HomeMy WebLinkAbout030-2091-20-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER f fi ,~I f~ co
ADDRESS
SUBDIVISION / CSM#_ss LOT #
SECTION 2C T o 5e) N-RAW, Town of ST ~s~a,c,~l
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~4
a
a
INDICATE NORTH ARR
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: J rt 7'~ c GL /
ALTERNATE BM: ~u.2r 13
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: M,',ee.,e 7- Liquid Capacity: /,re, a
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
.SOIL ABSORPTION SYSTEM
Width: Length .S Number of trenches :-2
Distance & Direction to nearest prop. line:
Setback from: well: _~_0 7- House Other
ELEVATIONS
Building Sewer ST Inlet; ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: zr'/
INSPECTOR: 3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor ahd Human Relations INSPECTION REPORT ST. CROIX
It Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan a: '1 -20-000
STOUT, RICHARD
CST BM Elev.: Insp. BM Elev.: Description: ST. jeSEPH Parcel Tax o.
0r , ~ lad . 6A77
TANK INFORMATION ELEVATION DATA d7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_
Septic / Benchmark ~a"Aa" d,
Dosing &)y1 r'
Aeration Bldg. Sewer 3'~ X03,_/
Hold' St/ 21- Inlet 3' day
TANK SETBACK INFORMATION St/Outlet /02,27
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet
Septic 77 /Z 7 NA Dt Bottom dd
Dosing NA Headerl_-
Aeration NA Dist. Pipe 7%f! 13
-M-0-rd ing Bot. System 97, 0
PUMP/ SIPHON INFORMATION Final Grade
Manufa r errand
e2 /d3,5~
Model Number GP
TDki-- Friction Syste Ft j"
Forcemain Length Dia. mead
Dist. To Well
SOIL ABSORPTION SYSTEM 71 F
Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
BED/TRENCH Width /
I -21
DIMENSION S DIMEN I
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI urer: INFORMATION Type Of ,r I CHAMB Mo a Number:.
System: , e,, O IT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s L ~~yy x Hole Size x Hole Spacing Ve it Intak
Length Dia. Length Dia Spacing ~d s
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade M
Depth Over Depth Over , xx Depth Of xx Seeded /Sodded Tx Mulched
aed-/sTrench Center Bed-Yfrench Edges, l / ~d Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: ST. JOSEPH.26.3Q.19W,NW,SW,LOT 2,AW KEE T,
r 1 )l~. C / 6.. L,qQ a s ~~O r., c~rryy r _ c-
n
Plan revision required? ❑ Yes No
Use other side for additional information. e- 9
SBD-6710 (R 05/91) Date Inspector's Sig ature Cert. No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
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I SANITARY PERMIT APPLICATION - COu
In accord with ILHR 83.05, Wis. Adm. Code
1 =tmmffil
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 614"1 b 73
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
1?11C1ke._1.1 -V:70 4;vl" c) %_6'4) %4, S a4 T , N, R /91 E (or o
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
W -2
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
oG 10:0r _5s A_.a a
II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD
a ~4ua►f~ e ~
❑ Public Y'SJ-1 or 2 Fam. Dwelling,# of bedrooms PARCEL TAX NUM ( )
111. BUILDING USE: (If building type is public, check all that apply) ese - a 0 ~r Z!y
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 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. TYPPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. &New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - 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 RSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 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
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
9''r, el Feet /if b Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed _T7_ F1 I [I
Se tic Tank or Holdin Tank 7''
Lift Pump Tank/Si hon Chamber
VIII. 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 Stamps) PRSW No.: Business Phone Number:
Sa 3 ~'Z- lS 3
Plumber's Address (Street City,
State, Zip Code):
l
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iX. LINTY/DEPARTMENT USE ONLY
❑ Disapproved Sanit YPermit Fee (Includes Groundwater a Issuing A nt Sign No S mps)
Approved Owner Given Initial ~urcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
I
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 the time of renewial 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 (SB0 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
I
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 & 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 in line A. Complete dine B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type,
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, 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% 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 mainsiwater 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; close 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 foram; 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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Wisconsin Department of Industry, SOIL AND SITE E V A L E P O R T Page 1 of 3
Labor and Human Relations
Divisioh of Safety & Buildings in accord with I LHFj t~3.45. ° .
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inch in size,.pl ► X64 include, ufi
, t apr .I PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), direct' "'nd 9% f efope sca
dimensioned, north arrow, and location and distance to nearest rare. , 030-2091-20
APPLICANT INFORMATION-PLEASE PRINT ALL INF ~lI~TI014 s F. REVIEWED BY DATE
PROPERTY OWNER: PR , - 116;
Richard Stout LOT. v4 SW 1/4,S26 T 30 N,R 19 if(or) W
PROPERTY OWNERS MA!I.ING ADDRESS # SUBD. NAME OR CSM #
1353 Awatukee Trl. na Bass Lake South Ma'or
CQPTAT WI./ 5401Z ~IP CODE PHONE NUMBER ❑CITY ❑VILLAGE [OWN NEAREST ROAD
(715 St. Joseph Awatukee Trl.
New Construction Use [xk Residential / Number of bedrooms 3 [ J Addition to existing building
(J Replacement [ J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/0- 8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ff2.8 trench, gpd/ t2
Recommended infiltration surface elevation(s) 97.67 ft (as referred to site plan benchmark)
Additional design / site considerations alt area step down trench 96.67-95.07
Parent material outwash Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
I
U= Unsuitable for stem ® S 13 U I® S ❑ U ® S ❑ U ®S ❑ U I ❑ S ® U ❑ S :91 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary, Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed rend
'"'W~ 1 0-9 10yr3/3 none sl 2mgr mfr cs 2f .5 .6
>n
2 9-34 10yr4/4 none co s Osg ml cs if .7 .8
Ground 3 34-8 7.5yr4/6 none s Osg ml na na .7 .8
elev.
101.67 n,
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-10 10yr4/3 none 1 2msbk mfr cs 2f .5 .6
A 2
.1 2 10-3 7.5yr4/6 none is Osg mvfr if .7 .8
3 32-8 7.5yr4/6 none co s Osg ml na na .7 .8
Ground
elev.
101.67n
Depth to
limiting
factor
+84"
Remarks:
CST Name _Please Print Phone:
Gary L. Steel 715-246-6200
Address: 1554 200th. Ave., New Richmond, wI. 54017
Signature: Date: CST Number:
8-26-94 cstm 02298
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2=of 3 _
PARCEL I.D. # 030-2091-20
Boring # