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HomeMy WebLinkAbout004-1027-60-000_ _ ~,~g~ 3~~ ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 Permit Holder's Name: I fl Citv fl Village fl labwn o' cL - c~~ lth ,Dan Cady Township / CST BM Elev.: Insp. BM Elev.: BM Description: ~ ~~ l ~~ d TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~ esa<e~ ~ ~ `Odc~ Dosing G o ~~d ra Ion Hol ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic y/v~' y~ ~ (~ p/ ~U' NA Dosing y/6u~ >( our CGS NA Ae NA Holdi PUMP /SIPHON INFORMATION ``~ Manufacturer G Demand Model Number ~~ ~ Z9,Z~PM TDH Lift ~o•Sbr Lriction System TDH1~.~ Ft `~ Z~ Forcemain Length (s ~ Dia.Z '~ Dist. To Well 7 / ~b SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No.: 363905 tate Plan ID No.: s ~o# :322 985 Parcel Tax No.: 004-1027-60-000 STATION BS HI FS ELEV. Benchmark '~ ~p U Alt. BM 3.3 q ~, Bldg. Sewer , ~y G, Ht Inlet ,w PZ e Dt Bottom Z.3 Header /Man. 3 JO p-p , •~ Dist. Pipe ~a 3-~ pp, Bot. System 3--~~ ~4 . ~,- 3r Final Grade ~ ~ St cover ~ ~~' S S ht~1 Q 3-Y`f [03.~~1 ~ao.o BED /TRENCH Width c I Len _ ~ No. Of Trenches PI No. Of Pits Inside Dia. Li uid Depth IM N I N J S DIMEN SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEA gnu acturer: SETBACK MBER M INFORMATION Type O ~ Jr~' r "~S ~ ~^,~' ~~ OR UNIT oe er: System: D DISTRIBUTION SYSTEM y~ h~`~- ~- `("`'~'~'`- ~ 33 ~54`~ ~.,,,,, ~-.G~. 3z~~ Header / Mani old Distribution Pipe(s) ~ ~~ x Hole Size x Hole Spacing Vent To Air Intake ,~.s lr ~ ~ v ~~ Length ~ Dia. Length -~ Dia. ~ Spacing ~/~ SOIL COVER x Pressure Systems Onty xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ es ^ No SBD-6710 (R.3/97} Dat Inspe 's Signature Cert. No. COMMENTS: (Include code discrepancies, persons present, etc.) ~'"~/~ l ~ Inspection # 1: ~ / 2I / oU Inspection . DB /Z rf / C° 3 Location: 483 320th Street, Kna , WI 54579 (NW 1/4 NW 1/4 12 T28N R15W) - 122815184 ~. 1.) Alt BM Description = 1~!~° 04 WP>'~ 2.) Bldg sewer length = ~j0 -amount of covf r = ~ 2 " n ~~"J0~ 3.) contounnr = `Z • ~Z l ~~~ `~ ~ ~,~ ~.e.. ~ ~ $ ~~ S~ c,w~~ v~su.~ox ~ 3_[-0l ~ Plan revision required? ^ Yes No Use other side for additional inform tlon. 3 ~ ~ r Safety and Buildings Division '`~SC011S%11 SANITARY PERMIT APPLICATION P o Box 7302ngton Avenue Department of Commerce In accord with ILHR 83.05, Wis. Madison, WI 53707-7302 1~1 i~ • Attach complete plans (to the county copy only) for the s e~Y{' pape-r`~teitil county than 8 v2 x 11 inches in size. ~, p 4 ,,~ ST. CROIX ~ I\~~~~`~~~ i id f i s f l • S s i hi ~ ate Sanitary Permit Number ee reverse s or n truct on or comp e ng t tion et s ap lus --• 3 ~ 3 qo Personal information you provide may be used for secondary purposes f{ ~ , ~ ~ ' ~ ~(~~~ 4 Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ~~ ~ ~ ~ 0,,,(,~ s~. ~ 1 ~-~ ,1 97 C~}IOIX f~ to Plan I.v. NumberSITE ID 194227 I. APPLI ATI N INFORMATI N -PLEA E PRINT ~ NFOR NS ID 322985 Property Owner Name t; ,: '''_ A RHY 1/4 ° ~ I S 12 T 28 , N, R 15~1'~ Property Owner's Mailing Address u Block Number N/A City, State Zip Code Phone Number Name or CSM Number SubdiviNon SPRING VALLEY WI 54767 X15 >772-3383 A ~/ II. T PE F B ILDING: (check one) ^ State Owned ~ !t~ Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms _~ ~ Town OF CADY 320TH STREET III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 004-1027-60 y 1^ Apartment /Condo I Z. Z ~. S/ 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 online B, if applicable) q) 1. ^ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5_ ^ Repair of an ______System ________System _____________ TankOnly_______ __ Existing System ________ Existlnc~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 ~ 42 ^ Pit Privy 12 ^ Seepage Trench 22 ^ In-Ground Pressure ~ 13 ^ Seepage Pit S s 43 ^ Vault Privy 14 ^ System-In-Fill ~ , 3 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 450 ~ Required (s ft.) Proposed (sq. ft.) (Gals/day/~ ft.) (Min./inch) ~ Elevation 102 11 4 / ~ . 1.2 N/A 99.7 375 375 Feet Feet TANK VII Ca aot . INFORMATION in allons Total # of r Manufacturer s Name Prefab. Site l S Fiber- Plastic Exper. N E i ti Gallons Tanks concrete act tee .glass App ew x s n ed st T nks Tanks eptic Tan r ank 1000 1000 1 NIIDWESTERN PRECA ® ^ ^ ^ ^ ^ Pum 7 m er 650 650 1 MIDWESTERN PRECAS ^ ^ ^ ^ ^ ^ VIU. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Signature: (N St ps) MP/MPRSW No.: Business Phone Number: BENNIE ~IELGESON 20292 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY /DEPARTMENT USE ONLY ^ D'isapproved Sanitary Permit Fee tlncludes Groundwater ate ssue Issuin Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~3 2 ~D 7 S / Z ~ ~ Y Adverse Determination c _ , (! 7 JU X. CONDITIONS OF APPROVAL / REASO NS FOR DISAPPROVAL: ~ a p/at-,_ , ~ / _ / -/ t°rC ~ S 14 v~.~ S r S r<Gw~ ~ ~ t Gt~~h~t ~ ~e r GO C~c. ~e h ~ w s ys ~ +e'.w- ss't, a~ sn.ly SP r v ~ _~ ~ l~rr.- ~.e~vt e SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite 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. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. 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 on 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. Vt. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number 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 received experimental product approval from DILHR. VIII. 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to stale 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 siphon 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. GROUNDWATER SURCHARGE 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 contamination- investigations and establishment of standards. ~ ~ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 15, 2000 CUST ID No.220292 BENNIE W HELGESON N7649 HWY 128 SPRING VALLEY WI 54767 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/15/2002 ATTN.• POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 194227, Dan Rhy St. Croix County, Town of Cady NW1/4, NWl/4, S12, T28N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 668534 Identifica '' rs Transaction ID N .322985 Site ID No. 19422 Please refer to both identification numbers,.. above, in all.corres ondence,with the a enc The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otn ential for a law suit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. BENNIE W HELGESON Page 2 6/15/00 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, t,~ ~~~" ` --. Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-785-9348, Mon. -Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us DATE RECEIVED 06/12/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 INDEX SHEET '~F s ~ ~~il PROPERTY OWNER: DAN RHY ~~ UN O N8029 110TH STREET <C~ '9~ 0~ SPRING VALLEY WI 54767 ~~O/~ ~ V PROJECT NAME: DAN RHY sO~ PROJECT LOCATION: NW 1/4, NW 1/4, S 12, T28 N, R, 15 W MUNICIPALITY: TOWNSHIP OF CADY COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Name: Bennie Helgeson Sign ~ Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: June 6, 2000 P~~ ~ri~i`1p~~V ®~ N1 Of COMMER UIIpING` PpRTME Y p B pE S E pNiS+O oNpENG~ ~OR~E S~~ ~'b~ lr ~4 ~'l ~~~~~~ ~a~ Rho ~pi~l~~. ber' ~c~nrn r-e ~~aeso~ 3~~~ ~"~ ,Y b u ~~3. M. t~c~/o. o~ ~1, t /V2~ I '? Dry. ,R ~ 1~ t~~h ~ V~ 1~'duaer tt'01-e.. ~,/~'1 /o O.Oa Top a~ l~ „ ~~~ lo,p~e ~3 --- -- -__ a ------ -- _ .•. DG ,JJo-F t7~s~~~~ !r---- ~.~e;~ Con~oc~~ Elev, yy,y~~ 4~ Ex~s~7 5~~~.~ -('a~.~C To ba ~uw-~ccd o..K~ FBI<<~ --~ T~, be ~x,S~'~^5 ~~~ ~~ ~Je`, L7r w t ~~.It ("=~ to ~roPosr~Q /~Q~ ~6°/ p S~Tati~ f "~~ e_~ ~. ~,~,y ~ ~, ~, Page Of Cross Section Of A Mound Using A Trench For The Absorption Area E/~~. ion.// Medium Sand Fill (ASTM C33), ~ H 6" Toasoi '~°I.7y E D Trench Of '~" - 2~" Aggregate,' 6" Below Pipe. Covered With Straw, Marsh Hay Or Synthetic Fabric arz~ /S ~~dL/ ' $•~fl ~ Plowed Layer ~~~~, `~ D~ ~ 3~ - Ft. E i 33 Ft. G /,O Ft. F , 87 Ft. H /, S'~ Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe /qa S/°P•` J Permanent Markers Observation Pipe A o----------------- ------------------- W B -~- K ..._.~ ~Tr nch Of 32" -• 2 Z" Rggregate ~,cv e- I I L A ~ '~ t. I ~.ln Ft. K~ Ft. W a , a Ft. Q 7,~ Ft. J 9•~ Ft. L y~• I Ft. License Signed: Plumber: Date: G(Xlh~ r' ~~ 1 ~C~~ Distribution Pipe Detail For PVC Force Main boles Located On Bottom Are Equally Spaced 1 End Cap ~ U (X "t ~ PYC Distribution Pipe ~E p - * Last Hole Should Be Next To End Gap ! First hole to be ~Qj~~from manifold end of bed P ~ fit. Hole Diameter ~~ Inch X ~~ Inches Lateral Diameter Inch(es) Y Ig Inches Force Main Diameter ~.~~_~Inches ~ Of Holes/Pipe o~6 Invert Elevation Of Laterals /~,Ft. Page_ Of Lateral Network ~~ ~~ a~ ,-~ COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) ,Approved Locking Manhole Cover With Warning Label Attached • Weatherproof Warning Label-~ Junction Box Final Grade 18" Minimum . ~_ 6" Min{mum 6" Maximum Insp. Pipe Page__ ~f_ - 4" CI Vent Pipe with Approved Cap, +25' From Buildings Approved ~ _~. Vent Cap 12" tti nimum ~ f-I 4' Minimum Quick Disconnect --- ~ I i I Al arm d`' On 6 t Baffles Approved Joint w/C.I. Pipe Extending 3' Onto Solid Soil ,/ $. o 1/4" Weep Hole A g Approved Joint .