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Parcel 002-1067-60-000 02/16/2005 11:32 AM
PAGE 1 OF 1
Alt. Parcel M 27.29.16.409B 002 - TOWN OF BALDWIN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
*
KEITH J & BECKIE L HINES HINES, KEITH J & BECKIE L
735 240TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 735 240TH ST
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
ao aVv'~L~
24"p V
Legal Description: Acres: 16.000 Plat: N/A-NOT AVAILABLE
SEC 27 T29N R16W W 1/2 NW 19W EXC S 293 Block/Condo Bldg: J464to -74-7
FT OF W 2 3 FT & EXC CS I~VOL 2/439 2
(epp Cg Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-29N-16W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 944/612
07/23/1997 911/519
07123/1997 827/327
2004 SUMMARY Bill Fair Market Value: Assessed with:
42532 Use Value Assessment
Valuations: Last Changed: 06/28/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 9,000 171,200 180,200 NO
AGRICULTURAL G4 13.000 1,400 0 1,400 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2004:
General Property 16.000 10,500 171,200 181,700
Woodland 0.000 0 0
Totals for 2003:
General Property 16.000 10,700 171,200 181,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 510
Specials:
User Special Code Category Amount
010-GARBAGE SPECIAL ASSESSMENT 45.00
Special Assessments Special Charges Delinquent Charges
Total 45.00 0.00 0.00
i
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~Q l°t-h y n
ADDRESS 7,Y,7 (=:24~ `S
SUBDIVISION / CSM#__ LOT #
SECTION TN_R~W, Town of ~c~rd~t,-,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i~
rOX ~yi
I
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK : ~S' / ! (JV s o l
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well >~Q House %:572r
Other
Pump: Manufacturer Modelk - Size -
Float seperation//'7~,h~ Gallons/cycle:
Alarm Location ~RQ,Stoko,&~
-:SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: A"
Setback from: well: House S4 Q Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet '
PC inlet - PC bottom _ Pump Off 0106
Header/Manifold - Bottom of system 9K,
Existing Grade - Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
l1TS
LICENSE NUMBER:
INSPECTOR:
3/93:jt
SANITARY PERMIT APPLICATION Bureasafetyu oand Bgs f Buiuiildii nWater ng Water
System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
+
than 8 112 x 11 inches in size. ;2t S'. rn i
• See reverse side for instructions for completing this application State Sanitary Permit Number
e
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)). State Plan I,D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name ,property Location
ke:IA t S ~~/&43W1/4,S nBlock N, R E (o r)0
Property Owner's Mailing Address Lot Number umber
City, tate >i Zip Code Pone u er ubdivision Name or CSM Number
ldfjji~ Will
11. TYPE F BUILDING: (check one) E] State Owned It~ Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Z ° Town OF.L7 u st
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)) ~y
1 ❑ Apartment/ Condo W4 - /v ~ / - v
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. IK 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 Cg Mound 30 ❑ Specify Type 410 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 5. Perc. Rate 6. System Elev. 7. Final Grade
r~ Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) ~y Elevation
0v _5D S' - 70, Feet Feet
VII. TANK capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or44"+dv"9-i"k x 4W 3-16 r C y E9 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank fiber X M / r ® ❑ ❑ ❑ ❑ ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans-
Plumber's Name: (Print) PI mb is Signatur o Sta s) PRP/MPRSW No.: Business Phone Number:
let/
Az K~
Plum er's Address (Str et, City, State, Zip Co e):
J says
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Signature (No St -WD)
roved Surcharge Fee)
pp roved Owner Given Initial 1~8z~,
C/~ ~J
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber
INSTRUCTIONS w' .
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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, 608-266-3815:
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.
II. 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 online 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 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 narne, 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 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 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.
