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Home My WebLink About040-1127-30-200 o NO CD °°'° 0 `0 c v; 0. o o I I o II I I I d II ' I I � I I •� I I A a I I c y E a) cu CL Z CD 0 z Z LL o L LL o E ¢ w E a ` ) a m d 0_ y w iii _ E O `� O = O V O Z d m y y � N w a m a m M F- Z I o I c t7 v I O Z c W- ai z 2 c o aci Z U) P c E E a� v �_ v 0) 2 CO N N N CL 7 cc 'C N CO) CL N y C N O c C O Q Z co Z Z H Z N z O N d N d C W Cl) '' C14 �o E I � R E � N a� Ac w a .. Lo LO 0 3 c d N 3 y N N p o o y G G a ai y r C r e a i4 N N z >° Ii 3 3 3 3 3 E_ o o • �' - aaa aaa v, EL 0 C N o o N rn 0 U) V rn rn } rn rn } O ° ° c o �l o: N o: M CD O O O C In in = C O O Y E N N O O O '� O O 'j y O N U n 00) U v ml y oI y °� Q} 1 o ti d Q} <n m CO 0 00 0 ffi °° N Y C _°- �' C E 0 o C,4 o= 0_ u d o o Oo ? N C C O C O C N_ N N S.r O 3 O y N O C C 10 M p � �'v w �Z w �w �'o"� rnv 00 ;; °� N n m c aI k cB • �S ~ m F`- ti o Z F Ii c o Z g iA a =E I =€ I cc G Z 0 ao to U) U) 1 *� S �BU LT SANITARY SYSTEM REPORT :dER +z y . - L. � �v F_ .F1�5 � , TOWNSHIP 21 Z SEC. T�N, R .0. ADDRESS � - "� , ST. CROIX COUNTY, WISCONSIN. '3DIVISION , LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4 iS . I its' t►�1�;'} Ir,1.p 7,�5 .'TIC TANKS) MFGR. W u s CONCRETE •✓ STEEL NO. of rings on cover / Depth A/ DRY WELL' ?NCHES NO. of width length area J no. of lines z width length area ,depth to t p o pipe I B" n JREGATE / ""f s �Z ::K RATE r — /p AREA REQUIRED AREA AS BUILT 6?'p :claimer: The inspection of this system by St. Croix County does not imply complete / :pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted "the County will make every effort to _ermine cause of failure. BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ` DATED 0 PLUMBER ON JOB , I LICENSE NUMBER -sue z _ , REPORT OF INSPECTION SEWAGE SYSTEM Sani•xaxy Penm.i.t _ Sate Septic NAME a Z ( �� e v C► s e townbh.ip I r 0 CIV S.�. Cxo.ix County •_ Location M. h section SEPTIC TANK • Size a.i.ionb. Number of Compan#menxa_ i 'D.iatanee Fxom: Wett �° it. 12$ on gxeatex a.Lope = Ax Buitd.ing it. Wettand.6 H.ighwatex 'DISPOSAL SYSTEM D.c.a #ance Fxam: WQ.L.L 12$ ox gxeatex 6tope ��. • Bu.i.Cd.ing Z Z � .t. W et.Landd F • Highwatex At. FIELD DIMENSIONS: Width o S trench / � Ax. Depth o j xo ek b e.Low td.te l L- in Length o6 each tine � 5t. Depth os xock oven t.i.ie_n. Humbex- of tin e.6 a Depth of t.i.2e betow gxdde (9 in. To #at..length o j t ine.a Stope o6 txeneh i n pen 100 ix. D" #ance between tined t. Depth to bedxoek � • Totat abe oxbt.ion axea / 4l' 6x2 Depth to gxoundwatex #. •. Requ.ixed axea At Type of Covex: Pa o St. PIT DIMENSIONS: Numbex o6 pit-6 Gnave.L axound p.i� yea no Oufi�.ide d.iame ex Depth 6 e�ow .in �e �• 2 Totat abaoxbt.ion axea 6t a A Area xequixed bt2 r" INS P E C LE PROVED ? ,DATE 19 7 REJECTED ,DATE 197. 1, P 1 67 j' j; i �5 State and County State Permit # / 7 5 7� I Permit Application County Permit # 4�g .c+:. `,• Q - e ri n `Y "��;,r� %� for Private Domestic Sewage Systems County � , *DENOTES STATE APPROVAL REQUIRED Date Approval 'Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailin Address: 144z -L r Y =KE i Eii/ .;-t-V rKK rAMI ei&LIE'591,2,a, 15 B. LOCATION: /Y % .�,4- '/4, Section _1 Tb N, R /'7 ; (or) Lot# City Subdivision Name, nearest wad, ke or lan ark Blk# Village 64. 