` w/C.I. Pipe C Extending 3' Onto Solid Soi D 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Tank Manufacturer:_~l~~ux '1~rw. p'''`i``'`t - Tank Size-Septic/Pump:~p_ 0~6.5~________ a ons Conc. Block Number of Doses: X09 Dosesa//~•~y Gallons Gallons Per Day/~- Volume of Backflow:.......+~Gallons Total Dose Volume:........=~ 7.5-Gallons /7G4/ Pew IH~ti Alarm Manufacturer: C T C ~~ c', "cfFr-'S' Capacities: A/.7 inches or 03 ~.~rGallons Model Number: - + B inches or_~-Gallons Switch Type: rcc~- + inches or fa gallons Pump Manufacturer: ~6k- `~ 3871 + D_ /~-~ nches or~~Ll l ons Model Number: - Po^ 11 r i nches or 11 ons Minimum Discharge ate: ~ Q,~ S Total....._ ~~,. Vertical Difference Between Pump~Off and Distribution Pipe:/~~•__~~~FFeet Minimum Regof~ForceuMain xr/s~,1 Friction~Factor/100~Feet•~.+~Feet ,~_F a et .. - - ~_Inch Diameter Force Main Total Dynamic Head:...=jb•3S Feet "~~ <i Internal Tank Dimensions: Length 78~_; Width S"5~~, Liquid Dept h Signature ~ ~ / License Number~~~ Date~,_ ~' .MODEL. 3871 ~_` Submersible SIZE. 3/4 SOLIDS, RPM:1550 '~~ Effluent IPum HP: 0.4 p .~, ~, METERS FEET '""~`` ~ # 8 25 ~ s ~~ ~~: ;5. r, ,: 7 w ~~~F ~~- g 20 ~~,,~ A~'. ~ _ ~ . g - ~'',~' ~ ~~ - - - '~ ~ ~` p 4 ,_,- J ) 3 10 .~~ O L ~. Y ~' ' I... q ^~ S 5 1 ~ -- ~;; 0 00 10 20 0 40 50 GPM ~f ,, ~ g 4 6 ~ 10 12 m /h 0 2 CAPACITY ` " ~ ~' k` ~t ~GOULDS PUMPS, INC: seaECn FAIlS Ni:NV vac c~a8 ,:~ a. ~~. 1 4, , C ; NM1y 4~ Xe , ' ~k ~~.~' 4 ~~ YrF.,. ~,. ~eS:lrfi~. 1".w. ,e~~~'~ ( .. , .. ~. ~,, _ :~~ .~~' . ~~leaiva OG'IOb6f~ 1Si89 ~ 01988 Gourds Pumps, Inc. SPECIFlCATIONS ARE SUBJECT TO CHANGE WRHOUI' NOTICE PRWfE~ W 4~s ~` .~~ ti~ ,:'" ..~~ ;Wisconsin Department of Commerce SOIL AND SITE EVALUATION ~ Page of Division of Safety and Buildings Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code . _----°~ / i ~ i ri 3 / 1 Attach complete site plan on paper not less than 8 1/2 x 11 Inches i~ea Plan ni !„~ ~ r COUnty __~ -- ~ / _ pl/ J~ " ~ but not limited to: vertkal and horizontal reference point (8M).direction and ~'~ , - > include ~ ,,~~ l~ ~" , percent slope, scale or dimensions, north arrow, and location ar~ distance to r~aretl~oad ` ~'~' arcel LD. # + ~ ~:..~~ I /~ APPLICANT INFORMATION -Please print all Ir~fornat~or ~^' y R v by Date Personal information you provide may be used for secondary purposes (~rivecy Lew, s.~~o4 /) (rq~'y~~ ~p Od Property Owner ,~, 2q~, ~~ ~ Location I ®ot ; ~ j ~ 1/4 ~(/~/4,S ~~ T ~~ ,N,R / S E (or Property Owners Mailing Address f ~r ~; ~ ~ `~ # . ,, ~@~ Subd. Name or CSM# i ~ ~~--~ N ~ D ~ 11©f~ - Phone Number City ((II State Zip Cod7e 3 I ~ ^ City ^ Village Town Nearest Road P 3a o fib ~5~~ C~ r 383 ~ T6~ (7~ ) 77~ : ~1 rlv~ ~ ^ New Constructlon Use: esidenflal / Number of bedrooms _~_ Addition to existing building _~r -- ~leplacement ^ Public or commercial -Describe: ~~ Recommended design loading rate S bed, gpd/(t2 ~ E' trench, gpdAt2 Code derived daily flow ~pdys) .