Wiscon$in Deprartment of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST' CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's KName: EITH C] City [I Village Town of: State Pla
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA ?//io%
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , S!1 Benchmark D. / "Z),
i
Dosing (VA e >w
Aeration Bldg. Sewer
Holding St41f Inlet
TANK SETBACK INFORMATION St/Ot Outlet
Vent
irIto ntake ROAD Dt Inlet
TANKTO P/L WELL BLDG. A
Septic > -<Z/ ~-b Ste' yf 7¢- NA Dt Bottom 9 66
Dosing NA HeadertMw.
Aeration NA Dist. Pipe ~pao '
Holding, Bot. System S' ?19 S '
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer an
r
Model Number 8uaMM
1, LOSS Friction., H System ! 'DH Ft
TDH Lift 1/
7- 7.
Forcemain Length 190Dia. Dist.To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length- No- Of Trenches IT No. Of Pits Inside Depth
DIMENSIONS DI N
Manu adurer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION TypeO nw* C BER Moe Number:
~R UNIT
System:
DISTRIBUTION SYSTEM
HP,A$/ Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. 02 Length v(~ Dia. Spacing 7~
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 / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: BALDWIN.27.29.16W, NW, SW, 240TH ST
Vet. LAC'
l
P
~.t`k."•f' ~-CR,~.- oYj 1~-"`ivY ~~~~r~C./..C- ! •~-~-r7 G~-YY~ IV`...`=,.L'~" 'r" lJ~,.e.~[-CS/~
Plan revision required? ❑ Yes 2"No /
Use other side for additional information. 1/~ /
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH 4 ,
SANITARY PERMIT NUMBER:
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
April 2, 1996 2226 Rose Street
La Crosse WI 54603
HEWITT EXCAVATING
W2062 HWY 10
MAIDEN ROCK WI 54750
RE: PLAN S96-40153 FEE RECEIVED: 180.00
HINES, KEITH
NW,SW,27,29,16W
TOWN OF BALDWIN COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation:
Note: The department recommends that the mound area should be deep chisel plowed
to help break up the platy soil structure existing at the site.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely, N
1
6erard M. wim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
cc: ST CROIX
SUDA-7897 (R. 10/94)
Scale: I"= Ft. PLOT PLAN Page 1 of
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1. Elevations shown are ground elevations unless noted /
2. Septic Tank l d-0 Gal. Pump Tank ZEO Gal. Mfg. by O)te Ser 0e/)C rc_&
3. Benchmark Elevation ADQ. ~ -A
L
Description of Benchmark_> I f /n COrnYr COST
4. Other Notes-6 /b ~tcrv- ar c~
® no dell ~cese~ 7~
Private Sewage System Plan Index/Checklist
S96-40153
Plan ID # Owncr's Name
S9tlc, ycl A -+.14e 11 r.
Legal Description Address
N6tJ ,TW c, P7 7~ 9iY >4 /d Q/ 977 f/~, . 63 Ba I Wr Sl/a~
G iyA4blaggJfown I I Count r01 ,
Contents Comments/Special Instructions
Page # Included Two copies needed for all
plans
1 Plot Plan
2 Plan View/Lateral ® Return by Mail
3 Cross Section
4 Tank & Pump/ 0 Fax Letter to (County) (Subtnitter)
Siphon Information Circle One and Provide Fax ( )
5 Hp System Sizing (Public)
6 Pump Curve Call for Pick-Up: ( )
7
0 Other
I, the undersigned, hereby certify that the Seal (if applicable)
plans and specifications submitted
herewith were prepared under my
direction and control.
Plumber/Designer Liccnse/Registrrtion 11
Dennis Hewitt MPRS 3186
Addre s City State
W2062 Hwy.10 Maiden Rock, Wi.
? 50
Signa re
For Ollice Use Only
Attachments:
/ AppLicatiAa-
n PRIVATE SEWAGE SYSTEM
FCC
Condition 11Y
Needed for Holding Tank Submittal:
One copy of notarized holding tank ask n
agreement. (Originals to County) 1111 111 OVEL)
Needed for At-Grade Submittal: Aprn 6L1A31QFIs
Original signed and notarized TRY. LAB & N BjjjL~
pp giUl1S AND BUiL€3t%GS
Application for "Use of an At- DIV av`SIQN AF
Grade"
County on-site SPONDENCE.
