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040-1131-50-000 (2)
St. Cro ix Co tt n t Planti uta and Zolli lig fVednesdqj,, A it crust 29, 200 at 3:0?:06 All Page 1 qf I Detail Sanitary InformatI011 --- C . omputer #: 040-1131-50-000 Sub/Plat: metes & bounds Section: 35 Parcel #: 35.28-19.545C Lot: TNIRNG: T28N R18W Municipality: Troy, Town of CSIVI: 114 1/4: NW 1/4 NE 1/4 Owner: Sumner, Steve 755 County Road MM River Falls, WI 54022 State Permit: 199863 Issued- 09/30/1993 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Per 0 Installed: 10/14/1993 POWTS Detail: Trench - Seepage Bedrooms: 3 W1 Fund: POWTS Pretreatment: NA Plumber Other Additional Notes Monfty Owed lssuerflq��cto�r As Built $0.00 Jim Thompson Yes Schmitt, Donavin Jim Thompson ff, Yes Scheduled PuLqjp Date Pumped 1st Notification 2nd Notification 3rd Notification 10/14/1996 5/20/2005 04/20/2006 5/20/2008 Owner: Sumner, Steve 755 County Road MM River Falls, WI 54022 State Permit: 128614 Issued: 08/11/1989 POWTS Dispersal: Non -Pressurized In -ground Permit: Reconnection County Permit: 0 Installed: 08/11/1989 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Other Reg ilrements As Built Ptqniber Additional Notes Mon y Owed O Issuertinspector it with '93 replacement. Found file this permit $0.00 Tom Nelson No Heise, Carl original soil report still in active files - will put in Not determined f.f, No archive folder ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET 0 HUDSON, W1 54016 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. 0 Water (VOCfS) $185.00 '9 Septic $25.00 D Water (Nitrate & Bacteria) $35-00 (Visual inspection) Owner: ,4 /vl J #-,C, Address: j-. City & State: Zip Code: .5� ozz-_ Telephone N2: ( ) q 2- 5W - / i Requested by: Address: city & St. zip Code: Telephone W: (_) Property address (Fire N2 & Street) : - - /7,1 0 `7 1 1 _y Town of T_:'_LNf R_ij� I — Location: _�L Parcel ID N Tax ID St. Croix Co., WI. House color: Sk Realty firm: Lock Box comboo Water sample tap location: ----------- TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF IS FO D No rA Is the dwelling currently OCCUPied? Yes 60 If vacant, date last occupied: 1. 11 - - LT I 19 kf�?l / ffYear Septic system installed by: ? a ag D a t e Septic tank last serviced by Previous Owner's Name(s): Have any of the following been observed? I Ili! Ely Slow drainage from houselb Dy Sewage Back-up into dwelling. to round surfacer Dy Sewage discharge gr road ditch or body of water. CC) 13 Dy Slow drainage from the dwelling. Dy Foul odors. 01 other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge* 3 -.,----DATE OWNERS SIGNATURE:- OWNERS DRAWING OF HOUSE & SEP IC SYSTEM LOCATION <I N Cod TO BE COMPLETED BY INSPECTION �AC - Y System design &/or permit on file? Yes 0 Soil series per SCS Soil Survey: sheet Type of soil absoLption system: 5fBlow grd DAt-Grd DMound Approx. size. --- iA DGravity ❑ODose OPressurized Ft,2 DBed []Trench gKryv -Well OBSERVED DEFICIENCIES DHolding Tank DOutfall pipe Septic tank [lot er Ounknown Setbacks: E]House.W []Well_(�e []Prop. lineE Other Dose tank .SetbaW'-. DHouse OWell OProp-0 line Dother OLocking'cove-r OWarning label OPump/Floats- O.Alarm DElec. wiring Soil Absorption Svstem Setbacks:.-OHouse owe 11 Prop. line �(Oother OPondingtT 0,ODischarge: General commens &r V[Ckf ice N INSPECTORS SKETCH of "SYSTEM LOCATION Z--., fl y - / 14 0 a!hspect Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSL 110.1, Carml-cylael lWad Hudson, W-L 5401( (715) 386-4680 July 20, 1993 First National Bank Attn. Mortgage Loan Dept. 104 E. Locust River Falls, WI 54022 To Whom It May Concern: Steve Sumner An inspection of the septic system serving The property located at 755 Co. Hwy. MM, was conducted on July 19, 1993. This inspection was based upon a surface inspection of said 0 system and did not involve any excavating or chemical analysis. Accordingly, there may be hidden defects in the system not discoverable by this inspection* Our records do not date back to the time this system was installed, so it is impossible to determine exactly what the system consists of or how many square feet of drainage area there may be. At the time of the inspection, the septic system appeared to be functioning, but not at full capacity. It was noted that sewage effluent had "overflowed" out of the drywell and onto the ground surface. There was also sewage effluent ponded within the drywell at the time of the inspection, indicating that the system may be approaching failure. Given these factors it is very difficult to estimate the useful life remaining in the system and I cannot guarantee or warrant that this system will continue to function properly in the future. cannot predict how long this system will continue to accept sewage effluent nor how soon the system will fail completely. In an effort to prolong the system's life as long as possible, I recommend that steps be taken to minimize the wastewater flow from the house which enters the system. For example, repair any leaking water fixtures and/or replace them with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there is a full load, use a washing machine with a suds saver feature, etc. I would also recommend that the septic tank be pumped at a minimum of once every three years. Based on page 90 of the S.C.S. soil Survey Manual of St. Croix Co., the size and topography of the property, and field findings of soil conditions in the immediate area, it appears that either a conventional or mound type septic system will be required when replacement of the existing system becomes necessary, depending on the specific soil conditions at the site. Should have any questions or concerns that I can clarify for you, please f eel f ree to contact me at th is of f ice between the hours of 8:00 am.