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042-1084-60-140
p tof o ~ a~ I a ~ I I o i I N o I I ~ I I I I ' I 3 I I 0 I LL o o v y I z Vi uj E N 00 rn M ~ fA m C O O Z C d Z a Z to F- c '2 M N O N f=/1 N O EL o L) I C C Y 0 z H Z C C M d N N W C _ O a C 0 a ooa` a °O N M Q O U) U) N 7 0 Z V O CL o ~~h~~~~''!!///^~~~ O Z O z R O a y a ►~l C N ro co rn Z O 'D ° o to J U 01 N moo 0 0 N E =3 > co O O _ Q z (A m W y O O O V- y C CD '0 E C14 I- c r- a) O C d X 0 0 O C) Q 3 V O V a 0 0 1 C 'a N N O co 0 O C N N *4 O N y r N N O -51 O N O ) J O z z cn V ~o a C a A 0CL 0U)u Parcel 042-1084-60-120 01/05/2005 10:51 AM PAGE 1 OF 1 Alt. Parcel M 30.29.18.474A-20 042 - TOWN OF WARREN 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 * ERICKSON, RUSSELL A & SANDRA J RUSSELL A & SANDRA J ERICKSON 960 70TH AVE ROBERTS WI 54023 I Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 960 70TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE SEC 30 T29N R18W SW SE LOT 2 CSM 8/2192 Block/Condo Bldg: 2AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/17/2000 633916 1560/330 WD - or=11-999- 607369 1444/118evsu>1 WD /23 --W7/171 6jh ft,61- 2004 SUMMARY Bill M Fair Market Value: Assessed with: 38576 250,400 Valuations: Last Changed: 10/23/2001 Description Class Acres Land I prove Total State Reason RESIDENTIAL G1 2.000 37,500 1 2,800 220,300 NO Totals for 2004: General Property 2.000 37,500 182,800 220,300 Woodland 0.000 0 0 Totals for 2003: General Property 2.000 37,500 182,800 220,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 559 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 %L-~ Goa- i0~v- o \ r .63 O FILED 2 456664 l: M.AR 15199bo- 9, JAMES O'CONNELL j R ister of Dews L CERTIFIED SURVEY MAP WILLIAM CLAPP ,A CTS Fart of the Southwest 114 of the Southeast 114 of Section 30, Township 29.Nortb< R rige . 18 West, Town of Warren, St. Croix County, Wisconsin. .'''•Y~ W OIndicates 1" x 24" iron pipe weighing'.1.13 1bs':f~l}n.: Z N114 COR. SEC.3o,T29N,R/9W, ~ (COUNTY SURVEYOR'S MON.1 ft. set.. a Owner's Address: Route 2, Box. 113 y " Roberts, WI 5402' 2 N ° UNPLA TIED LANDS Q a N 90.OO'OO-E 1221.02' O Q1 ? N 396.00' 264.00' S6/ 02' O Z r 3z LOT / LOT 2 GOT 3 4QIIM ^ O 3.000 ACRES (n 2.000 ACRES 4.230 AC ES p ° e7,113 SO.fT. 185,122 SO F /30,670 S0. FT O O ty O M ~I V N M NET a 2. 700 ACRES NET a 1.600ACR4 Nf T a 3. 25 A ES;~ q N QI. J ok. M 117, 6o3 SO. FT. 78,402SO.IF /66,6/0 .FT. ~Y. 'N a J w O O Z N 90. 00' 01 C 122 1.02' e 396.00' 264.00 S6 /.O I - i 396.00 264.00 36/ 02 M N90. 00'U0 "W 2640.04' S LINE S£ (/4 66' 70 TN AVENUE sr coR. sec. 3o, r 2s N, R 16 W UNPLATTED LANDS /COUNTY SURVEYOR'S MO,N.I ~ S//4 COR. SEC. 3o, T29N,R/6W (COUNTY SURVEYOR'S MON.1 h 3 SCALE I"= 200' 0 50' /00' /50'200'250'300' 400' 500' 600' 700' O , Description : `lr: o M That certain parcel of lane located in the Southwest 1/4 of the South, east 1/4 of Section 30, Totmship 29 North, Range 18 West, Town of Warren, Q W o h St. Croix County, Wisconsin, more fully described as follows; W % ° Commencing at the South 1/4 corner of said Section 30, the POINT OF k° ? BEGINNING, of the parcel to be herein descri::ed; thence N 00°42'30"W Q ? W (assumed bearing on the North/South 114 line of said Section 30) a m.~ distance of 330.00'; thence N 90°00' 0011E 1221.021; thence S 00°42' 30"E 330.00'; thence N 9000010011W 1221.02' on the South line of the Southeast 1/4 of Q.~ Q said Section 30, to the POINT OF BEGINNING, containing 9.249 acres, 'ing subject to easement over the Southerly 33.00' thereof for town road purposes ane,also being subject to easements of record. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, William Clapp, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that this map and description are a true and correct representation thereof. ~t 8 Odd r .U1 2 8 IN 5296 54 CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE SE 1/4 OF SECTION 30, T29N, RIM TOWN OF WARREN, ST. CRO I X COUNTY, WISCONSIN BEING LOT 3 OF THE C.S. M. VOL. 81 PAGE 2192 PREPARED FOR: DIRK LINDNER SNOTS; LINEIOFSTHEESEE1/4E(RECORD THE BEARING). 2 JUAN ~~~`Na s~+ 3 UNPLATTED LANDS S 90000' WE 561. 02' 's ~n 297.02' I 264.00' ' 0-3) N; SEPTIC SYSTEM 99E NOTE ON SH T 2 W. C7 , e • L T 4 o o: co • 0 2.25 ACRES ro 2.00 ACRES a d: N 88.009 Sq. Ft 4 87, 113 Sq. Ft. " ~D w O; $ H*use g m g C W: Shed ~ JA ............................Hl9hwcy Setback Line M ....yr.............. / . 0 O J N, O 1 DR / VE .I ; N 90.00' 00' W 561.02' _ 297. 2' 264.00' m . 33.00' 33.00' 297. 33.00' 264 _ 00' r/4 0 ' N90000'0 o f N 900 00' 00" W 561.02' M 7,0,TK - - Av.ExU.F - S V4 Corner of Section 30 Sc UP0ftV Y t_S 1/4 (County Monument Found). SE Corner of Section UNPLATTED LANDS Found). Monument AREAS EXCLUDING R.O. W. .