to the existing town road right-of-way over the Easterly 33.00' of said parcel and also subject to a blanket ease- ment to Dairyland Power Cooperative to place, construct, operate, repair, maintain and replace electric transmission or distribution lines or systems of pole type structures. I certify that the above survey, description and map are correct to the best of my knowledge and belief and that I have fully complied with the provisions of Sec. 236.34 of the Wisconsin Statutes and Section 5.4.2 of St. Croix County Zo ing Ordinance. Dated: September 22, 1976. Francis H. Ogden S-882 Job No. 76-706 Ogden Engineering Co. ,~~0N123 E. Elm Street 0'0,5 C' River Falls, Wi. 54022 lFRANCIS H. APPROVAL O~ ftZ' = t ,•T n~,, ,:CAI: FOR SEPTIC OGDEN _ z S 882 awl DOES APPROVED RIVER FALLS, ST~ i (r CIA. SY lop i W is. e O ♦ r r. •y~``~.~.......,,..,.- a ti- 1. 7 LOMPkEHENSIVE PARKS PLANN!N, "aft% Volume 2 page 331 AND ZONING COMMITTEE ` TES( Q2zd z aumToA I ' •uosnN sourer Xq pal jvap juaM14Sur sru1 I~ ZZOVS ursuooSTM `sTTVd Janr'd Z80SS slosauu'N `aGI-cmTTTIS SZOtiS ursuoosrM laasa@uloS :.aa.z;S WTd 'd SZT S xog `T# '2I 'E I# *d "d -•o0 2~uTaaaur.~?ug uaEfo assazaS uuor paad Xllag XJPW ~lg GaAa is Wd Qd1Cd/1 nS 'da(H RIMS EaNMO HDNdd N X- maarnwcD O►aNOt aNV ',L3S `100d 'Id'dNII/#89'T 9NIHOI A SdId WE ,VZ x ,1 O OMNNYN SAW AAV41l 4VM* Al AOD XIOvo'12 *Gmod`,LOOd TvUNI'I/#89'T JNIHM9M ddId NOW i,VZ X ,T 6 LL6t 8 1 AVA 'd VD Nd,LSNUH `an"lod ZN31n1f1 cw UaNdM NOI,LOdS IUMOD -4~- d3AO.ad&V. QN3od I M618 `NO£ 1 LI No1133S oz,z9H 01 53133 VaISAS 2i3N800 MS ~t1d3S b031bAONddd Nv3W ION S30C1 ~ 1901SIAMnS 8ONw Simi 40 IVAONddb 0 ooz ,001 0 ,001 o° v ~1333 NI 31VOS m s vY 3FA-af1S 631-giT8 15 JlDO5 xro-8 g '1S 30 I££_ 3_JGd `Z 3Wf1~On IVI 9NWHI 1-, 03080038 ddW A3A8ns Q31-411830 rn 1 919 ONINN1038 30 1Nl0d (X - ,LO'LIZ ,b~'OSI ,6S'6SZ N I . "O~ ,09'1£9 09 O b z 0 op ,091799 M .,Lt, °68 N OHO G1 6` 6' O ° O z r' C A kVM(3VO8* JN10f1~0X3 ° C0- v w S380t1 Z9L'b :m - l z I ::E N kVMGVOH JNIQf110NI rn :-I ° 1 = 1 S 380V 200'9 m :v w ° N ;r j D D „N)o 9m m w MS-MN - :z { LL61 s DOW o- o~m d 3 71 400 o° p ' s 1091399 S '(7 odoa I ~£2 ~O ,05' 129 3„IS,Zb °68 S 6(19 £5.089 NM01 0NUSIX3 I ' j ' - tb/I MS 3H1 d0 3NI~ H180N LI N0911-03S 919 83N800 b/I M SaNd- 4311didNf1 d` N Jl Aans 431311830 10; 0800313 S,aoa3noSM ' A1Nf100 XIoal xs r f~ Jyn'' un^''' PP~ tff{~ Parcel 032-2059-30-000 11/14/2006 12:09 PM PAGE 1 OF 1 Alt. Parcel 17.30.19.733C 032 - TOWN OF SOMERSET 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 - REED, JEFFREY M & CAROL A JEFFREY M & CAROL A REED 1518 42ND ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1518 42ND ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 12.440 Plat: N/A-NOT AVAILABLE SEC 17 T30N R19W 12.44A IN W1/2 SW1/4 Block/Condo Bldg: LOT 1 CSM VOL 2 PAGE 374 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/27/2006 819302 EZ-U 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/05/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.440 95,200 147,100 242,300 NO Totals for 2006: General Property 12.440 95,200 147,100 242,300 Woodland 0.000 0 0 Totals for 2005: General Property 12.440 95,200 142,300 237,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 304 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 340164 FILED MAY 20 1977 oIA't d 0 ST. CROIX COUNTY 340 1 64 r a>aOak ~ y, SURVEYOR'S RECORD CERTIFIED SURVEY MAP THAT PART- W 1/2 - SW 1/4-SECTION 17, T-30-N, R-19-W C.S.M. 2- 331 ~ 33'33'1 UNPLATTED- 1 S890-47-00 E 875.71 LANDS O 248.71' 220.95' 406.05' p O .p _ I I p°,pp M M O ' NO M O N 0, 0 APPROVAL OF THIS MliNOR SUBDMSION 33 m DOES NOT MEAN APPROVAL FOR SEPTIC / / 0 SYSTEM. REFER TO H62.20 / TRUE BEARINGS L O T REC.