- 5:00 pm-, Monday - Friday. Since ely, mes ompson Assistant Zoning Administrator cc: file UMINERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST* CROIX ZONING REPORT NO#+ 08418/01 ST* CROIX C"TY REPORT DATE*# 8/03/90 MTHOUSE DATE FECEIVED" 8/01/90 HUDSONt W1 54016 ATTN*f THOM46 C4 NELSON 0 2-f - & Sandra 0i 4141ER + f .3e-ve a Sumner Ct"i f% t 0 LOCATION# 7755Ct-yy *5 P% iver FaLts Collform Bacteria ml Nitrate -Nitragent mg/L 4 COLLECTOR: mo Jenkins SMKE OF SAWLE'#' Kii-i-hen faucet .6 COLIFORM& 0 /100 mL INTERPRETATION' BacteriotogicaLlYSAFE f NITRATE-N* 4 ppm Under 10 ppm is safe for human consumPtion. LAB TECHNICIAN# 4 Pam Dane WI Approved Lab Not 19 .0i*\t%DEPEN,0 r. Means "LESS THAN" Detectable Levp.l. Approved by ®R PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIx COUNTY ZONING OFFICE Ste Croix county Courthouse 911 4th Street Hudson, WI 54016 Telephone -- (715) 386b 4580 CroiX county Zoning Office offers the service Of septic The St, ections to Lending Institutions, Realty Firms, and and water insp private individualse jocatt.aAe provide the following inforTnation, enclose appropriate Please p Croix county Zoning office, and raile fee made payable to Ste Testing will be done as along with form to the above addresse soon an possible after fee and form are receivede WATER TESTI NGS... am emewwwwwwo now one �.N= vm__ rWm--FEE : � ZD 0 UV (For nitrates and coliform bacteria) FEE: $175oOO- WATER TESTING (For VOC S) amp am em F E E $25900 SEPTIC SYSTEM INSPECTION- m is properly functioning at time Of (Determines if sYst8 inspection) E - A uk ryl N Property ownerts, name , E k�}�� Property owner's address Section ► T ;�,F 1/4 of the of Legal Description il� Lot Number subdivision Name Town of JER JDCK X ty sign by house? --If Sol list firms Rea color of house EO: G-,�) _ l V-L�gASF. - INCLUDE, IF AT ALL POSSIBLE? A pti,081copy OF PLAT BO`O`Kp WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET* Testing of residential water requires a sample that is fresh* If some time , the water line the home is vacant, and has been so for must be purged by several must before the running the water for se test can be conducted* y times water lines are turned off, or sill WINTER TESTING: Many access to the home necessarye if cocks are turned off, ts, with this this is the caser please make proper arrangements office to ensure time when entry may be gained* Firm or individual requesting services: Telephone Number,. REPORT TO BE SENT TO 3 A closing date Signature f�� .1- , _ pe"aboe 14, September 8, 1998 Mr. Jerry Ginsberg 750 Co. Hwy. M River falls, W1 54002 RE: TON"SERP BUILDING PERMIT Dear Mr. Ginsberg: ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 I have reviewed the building plans that you submitted and the information that we have on file regarding the septic system that serves your existing three -bedroom home. The septic was designed and installed to treat ted from a 3-bedroom home. It is my understanding that you wish to obtain and dispose of the waste genera a building permit for an addition to the house, which is to include adding a fourth bedroom. i As the septic be undersized after the addition is completed, you must complete and submit the enclosed system willwho affidavit attesting that you are aware of this fact and will make this information available to any parties may be interested in purchasing this property in the future. It appears that this system meets current code requirements in all other ways. Accordingly, the only permit needed to proceed with this project is a building permit from the Town of Somerset. We have no objections to this addition being constructed provided that the addition does not encroach upon the required setback separations from the septic system. The addition must be at least 5' from the nearest edge of the septic tank, and at least 25' from the nearest edge of the drainfield. eel free to contact me at his office Should you have any questions or concerns regarding this matter please f between the hours of 8:00 am - 5:00 PM, Monday - Friday. Sincerely, James K. Thompson Assistant Zoning Administrator Cc: File Enc. 4 S G 10 4 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ' ►67V Pele�Ze— A SUBDIVISION % CSMW LOT � SECTION - .' T2A, I--R, w'f Town of T /j7'C) ST . CROIX COUNTY, WIS CONS IN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0� 13 ry r 1 � 9 . ; oiler. r y 11 i nr c- INDICATE NORTH ARROW • elevation -ormat ion can reverse of this -farm Provide setback and elevation ink Provide dimensions ions to center o f se t i_c taiik man1101e 'aver Z � BENCIU-fARK: l_��';�E en'l ALTERNATE B14: SEPTIC TANK / PUMP CHAMBER / HOLDING -TANK INFORMATION Manuf acturer: 4__f77_ A-S Liquid Capacity:- 1.0a Setback from: 1qe_111C)0 House Other P Amr---��u f a c t u r e r Model Size Float seperation Gal_Cyc Alarm i:6. n SOIL ABSORPTION SYSTEM Width: Length -Number of trenches -Ir Distance& Direction to nearest prop. line: 0"-w r, 2 ` Setback f rom: well House__Zl Other ELEVATIONS Building Sewer Z0Lfj-__ �-__ ST Inlet; q ST outlet 2!Z 5" PC inletA/j PC bottom —AA Pump Off . ee"_ Header/Manifold (7�); 7 Bottom of system Existing Grade ago toFinal grade _ M DATE OF INSTALLATION., PLUMBER ON JOB: 'kill e. I Ile LICENSE NUMBER: 3,2 INSPECTOR :- 3/93:jt I LQqAWsTmQkJ�rtTAPcYf ln4u�tty28 9 19 . 