[iiN 1 . ~yJ; LOT 4 LOT 5 2.02 ACRES 1.80 ACRES ST. CROIX COUN + Y 68,208 Sq. Ft. 78,402 Sq. Ft. ~:omprehensive Pt:;,Ir 'AW1i"Ift# O -SET f' X 24' IRON PIPE WEIGHING Zoning and ov G Q N N'W Parks Committee siz ~ .13 13 LBS. PER LINEAR FOOT. I~ 1' IRON PIPE FOUND. If not recorded N JAMES M within 30 davs of 7;~WEBER e --1 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Ufijet lC ADDRESS 7a 14 60Pt- e. Syc 3 SUBDIVISION / CSM# LOT SECTION _?C_T z;? N-Rlif_W, Town of Cy/4j le4,tl ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o 7 S6 ti ~p y 3Q o 0' yam` ` 011 -4 Tod o~ #s v~wr t/40 P" IF low. t~"F V L INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. v t r } - BENCHMARK: AV, -I- 7 ,re BM: ze~f_ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ",e Ar Liquid Capacity: / ®d Setback from: Well > 3-0 House Other Pump: Manufacturer Model# Size Float seperation Gallons e: Alarm Location SOIL ABSORPTION SYSTEM Width: Length gNumber of trenches 2 Distance & Direction to nearest prop. line: i Setback from: well:? House ys ` Other ELEVATIONS Building Sewer ST Inlet,. pp„z i' ST outlet f'g, yy PC inlet PC bottom Pump Off rS . e 6 Header/Manifold# i 93.92- Bottom of system f#At ( 1 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt h Wmconsin"Depa-tWntofindustry, I PRIVATE SEWAGE SYSTEM County: ST. CROIX LaborantfHuman Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 1> F; P L1M W's Nby, ❑ City ❑ Village ~ Town of. State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~bJ' Ott/Y✓~ sty' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /off, ~DD< Dosing 2 /X~ 1o0, Aeration Bldg. Sewer Holding St / Ht Inlet 58 loo, 7(' TANK SETBACK INFORMATION St/ Ht Outlet lv0.. y' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ' , NA Dt Bottom DSO' a2 a2- Dosing NA Header/ Man. q A;Z ~ ,9 ? a 9 9Y, g 3~, Aeration NA Dist. Pipe Holding Bot. System o.9 S' d , 5?' PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand 7y~ 9? 38 Model Number GPM TDH Lift Friction System TDH Ft e oss ad F Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ;2-j DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO pus-~ CHAMBER Model Number: System: '/D j J OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Bed th Over xx Depth Of xx Seeded/ Sodded xx Mulched Depth Over Depth /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN-30.29.18W, SW, SE, 70TH AVE Plan revision required? ❑ Yes No Use other side for additional information. SBD-6710 (R 05/91) Date Ins ct r'sSignature Cert No. ADDITIONAL COMMENTS AND SKETCH ' Y SANITARY PERMIT NUMBER: I SANITARY PERMIT APPLICATION Safety and uild ng Water Sn Bureau o of f Building 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. y • See reverse side for instructions for completing this application State Sanitary Permit Number C~7 41A5 The information you provide may be used by other government agency programs QCheck tf revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location _3~ y1/4 1/4,S T~2 1' ,N,R /E(o0J_W i Property Owner's Mailing Address Lot Number Block Number Ci , State Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE F BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF - Ill. BUILDING USE: (If building type is public, check all that apply) 'Parcel Tax Number(s) 1 ❑ Apartment / Condo " 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. jZ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: :r/ ;•o 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S ste lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) OK f V Elevation ja~p,~ t,>, 50 Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank s' f r i ",Sd,r ❑ ❑ ❑ ❑ ❑ p Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation tl~e onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta s) MPtMPRSW No.: Business Phone Number: F-,yam=t ~ ,4 -.s'G S 151 is Address (Street, City, State, Zip ode): u): IX. COUNTY/ EPARTMENTUS ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Ag nt Signat re (No Sta Approved F1 Owner Given Initial Surcharge Fee) / A IL Adverse Determination <b 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 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, 608-266-3815. 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. IL 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. 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 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 8 112 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 w'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. I H l o e k ti N w I i, ~ I y C c i n Rr W AA ~ h 2 ~ ~ ~ ~ a- ENO Gi o o ti 11 to 'S I ~ 1 t► - a n 1~ ~ ~ ~ W p N Z~ ~C 0 BOLDT'S PLUMBING & HEATING, INC. 820 MAIN STREET BALDWIN, WISCONSIN 54002 (715) 684-3378 FAX (715) 684-3144 October 8, 1996 St. Croix County Zoning Office ' a Government Center 1101 Carmichael Road Hudson, WI 54016 RE: Dirk Lindner Soil Report To Whom It May Concern; I am enclosing the revision of the soil and site evaluation sheet to show mottling discovered by the installer of the system for Mr. Lindner. The mottling, however, is not indicative of high ground water; but is a slow leaching problem of water down through the silt loams. Therefore, the system should be installed in the coarser materials; causing a variation in the system elevations, because of uneven distribution of the coarser material in the horizons. This system is to