74Al tA3Z ,t' �i� z� Township /r`zi ,,/ C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms ,5 No. of Persons D• SEPTIC TANK CAPACITY /> 6J() Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement r-- _ Lift Pump Tank or Siphon Chamber Total gallons Prefab co reI�r_Poured-in-Place Other (Specify) /YY E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate —/t' Total Absorb Area 6/5- sq.ft. New Replacement Y' Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width De h Tile depth (top) No. of Trenches Seepage Bed: X. Length S.Z Width /2. Depth Tile depth (top) Sr) "__No. of Lines Seepage Pit: Insid diam er • —Li uid pth No.of Seepage Pits Percent slope of land • f. / 2- /" Distance from critical slope WATER SUPPLY: Private Lj1 Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME / giticpwy C.S.T. # '5— 24/ /..and other information obtained from *It , hp` .dg c, (owner/-b 1dex). Plumber's Signature ,2 P/ # __ -9 Phone # � 9J77' Plumber's Address /B.�` 7 • PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Ft- 4,___ tv./ - c i .'51' K • t fir.i x 3 --- �` lope ,(.72,4.4 ✓ / ' i, , L �f �_. fit Itv.Gc .--_ r'i v.. L --- (N&w) 'Mute 1,1n1 �; VIZ .., ..j..fikt. / ----.2.t.'k 0. Not Write in Space B ow - FOR COUNTY AND STATE DEPARTMENT USE ONLY e of Application % / 0 Fee Paid: State /,5' County ate !, c' it Issued/Rejected ( ate 6 0 Issuing Agent Name I*,24,te ,,�....--, •ction Yes IXo State Valid# Date Rec'd ounty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 . 'ate (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 ev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 • LOCATION:,`✓E•'/4^/ "Y4,Section.3 =,T2(SN,R E (o W, ownship r Municipality T--e-.) Y' Lot No. - , Block No. County 7 G..,C='O/X Subdivision Name Owner's/Buyers Name: -.'"mot' -'G e' F•.c ./�/ , ._r ."-1 Mailing Address: > . T/�•iG, /`.; Ni ( v��. C7J . 'r vim- �Qe Z.-_r tn/ /f_ S UZL TYPE OF OCCUPANCY: Residence, No.of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT x ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS J -7<�- CU PERCOLATION TESTS tic:'-'-' ""' O-'L,,e----iT� SOIL MAP SHEET c.') NAME OF SOIL MAP UNIT - - - U7- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P --Ki /--E 4>L,(T/' /`! T—fT� .hc"Si.� -/" '.e`l7 .U/ . ./.. C.-E- - --f P- C:p_-..•c- �..vr .._r-4.v.v>- Sn/4_ c c .v.d/"TAO A-e , .f=E-e �dl�/L/Ty P- C�-=--- Ty-, ter, i--(_,G-' ' r - -r7 g 10.E -/"> !--e._, ._f":>./l_ P- f`v 4/E / rT ,----r. fo/X r'• t /__ TY . 6.1..1-, -/(-) /+rt i/�✓Z.... P- /=":c/ G. '— ' .z ' 2. rl ltcG..el = . ,c X 4-� -= --- ..' p• L"l r-,� P- 7-, '6 - /"E� c:>2 X_ 4: - , rf"E/----, . .' _may.C.r✓C SOIL BORING TESTS •'<'r'r'y-4f_G- �'f'rN'' dT. 9 _00 TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES ., B-/� 8 '/ 'v v'`1 � 7 � � ,-- t..L - 'i.r O /._ ,-, -5-0-M�c/ r /_ ,-; B- B- a 0 -7. c ' (z_. z_- , -'G —'.c,, 24 ' //., 4i-a •' dr B- ("?',-) ` G i 8-/- ✓✓ so rs u /- L. L z0 �G .rr.-..< . -S / !-.) 'Cre-12' -gymctcl B- c G'.-) " PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy �dS.-= G/S-.Indicate scale or distances Give horizontal and vertical reference points. Indicate slope. -S'SJ �T , 7- -----------_______ __,-„..<-,_, 7 ______ ,, „ 1. , , ____ . ___ ,._ , , I N �-G.E v.0 Tim--v.j— fJ 0 y ' � tit y — ov s 9. -T: _ gam- > o / dam - - Vf I -- k 0 � . r" n 6 ' itii ' e 01 0 U 1 \ I,the undersigend,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 location of test holes are correct to the best of my knowledge and belief. Name (print) ---a-c-)'�E'`/� - <-1,• •,'--> ",' Certification No.�� G47-'¢ ---- Address - ' - -'r1 —7 .'/'/�. '�'Ce-- ---.f - lv.--(7. Name of installer if known .