545$010f iNAGM`YSTEM Labor and Hulman Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION TANK INFORMATION TANK SETBACK INFORMATION PUMP SIPHON INFORMATION ELEVATION DATA SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengthy No. Of Trenches PIT 'CH] No. Of Pits Inside Dia. Liquid Depth KIC 4, I N DIMENSIONS DIMEN 10' LEACHING Ma-nUfacturer: SYSTEM TO P L BLDG WELL LAKE / STREAM SETBACK 7— CHAMBER Mo6et ber: INFORMATION Type Of k�, UNIT System: DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent To Air Intake e x Hole Spacin� Header 1 Mwf*k#d Distribution Pipe(s) 17? (L Spacing Length Dia. Length Dia ef MS SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Depth Over Depth Over V xx Depth-Ot-, Akbd /Trench Edges 1Bg!rQP- Trench Center -co Topsoil ..xx- S'e6ded /Sodded xx muf�heyd No yes E] No 0 Yes ,6 COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: TROY 35,28-19, 45C,NW,NEICTY* MI 7 Plan revision required? El Yes r.j I Use other side for additional information. f Cert No. SBD-671 0 (R 05/91) Date Inspector's Signature SANITARY'PERMIT APPLICATIONCOUNDILHRIn accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than El 9 q 61 8% x 11 inches in size. Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION A�TJ � api/v 4-le IV W14 "1/4,-S 3 T , Nj R P E for}) PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER NA 11.11.. TYPE OF BUILDING: (Check one) State Owned CITY NEAREST ROAD VILLAGE : ❑ 0 JOWU2L. � = Public A 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) Ij I 1 El Apt/Condo 2 ❑MedicalAssembly Hall 6 Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 El Church/School 8 Mobile Home Park 12 El Service Station/Car Wash %; F-1 I-Intiml/lUintp-I 9 El Office/Factor 13 F❑I Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑0 New 2. EN Replacement 3. El Replacement of 4. El Reconnection of System System Tank Only Existing System B) E] A Sanitary Permit was previously issued. Permit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental 11 El seepage Bed 21 0 Mound 30 El Specify Type 12 Seepage Trench 22 ElIn-Ground 13 N Seepage Pit Pressure 14 El System -In -Fill V11. ABSORPTION SYSTEM INFORMATION: 1 1.GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE GA ABSORPTION So F L i LO S F REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0 4 V11 T CAPACITY Site V11. TANK in gallons Total # of Manufacturer's Name Prefab. Con_ INFORMATION New rxisting Gallons Tanks Concrete structec Tanks I Tanks 5. [:1 Repair of an Existing System Other 41 El Holding Tank 42 0 Pit Privy 43 El Vault Privy 6. SYSTEM ELEV. 7. FINAL GRADE ELEVATION q!Yl .rr Feet 906 Feet Steel Fiber- Plastic Exper. I glass I I App. Septic Tank or Holding Tank ZN I - 1(jC4;I_ / I "_-17 1p—r4= IN, VN I I I Lift Pump Tank/Siphon Chambert.- >1 M V111. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb 4fsspignature: (No Stamps) MeEn`W No.: Business Phone Number: n.1rAfA,,,v.,jL j e-_1710q A4 Ywr i -7m 7- 3, C) - 7j 6*) Mumber's Address (Street, City, State, Zip Code): 7-1?_ b 016FLIJ IX. POUNTY/DEPARTMINT USE ONLY Disapproved )dS itary Permit Fee (includes Groundwater Date Issued issuing A nt Signaftm Approved El owner initial 7 Surcharge Fee) Adverse Determination, X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 0 A sanitary -permit is valid for two (2) years. f Z. Fours r itary permit may be renewed before the expiration dater, and it the �=��e of renew��i ar��, new criteria in the Wisconsin Administrative Code will be applicable. All revisions to this p€ ,rmit rnust be approved by 'he permit issuir-g authority. 4. Changes in ownership or plumber requires a .unitary Permit Tr ansferl/Renewai Form 6391.11 to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(Fs) must be pumped by a I censed- pumper whenever necessary, usually every 2 to 3 years. 6: If you have questions concerning your onsite sewage system, contact your local code administr,itor- or the State of Wisconsin, Safety & Buildings Division, 600-266-3616. To be complete and accurate this sanitary -permit application must include; I. Property owner's name and nailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if ; or 2 Family Dwell ng. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. Vi. Absorption system information. Provide all information requested in #1-7. V11. Tank information. Fill in the capacity of every new and/or existing tank., list the total gallons, numLer of tanks and manufacturer's name. Indicate prefab or site constructed and tank. material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approvai only if tanks , e�:eived experimental product approval from DILHR. vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. IMP, etc.), address and phone number. Plumber must sign application form. lX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 61� x 11 inches rrLlist be subi � ittf-id to the cour ty. The plans must incl���e the follow'ing. A;i plot plan drawn to scale or � th_.,,e �io��j �,� /��� ��-�y�s o� i p� �,�r if +� } i 4 s � � •- s l c'a.4 � L - i " ��i€d 9 i firj : s iq1 ), �i 3�S�s I or�i R r QJIL 4 ter? 49. tanCain' i. �1�E:.s� r r � � � r �v } `o-�#F iwii'ifg'f�,,��qq {r py �- �9 s ` 1 f 9 3 s Sv Y �e s `-'.i. 8 r iL•i- ate• a.m.: si�4 streams 31,,,ci ;akes- pump or siphop tanks, tic trf►.bution b��.xes, x4��� � ��;��',�3"!"`@ ��'� � yst�►x��; ���la�-.:� m�����-��. J Ste. areas- and �he i�. cat -1,3'n i� �Lhe buii ` �g +�.3ef y°1 f-d' L�� he lz o �e-ag l.s?.! �� s'F�-:r..Ly��r�`� ��#ti»�',..�4i,��� �'�� ��r'�. � PO 9 it �' �' 9 ` complete `:;ecifica ions for PLJM )S and controls: dose voju j-!- P,Je"eI A` � �� 'iyj?�er •j � �s f . •y Fdi �. 1 �i i [ l .f S• r i r. 1- 3! d ! z.,..` s.