be installed with a .5 bed or .6 trench loading rate, and widened or lengthened to accomodate spotty areas where the loams run deeper. These findings have been collaborated by LeRoy Jansky, the DILHR soils specialist, under the observation of Jim Thompson (Zoning Administrator), Dave Fogerty (Installer), Dirk Lindner (Property Owner) and Dale Hudson (CST). Please refer to inspection report, dated Sept. 18, 1996, made out by LeRoy Jansky, WWS. Sincerely, Dale E. Hudson, MP #6629, CST #3413 c.c. Jim Thompson, St. Croix County Zoning Dave Fogerty, Fogerty Plumbing Dirk Lindner enc. 1 DILHR in accord with ILHR 83.05. Wis. Adm. Code ` COUNTY Attie, msto site plan on paper not less than 81/2 x 11 inches in size. Plan must include. but Cr'a %X not b4ted.to vertical and horizontal reference point (BM). direction and % of slope. scale or PAItCEL1.0. z arnonooeed. tarth arrow. and location and distance to nearest road. e Se APPLICANT)NFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY GATE co PROPERTYOWNER PROPERTYL ATION GOVT. LOT S14) u, .`E u4S.361 N.R %o MOPUITYGNNEWS MAILING ADORE §S LOT If BLOCK # Suu419. NAME OR CSM 9 V4 49 /A/ve . -5 A""o Gdf 3 / c 2'19Z- CITYSTATE Id l- CODE PHONE NUMBER ❑CITY'' (]lVILLAGE MOWN NEAREST P Idl- (7/5) 7,Y9 - ~o l D G~/Q r r G r►- New Con hxlion Use ()C) Residential i Number of bedrooms j j Replacement Public or commerdal describe Code derived daily Now Asa gpd Recommended design loading rate bed. gpd ? ' G trench. gpdO Absorption area regrdred`750 bed. ft2375 trench. g2 Maximum design loading rate bed. gpd0 =trench. gpd 9 Recommended Infiltration surface elevation(s) /)/14 It (as referred to site plan benchmark) Addihomldesign /site cauidetations2 T4s p be :hs P. hto sZ ~n°/~ow ~ol~P ekv- Parent material n n / Food plain elevation, if applicable A~4 n S - Slut" for system =IVM ZONAL "10 MGROINr PRESSURE &r DE SYSTEM FILL HOLDW TANK U - unsuitable to tem s ❑ u P' S ❑ u DM ❑ U s 11 U ❑ s IU os-iiali SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Y Roots GPD/ft in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. Bed Trerrt 1 77- 0-9 ,5` 9 312- e- z 7s m e- ara cry -5 z 9-z5 ioY 56c z al 75 zI,25K ~ c - :5 Ground -3 Z5-57L ' Alm, S~r S I1 co --7 • d elev. 9•3/fL. `f SZ-96 •Jr R Yl CSY 5,q /n Z 1 •7 , L/ C/ mo Rem jt { rnof f~e_5 l°S o;r/' o» ` p e Av.s p ` Cacing 9 6-I Z_ Z 7,$),,R s z.nsb rn ~r- . r=v G0~v ' 5 1 4 Z 2- -36 It o Y\ C, s s v ,r c 6 Ground 3 39-AH j7,5~ye~4 S tAr elev. o s/ 2,-s~7~ Y' LJ ' I •6 99-211L N89 7-5~ 6 e -s S -7 • g Depth b - 1 Remarks: >"oui'1 W GLi ra,6 e CST Name:-Ptsase Print' Pia; Address: ~ZO /Za,' 2 Sgmture: ~ Date: CST Number Boring IF Horizo Depth Dominant Color Motow Structure GP l/ ll 1/ ll Cons~stenoe - in: Munseil pu, Cont. Color Texture Gr. Sz. Sh. ~ ~ Roots 3 Bed Nrees C vim-in a .cam _ , Z /-ZI /O Yx C 2- Q1 7 S S~ irI Gr.J C{~ 0.45 ~ •1, Ground -l elev. o ne~ S Z rr~S~ CGt~ ' 5 = 9h y y-y9 715 ~ y ,,,P ucs s / C. Depth lo CS t3r 59 firnifing Wor Remar , r o r c `S r'fjot ~ ` Boring # 2-7 Y Z- ItIo nr- S Z,y, : ~7j Qua C, F~i 13 Y9 o C w C- Ground 7=5 Yik Ala C : 8 elev. 179 6 Q y - e s •7 ,D Depth to smiting facto 79 Remark's: ~/~F_ n P Y- Boring # o-q "Y9 A/one, s Zms6 ~>c~ G?td CrYI •5 A 3K El 2 93n 7,5 Yf y O ~ r Zrnsb~ /YI✓ ~ tc~ CT ' 3 3o-y6 7, 5 ~'y Ground S Y f A7 G 14,) +7 _ elev. 6 65 7•5`~ r✓ S~p r 93-5'l n - 51, 1~11 Y G cJ Depth to 5 S.-'7~j , 5 o C'S 8 f r a7 i limiting -2221- Wor Remark's: Boring # Ground elev. IL Depth to 6midng factor i Remarks: =wb: Safety and Buildings Division 1r"~i SANITARY PERMIT APPLICATION Bureau of Building 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application state sanitaarr Perrrmit Nub rr The information you provide may be used by other government agency programs ❑ Check i r.JisiPebfCt jrevi: d uspliEatilr' [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1 /4 1/4, S T Z 9, N, R E (or)69 _ft O&E Property Owner' llin Address Lot Number Block Number City, ate Zip Code Phone Number or CSM Number GGtL~ 1(7zf~- JO xt II. TYPE F BUILDING: (check one) ❑ State Owned El ityage Nearest Road p Vill Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 7, 0 46V C III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 !y.0 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. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 'If f ff. O 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) f f/ gs", L Elevation Feet el 0 *W I O Z , If 91 s Feet ,Z 3 P3 VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App. New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT the undersigned, assume responsibility for installation of the nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta p PRSW No.: Business Phone Number: +v-r V1 A /2 s s'L -um I ber's Address (Stree , City, State Z p ode): , Z- IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) XApproved E] Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) 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. Onsi'te sewage systems must be properly maintained. The septic tank(s) must be pumped by alicensed 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 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. 