- d/fts nch tr ~~ 2 ` e , 9p _ Maximum design loading rate bed, gpdffl ~ed, ft2 ~~~ trench, it Absorption area required ~ aov _ ~ Bc~-~ Cf 9, 7 K ~Urr f ac,~ ~ yl ft (as referred to site plan benchmark) ~ t' Recommended infiltration surface elevation(s) Additional design/site considerations ~'~n %~ ~ u K GcNO~OV- if applicable ~~ ft '+' . in elevation l d Fl , p a oo Parent material 7~~ stem Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank itable for s S 11/ , ^ S ® y u S = - U = Unsuitable for system ^ S [~`l~ ~ ^ U ^ S 0'l~ ^ S ~~, ~ S ~-~ .,~.....,~r,rr~u nronoT Boring # Ground elev. 98r ~ ft. Depth to limiting factor ~_in. JVIL YLV V~~~, l ^,V~~ Structure t GPD Horizon Depth in. Dominant Color Munsell Mott es Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistertce Boundary s Roo Bed ,Trench o- o . 10`!12 ~ti - vw ~ (~~ .s , 'ro ~ a~ 10 `f G~ ~'ra ~ ~~ w. s~dc ~h ~ ~S - S ~ ~ .S ,~ -y ~ v `fly ~`~ 3 w ~ C u -- l'° .. ~5 ~ ~ ~o " ~° Remarks: Boring # p-/ 1 . / O `/ ~ ____ S ~ -~~s b~ t~ ~ v~ - i £ , S ;, ~ 3 ad- .~~4i .~y ~.s ~~ ~ s ~ ~ a~ r'~ .s~,~ . • . ~ 9 I~~. ~ .~ •~ ~ 2 .~ ~ ~s s L ~ ~ ; $'o , Depth to limiting factor ~iri ~ ~ ~ Remarks: ' nature Telephone No. CST me (Please Print) 9 ~/ 77°~ _ ~~~.~ ~~j21f'1 vi r -e Addre ~ Date CST Number ~~ SOIL DESCRIPTION REPORT PROPERTY OWNER ~ ~~ PARCEL I.D.# ~6`f `~~~~~oG' Boring # Ground ele 9~Ln. Depth to limiting factor ~in. ' ~k~ Boring # ^ Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. n. Depth to limiting factor in. Boring # Ground elev. ft. Page of rizon H th De Dominant Color Mottles Structure R t 2 o p in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary oo s Bed ,Trench a o-i~ - j oy2 ~- - s ~ .~-- ~ ~~ ~ -~ ~ , ~ Remarks: Remarks: Horizon th De Dominant Color Mottles Structure B d R t p in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Cons(stence ary oun s oo Bed ,Trench Remarks: Depth to {__..~ limiting factor 'n' Remarks: SBD-8330 (R. 07/96) c~ o ~ t' `~ ~~ ~ 3~.re I ~~h~~~ ~~~. ~ ev1n~ ~ cso a~p~ ,~ s ~~ i a -~ v ~, M. +- UPS . ~P..I.~o ~ ~~~I~ ~~~c R.~l-er ~..,~ ~- v~P. p 1 ~ ~ .~ a --r~~ o~ ~a ~~ RUC f i~ra '" 5 t~0 ~' ~K~ ~(A,w Se,o~.c ~Qh Lpt,W h ~le~, 9 ~. ~~ y Q, SL ~~ I ~~_ 4~ ~ _~41e. ~3 ~rt~ _ ~ s~~~~b l~ T ~ ~ ~N~ `tom ~,cu~l ( ~ ,~ r~~ ~ CoN~u~ ~ ~17~Q `- ~--~ R ~ °~'It~. ~ I `~~~ es' I (~a d~ Y ~ v -~- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address f ~~ 3 aG (Verification required from Planning Department ~'oi new construction) ~~ City/State ~n~~ v, L~J~' Parcel Identification Number C.»n ~ -~o~ Z ~~ -moo LEGAL DESCRIPTION Property Location I~Cc~ '/4, ~~ %a, Sec. IZ , T o'1fS N-R 1~ W, Town of ~~~. Subdivision ~~A ,Lot # ti ~ Certified Survey Map # ~ ~A ,Volume ,Page # Warranty Deed # ~o a ~ 18 ~ ,Volume /~// ~ ,Page # Spec house ^ yes f~J no Lot lines identifiable ®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 wastewaterdisposal 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. Uwe, 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 system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days(o~f the three year expiration date. ~J~~~ 06 / 08'/00 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty de ribed above, by virtue of a warranty deed recorded in Register of Deeds Office. OCo /0~/Ot~ SIGN O APPLICANT 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 Yili..1.~.1~PAGE 3 74 ment 'Loren G. Berkness . ~`,~', 1%f ~"~, ~.f n,12I~d.9..J 'Terri Berkness RECEIVED FOR RECORD Loren G. Berkness and Terri B. Berkness, a/k/a Terri E. Berkness, husband and wife, as joint tenants, conveys and warrants to Danny E. Rhy and Mary Jo Rhy, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: 6231$2 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI 05-17-2400 9:45 AM WARRANTY DEED EXEMPT li CERT COPY FEE: COPY FEE: TRANSFER FEE: 267.00 RECORDING FEE: 10.00 PAGES: 1 Name and Return Address ,~ The Bank of Spring Valley PO Box 159 Spring Valley, WI 54767 004-1027-50, -60 (Parcel Identification Number) The North Half of the Northwest Quarter (N '/z of NW '/4) of Section Twelve (12), Township Twenty-eight (28) North, Range .Fifteen (15) West. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this . (~ day of , 2000. AUTHENTICATION Signature(s) ~ ~'~-,/S.~Fr~~ru;s ~P. r ~ i(.+^.Dd~ ~ r + ~CIQa~ .ems ,~"~~~ authenticated this /J day of , ~~'se1L.• signature ~ ~N~ wt e 3 A r _lwc:td~'~a type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 54002 ACKNOWLEDGMENT STATE OF WISCONSIN ~ ST. CROIX COUNTY Personally came before me this ~ day of 2000, the above named Loren G. Berkness and Terri Berkness to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. signature type or print name Notary Public St. Croix County, Wisconsin. My commission is permanent. (If not, state expiration date: •) 'Names of persons signing In any capacity should be typed or printed below their signatures. Information Professionals Company Fond du lae, Wisconeln 800.855.2021 Parcel #: 004-1027-60-085 04/22/2008 08:38 AM PAGE10F1 Alt. Parcel #: 12.28.15.184A-07 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/01/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -RHY, DANNY E & MARY JO DANNY E & MARY JO RHY 483 320TH ST KNAPP WI 54749 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description ' 483 320TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description; Acres: 4.590 Plat: 4723-CSM 18-4723 004-04 SEC 12 T28N R15W NW NW FKA Block/Condo Bldg: LOT 3 004-1027-60-050 (184A} EXC PT TO CSM 15/4226 &EXC PT TO CSM 18-4723 NKA CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 18-4723 LOT 3 12-28N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 04/01/2004 758434 