-; c--.. - c, v� Copy A—Local Authority CST •gnature Parcel #: 040 - 1127 -30 -200 12/14/2005 05:07 PAGE 1 OF F 2 2 Alt. Parcel #: 34.28.19.529A -20 040 - TOWN OF TROY current `XI 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 - JOHNSON, DONALD L DONALD L JOHNSON C - LIPE, PAMELA S PAMELA S LIPE 680 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 680 CTY RD MM SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 12.720 Plat: 3798 -CSM 14/3798 SEC 34 T28N R19W NE NE &NE NW SEC 27 T28N Block/Condo Bldg: LOT 1 R19W SW SE BEING LOT 1 CSM 14/3798 ALSO A PAR IN 27.28.19 DESC AS COMM S1/4 COR Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) SEC 27;TH S 89 DEG E 494.48' POB;TH N 02 34- 28N -19W DEG E 183.08 ;TH S 89 DEG E 796.02' TO NLY COR CSM 14/3798;TH S 51 DEG W 289.41 MOT... Notes: Parcel History: Date Doc # Vol /Page Type 07/05/2005 799226 2835/026 WD 03/28/2000 620256 1498/316 WD 07/23/1997 1008/346 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 103041 261,700 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.720 108,500 143,400 251,900 NO Totals for 2005: General Property 12.720 108,500 143,400 251,900 Woodland 0.000 0 Totals for 2004: General Property 12.720 108,500 143,400 251,900 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M 142 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 T otal 0.00 Parcel M 040 - 1127 -30 -200 12/14/2005 E 2 0 F PAGE2 2 2 Legal Description: cont. FT;TH N 89 DEG W 576.64'POB EZ -UT- 1505/77 9 G® 10 61'7463 LO A - 5 20M ST. CROIX COUNTY co\� SURVEYOR'S w� CERTIFIED SURVEY MAP Philip J. and Patricia Feyereisen Located in the Southwest 1/4 of the Southeast 1/4 of Section 27 and in the Northeast 1/4 of the Northeast 1/4 and the Northwest 1/4 of the Northeast 1/4 of Section 34, all in T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin This parcel is be created for purposes of farmland consolidation OWNER'S ADDRES4 .. ................ W , 201 Villa6e Drive Georgetown, Texas 78628 West Line SEl /4 -SE //4 Sec. 27 UNPLATTED LANDS \ (East Line SWt 14- SE //4 Sec. Zr) f % Ilk ��O ti , South Line SE/ /4 Section 27 i� u �' -- 1566.12 7 -- — ' 1 6 19 1 41 ° £ . 1071. /2 s' I \< . k CO,pNER SEC. A7 �Nor1h,L'i!)eNE //4 Section 34 ( �6, �Ra \ S y lNf CORNER SM54) �G ---S89 f 2637.24 -- -� i S `r 6g0 \�N a.- hNrsEN ALUM /NUM SOUTH 114 CORNER SEC. 2? \Z 6 C� ?/ • MONUMENT! (NORTH 114 CORNER SEC. 341 T2eN, R 19W �(' SHED f &ERNMN ALUM /NUN M0N.1 \p� o L O T I SHED( _ 35 -- N SHED • SHED pO 1 W a1 0 DRIVE �Y obi u DAR. O . \a ° QC O L WON LineNE / /4 -NE l /.4Sec.34 1N (East L /ne NW l/4 - NE 414 Sec.34) 1 2� Scale in .Feet I " - - 200' / 0. 6 ' 050 /00 200 400 Beorings ore referenced to fhe North QVPf line of the NE //4 Of Sect{on,j4, assumed bearing 589 ° 19 4t E. J Dated: August 16, 1999 Revised: November 9,1999 1- 4FeQVD APPROVED Revised: Januory 19 ,2-000 ST. CROIX COUNTY INDICATES / "x 24�� IRON PIP£ SET Planning Zoning and Parks Co ,r��Nft ST. CROIX COUNTY ZONING DEPARTMENT i\ AS BUILT SANITARY REPORT d('f Owner f z -P U. r/4,, Address i''t � City /Stat cMiN„j^�n, j \ CbC�10- i3 Legal Description: Lot 0_ Block Subdivision/CSM # - - -- '/, '/, .LZJL, Sec. T 2 4- N -R-d Town of i PIN # 7 - , 1 "1 .52�1'/� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 4' Size ST/PC / Setback from: House a /'6- "Well 'P/L /e- Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM 2 , Type of system: f" --, ,4 x s Width 3 ' Length ° Number of Trenches Setback from: House - Well I PAL 7 " Vent to fresh air intake /o ELEVATIONS Description of benchmark To r% x 6./r °/ Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet �� 58 ST Outlet XJ , G / PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines (I) 7 � (� >) b' (�) ' y 87- Z 7 Bottom of System (/) �'7 r 3r () 60 4d "£' / Final Grade Q) q1, ; 1, (�) r 5 Y 5 ? S Date of installation / �/ermit number 3, 7 7zlV State plan number Plumber's signature /; r j License number J r'1' ItL �,e� Date 5 / Inspector �nf complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW • — le/ .,j1v4A � e MIME — 10 cRwi o; ..._ 0 1 \ J� ¶ Ctin.talr_ � I \ 1—[ I cl,u"l�,s o I Tietibc .. _...0_I 7' INDICATE NORTH ARROW 'pnsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3P(g"Tt: Personal in you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. ft ��r;1 ft , e ' PHILLIP [+f4 f7 Village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 1010 -�1127- 30 I oc-�' I 1 0 1 - 4 TANK INFORMATION ELE ATION DATA A9800129 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ept� �/cc. K 12v o Bench 7 " oD,s c�c7 Dosing a 0A g 3/ /o0 7 Aeration - Bldg. Sewer n,l Holding i/ !g Inlet jpD."t3 TANK SETBACK INFORMATION C & Outlet 100• 101 +►,' oaL 90,E TANK TO P/ L WELL BLDG. A;r� I nta ROAD Dt Inlet eptic 38 -7 Z p Z q' NA Dt Bottom h Dosing NA Header / Man. Aeration < NA Dist. Pipe Holding Bot. SystemTti !00 - 13 641 s PUMP/ SIPHON INFORMATION Final Grade 1 1 1• 73 IA& Manufacturer mand >3,t s, a,�• i 2 0f mss. Model Number GPM T3 (OV i?9 � +i- 4 B* T Friction S st TDH Ft I� ?7 � rt l60• i� o,. l&. Forc main Length ia. Dist.Towell pb�lo ovw tub. 92,,o12 SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Tr ches PIT No. Of Pit ia. Liquid Depth DIMENSIONS 3 S `• DIMEN I IN SYSTEM TO P / L BLDG I WELL LAKE / STREAM L ACHING Manufacturer: SETBACK C MBER INFORMATION Type Of Model Nu er: System• Q °IC) OR U DISTRIBUTION SYSTEM 4-CL Header / Mani old l �t Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length sir Spacing (o 2_ 1p Ov SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed / TrencVEdges Topsoi r Ves COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 34.28.19.529A,NE,NE 640 CTY RD MM C:r Plan revision requlre ? ❑ Yes W No �� Use other side for additional information. U1 SBD -6710 (R.3/97) Date UWspectorYS ignature . No. I Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. Visconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County S j (, i than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number '30 7 ry The information you provide may be used by other government agency programs E] Check if revision to previouBrap plication (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property ner Name P � p } oca ti 7/� / / lv� !�/g S T , Xt , N, R 1 (or Property Ownerl Mailing A ress �� Lot Number Block Num4e�r 690 &4 Cit State / / ` Zip ode Phone Number SubdivisionNamee or SM Number tiler II. TYPE BUILDING: (check one) ❑State Owned ❑ lt� Nearest Road ❑VII age G! Alm Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 ❑ New 2. ;? Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System - - Tank Only ---- - -- - - -- Existing System - -------- - Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. S stem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) T1 167.5 r9 94,4 l Elevation l2 7� Feet Feet VII. TANK Capacity Site in g allons Total # of r N Prefab. Fiber- Plastic Ap f p - INFORMATION g Gallons Tanks manufacturer' ame Concrete Con- Steel glass APP New l Existing structed Tanks Tanks e tic T Ing Tank Q0 �� !S �i, >Q ❑ ❑ 11 ❑ Lift Pump Tank /Siphon Chamber I ❑ I [I El 