One additional set ol'plans SUD-10268 (N.01/96)
Page 3 Of 6
Straw, Marsh Flay, Or (;I(C)I ND E,I'Ey.
Synthetic Covering
Distribution Pipe
Medium Sand _
_ H _ G
Topsoil F TPM - 6
-J
3 E D
"
N
4% Slope
Bdd Of i"- 2 %2 Force Main Plowed
Aggregate From Pump Layer
D u
Cross Section Of A Mound System Using E
A Bed For The Absorption Area F
G~
A~Ft. H~r
B_ Ft.
I Ft.
J J Ft.
K ~Ft.
L Ft.
Force Main W Ft.
L
Observation Pipe
W ~o -----------------------I
Distribution Bed Of % z- 2
2
Pipe Aggregate
I
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
Page 2 Of 6
Perforated Pipe Detoll
End View
Perforoted
End Cop] \e i' PVC Pipe
i (to~ce
Holes Located On Bottom,
\ S Are Equally Spaced
a =3
/P PVC
Manifold Pipe
P°
Oislribution altlon Of
Pipe j~ Force Main From Pump
Lost Hole Should Be
Next To End Cap
End Cap Distribution Pipe Layout Py /
R H~
S
X
Y
• to tlon at.m.t.n ~
Hole Diameter Inch
t/a•In ta.a mm]
Lateral Inch(es)
s e Ir Manifold Inches
Force
Main Inches
tn° HOLES PER LATERAL
p
062 INVERT ELEV. OF LATERAI
1 4'
0 9~ I SYSTEM ELEVATION
o to 10 ao so .o 70 eo 90 too tla t:o uo t.a tso
Let.r.l L•nath (ft.)
Page 4 Of 6
COMBINATION SEPTIC TANK/PUMP CHAMBER
4" Cl Vent Pipe with
(No Scale) Approved Cap, +25'
,Approved Locking Manhole Cover From Buildings (15')
With Warning Label Attached
Weatherproof Approved _
Warning Label Junction Box Vent CapT
12 Minimum
6" Minimum 4" Minimum
Final. Grade-,,,
r
6" Maximum Quick
4" C.I. Disconnect
18" Minimum Insp. Pipe or PVC
1/4" Weep
Hole
Baffles l~l
pproved Joint ; A
/C.I. Pipe r
xtending 3 Alarm 6' B Approved Joint
nto Solid Soil On 6; w/C.I. Pipe
or PVC I C Extending 3'
Onto Solid Soil
PUMP OFF ELEV. Off or PVC
D
Conc. Block
3" of Beddinq Under Tank--/
,
Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day r//,,
Gallons Per Day/ of Doses: /J V Gallons
Volume of Backflow:....... +]Gallons
Tank Manufacturer: car ~n cre' c. Total Dose Volume:........' Gallons
Tank Size-Septic/Pump: 75Gallons Alarm Manufacturer: S. J. ELECTRO
Model Number: 101 HIGH WATER Capacities: A -Z~)- inches or -S/ad Gallons,
Switch Type: MERCURY + B ? inches or Gallons
Pump Manufacturer: ` I'lly-er-5 + C Xinches or Gallons
Model Number /YI -f + D inches or / Gallons
Minimum Discharge Rate: GPM Total. inches or-~ Gallons
ag- L "hoAes 7)
Vertical Difference Between Pump Off and Distribution Pipe:AFeet
Mi imum Required Supply Pre s re 7. Feet
Feet of Force Main x~Friction Factor/100 Feet: +_LZFeet
__,:~_Inch Diameter Force Main
Total Dynamic Head:...= / Feet IIInternal Tank Dimensions: Length - Width_'_; Liquid Depth 1~'r~ /,(/jCG11. ~Er InC~I
PAGE 6 Of 6 "
1
e
ti
h.;
Performance Curves
MODEL ME40.ErrL.UENT PIMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
I
40 12
35
10 v)
30
ME-40 Series sP 25
ZLbf "00" -4-
4/10 HP Effluent and Drain Water Pumps 20 av ' la / 6
TWO VANE IMPELLER DESIGN PROVIDES MAXIMUM
DOSING EFFICIENCY 15
■ Enclosed design for high efficiency pumping. ° 4 0
■ Eliminates possibility of jamming between impeller and 10
volute.