`}, • P Ur y" p performance curve; purnp model and pump manufacturer; D) cross sect ciNn (,J the soH ��bso=� �i���� � �ster�� if p- required by the county; E) soil test data on a 115 form; and F) all siz4ng information. GROUNDWATER SURCHARGE 1 w Psir° Act 4 r0 included the cc-ean,ion of surcharges rges ,flees; or S:,a. n1ur} L .sf ifC regw'ated practices which can effect groundwater. �T h rrtonI� �.`cHe,:I�d through th-esi�. surcharges ale use's fol r-;_tc,, ' le-� �' �s. E ; ,:ij .a- - water contami ndr fion investioatlons and establ ishrnent of SBD-6398 (B.11/88) PLOT' PLAI\1 SCALE c&= sl-f,51-laq /11 Page of 's Oki T 7L 6 0 zy Is k S T CY-1 e s -Av CST Signature ik 1F L IF 13 Date Signed 71-5 m005 7 6 Telephone No. CST # • "41sconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of tabor and lAunian Relations Dlvisjo,n of Safety & Buildings in accord with [LTIR 83.05, WIS. AdIT1. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, bUt 7 1 X not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. CD Ll 0 APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY ®ATE PROPERTY OWNER: PROPERTY LOCATION TAEc 1 1--f 'SY 1� p 01) GOVT. LOT LA.) 1/4 K) t:_� 1/41S __-_�S T AR I '� E (o PROPERTY OWNER'.-S MAILING ADDRESS LOT # BLOCK # SUBD_ NAME OR GSM # C� li-S 0 YN J CITY, STATE ZIP CODE PHONE NUMBER EICITY [-]VILLAGE MTOWN NEAREST ROAD -�� 3 01V" S 6 (61Z)169. ❑1-f I -It New Construction Use Residential / Number of bedrooms Add1tiQ9 to existing building Replacement Public or commercial describe Code derived daily flow gpd Recommended design loading rate cs • bed, gpd/ft2 ® - 5 trench, gpd/ft2 Absorption area required \\ZS_bed, ft2 qD0 trenchft2 Maximum design loading rate 0 • bed, gpd/ft2. c)- S trench, gpd/ft2 Recommended infiltraluion surface eleva-tion(s) 4. s 3 ft (as referred to site plan benchmark) Additional design / site wnsiderations Parent material Flood plain elevation, if applicable 1%-,) - ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT - GRADE ---- SYSTEM IN FILL HOLDING TANK U = Unsuitable for astem S o U os OU S El U MS EIU WS El U El S MU SOIL DESCRIPTION REPORT Boring # Ground elev. 8, 18 ft. Depth to limiting factor 7 cy -L Boring # Ground elev. 01 -) - 3 ft. Depth to limiting factor 7 1� �: Horizon Depth in. Dominant Color M unsell Mottles Qu. Sz. Cont, Color Texture Structure Gr. Sz. Sh. Consistence BounJay Roots GPD/ft2 --- Bed Tterch F 1 0 _1 b �,b �. �Z z l i. -- S i _ Z _3JL — 1.0-S 3 36-�Z 1.0 `t �i. Wy Y/Y 'T S \ Q- Sbk Yn U 0-S o -2 SS�� C' Remarks: I 113-�11 I I '-IV- -31Co 14 J,47--nj Wy s i V �-`' h �` c %j c-s 5 Remarks: CST Name --Please Print Phone: A,4Arthur L. We ever 7 15 —4 2 5 —016 5 dreSS: T�egerer Soil Testing & Design Service P.O. Box 74 River Falls,WI 54022 Signature'. Date. CST Number. C/ M00576 PROPERTYOWNER_ �SOIL DESCRIPTION REPORT PARCEL I.D,# Qv 6— 7D P age of R r Boring # Ground elev, Depth to limiting factor n t'\ ►► Boring # s-: 4%:tit;.; ;.; •.�.}'::`�: Ground elev. ft. Depth to limiting factor Boring # a Ground elev, f t. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting fatter Horizon Depth in. Dominant Color Munsell Motues Qu. Sz. Cont Color Texture Structure Cr. Sz. Sh. Consistence Bou �Y R Roots G P Dlft Bed Tree & S,t Z` S b 0 -3 L S ez. S o. L 6,5 Remarks: Remarks: Remarks:. r-�er��arres: _ SBD-8330(R.05l92) AC -f' j) spec T101V 0 ,26 Af-popoveo 6er S -X,5 Tezwl 9% 6' S'-f�rom le -,3 vla is -Z' vk eoca y I QYZ" op CN �-Nf{ C) I TN. L-jutl'N lvC/0' es r5ot?: Y3 r3c)MIC-Ai5-c T 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 igtt;uance. Should this S N LAN D S, Y I NG-'- HUDSON s WISCONSIN 54016 (715) 386--2007 Nome River Valley Abstract & Title Inc. Address 220 Locust St. Hudson, WI 5401E Description Part of the NW 4h—af_Section 35-28-19, St.. Croix County, wiscons . 4 C89-1 Steve W. and Sandra A. Summer PLAT DRAWING N Thir�, is not,- .,.a complete -Land: Survey W t S Hous 4 � QRaII 1 THIS gpwCe RE5ERvL7 ro# RT�CflR04FIG DATA ti�ENT No. LTAL BAR of wlsca�5a��fl ` Docu WARRANTY rRE ' 5033-47�,,__ r TER'S OFFICE ---- iAl c'd fOr ReCord f Steve ---- --' fir --and_ ------- ` This Deed, made between __... _._..__. " f e-----------------------------G 3 1993 _-- -- -- __. --- - -- --- -------------------------- --- Grantor,0 P , -------------------- ---- - _ -- --.-----------_-------------------------------------, - - M Gerald_ B . __isnsb erg-------------- ------ - __ _-----------rr o� r. eeft and...------ ----------------------------------------------------------------_-4-_-------------- ..__---------------------- • __...--__..._.__ .------------- ---_-___------------------------ Grantee, i ------------------ a valuable consideration_-__-- --------- 77 W1tnesseth, That the said Grantor, for o �. a:r S. _ -_� .. _ -- - - - -"- TURN 1. ST I'a Thousand __��70-s-��Q---(}_��_ - R Sieveln.ty_ - 5t�---Cr01X_------- BOX 166 conveys to Grantee the following described real estate in RIVER FALLS, ',NISCONSIN 54022 - County, State of Wisconsin: t ,�f the North lQ acres of the Tax gRrcel No: _____ --------------------------- A,11 that par of Section Thirty- Northeast Quarter " (NEl/4) Wei �ht (25) N ;rth, •n art of five (35), Township Twenty � lying Westerly of highway and being of Range Nineteen (19) West* y '� Northeast Quarter (NWl/ 4 of NE 1 Range $ carter of the Nor the Northwest Q " Township Twenty --eight (28) North, y cLaughlin Section Thirty-five (35)9 Town P arts conveyed to James B. and Ruby Nineteen (19) West, EXCFPT p 2{09. in Volume 4, page 2b a e 364, and in Volume 450, page ' � ��� i ti`•f� h�_r 4j i property d teap. [� This--------�-�--------------- homes Y appurtenances thereunto belonging; Together with all and singular the hereditamenta and apg h3,1.aband--and._ wi.f e...---------- . TogtlA1n"r e- - and. _ .a _d . • - 4 nd-_.