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 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 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.41 15 form; and-F1 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. DIME POQERTY PLU 1~ Ucemed FWk Testa & Plumber si3233 03209 No WMCORoad RAno t" No ot7 A 74 7 6 ~ wtiw ~ Flo' sysf~ - -oar CLoT f~/) +R 2 30~ ~y 0 a ~-B/iR, Tot' eF j ,tTeirr ~1rj~rru►6. ®o = ,8' 75 . . ~ ~ a~css All Ad*AQ 407- 60A L*,E AV ACC oovTt`v 3-OX•) 70 Svc. ~1. ;s~IR=~ µ~CM'==S f+~ G,=+~'{?li_'~~ x~..,r. :tnrr4 r Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (725) 749-3656 r It v~c►N~ r i...- -T y ..~/W, X3.1 (n" ti. r _ Vii/ ~t~~iL : s.6 ' 33 ' c ti y A p"-01 PY• 3 .act sw = ~~7• pD n orwLHR in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1 1 i r Ian must include, but -9t' C,.p ~ not limited to vertical and horizontal reference poi ec ro ope, scale or PARCEL I.D. 0 dimensioned, north arrow, and location and dis nearest ro d. APPLICANT INFORMATION-PLEASE P ~ ALL 1`0F,0 R N REVIEWED BY DATE dr _ PROPERTY(NINEFL FE&ARTY LOT SW 1/4 5'11/4,S30 T Zq N.R /Y 0(or W PROPERTY CINNER:' MAILING ADDRESS %Z S IBLOCKI SUBD. NAME OR CSM rr 966 '7p ve- . v Z~3 8 A 7e 21~Z CITY, STATE ZIP CODE U ER CITY ❑VILLAGE TOWN NEAREST ROAD New Construction Use Residential / Number of bedrooms j j Replacement ( ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 • 6 trench, gpd/fl2 Absorption area require675j bed, ft2 375 tr enc , ft2 Maxi um design loading rate a 7 bed. gpd/ft2 • ` trench, gpd/ft2 Recommended infiltration surface elevation(s)-f 9 Z 3 ft (as referred to site 0 bertchmar~C) , Additional design 1 site considerations S Ce,n ✓ed? / "on a / _y X 9 Parent material 5,•. a j /o 0 s-cQ6, ,yen f Flood plain elevation, if applicable /Vs9 ft S = Suitable for system CONVENTIONAL MOUND "ROUNDPRESSURE ATGRADE SYSTEM IN Fill HOLOWG TANK U= Unsuilable fors stem KS ❑ U X S ❑ U f9S ❑ U M S ❑ U ❑ S XU ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax-dary Roots GPD/ft- in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ~Trend /Vt,J 7,6YR 3/z v/1 c, s~'~ 2r~s'~~' C!w C02 •5 j ' G_ f L 9-z s ~o Yee S 6 s; / :2 _r 9s -k r7l r C- &0 Ground 3 2s-SZ T7, 5 YR /?'I V-7 r c w •'7 j . 8 elev. I q 31 ft. 4/ 5Z- SCJ W5 4-7 -9 Depth to j limiting - tactor > 90 Remarkss:_ Boring # ~/Z o~l~ s.'I 2m5"br c~r,o Cr-I i •~j BZ 2 Sw 1Z-36 25Yse s/ 2.n5 ~ /ylV~r GW •5I Ground 3 36-yy T5 Y91 .n/ C~ •7~~ - elev. `1 ~j1-7~1 75W s64 /n✓-fr CW •5j~~ - r7 Depth to 5 7y- 89 _'7r S ye G d r S • 7- limiting tact r - - I Remarks: CST Name:-Please Print J/ Phone: 7/5'-68y -3378 Address: 9ZO Signalwe Date'. CST Numbo( ~uY` 5-5-9.5" 31//3 Boring t/ Norizo Depth Dominant Color Mottles Structure Pf)/ft~ in. Munsell Ou Sz Cont. Color Texture Gr. Sz. Sh. Consistence Bo~ Roots L/L 7.5y Nc,- e- cry .s. Ground 3 21-31 '7.5Y)~ YI/ 51 Zr»S6~ ml4r C,,~ •5 ,~o elev. 97.35n. y 3~-vg 5 y~e y VC, S-6 5~ Depth to 7.5 YR61 limiting C s r $ /0/ • 7 ' 8 factor ~75 Remark's: Boring # 0-7 7,5 XR /z s~ Z 7-15 7,5Y1 y s/ z,~-,s>; <:w wn,4i4i1 Ground -3 /5-yy Y9 elev. Depth to limiting factor Remarks: Boring # f - -q 7' S Z- „n e Si~ 2r~ s c~ G rr) (v NE ,xis Z o y -3 7-5 Ground .3 3a-y6 7,5Y~ J/1' 5v r S /~?V4- GLD Ig elegy 14 `16-65 7,5 Y -ki Depth to S 65-79 7-5 ' limiting y for Remarks: Boring # Ground elev. n. Depth to limiting j - factor I Remarks: FILE Copy 93,7 7 BM 2 L.y' Sfax Sri ay ~ Q4-- rs (03 ~ 63 i Prori t 10- 1N045G i f o ~ #Z 3~ Gi~►*°le i ' 11Od ~ 140 DRIvewAY Lou WWw /M_ yon 70 134' Gy STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ JOr~X 4Z^,✓V,4/412 MAILING ADDRESS f4a PROPERTY ADDRESS ED 7B iE Rk /11_-2A 73 w.r S~'y©13 (location of septic system) Please obtain from th Planning Dept. CITY/STATE PROPERTY LOCATION ~J 1/4, 54E 1/4, Section '3e T Z % N-R / W TOWN OF C-4,dL~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ~A_ Q AWVOLUME l'D , PAGE ,29~ 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:' j DATE: y- 3. 0-- ~y 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 Azff7 r Location of property_g 1/4 CC 1/4, Section ?,a TAI _N-R /lam W Township w~ce,es~✓ Mailing address 9r~ L4* W l Address of site !?7o ;7,05 44,.c yo,i2 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Z. yd Total size of parcel 2 ®D~ Date parcel was created /QQS~ Are all corners and lot lines identifiable? /Yes No Is this property being developed for (spec house) ? Yes No Volume oC77 and Page Number -Z/g? r as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ,,Z4 l2r_ , 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. a69 Signatu of Applicant Co-Applicant EASEMENT AGREEMENT Document Number: VOL 543ZS5 o CRO C TY, W3 E' Rud'd for 8000,"I k F Return Address: MAY 6 1996 DO 1A Parcel I.D. Number: 042-1084-60-130 WHEREAS, Dirk Lindner, ("Lindner"), is the owner of the following described property: Lots 4 and 5 of Certified Survey Map recorded in Vol. 10, Page 2931, as