18/4723 CSM 05/17/2000 623182 1511/394 WD 07/23/1997 721 /23 07/23/ 1997 413/428 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 175,600 203,600 NO UNDEVELOPED G5 2.590 1,700 0 1,700 NO Totals for 2008: Gene ral Property 4.590 29,700 175,600 205,300 Woodland 0.000 0 0 Totals for 2007: Gene ra{ Property 4.590 29,700 175,600 205,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/15/2005 Batch #: 05-13 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 004-1027-60-075 oai22i2oos 08:34 AM PAGE 1 OF 1 Alt. Parcel #: 12.28.15.184A-05 004 -TOWN OF CADY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/01/2004 00 4 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -RHY, RETIRED NUMBER RETIRED NUMBER RHY Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 34.858 Plat: N/A-NOT AVAILABLE SEC 12 T28N R15W 40A NW NW FKA Block/Condo Bldg: 004-1027-60-050 (184A) EXC PT TO CSM 15/4226 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-28N-15W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 05/17/2000 623182 1511/394 WD 07/23/ 1997 721 /23 07/23/1997 413/428 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/28/2005 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: General Property 0.000 0 0 0 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 ~ ~ ~~ ~ ~_ ~ ., ,~ "per ~ /~ 4 ~' ~ ~ ~ 7Si8434 ~ Pifif~ A ;-- VOL 18 PAGE 4723 ` f KATALEEA H. ~- ~.- - ~~ REGISTER OF DEEDS ' ~ 3 ~ `.`~ ST. CROIX CO.. MI ~ ~ -r~ RECEIVED FOR RECORD ~°°-°^w 04/01 /2004 01 : 25PM CERTIFIED SURVEY MAP CER T ! F 1 ED SURVEY MAP ~~YF.s~2 3' ~ L OCATED f N THE NW 1 /4 OF THE NW i /4 OF SECTION 12, T28N, R 15W, TOWN OF CADY, ST. CRO I X COUNTY, W 1 SCONE I N. PREpAREO FOR DdN RHY NW CORNER OF SECTION 12 -FOUND 7 lit" IRON PIPE. :i .~ :~ ~a :~ :m :O ~r ~n =v :y UNPL A.T7ED. _ L i4NOS NOTE: BEARINGS ARE REFERENCED TO THE WEST LINE OF THE NW li4. (5T.CROIX COUNTY COORDINATE SYSTEM). S89° 48' 46" E 400. 00' 33.00' ~ 367.00' e a S~ ~~ DO• SHEDS M06ILE HOME . I t~ FOUNDATION ~~ V OR/VE 1~, a LOT 3 fi 4.59 ACRES b ! 99, 895 SO. F T. 4. 2 ! AC. EXC. RiW 183, 496 SO. FT. :_ :~ .~ 100' 7ryq :m .a :x r :2 .m 33. 00' 36 7. 00' N89° 48' 46" W 400. 00' FALLS 12' NORTN OF FENCf CORNER SOUTH L 1 NE OF THE 1 ~~ ~~ O• m I AI !V N) ~ I . ~~ I W :N :0 f Z I f 33' 33 • f r f f m I I ~ I $ I 2 I ~ ! I ro f i+. I ~ 1 f ~ ( o l $ _y{ f rn f I :yl f f I I f 33' 33' I I I ~, f I ,N ..w .~!vP4A..T.T~P...~. RQNI~D ~ I N $T. CROt)(„ LINTY - ~ zorrrq •~ PaAcs commmo° m APR 0 12004 W li4 CORNER OF SECT 1 ON / P -FOUND If not nyCOrded within 30 days of AL UM-NUM MONUMENT. approval date approval shall be null end void O - SET 1 " O. D. X /6" IRON PIPE WEIGNiNG 1.l3L8S PER LINEAR FOOT. / ` - 100' SHEET ! OF 2 O 50 !00 280 2003064 THIS INSTRUA~NT DRAFTED 8Y J1M WEBER Vol 18 Page 4723 w :i A :~ .,- N =b :ti ~ :m :~ ~r- :a :o O .y FALLS 12' NORTH OF ELECTRIC FENCE JAMES M. WEBER 8-1804 vwtu WI JAMES M. WEBER S-l804 LANDMARK SURVEY / NG, 1 NC. DATED rV 'Z~i '~~ ~ ~~ N N