__5te�-a__'}__-- fee simple and free and clear of encumbrances except Basemen , A indefeasible 1n 1 t warrants that the title is good, v^tiCans and restrictions of record; reser and will wJU arrant and defend the same. -'- • - .._._ 1993__-. Dated this --------------a _--------- ._. (SEAL} ----- --- --- - - ------------------- (SEAL) -- -- - --- ------------------ W , Sumner --------- Steve --- -- ------------- ...__ .-__. - ------ ----------------- -- - , ------ �►) ; -------------- - - (SEAL) Sandra -- A-.-- Sumner ------------------- E *-------. i� ---------------------------------------------------------------- ACV,lgOWLRDGMENT t _ STATE OF WISCONSIN ature(s)---------------------------------------------- 'Pierce -County. ----------------------------------------- ----- —----------------------------- me this _ ._---day of -----------•--- ._._._.__---------- Personally came before �3_ .da of___________________________ la------ -----------------.., I9_.___ ,the above named authenticated th18 _ _ _ _ _ y { _------ and. S andr a__ A:.._---- .---____ - teve 5ug'r------- ---------------- --------- =--------- -------------- _- ---- husband and wife s--------------------------- -- F WISC(3---------------------- ---- , STATE BAR O-------------.--_-•- ti TITLE: MEMBER S -----_._.._-_. , -----------------------------.__.----- executed the ------------------- who ------------------ to be the person $_-_- (If not, __..------- 7O6.D�B,-Wis•_ Stats.) to me known ------- authorized by foregoing instrument and acknowledge the same• THIS INg7RUh�ENT WAS ORAFTEU BY _-N -.� -- _._ -- me at La--- ie C , Mvelte __------------- har_:._.Wh s __�! t0---- _ -- -............------- - ---St . Croix -----"__Count �4i River Falls ,.__WI----- - 4 -- - -----------------------------Notary Cmrnissian VV - ma be authenticated or acknowledged. Both -xxx.------- ---- (Signatures Y )W.. _- exp it a s-_-0 4 1 a ---- are not necessary.} - Y d Wcoxvin ���--- — w their signatures. *cam E "� croons signing in any capacity should be tYPe'1 �r Printed below +Na►rnee of F f1 W15CON5['-'t Wisconsin Legal Blank Co. Inc - STATE BAR R Milwaukee. Wis. WAIMANTY ]DEED FORM No. V'lIsconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Co/ision'of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY -OWNER: PROPERTY OWNER':S MAILING ADDRESS — - t� % � K � I S CITY, STATE ZIP CODE PHONE NUMBER y to Page I of COUNTY 1 X -5, PARCEL I.D. # 1 0 Li 0 REVIEWED BY DATE PROPERTY LOCATION GOUT.LOTKl�1/4$S-SST INIR ° E (or�W LOT # BLOCK # SUBD. NAME OR CSM # [:]CITY []VILLAGE OTOWN NEAREST ROAD -T-XZQN1--f New Construction Use PQ Residential / Number of bedrooms j AdditiQ9 to existing building Replacement [ ] Public or commercial describe Code derived daily flow SO gpd Recommended design loading rate_ cs 0 V _bed, gpd/ft2 0 _trench, 9pd/ft2 Absorption area required \\Z S _ bed, ft2 Ll 00 trench, ft2 Maximum design loading rate 0 - q bed, gpd/ft2 c-)- S trench, gpd/ft2 Recommended infiltration surface elevation(s) Cly 14. S 3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material 'Si-L-r (-,)Lkm *n%-t, oQvsr( T %a Wj Flood plain elevation, if applicable ft LS Suitable or system U Suitable for syste CONVENTIONAL S o U MOUND IN -GROUND PRESSURE AT -GRADE 0 S o U � S 0 U MS Elu SYSTEM IN FILL 121 S El U HOLDING TANK 1:1 S OU SOIL DESCRIPTION REPORT Boring # iHorizon Depth in. Dominant Color Munsell Mottles Texture Qu. Sz. Cont. Color Structure Gr. Sz. Sh. Consistence Bwxlay Roots GPD/ft2 ...... Bed Tmr& -z St L 0-S LS 0 Ground I-Z- Y/Y Cy.•S 0 elev. ft. C3 '-y Ct Y/y Ls . Depth to limiting factor Remarks: Boring # L o Kx ................... Air .J " + Lr... V R' '"- 1 L. 1!( • r i "" CN Ground elev. ft. Yh U Depth to V limiting factor -7 -10 Remarks: c1c CST Name: —Please Print Phone: � ~•. ,.r4..-; "4,{ Arthur L. Wegerer 7 A,4dress- V.eg�rer Soil Testing & Design Service-P.O., Box 74 River Falls V_I_ 5_4r 22 Signature: 00 Date- CST Number:0 5 76 PROPERTY OWNER SU�yV� SOIL DESCRIPTION REPORT Page I?0f all PARCEL I.D.# Boring # Horizon: {.•:es.� titi::•:$::`:•: —71-3L r:Ly .w Ground elev. Clt' o ft.M Uik CS 5 Depth to limiting factor Remarks: Boring # L :S.Li4 S�ti'�:•:.`�.S �t .•titi y L...1-.111-11.... 1 Ground elev. ft. Depth to limiting factor r Remarks: Boring # 1 } q OSi: 1 1 ���:yti ytirr.'r SY?:S! i i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground i r elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) Depth in. Dominant Color Munsell Motde� Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bo � Roots � P Dlft Bed e Trench 3 3 �-S❑ � � `� �. 3/ � �- S � �, �- 5�1z vv� V `�- � S — 6 • �1 0.5 J PLOT PLAN 'Page -:5 of a SCALE 1"-C7 �'-� OF s'-Y 5 I -Om �A w Wit. L x -Z uXj O' --,.. l t� F- t` i 1 I$ CL 8 L1 t r �uu� OX3ST. k" :" r t3 . LT3 LIB 4 V � Q� VL 9 On.--� c3. � :! 01 r C 3i) a �.- � �= ► S Lop L-A l��b G- PI P� $ L_ ! �� 5' M-L. L O CST Signature Date Signed q3_ )s9 � 715 425-01n5 M00576 Telephone No. CST # Wisconsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATIOO N REPRT Page i of Divislbn of Safety & Buildings in accord with ILHR 83-05, Wis. Adm. Code COUNTY 'S 7 � I X Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but COU NTY'S T-- not limited to vertical and horizontal reference point (BIVI), direction and % of slope, scale or PARCEL I.D. # Ll dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION FREVIEWED -BY DATE PROPERTY -OWNER: PROPERTY PROPERTY LOCATION GOVT. LOT L-J 1/4 M e 1/4 T N R PS E 0"i PROPERTY OWNER':S MAILING ADDRESS [G LOT LOT # BLOCK # ---- SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER , S 6 Z-*-� Z (611) -7 6 9 (mo V L ❑E]CrTY EIVILLAGE @TOWN NEAREST ROAD New Construction Use Residential f Number of bedrooms - AddifiQ9 to existing building L�j Replacement Public or commercial describe Code derived d* flow 'A SD gpd — IV Recommended design loading rate cs. bed, gpd/ft2 0 - 5 _trench, gpd/ft' Absorption area required \1Z S _ bed, ft2 cj Do trench, ft2 �.