Doc. No. 529654, being part of SW1/4 of SE1/4 of Section 30, Township 29 North, Range 18 West, St. Croix County, Wisconsin; WHEREAS, the septic system servicing the home on Lot 4 of the above described Certified Survey Map is located on Lot 5 of the above described Certified Survey Map; WHEREAS, Lindner, by this document, is establishing an easement over Lot 5 of the above described Certified Survey Map so that the septic system as presently located may remain; WHEREAS, Lindner acknowledges that when and/or in the event septic system fails, or needs replacement, this easement shall terminate and cease. NOW, THEREFORE, Lindner acknowledges as follows: 1. Lindner, as owner of Lot 5 of the above described Certified Survey Map, conveys to Lot 4 of the above described Certified Survey Map, an easement for the septic system presently located on said Lot 5 and further grants and easement to Lot 4 for ingress and egress necessary to repair, maintain and pump said system. 2. This easement shall exist so long as the system is not failing and does not need replacement but shall terminate when said system fails or needs replacement. Dated this day of May, 1996. Dirk Lindner "scribed and sworn to before me s slL day of May, 1996 YCLI" PAS Notary Public -hfI>k air My commission !-emi This instrument drafted by: Attorney Kristina Ogland Hudson, WI 54016 Vam.%■ GO Y V...-. LOOXTED IN THE SW 1/4 OF THE SE 1/4 OF SECTION 30, T29N, RIM TOWN OF WARREN, ST. CRO1 X COUNTY, WISCONSIN BEING LOT 3 OF THE C.S.M. VOL. 6, PAGE 2182 PREPARED FOR: DIRK LINDNAER NOTE BEARINGSTAREBREfERENCED 79 THE - BEARING). a f .UNP.~ATT~D..LANUS S 90° 00' 000 E ..561.02' N - ter. Oz' 264, 00' rn. I0 f it '-T OT 5 2.25 ACRES ro 2,00 ACRES p N 9e. 009 Sq. Ft ~i 87,113 Sq. Ft. J. - ti ;I r+ W O ~ p House g d ~ R ■ sn.e M W M........__........ Highway Se lDoch L InP J: X. U' ORIVE) c) . ; N 906 001 001 w oe 1.02' 257• $3.00' M 284.00' 35.00' 33. 0J14 ^02' Pf17.02' 264. 00' 199 N9o•oo' ov'E N 90000' 00• W 561.02' 8 1/4 Corner of section 30 South Line Of the SE 1/4 (County Monument Found). SE Cornor of Section 30 (County Monument OFP ATTEO, ,LANDS Found). AREAS EXCLUDING R. 0. W. LOT 44 LOT 5 2.02 ACRES 1.80 ACRES 68.208 3q. Ft. 70,402 Sq. Ft. A" 641 o •SfT I X 24' /ROY PIPE WEIOHINO ~};~1~''~„ 'F/~~ ~s~ +I 1.13 LOS. PER LINEAR F007. h■ 6- i• JRdV PIPE FOUND. JAM M_ y,/Efii,S S ~ 13U4 SP1~1NCi VALLEY WIS. a 100 a 0 1 00 200 300 ~ 1% 4% i GRAPHIC SCALE FEET 4 Iloilo JAMES M. KOER 9-1804 SHEET 2 Of 2 NELSEN-WEOER SURVEYINO r DATED Ttil3 1=} DA't OF 1890. Tn1e Inatrument dratted py Jim wsbor CER I IF I ED SURVEY MAP .LOCATED IN THE SW 1/4 OF THE SE 1/4 OF SECTION 30, T29N, R18W, TOWN OF WARREN, ST. CRO I X COUNTY, WISCONSIN BEING LOT 3'0F THE C.S.M. VOL. 8, PAGE Z 192 331 ' i PREPARED FOR.' DIRK LINDNER I SHOO H DEARR1NG8TARHE E EsRElERRENCCEED TO ME LINE BE AR I NO MNKATXP ,LANDS S 90° 00' 00e E ,561. 02' 297, oz' P64. 00' I w: z LOT 4 14 y$ N: 2.23 ACRES 2.00 ACRES b 90.000 Sq. Ft p O N 87,IIS Sq. Ft, m ; . Q $ NOV,~ O G o p: Shea N . W yT--,r H r+1 woY Se l Dot.. Z: 1 ( DRIV~ N 0000 00'W 561. GPe J3, 00' 207. 264.00' 33.00' 297.0¢' 284.00' 1419. 02' Ns0~oo' oo•E N 90° 00' 00' W 561.02' M ,lOT~, i _ _ A MM, _ $ 1-14 Corner of section 30 South Lino of t!e BE 1/4 (Counly Monument Found). SE Corner of sootlon UNQ~ATTEQ LAND 30 (County Monument ~ Found>. AREAS EXCLUDING R. 0. W. LOT 4 LOT 5 9.02 ACRES 1.90 ACRES 68,206 Sq, F t. 10,402 Sq. Ft. C .SET I• X 29' IRON PIPE MI 1GNlNO~:~~° K~ Of. 1-13 LOS. PER LINEAR FOOT. ! • • I' IRON PIP 1~1 3 E FOUND.' ' CZSPfAING~,~~VALI.EY 100 o i 00 200 300 + ~O*~~ ` . 40 GRAPHIC SCALE FEET i +a°°6°1 e ~ U " i _ JAM $ M. WEBER 8-1804 NELSEN-WEBER SURVEYING j SHEET 2 OF 2 i This Instrument 4roft.4 by Jlm Weper DATED Tmis 'DAY OF P.~ a~~ _1ee5 j I 1 LOT 2 C, S.M. . VOL.. .8.. PAGE 2192 t . d , 30 A .00 •Q£E lilt .OE .Zb,oo N .ao •tsa 4 z m Crrn T ~Iw m N `_T I"T ro 4 ~ CNT ~ a ~i o Fn A C a ~ m m ' ; • min O O ~ i ~ o pp ♦ O ~ g Q 00 .00 c 3A£.ZO.DO S :Q 4;p A lot r :pj a ~ AE ro q3 Q a p a 8 O a D rq~ D a a A O k m r Iv W ~ 0 c a° .c MIZE 43%- - - - b ,00'0£E 3.0E .Z~o00 S UNPLATTED LANDS T ~ v' 3 s n t 232 r ~//7 /60 Mer u ` , W v ~ C~ u CQ/r7i/,~ o W /le s S .DQVid M '~'5 0 0 o C v o 1~uane 7~q /(e /"~r/~Gnnct 7 h M K7.S7 ui- 4 z o 0 /am f !2 /Mo' • F 3¢3./4 C a ` 5~r ~~j s• ese O ~r a10w~ rG/7 to ^ fIMQlYUSf/. ~ ~~?k+rCT L Q . ~ pp~..~r, Lei . k ylc N mac' H.10 d C h v' r Q r e a./ /y, W s z /CGDC/'7` L. f /34.6 Sand/-ct Gordon F fRR sor .9/6,:i X 7' h Gc. d9.2 Per/' t .Dorn M Gr'afs y.... y J ' a•n . E Evc/ S""'`LL C~ l C Jones • a I'✓.ibewo- ~6 B tips Q v Tr.V/GG.22 •r I3.9 i ~e r - /A376 . ROBE RB=I .s S iS 44.44 r• . K .T -7 ~h.Y/o Al Gay/ F. s c ` 1' I • ~ •pdurn Don '^h -c j `r Ccra/cT 2dp Asides Ea~ic • h „ t Y/07 Q 0 y d ~ ~ •d ~~G A GfPlSOf! .rs ~TO",i ~ ~ -aecr Its 'ilt ?5 Mrrstii~ .p n~Q~d S y 'sB• : . ' s 3 4' ~5,,,;=~~ ' 1Joris h o oT i ' son Tr s N /vo us 7B• • /l'~~/~~ Ida tL i .6 S" 4 ~ E/eQlap,r .~3 •SF rlCDeid 4' S rats of Lanei~ocf ,redo/.! ~Iam.7 ao"iS fr.Pcrdo/ fi 7 Iscons+r7 .rra.