■ Passes a full 3/4 inch solid. 5 S? P- P 2
■ Original performance can be restored if wear occurs by
replacing volute seat ring.
■ UL, CSA and SSPMA listed. o D
0 10 20 30 40 50 60 70 BO 90 100
DURABLE MOTOR WILL DELIVER MANY YEARS OF CAPACITY GALLONS PER MINUTE
RELIABLE SERVICE
■ Oil-filled motor for maximum heat dissipation and 4/10 HP
continuous bearing lubrication.
■ Overload protected, shaded pole motor eliminates starting
switches and relays which are prone to fall.
X Positive sealing, quick connect float and switch cords make
replacement simple if service is ever necessary.
■ Field tested, wide angle, mercury-free mechanical flat
switch provides maximum draw down. (Automatic models
only.)
PRODUCT CAPABILITIES
Capacities To 80 GPM 303 LPM
Heads To 32 H. 9.75 m
Max Spherical Solids 4f Um
Liquids Handling domestic effluent & drain water rG'
~ y ~m ~ U 1 f- 0t() rd C Intermittent Liquid Temp, up to 140° F up to 60° C CI J ~Q
Motor Electrical Data 4/ 10 hp, 1600 rpm
shaded pole.oll-tilled FRICTION CHART FOR PVC SCHEDULE 40 PIPE (Flow Coefficient C-150)
115 volts, 11.5 amps, 1 ph. 60 Hz Flow
230 volts. 5.8 amps, 1 ph, 60 Hz avm VA' 11n• 2' r e
Third Party Approvals UL CSA a v 14, v 11, v 14, v H, v 11, v N,
Acceptable pH Range 6-9 111
specific Gravity .9-1.1 8 1.72 1.19 1.26 .556
Viscosity 28.35 SSU 10 2.15• 1.78 1.58 6834
Discharge, PIPI I li In. 38.1 mm 15 3 22 3.76 2.37• 1.74 r33 .516
Min Sump D1a. Simples 24 In. 6l Cm 20 4.29 6_42_ 3.16 2 96 866 1.34 .365
5 37 9 74 3 9n 4.46 1.68 ,540
36 In. 91.4 cm - - -
30 ban 136 473 627 161 7.01• ,755 1.30 .264
1 7 1 1112 S1 n 40 2 :15 1 01 1 52 23.6 6 30 10.7 3 03 2.68 1.28 1.74 ,444
45 _ _ _9.67_ 29 S _ 7.09 17 5 4 JOJ OS 302 1.54 1.95• .552
50 7.A8 16.5 _4 70__ 4 f.8 3.35 1693 2.17 .665 1.26 .175
GO . 9 n 7, ,3 6_-- 'r 7.1 r r2 40_2_ 2.72 260 .9Je 161 .247
6.70 8 uf, 4.69 3.67 3.04 1.25 1.76 .330
00 - _7 fi5 11.5 _S 36 4.69 3.47 1.59 2.02• .415
_ 90 _ - - a t,0 14 3 6 OJ 5.83 3.91 1.99 2.27 .517
100 - - 6.70 7.13 4,34 2.42 2.52 .627•
125_ 8.38 10.9 5.43 3.72 3.15 .959
6.51 5.16 3.78 1.34
175. 7.60 6.90 4.41 1.79
200 8.68 8.93 5.04 2.27
225 9.77 11.2 5.67 2.64
2 0 -
6.30 3.37
275__ - 6.93 4.13
1O" - 756 407
J2'. 8.19 $ 70
37S
400
V Vn. t'n7 n f1'~x'C lip IlpMt lux! w, 111100 A W 1.1.'