-C.S.M. m VOL. 2, PAGE 331 12.44 ACRES 'A,',, w EXCLUDING R/W OD O UNPLATTED 2 / LANDS M (D APPROVED a o 10 99. ' (Ell MAY 18 1977 of 2~b.? 8 W s 7Qo ST. CROIX COUNTY Op ~M/R iSN~E /A11K5 PLANNINr, 5 CURVE DATA Am- -;0`40 CoNARTEE CURVE NO. A 8 r ~v RADIUS 520.88' 3824.81' p A LENGTH O CHORD 40 LENGTH 629.95' 215.78' M~ of LEGEND CHORD S 37°- 25'-27" W S 73°-00'-54"W BEARING Z, CENTRAL 740-24'-53" 03°-13'- 58 *--I" IRON PIPE FOUND ANGLE ARC 676.51' 215.81' LENGTH 0--1" x 24" I RON PI PE SET SW COR. WT. 1.68 LBS./LIN. FT. THIS INSTRUMENT DRAFTED BY G.C.Shaffer (CO. MON.) T30N, R19W 150' 100' 50' 0 150' 7 7- 28 „ I SEE REVERSE SIDE FOR SCALE' I = 150 ~ tittftftllf®t~~~d"a I SURVEYOR'S CERTIFICATE I r 0 Go. . GME 0. x VOL. 2 PAGE 374 r SHAFFER S-1325 W CERTIFIED SURVEY MAPS HuDSO O ST. CROIX COUNTY WI. WIS. ✓o ~ O F0,00.4, SUR%j 41tttlots MR Form- STC- IT14 AS BUILT SANITARY SYSTEM REPORT OWNER STeue 104,_r0r. TOWNSHIP So A.; err=t-r SEC. /7 T . N-R if' W ADDRESS -5/r y' rr ST. CROIX COUNTY, WISCONSIN SUBDIVISION kr /A,1 LOT .4v J.10 LOT SIZE "e' PLAN VIEW 30 ! 733 8 /o Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I YO a L✓zLL JJ 3 b ed roc ~~cr gar. ~ - - - - =ys• l~r,e,T- - • INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used a.de3_ s -.Ice Elev.4tion of vertical reference point: Proposed slope at site: isv SEPTIC TANK: Manufacturer: Lt+t;_s~rC Liquid Capacity: Ioc'c> C Number of r:_ngs used: - O Tank manhole cover elevation: Tank,Inlet Llevation: Tank Outlet Elevation: Number of ft.et from nearest Road: Front,QSide,ORear, O =L'_` feet From >>earest property line Front, QSide, ©Rear, O 0vte -no feet NumbE r of feet frow: well Svf building: .30' (Include this information of- Che above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE „ - t ~ r• . I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: BotLu.: of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property land: Front, O Side , Rear , Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed: Trench: Width: Length: 6 Number of Lines:_ ~ Area Built: Y V Fill depth to top of pipe: Iq dUe. Number of feet from nearest property line: Front, O Side, Q Rear,O Ft Number of feet from well: pve~ i~o' Number of feet from building: o u e. /06~ (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 J A Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation pf 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: Inspector: Dated: ~aG~/sic, Plumber on job: 4 - License Number: h+i°63k 3 84:m' I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAB'°R & kUMAN FfELATIQNS PRIVATE SEWAGE SYSTEMS DIVISION P.O.0-OX 7939 BUREAU OF PLUMBING MADISON, WI 53707 ®CONVENTIONAL ❑ALTERNATIVE state an I.D. Number: Of wipnta) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION 13XIT' Steve Johnson 248-4th St., Bayport, MN BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: Cr REF. PT. ELEV.. NW-'4 SW-4, Section 17, T30N-R19W, Somerset Township Name of Plumber: RSW No. coumv; 17nlary Permit Number: Michael E. Wilson 6388 St. Croix 34805 SEPTIC TANK/HO ING TANK: S' MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELE ARNING ABEL LOCKIN COVE y PR VI ED: NO PROVID YES ❑ ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH NUMBER OF RO : R ERT WELL: BUILD G: IV ENT O FRE H ALARM: FEET FROM LINE: / AIR I ❑YES O ❑YES ❑NO NEAREST o 0 J DOSING C ?(AMBER: MANUFACTURER : BEDDING: LIQUID CAPACITY. PUMP MP/SIPHON MANUFACTU ER: WARNING LABEL jLOCVj1NCOVER PROVIOEOPRODED: ❑YES ❑NO YES ❑NO ❑YES ❑NO. 40 GALLONS PER CYCLE: D$ll1R/TRO OPERATIONAL: igMPROPERTY IWELL1 ISUILDING: V N (DIFFERENCE BETWEEN F LINE: AIR INLET: T PUMP ON AND OFF) /'O~V[E] ❑NO S SOIL ABSORPTION SYSTEM. Check the s moisture at the de th of plowing FORCE E 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.) C NVENTIO AL STEM: WIDTH: NO. DISTR. PIPE SPA IN(i: INSIDE OIA. #PITS. LIQU BED/TRENCH 4 TRENCHES M 1 L: PIT PTH. DIMENSIONS ID GRAVEL DEPTH D LL I R. "PIP DISTR. PIPE Is 1 MATERIAL: O. DI R. ER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: B "ER: ELEV. INLE ELEV. E D: PIPES LINE: AIR INLET: FEET FROM O Z NEAREST '02- .7 Al MOU Mou 1tl site~ldWed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO TEXTURE: PERMANENT MARKERS: 0BSERVATION WELLS. t ❑YES ❑NO ❑YES ❑NO D DEPTH OVER TREN H/ D DEPTH OF TOPSOIL. SODDED. SEEPED. MULCHED: ENTLR: EDGES: ` ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO i DISTRI13UTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: uEb/tRENCH TRENCHES: DINIENS(QftIS j MANIFOLD PUM MANIFOLD DISTR. PIPE MANIFOLD MATERIAL . NO. OISTR. DI PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV. ELEV.: DIA. ELEV.. PIPES DIA.: y ELEVATION AND OtSTRIOUTION. ' INFORMATION HOLE SIZE HOLE SPACING ilLLED COHHECILY COVER MA ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS Y ❑NO ❑YES ❑NO N IVeR AN N OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: 3 DYES LINO ❑YES El NO NEARE/S,T 77 517 -To 1~0& CA~ SG Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE wM`- 1 10 DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, ' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 i Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensiori+ild or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer.14,4esigned by a Master Plumber, the date, signature and. license number must be shown. A legible reproduction of the soil test report or the ovvr's copy must be included. Property Owner: Mailing Address: S7-_ Property Location: City, Village or T`cwn County: , Q Y4 Sw US iT .?o N/ R S E (or) a S ; C Lot Number: Blk No.: Subdivision Name: Lake or Landmark: State Plan I.D. Number: D (If assigned) &ae 1A. e, r .1 TYPE F BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)jJ~J, Bedrooms: 194 or 2 Family *State Approval Required. 3 TOTAL NUMBER. PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE-OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY /O00 HOLDING TANK CAPACITY yy LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: L-le'e, Con r.od EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 59-New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage'Trench 6 ~ Sr _7 Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): JELPrivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: /MPRSW No.: Phone Number:' Plumber's Address: Name of Designer: Q G,J /y COUNTY/DEPARTMENT USE ONLY Signs ure of Issuing Agent: F22: Date: APPROVED Sanitary Permit Number: Cl~&9 ❑ DISAPPROVED .,J A Reason for Disapproval: Alternate coursels) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) r: DEPARTMENT OF ' REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; I GG DIVISION P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.0941) & Chapter 145.045) LOCATION: SECTION: /MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: L,; .S4 /T.?oN/R/g E (or So--- COUNTY: BUYER'S NAME: MAILING ADDRESS: sl-c'-o i t r USE ATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED SCR P 10 S: 1PERCOLATION TESTS: Residence New ❑Replace I y/ 2 j/ S L Z j/ 8'3 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:-SYSTEM-IN-FILL HOLDING TANK :RECOMMENDEDSYSTEM: (optional) ® S DU © S DU ZS DU El S ®U If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: L"' Floodplain, indicate Floodplain elevation: L"14e F* ROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATE -INt!"FS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Hk ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- S 4s~~ B- .Z S oa 7 6 :33 yvo n e 7 QO j. I') 6L, lc . 8J Q A S 0. 60 C C S' oo' A- S ~ B- S S S', oo by on e • oe ` X ` C S C S 0.. S C L 7 Q S SC ' 7 ~l?•, S B- S S SFl „ °O1 Loo" C 'D -1 B- M a G I PERCOLATION TESTS Fe e TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LNOWeS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P PER INCH P- 1` h2o S % 3/S/ 10 / P_ P- 17 i /Vo P__ I P- 74' 7 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 1 r Q2 C7 ~.3~ ~:vG 4 QJ f7'.[7 Scr¢sS ~t~.f, t: , /Vt fcN S' Tc i 3 J►td e^po 3r' Via''"' i q ' Se' 17 sr~~ •`LLc ! J'~ ~ I tol ~ l 1 S 3 '1 I . 