- e4.P-; ~rec~9~ . o ll%%//QJr) S. /C M Y0. Q. 47 /SDI /3J ~ LS'chwa./Gr! ® 915 • / a./efy /07.ert Rc,~jjL • cTar,~s v~ o ;9iian r A.c~ / /l esfeQ~ . .~es.ra ~rnn r e~aneJ ~vn c . Roo i. I C /V Erects= ,rrrrr~ t mar-jorle ri € it14 rick m Fo4d~fy Fo G/' Z ITCWGt'f' /S9. L S ~ tiecer~ \ /E'$•~,. ~ /9•SJ~o~ GrQ//`1Q/o Pcr /S~.ZnC. 900 1000 SE£ PAG£ !7 1100 1200 ~'crN•zr C. `_'A~Le~ %.r ~r,.; ~ t'-3' 3,€C-' 7? PREPARE FOR THE FLIM~ UNITED STATES JoG DEPARTMENT OF THE INTERIOR + Ty GEOLOGICAL SURVEY 92°37'30" R 19 W R 18W 531900-E 532 35' 45°00' l 002 13 ~C 1$~ 17 _ o - 8 - r i o i G - a' F p Holden' G el Pits'- ° Q 0 4982000-N \ 095 060 ~000 - _ -241 eg a - - /0/4 2 1065 J O Np8 O - B c° - - - - _ /072 _ 9,94 X 998 - - Q lad?_ 8 - g4980 - - - ~j _ - _-~1 /084 y- /TM~o•-_ _-i--~ - 25 00 10 "iloo mo . \ SN l ,1038 9-99. 94 57'30" 996 36 31 _ o~ 4Gravel Pit 4978 r.pian6pit~ 32 A057 T28N 77~%F' I r \ 7a ( isi oQ 4977 Pr 1010 AP471$-95 T U E ©229 Phi NELESEN WE BE F.' 11F.VEYING, N 1 f 15 4'25 68 n4 F. 01 s x ~z~ r c~Iv A parcel of land located in the SW 1/4 of the SE 1/4 of Section 30, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, being Lot 3 of the Certified Survey Map recorded in Volume 8 of Certified Survey Maps, Page 2192, more fully described as follows: Comnencing at the S 1/4 corner of said Section 30: Thence N90000'00"E along the South line of the SE 1/4 a distance of 660.00' to the POINT OF BEGINNING: Thence N0042'30"W 330,00'; Thence S90e00'00"E 561.02'; Thence S0042'30"E 330,00' to a point on the South line of the SE 1/4 of said Section 30; Thence N90000'00"W along said line a distance of 561.02' to the point of beginning. Contains 4.24 acres subject to 70th Avenue right-of-way over the southerly 33' thereof. Also subject to any and all additional easements, right-of-ways or conveyances of record. I, James M Weber, registered land surveyor, hereby certify: That In full carnpl i ance with the provisions of Chapter 236.34 of the Wisconsin Statutes and'the previsions of the St.Croix County Subdivision Ordinance. andkunder the direction of Dirk Lindner, I have surveyed, divided and mapped the above described parcel of land and that this nkapis a correct representation of the boundary thereof. ~,eeeeewo,a Dated this day of pRi._ , 1995. /!/Mi James M. Weber S-1804 JAMES M. NELSfiN-WEBER LAND SURVEYING wEnE4 5.1804 5PrfNQ VALLEY ~ WtS, R' • • r~ U III NO LOCAL TS.: THE PARCELS SHC%N ON THIS MAP ARE SUBJECT TO STATE, CCX1N -Y lot 101A, ACC SE SW LAWS, RULES AND fEGULATIGINS.(i.e. WETLANDS, M1NIML.M LOT SIZE, ACC2S O PARCEL, ETC.) . BEFORE Pf TQ(- -''AQ- rtiv „w. 1+ I ~ir ~ G~+~~oIMGY SeG.30 66z 9 1'~0 6 a r~J Gc~,' , . s:te CST .~y/,3 76A- Ave-, f77// 11A z", d~lUB a ♦ o p Jq So i CbV GJ d C u o m .V ~e • O6(o oQ~~°" y w) Q7 / I P' C'o r'C6C~ ~l o C)! 5t 044 SC. _ - - - - - - -O Area 93 /ooo~ ~ flees, pt 95, Seo L 330 zo 4 BY Pro~a , GA NO. /,~ouSG ! Rage 80 rUwRGr : , ' _JrOuJ/~ L.~y S1 cC- ~C~ ~~UCt ~LCG~Graor `I~6 70` ~4ve , !i /~1P G6Z 9 i c s7- .3 1i o ber7~"S W sr~'e `lot- /eve, Lorne.r gM Z Get Stake ~~t ~ta~L 78~ eX,s / / n ~JO!/se ors Lof'~y ~e»/P, e BM #1 cam- ; j ~3 n 63 E ' 13 Z P'' /YOUSC ' ~f"] a No. i i /55 r aoCUrwENT NO. STATE BAR OF WISCONSIN FORM 1-1989 TMIa NACa acaaaVao IOa *KC010100 DATA WARRANTY DEED r 4GIOG9 51 fPAGE REGISTER'S OFFICE This Deed, made between W.....S.....Clapp ST. CROIX CO., WI Reed for Record r _ . Grantor. AUG 0 1990 at - ~ --_•.._o.-man All and....41~.>~ ..ilndn.Or.:...~..1 (?Iep• r on 2:00 P. • n Witnesseth, That the said Grantor, for a valuable consideration.....- t rt IIaTYRN TO '.y conveys to Grantee the following described reai estate in St-.--Craix____-- County, State of Wisconsin: ti Lot Three (3), Volume Eight (8) of Certified Survey Maps, Page 2192 Doc. No. 4566649 being a part of the SWk of the SEk of Ts.: Parcel No Section 30, Township 29 North, Range 18 West, Town of Warren. r Vi i% r - - :c rr This i*__ nqt......... homestead property. - (is) (is not) " Together with all and singular the hereditaments and appurtenances thereunto belonging; z And...... W,e._.Sw..-~ilap d, x warrants that the title is goo indefeasible in fee simple and free and clear of encumbrances. except easements and rights-of-way of record, if any, R •'`R W and will warrant and defen the same. : 0! Dated thle tf? ....3. day of . ' 19 9.....- . .•-.............(SEAL) .........---.................s,'':...._... (SEAL) W S . C1aPg............... .(SEAL) ....(SEAL). r _ AUTERNTICA`PION ACHNOWLSDGMBNT Signstnre(s) STATE OF WISCONSIN v ss. CYo, ' F!__._...__...1~ .............County. t authenticated this day of ...........119 P pally came before me this day of t ► 19.90. the above named - ......