• M.n Gr'M A Vr.tK.ny I'•r I4M5' a
n ,.rl.Vn,,ll)1 1 fwc. Vnlw, 1 f•rr V.lvi a 5 r11,-r.
DEPAATMENTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDIi.
DU~TRY, DIVISION AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/AttT'/: LOT~f~O.:BLK. N SUBL~IV SION NAME:
NW 1/4 sW1/a ~`l /T~ N/RJ( E c r) Awti /"V)1'/tj
COUNTY: OWNER' BUYER'S NAME• MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESC IPTIONS: PERCOLATION TESTS:
91 esidence New ❑R`e'place G / ~S
RATING: S= Site suitable for system U= Site unsuitable for system fQ37---
ONVENTIONI: ` ~ 7
JMOUNDS ou IN-GROUND-PRE: ISYSTEM-1N-FIL O~LDING T~: RECOMOuN~ SYSTEM: (optional)
LJ•J •J DESIGN RATE:
If Percolation Tests are NOT required ! V If any portion of the tested area is in the f / J
under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: N /Lq1
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
32 881 S)lTs 1194 6,1 5L. 11 1,~ h SL FrID a .M.4j--.
rr~~ U 4- 1 stt Ts 6o11Bn S•1 /3"8h SL S~ ~j~Q CRS
B-ol 715 C t' . "f- V
B- C( 9"81 igd is S; / si-
".4A 10 A lot
511 -t5 /Y" 6, ~s 3" Brn S4 ~F~orJ
B- 5`b y, oZ ~ " cL o
`~$1 5J TSLSL I$.. Bn S►- MFFOr_~ /k
PERCOLATION TESTS
T DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMB R INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 P R D PER INCH
P- n on e_
r_, PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION / & fl aW. ~ k i~e
e
N~,,
~o" S:I rs
3
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i E
i
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t
IN TRI CTIC NS OP TIN FORM 15 ° SBD - 6395
To be a coins ~ i accurate sail lest, yc mcljde
1, Gc~mpl£.°~' script;on,
2. Tire use s,~, ust clearly rick ; tt rr~siden=,:e it„ c;ornrnetr al project;
3. MAX lMl+''. - i` bedvoorns t
4. Is his , n- ~ £rtent system;
5. Cotnpl-t". iatirn£1 bet SUITABLE FOR A HOLDING TANK ONLY I ALL
')N SOIL CONDITIONS;
6. PLEASE a :ts sh{.. ` iting profile descriptions ar c ~ plot plan,
7. MAKE A 1 ~r) aCCUOtely your test locations. Dralrbg ~ rcr9. A
- separate She, ~ it: desire%1',
8. Make sure, y{ = id vertical ekvat: refer once >ioint are clearly shokvn, °rrnarlerit;
9. Complete all ~iMs as to dates, narnes, ~£s`dr ,fond plain data, percolation test exemp-
tion, if ?aJ1lror.'~~ .
10. if the info 7 Wi Im, e, do, s -iale box;
11, Sign the form,,; .Ir_ € yri <a i rich
12, Make legibl: and distribute as r ~iwd, ALL L TESTS _ FILED V111-1-1 THE
LOCAL A`J VVITI-111`1 3t3 DAYS OF COMP_
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures 0- ~ nbols
st - Stone, (over 143") X313 _ -edrock
rob Cobble (;3- 10") SS Sandstone
gr Gravel (under 3") _S Lime 'c
"s _ S. d High
cis & Sand
rned s •r,i Sand'
C
U y
sci ""Wry,
4101 :~.;L=" Lcm -n iYYC"tt
s' t u
sic. S 'l,"', C, fff few, f3rte, rat.