3 t i T ? Q Da J tlo a Po, es "4 -AV 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 COMPLETED ON: /i "!Q 4 C S ti Y ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 2 y 10 ox .19eA- -1 49.S O --2 6 S'" - 7 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - i f INST""TIONS FOR COMPLE°ING FORM 115 - S31 - 6395 To be a cornpi,r„ _irate soil test, your d r lust include: coo' siete legal ,n; 2. _ 3c section '~arly indi. ~etll a residence or co, project, ~!'."l)M ri,inr. bedroor, planned; 4 nt - 'in A SITE BLE FOR A }i jG TANK ONLY IF ALL F T BASED C DNDITIOP Wia here for writin description ; completing the plot -.n; I. _ely locatir19 Y(111 -'ations. D st c~ . it - .,icu point ara : , i(!s' flood tlc n, itwa`' n ~ly, ial.. 7 box; oul anon [W d ~,LL`1L TEST:" ITH THE Y THIN SO D PL.ETION, s= - IATIONS FOR CERTIFIED SOIL TES -TE.RS Textures Other Symbois BFI Bmir{ SS S is LS L s - IIG { _ t B Gy L( ant y .v !(tarn R Loam mot - "lay vv - ,y I HWL H vel, x ax` i 3i ;te BM S.. J = . VRP - Vert3 . r TO THE OWNER: T' art is tI y permit. The county or C' '.1-?rtr may request soil -Ili issuance. A comp; of Fes? ns <<,r the private a pern -i' applica. )mitted to the appropr local a,. in order to Ohl C. The sanitary permit mug f be obtained and posted prior to tl art of a uction, I D o ci (n ~ f ~ n p J 'S A !ti q, r L 1 0 ti P y r ~ r QQ r s ~ I I I I j I I I ~ I I I I S ~ .r /go 0 Gp y 0 n V3 a c~ '1 r t 0 I,J 6`r X' r ~ ~ o A o ~ n .r P o .Sl o s r ~ h A 14 y T ~ m 1 ~ P D irsry Roo d DEPART'VENT.QF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INrDgST1~iY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707969 HUMAN RELATIONS LOCATION: SECTION: TOW59 N SHIP/MUNICIPA-LIIT-Y: OTNO.: LK. :SUBDIVISION NAME: x,''/45'4 1 /T t ~/REfor 'frv a I"S -7' l / 7f k114 COUNTY: OWNER'S/BUYER'S NAME: MAILING ADD SS: 5 / i h u r ti 1 f' -5 USE DATE ERV IONS MADE NO. BEDR : COMMERCIAL DESCRIPTION: ST : esidence A5 ~ -I New ❑Replace , /-.=xc-yam RATING: S= Site suitable for system U= Site unsuitable for system QNVEN U Z SYSTEM: y%~ ` - ~ r I AM STIaU • OUND: ❑u INUS 0 ~ RE: SSTEM-IN-FILL ODLDING : NDED ` I S C~ TI If Percolation Tests are NOT required DESIGN RATE: SYSTEM ELEV. If any portion of the lot is in the under s.H63.09(5)(b), indicate: n Floodplain, indicate Floodplain elevation: A)IA-- 7PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- r B- 1 r /Z --2 4 _7 k B- ; -'~4 _ 2 L) i i f 4/ j v •-e 5 ERCOLATION TESTS cox/}r 5 1J~! TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RIOD 1 P RIOD PER INCH P- / P- P-. P- P- PLAN VIEW: 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 slop. SYSTEM ELEVATION W . £'f1~C N. ►y a~ . - err. ~ fC. ~ ~ ~ _ E (1.ae ' I ~ 141 , i E , I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures meth s specified in the Wisconsin Admimistrative 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 COMPLETE ON: r-, e~ I I - C ~j ~4') ( - / - 2 y' A MESS: CERTIFICATION NUMBER: PHONE NUMBER optional): -1 L,.-.g L r, ..I! a-) CST NA UR : O 66DISTRA J^jA: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. _ (N. 0 3/81) 1) DEPARTMENT OF MPUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABbF1 & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL ❑ALTERNATIVE State Plan LD. Nlrmtw: pr aaiotndl ❑ Holding Tank ❑ In-Ground Pressure ED Mound NAME F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: ~e') 1;.. S-. n X0.1 '6 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:. REF. PT. ELEV.: ST REF. PT. ELEV.: Name of Plum /MPR WW No.: Cou nitarY mitt NmrlMr: 7 (P SEPTIC TANK/HOLDING TANK: MANUf ACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HI NUMBER OF ROAD: PROPERTY WELL: BUILDING: IVENT TO FR=EH ALARM: FEET FROM LINE:. AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIOUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES. ❑NO ❑YES ❑NO. GALLONS PER CYCLE: vuM AN 017013 OPERATIONAL: NUMBER OF PROPERTY IWELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET. PUMP ON AND OFF) ❑YES ❑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 C NVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES DISTR. PIPE SPACING MATERIAL: PIT JINSIDE OIA *PITS DLIOUID EPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH UISTR I DISTR. PIPE IDISTFI. I A IAL: NO. DISTR. BE OF OPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET ELEV. END: PIPES. FENUMR ET FROM LINE: AIR INLET: ----=~P NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. OIL OVER TEXTURE: PERMANENT MARKE : OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO LCE PTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. 15EEIIED. MULCHED: NT ER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE LL DEPTH AS DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MA EHIAL. NO. DISTR. DIS DI HIBUIION 1 E MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. CIA. ELEV.. PIPES DA: ' DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING 1 ILLEU COHHECI LY COVER MATERIAL VERTICAL LIFT ORRESPONDS TO APPROVED PLANS Y ❑NO ❑YES ❑NO COMMENTS: 7MANENT A OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES -[--)NO ❑ YES ONO NEAREST f Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) 1 i r ~ . z • ~ DEPART,MgNT QF APPLICATION SAFETY & BUILDINGS 106STAY, FOR SANITARY AjL& DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: Qity-ViffaWer Township: C nty: l v t/a i i~Jt/aS iT ' (N/ R f E (or g s (~is7~ Lot Nmb er: Blk No.: Subdivisi n Te: Nearest Roa Lake or Landmark: State Plan I.D. Number: (If assigned) r I JVZ74- /A- TY E OF BUILDIN Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedro s: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM 171C c C)t- 7 >e- PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): /rte New ❑ Replacement ❑ Experimental be-9 Seepage Bed ❑ Seepage Pit C- / ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Nam a 6 Listed on Soil Test Report (If other than present owner): Private 1:1 Joint E] Public i .ucc I, the undersigned, hereby assume responsibility for installation of the rivate sewage system shown on the attached plans. Name of Plumber: Signat 911P/MPRSW No.: Phone Number: r- ? O/s-y~ Plu r';Address- Name of Designer: C 4 COUNTY/DEPARTMENT USE ONLY Signat e f Issuin pwa+. W Fee: Date: y APPROVED Sanitary Permit Number: ❑ DISAPPROVED 31 -7 7 Reason o Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) EH 115 (11-74) .t WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH t • P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: __J/4, Section T-N, R -:E (or) W, Township or Municipality Lot No. , Block No.-, County . , Subdivision Name Owner's Name: ._---.Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONSMADE: SOIL BORINGS PERCOLATION TESTS t SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST 'DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL; INCHE RATE CHARACTER OF SOIL SINCE HOLE HOLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES INAN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 :PERIOD: 3 P- P- , P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH TO BEDROCK IF OBSERVED) NUMBER, INCHES OBSERVED ESTIMATED HIGHEST B' ti 6- PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) F Indicate on the plan the location and square feet of suitable. areas. Indicate number of square feet of ab f needed for building type and occupancy. IndicM sere or distances. Give reference point. Indicate slope. S° t t t; the undersigned, hereby certify that the soilte.reprted oath' made by mein accord with the procedures nvkhRds specified in the Wisconsin Administrative,Cod ecorded and location of test holes are comes y knowledge and belief. raw ~Gl ~ , 4,0 3. ' p r r w OP 4f _ ~v • Y J V ~ _ , MOO J 0 I. d c3 ry I ~c i r n s K ~ 131 .9 r i i \ Oo 4v v D d 0 cl 'o s 3 3 a ~ a o~ 00 tA 0 Q t 3 i 3 v ~ o ~