_kt~._..S_.. ~ pp--•----------------------------------•--•---• TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorised by 1706.06. Wis. Stats.) to me known to be the person who executed the foregoing i trumggt•and *nowledge the acme. THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord AttornaY...._...... r==-° Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 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. C,le r-rX 0 See reverse side for instructions for completing this application State Sanitary Permit Number % The information you provide may be used by other government agency programs Check it r@vision 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 - ~ r < i~ 1i45 _ 1/4, S - T P . N, R /d"'E (06 Property Owner's Mailing ddress Lot Number Block Number City, State Zip C/ode ~ Phone Number Subdivision Name or CSM ]Number ...5 I(// /I t!lfs~ S.~r'c~'>y ft~ Rfy/ fir % ~ II. TYPE OF BUILDING: (check one) ❑ State Owned f El City Nearest RQd Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 6 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 77777 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. ~ystgyn Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation, Feet Feet 'd TANK Capacity VII- in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ~ -IK-~ - r'° El ❑ El E] 1:1 Lift Pump Tank /Siphon Chamber El El El ~ 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu(nber's Name: (Print) Plumber's Signature:,_(No Stamps) knP7MPRSW No.: Business Phone Number: M T[, ~s Plur)l>er's Address (Street, City., State Zip ode): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature,(No Stamps) - Surcharge fee) ,E ]Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS . 7 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 rpust 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 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. 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 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 8 112 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. AS BUILT The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment ofAfirw"i6lio Name Date Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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. t 0 See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs dcheck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Own r Nam Property Location , j g r. 1/4,S T - , N, R E (04.W Property Q)evrger's Mailing,44dress Lot Number Block Number r F.. - . me } Ckty>StatQ r`V / x Zip ~deS `ho Number Subdivision Name or or CSM~lumber II. TYPE OF BUILDING: (check one) ❑ State Owned !t( Nearest RRO Rvil,e Town OF Public 1 or 2 Family Dwelling - No. of bedrooms III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 6 New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ___System_____________TankOnly 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 H Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. ~ystpm 1:lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/dpy/sq. ft.) (Min./inch) , Elevation, p.t «rry i, a ! r Feet f Feet VII TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Exist- Gallons Tanks Concrete strutted glass App- Tanks Tanks Septic Tank or Holding Tank J / r, r'.s" ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ El ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature.: (No Stafbps) WfP/MPRSW No.: Business Phone Number: T -All Plumber's Adds (Street, City, State Zip Code): s, m r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) _E] Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety a Buildings Divmion, Owner, Plumber INSTRUCTIONS 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 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 8 112 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. R The monies collected through the44Sse` oblarges are used for monitoring groundwater contamination investigations and establishmFonut fifsttandards. Muer Name Date Leroy G. Jansky, WWS 13 East Spruce Street Wisconsinbepa't ent oT Industry, INSPECTION Chippewa f=alls, Wl 54729 Labor and Human Relations Safety & Buildings Division REPORT janskie@mail.state.wi.us E-mail Bureau of Building Water Systems (715) 726-2549 Fax IS Ibr 18, 1596 (715) 726-2544 Voice medwei 1"f6perty Yll,rc'tiG, Jl7,ILgcr VV AM Knahip ~~rro1x of 5 CSM Vol 8 Page 2192 I e Master'PlumberFirm Name and Address an I.D.'No." ~f S , R9l} 289 Sox 130 f „ Sanitary Permit No. Roberts, Wl 54023 r e n m er/Soi icensed Pars n ame(s) and Lic s um er(s ~"uc~san t~rM 3413 f~resent: iompson, x.1463 ot~, D. Fogerty, D. Linder QytirejiN~rngaa~d Address Estimated Daily Flow: 450 gpd Roberts, Wl 54023 Use: Now- Residential E Onsite soils investigation to determine the suitability-of -this site for below graded soil--absorption, at the ;request of the dumber.; During construction' of the sc~il..absorption trenches, the installer noted unsuitable soil colors in the :excavation and halted construction until a determination regarding soil suitability could be made., Two.svii--pits-. vied-- The f"frst--pit on--the-east-aide of they pr'oposed,area was,~witableAo a depth of 7 feet. The second-,pit a red_somevrhat.cluest ort k le in that..the soMm.vver..t e.. +ash_sands_ - - , p - exhibited redux features directly move the lithologic discontinuity. The area of rei~ax features was less tha one oot!thi #c and thin the one foot l in greaterrsf per