�bed' gpd/ft2 c>, S trenGh, gpdVft2 MaAmum design loading rate 0 - — Recommended infiltration Surface elevation(s) cy q. S som fit has referred to Site ben plan chmark) AdcUtional design / site Considerations Parent material St. L-r c.NLAM -n Flood Pain elevation, ff applicable —M -A ft S = Suitable for system U = Unsuitable fbr system CONVENTIONAL Q S ou MOUND ZS EIU ROUND PRESSURE IN S El U AT -GRADE S [I U SYSTEM IN FILL 0 HOLDING TANK S Ells 1:1 S ou SOIL DESCRIPTION REPORT Bonin g # Horizon Depth Dominant Color Mottles in. Munsell QU. Sz. Cont Color Structure Texture ctu re Gr. Sz. Sh. COrMiSt(Me Bailby Roots G P D/ft2 il S1 S" Bed S tl� 0-S Ground L-�- Y/Y elev. L S Fim © - Q. Depth to limiting factor 4 Remarks: Boring # $A. -S Ground �. -u Ll *3 S i e-5 1ry V.. — . S elev. � �- fit. �'' — s a U Olt . s Depth to limiting factor -7 Remarks: CST Name: --Please Print Arthur L. WeRerer Plhone. 7 15 —4 2 5 —016 5 egerer Soil Testing & Design Service-P.O. Box 74 River Falls WI 54022 Signature:Date: . I CST Number- S? CI-2) M00576 PROPERTY Sv rV SOIL DESCRIPTION REPORT 4 Pageof. PARCEL I.D. Boring # Mottles Texture Qu. Sez. Cont. Color Structure Gr. S z. Sh . Consistence Boundary G P Deft 2 Roots Bed Try Horizon Dept h in. Dominant Color Munsell L y"; to vi -3 L Li iz- 3/ `� 5 � � �- S�D1Z v,n U `�h � S � a • �1 0 . S Ground elev, n ft. L j 50 90 1 � R- � u Depth to 1 limiting 1 1 factor '• Remarks: Boring # 1 1 yi4y i Ground 1 1 elev. Depth to ' limiting 1 1 factor . Remarks: Boring # ff� i 1 y . y� L+ L.;1• i Ground elev. ft. Depth to limiting factor 1 Remarks: Boring # I L •.1•.tiY:•.i: J.: 1 i L Ground 1 elev. ft. Depth to limiting factor Remarks: 5BD-8330(R.05192) P_LOT PLAN Page --5of 2) a SCALE I It= 4 4q0- �3 CST Signature 'Date signed 93_ )S9 715, 42-5 - MOO 57 6 Telephone No. CST # St. Croix CountPlanning and ZaninYTuesdtq, December 20, 2005 at 12:40:58 PM Detail Sanitary Information Page I of I Computer 040-1131-50-000 Sub/Plat: metes & bounds Section: 35 Parcel #: 35.28.19.545C Lot: TN/RNG: T28N R18W Municipality: Troy, Town of CSM: 114 1/4: NW 1/4 NE 1/4 Owner: Sumner, Steve 755 Cty. Rd. IVIM River Falls, WI 54022 State Permit: 128614 Issued: 08/11/1989 POWTS Dispersal: Non -Pressurized In -ground Permit: Reconnection County Permit: 0 Installed: 08/11/1989 POWTS Detail: Bed- Seepage Bedrooms: 3 Wl Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Not determined No Heise, Carl Signed Off: No Maintenance Scheduled Pump Date Pumped 1 st Notification 8/11/2006 Other Requirements Additional Notes Money Owed check for original permit - this likely not inspected $0.00 but check archive permit file and attach notecard 2nd Notification 3rd Notification Parcel #: 040-1131-50-000 12/20/2005 12:37 PM PAGE 1 OF 1 Alt. Parcel #: 35-28-19.545C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-owner 0 - GINSBERG, GERALD B GERALD B GINSBERG C - SMITH DEBRA ANN SMITH DEBRA ANN 755 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 755 CTY RD MM SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: SEC 35 T28N R19W.92 AC IN NW NE COM 539.9 FT S OF N11/4 COR; S 38 DEG E 500 FT ON CL OF HWY TO POB:S 38 DEG E 200 FT, S 51 DEG W 200 FT, N 38 DEG W 200 FT TH N 51 DEG E 200 FT TO POB INCLUDES P545E Notes: 2.920 I Plat: N/A -NOT AVAILABLE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 35-28N-1 9W Parcel History: Date Doc # Vol/Page Type 01/04/1999 594974 1392/344 QC 07/23/1997 1025/512 WD 07/23/1997 756/63 07/23/1997 710/141 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 103076 2879600 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL GI 2.920 70,000 206,800 276,800 NO Totals for 2005: General Property 2.920 70,000 206,800 276,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.920 70,000 206,800 276,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENZ OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR 4 HUMAN RELATIONS DIVISION P.O. BOX'*7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION ;� " S ln11 "2 8, 1 9W RECONNECTION EXISTING SYSTEM State Plan I.D. Number;'R�I . Troy ❑ CONVENTIONAL ❑❑ ALTERATIVE (If assigned? Town o� y CTY H.wy MM El Holding Tank In -Ground Pressure ❑ Mound NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER INSPECTION DATE:. Steve & Sandra Sumner 755 CTY Tk. MM River 1'a l l s , WI BENCH MARK {Perrnanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name Of F'I:;r i er MP/MPRSW No.: County: Sanitary Permit Number Carl Heise 3378 St. Croix 128614 SEPTIC TANK/HOLDING TANK: _ MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES EI No 1 ❑ YES ❑ NO BEDDING: _ VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: YES ❑ NO ❑ YES ❑ NO NEAREST --- * DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: I PROVIDED:. ❑ YES ❑ NO D YES ❑ No I ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:. PUMP ON AND OFF ❑ YES ❑ NO NEAREST 1111111110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) [.0NVFNT10NA1 SY_STFM- BEDITRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO, DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST --� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make Certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ No meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS: ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL_. SODDED: SEEDED: MULCHED: CENTER: EDGES- Ll YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE- FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR, DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: Dikl: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO C❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY LINE: WELL: BUILDING: FEET FROM ❑ YES E❑ NO ❑ YES ❑ NO NEAREST ----r* Sketch System on Reverse Side. SBD-6710 (R. 06/88) Retain in county file for audit. SIGNATURE: TITLE: Zoning Administrator Thomas C. Nelson M LLM■ MEMC041an SANITARY PERMIT APPLICATION I�Y ILHR In accord with ILHR 83.05, Wis. Adm. Code mom % —Attach complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. —See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S Q iL -k- sonolk PROPERTY OWNER'S MAILING ADDRESS LOT # `Tk ti COUNr�� STATE SANITA6Y/ERMIT #11f JV heif revision t4revious application STATE PLAN I.D. NUMBER T c2g(1 N, R (or) W I BLOCK # r1TV STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4 J 4 CITY C 11. TYPE OF BUILDING: (Check one) F]State Owned 7 , VILLAGE OWN QF: T Fv Y E]Public Ell or 2 Fam. Dwelling—# of bedroor4 LARCEL TAX NUMBER(S) 111111. BUILDING USE: (if building type is public, check all that apply) 3/ 1 El Apt/Condo 2 0 Assembly Hall 6 ElMedical Facility/Nursing Home 3 El Campground 7 ❑ Merchandise: Sales/Repairs 4 El Church/School 8 ❑ Mobile Home Park 5 El Hotel/Motel 90 Off ice/Factory IV. TYPE CIF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 - El New 2. F Replacement 3. El Replacement of System System Tank Only B) El A Sanitary Permit was previously issued. Permit # V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution 11 ❑Seepage Bed 21 ❑Mound 12 ❑Seepage Trench 22 0 In -Ground 13 19 Seepage Pit Pressure 14 ❑System -In -Fill NEAREST ROAD 14 10 ❑Outdoor Recreational Facility 11 El Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 130 Other: Specify 4. , XReconnection of Existing System Date Issued Experimental 30 ❑Specify Type 5. El Repair of an Existing System Other 41 ❑Holding Tank 42 ❑Pit Privy 43 ❑Vault Privy V1. ABSORPTION SYSTEM INFORMATION: 1 aALLONS PER DAY . ABSORP. AREA / , 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ,2 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7�� Feet Feet tV11TANK CAPACITY Site Fiber- Exper. INFORMATION New xistin ., in gallons Total # Of Manufacturer's Name Prefab. Con- Steel glass Plastic App. g Gallons Tanks Concrete Tanks Tanks structed Septic Tank or Holdina Tank 1:1 Lift Pump Tank/Siphon Chamber Lj El V111. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) J�WMPRSW No.: Business Phone Number: Cf 12 _�_62 11 > arl i _caa_ Plumber's Address (Street, City, State, Zip Code): lo4,2 daid�-, 5re X L -u,-ev IX. COUNTYIDEPARTMENT USE ONLY ISanitaifig F-1 Disapproved ry Permit Fee (includes Groundwater Date Issued Issu nature (No Stamps) g j gent Signature g Surcharge Fee) (II/cy I �t C_ oop, IC (Approved El owner Given initial Ifl L . CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS A sanitary permit is valid for two (2) years. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. All revisions to this permit must be approved by the permit issuing authority. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399'� to be submitted to the county prior to installation. Cnsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, numbEbr of tanks and manufacturer's name. Indicate, prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks r+aceived experimental product approval from DILHR. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or si0hon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. APPLICATION FOR SANITARY PERMIT STC-• 100 his application form is to be completed in full and signed by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, ("spec Ouse"), then a second form should be retained and completed when the property is P Y old and submitted to this office with the appropriate deed recording. - M ! - - - - - - - - - - - - - - - - - - - - - - - - ,- - - :mer of Property �� .V J�� i ►U�Y1�S ocation of Property !V itE Section ion 3- , TN -R I G1 W ovnship R.0`-4 ailing Address R 3 -155 Cf t t)IS 540a;( ddress of Site SAME l� ubdivision Name of Number revious Owner of property T 0 S otal Size of Parcel, ate Parcel was Created _ re all coirne.re and lot lines identifiable? X Yes No 9 this property being developed for resale (spec house) ? Yes No olumeS and Page Number as recorded wi th the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: Warrant -Deed which includes a Document number, volume and page -- number, and the eel of the Register- of Deeds. In addition, a certified survey, if available would be elpful so as to avoid delays of the reviewing process. If the deed description r P of er- nces to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - -- - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION (we) eeAti6y .that att a to temen. 15 on thi.6 60" ahe .true to .the but o6 m ncwtedg e; that I (we) am (ahe) the owneA (.6) 06 the to eh.t dens cAib y i,6 n6otmatzon 6onm, by viAtue 06 a wa,�Aanty deed tecoAdedp.in th O ed in .th.c,a o �,y Regis .ten o 6 Ve ed�s as do cum en t No. e 6 6�.ee a 6 the :un the pnopva ed a c.te 6oh the b ewa e d-t.b as � -) ! and that I (We) p)tu en tty q p .d yes em (ah. I (we) have obtained an as emen-t, to hun with .the above des eh.ibed pnopv ty, bon the con tAuc tcon 06 said y,6tem, and the name has been duty tecarded .in .the O66iee o6 .the Count Re iz.teA o eeda , a.a Voeument No. y y 9 6 I GNATUR.E 0V OWNER t ;TE NATURE Q -OWNER (IF APPLICABLE) 6 ' ATE S I GN�ED STtr,.