Pt - nirn Many, i
d - d;stir
P pvo€nir,.
I- WL H"gh
~s(, e BM B is
VRP Vr,& 1CC, p6nt
T
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
II JJ QSt. Croix County
OWNER/BUYER Pil'TI1 lC j/!Lf
MAILING ADDRESS 2'? I y 3 W / S_) 6 Z
PROPERTY ADDRES7-3 v '0 /l y. All 6 D Z
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE /it liL/ J d Z.
PROPERTY LOCATION 1/4, s kI 1/4, Section 2-7 , T Of) N-R_Z&/ W
TOWN OF L3al~w~~ ST. CROIX COUNTY, WI
SUBDIVISION ,N & LOT NUMBER ,
CERTIFIED SURVEY MAP 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 returned 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 &M,
Location of property l/4 SW 1/4, Section :;~:7,TfD N-R W
Township Mailing address 977 hi#U lv.?
)n sycaz
Address of site7• Q 7~_ I DaZ
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property -j-euu Ink/.son (JeAo_e~ 4- 144,4
Jol~nso~
Total size of property l ~ f}cr~cs
Total size of parcel I& Azle s
Date parcel was created D~Ob~,e /93/
Are all corners and lot lines identifiable? 'Yes No
Is this property being developed for (spec house) ? Yes )4- No
Volume 9XV and Page Number _LgIZ_ 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 i the office of the County Register of
Deeds as Document No. O'a5/4' , 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.
i nature of Applicant Co-Applicant
nat . O sianatur, nlt n f nr at,,, n
~.I
•.-..t ,,I THIS SPACE RESCR,,ED FOR RCCOROINO DATA
ROCL TRENT No. WARRANTY DEED
STATE BAR OF WISCONSIN FORM i-"= 1
c
` 481.846
U9ER 944PAGE 612 ' REGISTER'S OFFICE
ST. CROIX CO., W1
Jerome E. Johnson and Judy C. Johnson, _ Reed 1W Record
husb_and and wife, holding as survivorship i
•
maritat...property APR13'992
- -
8:30 A. M
-
conveys and warrants to a ith--.Hines-- and---Be.c ki-e L.--
..Hine.s.. hp.s.hd.nd...an.d..wif----
..s..u..r.......viv...o...Sb.~.P...ma.rital...pr4R.ertX....................
r
- - Rego of Deeds
-
,.I RETURN TO
S.t.....C.r.Q.i.X ......c410ariay.
the following described real estate in
State of Wisconsin:
Tax Parcel No:..............................
The West One-half of the Northwest Quarter of the Southwest
Quarter (W# of NW'I of SW'I) excluding the Soutitl 293 feet of the
West 293 feet and further excluding the Certified Survey Map as
recorded in Volume 2, page 439, St. Croix Co,.znty Register of
Deeds office, all being a part of Section Twenty-seven (27),
Township Twenty-nine (29) North, Range Sixta'n (16) West.
lit
as
This 1 S not home,tead property.
XAX(is not)
Elxception to warranties: Easements and restrictions of record.
t , ly 92
Bated this /St day of
J
ltc ISEALI
(SEAL)
•Jero7re E. Johnson
.
(SEAL) (SEALt
Judy C. Johnson
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF WISCONSIN '
.l' 3.
authenticated this dad of-__.. 19----- came beforc nm t92 iac W
19 :"r .Ilse nan,,i
- - ' Jero7re E. Johnson and Judy C.
+
) n
l -
TITLE: AEJIBER STATE BAR OF WISCON.:IX
(If nat. .
authorized by i 706.06, Wis. Stats.) LP 1tt' - 1n t..• LiIQ etirc lltcd ti'.e
fo: _ i.r_.::. pt a acknowleAxe tLr ear^e.
i
T-5 INSTRUMENT WAS DRAFTED BY ~~l it yIr
- '1
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1
y ~ ~
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