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name: (Print) Plumber's Signature: N tamps) MP/MP SW No.: Business Phone Number: 7l .:� 77/Z — �i Plumb 's Ac dress (Street, City, State, Zip Co a :,' awl Igo IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (InciudesGroundwater ate slue Issui, Agent Signature (No Stamps) pp ❑ Surcharge Fee) qtsm roved Owner Given Initial �. �U I v fv Adverse Determination C) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 IRA 1/96) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber JOB v �� l�itJ /- �!s (/ 1 Ae /I TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY 'r?✓ 70 Al DATE (715) 772 -3214 (715) 386 -5443 DATE MPRS #3224 WI MPCA #696 MN CHECKED BY SCALE-, yd / ;... ....... .......... .... ..'... ...' :....................... . ................ ... N 1 ... ........ ...: ..... .... ..:.. . . ..:. TL 5r>' �4.7a ., .. ....... .... ....... .. ...... 3 S� 1j .. .... 86.- 5 .....:.......... ... fd --. �Q... J` ... ..... ... ... .. irli"rn ..... ; ... ... .. f . :..... . :... .. �r ..... ... .. s . .... .... ..... _... - - - .... ,. PRODUCT 205-1 � Inc., Orolon, Mass , 01471. To Order PHONE TOLL FREE I- M225 -M JOB �I1 —Z e titer i SQ n TIMM EXCAVATING Route L BOX 192 SHEET NO. 2 OF WILSON, WISCONSIN 54027 CALCULATED BY �Lti DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .. .... .... : ........ .... .. .. .. ... ..... ........... .... .... .. ..... .. .. .. .. ........... ............. .................... c .,� .... . . .... . <- ................. .......... .............. �,e h .. ........ .. 9 t . ?� 'l ... 3 ' 3 _ . PRODUCT 205 -1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1- 800 -225-M Wisccjnsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Oivision of Safety and Buildings ith Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not I c 'in size. Plan must County include, but not limited to: vertical and horizontal ref BM), direction and St. Cro percent slope, scale or dimemsions, north ann a d� i car) tance to nearest road. - - - - / Parcel I.D.# 040-1127-30 APPLICANT INFORMATION - #'�� rin t a mfo1 Reviewed B Date Personal information you provide may be use ndaryMw vary 15.04 (1) (m)). y I - - - - -- - - -- - -- L -- - _ . . Property Owner V 5 , qoperty Location Feyereisen, Phillip - J' I + � vt. L NE 1/4 NE 1/4 S 34 T 28 N,R 19 W °- -- - - - - -- -- - - -- - - - -- --------- - Property Owner's Mailing Address ST , ,t•iQlk t # Block # Subd. Name or CSM# 680 CTHW MM Ot, sdTY �_ -- City tate -z tiff \ City Village XTown Nearest Road Ri ver Falls WI 5 15 -425 -7 Troy I CTHW MM New Construction Use: Residen o bedrooms 3 ;Addition to existing building Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate -5 bed, gpolftZ .6 trench, gpolft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate -5 bed, gpolftZ •6 t rench, gpolft Recommended infiltration surface elevation(s) 87.9/86.9/86.2/85.8 ft (as referred to site plan benchmar install 4 - 5' wide trenches totalling 250 running feet; 4' below nominal contour to sys elevation Additional design / site considerations - - -- -- - -- - - - - - -- Parent material sands _ _ _ Flood plain elevation, if applicable ft I S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U=Unsuitable for system ;� U; S U ;x; S U : S U U U 501[ IJESCK Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench 1 1 0 -4 l OYR 2/2 - sl 2 m cr dsh cs 2f /m .5 .6 2 4 -20 l OYR 2/2 - sl 3 m sbk dsh cs IM .5 .6 Ground 3 20 -28 7.5YR 3/2 - sil 2 m abk mvfr gs if .5 .6 elev - - - -- - -- - -- -- - 91.6 ft 4 28 -54 10YR 3/4 - sit 2 m abk mvfr cw if .5 .6 Depth to 5 54 -65 l OYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 _ - - - - - -- - -- -- - - -- limiting 6 65 -69 1OYR 4/6 - Is 0 sg ml cs if .7 .8 factor 1 "__ 7 69 -75 l OYR 4 /4 - sl 0m mfi cs - .3 .4 L.