�t7-n Stock No. 1301 SrATZ -Yom I am OF MCMIM M cab TOM SPACE PASOVE0 1001 NECOM"a 'DAY' 01"Up" AU of the North Sevniq (70) acres of the W4, (•Jer Ow Of aft^ 11drty-Five (35) _4_1_ firsenty- (28) North, RaW (19) Tax Key No. TOWNUP � n Wfeet4wPvtof higWW aid being part of the N=d*m*t:Qqqjmrter Of the N=Jie"t 1(�Wrter (NWk of NEk) ,of &cdm Thtay-Five (35Y, TbwWiip Twwty-Mg1ht (28) North, R� PML (19) to James B. ard Ruby Mcl.MUAK a a a IL in si2 11 364 slA In :JIM rill t to fumish water supply c M-t no in DeW reawd in Volume 426P . 285709. FJM Tbis--4.S_�hosesteed pfopoty. Togetber wi* all aad sinpim tiro heteditaments and apWonances thet*unto belonging; at- ak &Jrwl W*K*gs the titW is qW, indo%asibl* in fee simple and ft" and clear of encumbrances except OR Wrkt Cm of record; &W will wanant and MOM the save. Datod this lot AUT"INTICATION Signatures authenticated this '19- L�4AL,__ (SEAL) _. I __day ol TITLE: MEMBER STATE BAR OF WISCONMN (If not, authorized by " 706 UO, %is StiiM) (SEAL) (SEAL) ACKHOWLEDG14INT STATE OF WISCONSIN 111 FIE= 'County. personally cam* before me. this day of OCUberjo, 19"t __ the above Thown A. Joy, a a ingle man, This instrument was drafted by CharlAts E. A-tite, Attorney at Law It# -no- knlrAri try be tht person who executed the fore- WOVK MSI(WrO�111 And h ti 4rdiged the same. River Falls,, wisconsin 54022 4 4t Doris E. Deiss (Signatures may be kitithenticated or acknow, J St. Croix _.,___Countv, Wis. are not nece%sar� C1 0 A*X wires 1949.-.) WARRANTY DEED - STATi BAV Ot 1 �JJWM %i4 H C.MdlerCompany Stock No. 13001 .- ... �- 0 .1 DOCUMENT NO. rw 4177-5 BOV. F A! Thomas A. Joy, a s man, THIS DEED, made between Grantor and Steve W. Sumner and Sandra A. Sumer, husband and wife, as survivorship marital Dr0Derj;y, Grantee, Wi t n e s s e t h , That the said Grantor, for a valuable consideratiotl Fortv Thousand and no/100 ($40,,,000.010) Dollars-------- - conveys to Grantee the following described real estate in _St,__Groix__ County, State of Wisconsin: STATE 13AR OF WISCONSIN—FORM I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA RVN,51'M5 OFFICE 5-f. CROIX 00., WM' Rec'd. fcw Record Oth 6 t h a .1 crf Oct. 86 A4A RETURN TO All that part of the North Seventy (70) acres of the Northeast Quarter of Section Thirty -Five (35), Township Twenty -Eight (28) North, Range Nineteen (19) Tax Key No. West, lying Westerly of highway and being part of the Northwest Quarter of the Northeast Quarter (NW --,of W,-) of Section Thirty -Five (35), Township Twenty -Eight (28) North, Range Nineteen (19) West, EXCEPT parts conveyed to James B. and Ruby McLaughlin in "426", page 364 and in t'45011, page 209. up Grantor hereby cancels and releases agreement to furnish water supply contained in Deed record in Volume 426, page 364, Document No. 285709. FEE This is -homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements5 reservations and restrictions of record; and will warrant and defend the same. Dated this lst day of October 19 86.. ,(SEAL) (SEAL) nmas A. Joy (SEAL) (SEAL) A U T H E N T I C A T 10 N ACKNOWLEDGMENT Signatures authenticated this ----day of STATE OF WISCONSIN 19 PIERCE ss. County. Personally came before me, this _ 1st _. day of October, 1986, the above named TITLE: MEMBER STATE BAR OF WISCONSIN Thomas A. -Joy, a single (If not, authorized by § 706.06, Wis. Stats.) This Instrument was drafted by Charles E. White, Attorney at Law to me known to be the person who executed the fore - ..going instrIment end acknopiledged the same, River Falls, Wisconsin 54022 /j ." .�i Doris E. Deiss (Signatures may be authenticated or acknowl$(f�74T' lWh are not necessary.) LLJ _j �40�_ary Public _—St G-1�0iX_ County, Wis. My Commission 0 expiress: January 1989 4 *Names of persons signing in any capacity must t� pri d•QjV their signatures. WARRANTY DFFD-STATE BAR OF WISCONSIN, FORM NO. 1-1977 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY,, P.O. BOX MADI 7969 LABOR AND % PERCOLATION TESTS(115)3707 SON, IIIII 53707 HUARAN RECLATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION:) TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: C' �v 1/4N 0/4 N Riq g (or) W TR�� COUNTY: NER'SIBUYER'S NAME: MAILING ADDRESS: E T/c USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence �� ❑NewReplace 4 / NA i t't RATING: S= Site suitable for system U= Site unsuitable for systern CONVENTIONAL: ND: lN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ICI c Fn 11IMIO' . F7 « 1z F� I F� q 111 f 1 R � 111 xl g STC-- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER .5JEE tE;' W RANI')� 5LAMNF,< ROUTE/BOX NUMBER ..3 Fire Number CITY/STATE WEK_ VA115 WIS, Zip ``����. PROPERTY LOCATION: ! k 14, NNE.. �, Section - 'r A6 N, R Iq W, Town of KiJU_ VN5 , St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prober maintenance coii- sists of pumping out the septic tank every three years or sootier, if needed, by a licensed se tic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix COLI,nty Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned,, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards get forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form mist be completed and returned to the St. Croix County Zoning Offk_e within 30 day: of the three year expiration date. S I G N E D r _ ' ` _/, � DATE -q- St. Croix County Zoning Office P.O. Box 98- Hammond , WI 54 015 715-796-2239 or 715-425-8363 Sign, date and return to ,above address. H 0 x b N� A 7 u NA '*'1 S -7 n;l1s 1`11114� 40F 0%4 1 ga , %-Woo on c IA" 16 _JLO (4� )48 B ES OWNED COUNTY 'DESCRIPTION 545 D �\ �545 C StE�E, DAN 00 �OlNtR,. IZ4, 3 155 Ci%.l MM Qi���2 fAIIS , W15 - NW //4 - NE l/4 545 A 545 B S W //4 NE l/4 546