odiicrosaturatio (Uptp 24-inches) ltti tsito sit is hould noopinion 6 at even if thire ry as a grerisiderectnsuitabie'for a belowgra*system-- stailation.3 The-site,';bei -i'n a sides,16pe popiti6 hoi Id haveexceile► sut#ac water+ii°aina 'e co _ bilifies, and tlrr_rroc_featlur`es Ubs(~rved are.an{y due the inability Qftei to__ . . readily move ?into the coarser strata immediately below. E Sfioutczrndttioi be ertcaclntered 'elsewhere on-the parcel; it may be ignored as a threat to proper syr ten -ooeroior -or-fir 6ndwater-oen#am ation Hover; -cdnstruction, of an absorption trench must be-- either below thisllayer or at least 3 feet above it to ensure,. proper, hydraulic performande oft he system. ; In addition, tfis IQt t quite large, and ether areas for onsite disposal may be availab{e for consideration as may be~;other, _ m types 'that-would better suit sell and site conditions. . The,_C T needs to,.reev luate_ soil and site conditions_with the abave4esiignpatarrieters in..mind, f Ilf there are any further questions regarding this matter, please contact me. e RC F~ Page Of Signatur Responsible L' sed P n (only o e needed) '(ign 4- re of Plu g Con ultant/P"ri ate Sewage nsultant Check all Original: Copiesto:. that apply Ssow-8192 (R; oom i) District 0 DiLHR 2rPlumber 0 Owner County/Local insp. 0 Other • s J BOLDT'S PLUMBING & HEATING, INC. 820 MAIN STREET BALDWIN, WISCONSIN 54002 (715) 8x4.3378 FAX (715) 684•;$144 Odowr 8, 1896 St. Croix County Zoning Offloe Government Center 1141 Carmichael Road Hudson, WI 54016 RE: Dirk Lindner Soil Report To Whom It May Concern; I am enclosing the revision of the loll and site evaluation shoot to show mottling discovered by the installer of the system for Mr. Lindner. The mottling, however, Is not.1hdicatlve of high ground water, but is a slow Waching problem of water down through the sift looms.. Therefore, the system should be installed in the coarser materials; causing a variation in the system elevations, because of uneven distribution of the coarser material In the horizons. This.system is to be installed with a .5 bed or .8 trench loading rate, and widened or lengthened to aooomodate spotty areas where the looms run deeper. These findings have been collaborated by LeRoy Jansky, the DILHR soils-specialist, under the observation of Jim Thompson (Zoning Administrator), Dave Fogerty (Inttallor), Dirk Lindner (Property Owner) and Dale Hudson (CST). Please refer to inspection report, dated Sept. 18, 1886, made out by LeRoy Jansky, WWS, Sinoer>sly, Dale E. Hudson, MF #66281 CST W4113 c.c. Jim Thompson, 8t. Croig County Zoning Davis Fogerty, Fogerty Plumbing Dirk Lindner .a~~ ~ Nf~ti b~ f c r-V ALUA I IUM ,Mtt•UM I I„r In accord wEth II H R 83.05. Wis. Adm. Code CMINTY AIIfI&U-6, iplols ate flan on paper not lose than a 12 x,11 inches in site. Plan must indudo. but Pal j not IiAgd to ver" and hofizornat tefsrence poN (Biog. d'escOon and'lL of slope, scats or dimensioned. nonh arrow, and location and dlstence to nearest roan. ee V / .i'e ATE APPLICANT INFO RMATION-PLEASE PRINT ALLINFORIMAT'ION t;EvlEVlli: BY PROP RTY t74YNER POPERTY ATION .~:.4 ' 0M'wT : W . u4 S-"u4J83bT N.R tla O+ MERS MAIM ADORES Loy $ iv. ' .JfA1lE MUM ~lG c '7D f✓~','r • 7` N • ST AOAO anSTATE ZIP CODE M" WO"weER 0d eE glyR . 70 w Mew ComirtiMon use 0q Resbceli w r NMberot tle*c;;4 L I Reptaoement I I s t~itc or ewwwdlal desalbe Cote derived d* !bw y3:o gpd ReoannlendeddWF b8*V role _bed. ~pdAt~_ ►e , OPOO AbsOfpW area teq*ed750 bed. M2 -T7-1 bench, IR Maslrttw deslpn ba&q tale " _bed. ppd* Qench, VW Remmmrendefi trntltradon surface elevauort(s 1,44 it (as tereaeo to site plait be arp Addidoast design / site considerations 2 1 o ~e Z's 36 ` to SZ Io a v. Parent matefiai n 'itlB FlooO plots ~eva6on. >E appik~bb64 ft S •w Suitable for sydem COW90 ORAL two of PAESSIiHE T IDE SYSTBd ML ttOLONG TAiiK U UnsuUable for fain S❑ U AT Q U ~~I'S ❑ U C~ U C7 S ~'U C~ S SOIL bgS'CFiIPTION FIEPbAT t3oting 0 Not -zo Depth Dominant Color Mboft Texture sitieWre Corebtenoe Budwy Roots GpDM In. Munsell Ou. St. Coat, Color Or. Sz. Sh. Bed Trttctd q 7,5 YR -Y4 A. I& erv 14 9=z~ O 5 2. Z.ri /~f r c-P Ground 3 -S 7r o e s~i~ $V C-0 -'7 • 9:' !IL . st-8a 7'5'Y'R A-46 6 CS s 0'7 lip o Rem o .5 ~h C . Boring N a-~Z-~ 7.5Y S Z s~ rl r cv C'M •5 , 6 Z Z -36 ,Sys Of s • j • -ce Grouse 3 36-~ Ma", r' _ W ' ? 10 IL t/ly- C-0 a 711-917- S s r oepet lo RecttstAcs: r'o /YS CST Haw-. %ase Print'. Q/ , / Photo. ,S r.•4., 1Y r Afton: L Si~naturr• Dab: CST Nay w: Depth Dominant Color Structured :4P boring 0 140rizo MOB Toxtute Ca~isterra~ 8o;r?d'y H Munsd du. SL Cat C4W OF. Sz. Sh. YMM 3 'S~ • Z or) elk. . 13roiRia > ~ ~ ' S ~S inv CcJ - 5 . 9 ~ y y-y 2.5 y -Ajia P VCSYAN s / c u) y-c. k2 pepd+ b Y?-M 7,52Z.Oy 4- IM" ; >4 T-5 t ~ Remar ere v Y,- f-g! Boring N C07 -51 s z y y s s,~ cM~) Or • S I I/ A la 3 5- 7.5 Y 7 ' S Grewd 6 5 Do 10 Remarks: ; W69 N or, wqw Yee y .~sd ci' • 5 # . S Z 9730 '7•s 3, 3o-yd '7.5 . SY r r GcJ •7 1 Ground r CIO .7 . etev. 594 7,5 5 Dow OOP Q Rematic: ( s ( 1 i goring A ~3rou~4 ..._'ft. odor !