- i -6- t Remarks: 8. 75 -104" 10YR 4/6 s (0, sg, ml) 0.7 & 0.8 gpd /sq ft; 9. 104 -114" 10YR 4 /4 sl (0, m, mfi) 0.3 & 0.4 gpd /sq 11; occasional SS gr 2 1 0 -6 10YR 2/2 - sl 2 m cr dsh cs 2171 nn .5 .6 2 6 -25 l OYR 2/2 - sl 3 m sbk dsh gs if .5 .6 Ground 3 25 -42 7.5YR 3%2 - sl 2 m abk mvfr gs If .5 .6 elev 88.7 ft 4 42 -64 10YR 4/4 - sl 2 m sbk mvfr cw if .5 .6 Depth to 5 64 -85 10YR 4/6 - Is 0 sg ml cs - .7 .8 limiting 6 85 -90 l OYR 4/4 - sl 0 m mfi - - .3 .4 factor -- - -. - -- -- > 90" Remarks: horizon ' 5 has very occasional inclusions 2.5Y 7/47s, horizon 6 is somewhat tight w/ occas SS gr but clean of mots CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 665 - 2681 nap p, -- - = - - - - -- Address -- Date CST Number Ref # 5/27/97 222774 138 PROPERTY OWNER: Feyereisen,Phillip SOIL DESCRIPTION REPORT [1 Page 2_of_,3 . PARCEL I.D.# 040-1127-30 • , Horizon Depth Dominant Color Mottles Texture Structure GPDIft2 Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed I Trench 3 I 0-4 10YR 2/2 - sl 2 m cr dsh cs 2f/m .5 .6 2 4-25 10YR 2/2 - sl 3 m sbk dsh gs 1 m .5 .6 Ground 3 25-33 1OYR 3/4 - sl 2 m abk mvfr gs If .5 .6 elev _ _ 90.0 ft 4 33-58 10YR 4/4 - sl 2 m sbk mvfr gs i m .5 .6 Depth to 5 58-82 10YR 4/6 - Is 0 sg ml cs - .7 1 .8 limiting — — — . factor 6 82-86 10YR 4/6 - Is 0 sg ml cs - .7 .8 86 7 86-89 10YR 4/6 - Is 0 m mfi - - NP NP Remarks: horizon 5 has occasional 10YR 4/4 sl inclusions;horizon 6 is tight in places w/some SS gr;horizon 7 is effective BR due to resance to penetration Ground elev _ — — — — Depth to limiting 1 factor Remarks: _ +tGround -- — — — — — elev Depth to limiting — • --factor Remarks: -- I- . Ground elev 4_. + i I Depth to limiting factor Remarks: -- 3 ! N r^ I IDO LA 7 -b � 3 � to A 0 Iv �� 9 ° ✓ O i t ZO ffi c , +- cr 0, 0 * .A .� 1151�� a f o J STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERJBUYER l c,t7 MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE ,0 �v PROPERTY LOCATION /vZ 1/4, /1/ 1/4, Section 3 , T 02 9 N - R /5; _ W TOWN OF V ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP 4 ,VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and retumed to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 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 t _ Location of property_ E 1/4 ail 1/4, Section 3�l ,T N -R /s _ W Township � M / ai1ing address y � elf �d / /pj 5 V z Z Address of site Subdivision name Lot no. yiL Other homes on property? Yes X No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house) ? Yes X No Volume and Page Number J , L�' 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. �f I and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of App 'cant Co- Applicant /d - a-- - X, 7 Date of Signature Date of Siqnature s „qIM .y . = 3 ;'#!'�i+ :: �i "+ 3` "9w:•ir.. ..+t°. ." -•.. a. ..s ,. _ i - VOL iOW- 346 DOCUMENT NO. $TAT$ $Alt OF WISCONSIN TOiM 3—IM TTMe 10 �w ran MTA Over CLAW Din 49, - REGIfSTE s OFFICE Philip J. Feyereisen and Patricia Feyereisen, Seem " ............ .. ........ - -- ............................. .hug sl MAfe.. s - tenants $n eQlw�on, an .� _ i M�d forhmd div#?!__oue Z}alf interestn each MAY12 M gait�elaims to $�}�lip J _,Feyereisen and Patricia ..__._ g:3Q A. I reY_er e v sise_. � • _husband and rife holdfng as d M ... .............. surorsh j . _marital property :� ........ ................ . .. ....................................... ... �d the foRo.ins Aocribed raft ..eat. is t . Q .............. C - wt. state of WbWomte: m Pared No: YO : 11V - See attached rider for real estate description. ab .._ . _.._. tea- t3� #cyi) - - - -- hea4waad ... .......... _.._. Y..... ._.....--- •------ •- •---- . - - -... ls. Dated . .... . ............. iyr et ....................... Ma 93 ................•---..........--- ........_._................. ..._.. {SEAL) _ :._. .. �--- LT�- �'�ek441:!!- � ........... (S!�►L) • .Ph i J. Feyereisen ............ . ......... ............................. . .. (SRAL) Y•. -Q ' Z .M gg , ) ........ (SEAL) • ............ .. .... • ... -- ...X......... -.. .................... 4os = =l TICATIOX ACZNOWLDDGKXKT ,,�� of Ph J. le ere s�n� sTars OF WUMNSIN is .. ... ... ......_. eama before - this —___ --day ... ... � ......__.. ....... ...... ....,. 7---............. — 19 .... -- the above named _ -- -------------------- ° ----- _--- _-- .--- -- -- -----.---...___•-_._—_-- 4'I?LEt VMS= 8TA?l4 "R fib' WIQNSIN .m .. ...... ........ _ -- ._... ---------- ---------------------------------------- ----- ---- -- at aMR, .._.. .......... — -------------- ---- -••-----_--- aulhor3sed by 1 70&% Wig, %A&) to aw known to be the person ..-- wbo a medal the forctolas instrameut and Wknowle fte the same. TO" INSTRUMENT WAS eMtAMYR© eY 1008 347 Quit Claim Dead from Philip J. leyereisen and Patricia teyereisea, husband and rife as tenants in 000mon, an undivided ova -1t interest each to Philip J. Peyereisen and Patricia Teyesei husband and wife holding as survivorship marital p ' rop.rtY. The s 1/2 Of the NS 114, also a piece of land in the M i # Ni 1/4 'bed as f011 to -vlt: Ccsmanolug at Of said M 114 of the vX 1/4 thence N an the It 1.in* of Section 13 rodst then" S parallel with the N , tre ct Section to center of hi on said 1/4 section kr+c+ai11 lboad of River tells and A else ant so*", thence along cantsq� side am Uly direction until it intersects Section if Ot said 1/4 f4bat thence M to beginning, all of b e ing Section No' 34; also M 1/4 of section Ito. 35, all ja AXD. $ II Y ..+ • ....i .. y.. ft -4 Wjt The East 5/a o! the N 1/2 of the 8E 1 /4i also the s x 114 except a triangular piece in the NZ corner thereof 1 O* the s ad le i n h Road (So-called) running from godson to River sj all beiuq Section 27- 28 -191 excepting part of Sg 2/4.'. 27- 20-19, described as follows: Comsencing at Ss Section 271 thence N on E line Of said SE 1/4, 435.6 feet) N parallel with S line of said Ss 1/4, 500 teed thert�e S . with line of said 22 1/4, ng 435.6 feet( thence E alo #. Bz 1 14, Soo feet to the place of beginn line Of said SE 1/4, 500 teat to the pla �o�. described in the praxis #ens of a land contract be 8e #Tiq , etc. to John P. I[ilbrath, etc. Also oth excepting from the above described real estate the fag p4r.»2 of 1.1 acres located In the NX 1/4 of the NE 114 4t= 34 and the 82 1/4 Of the U 1/4 of Section 27-23- d6scriDed as follows: Beginning at a point an the N 1 Section 34 a distance o! 1000.4 lest N of the HE corgi.. Section 34; thence N6 a distance of 12.0 foett _ g Parallel with said N line a di of 267.0 feet; tlsenemt �► a distance of 154.3 feet, ttlenosG 864 a distance of 170—V- thance N47 along C.T. **-N" a distance of 128.6 feed, N6'12 a distance of 133.7 feet to the point of beginning St. Croix County, Wisconsin.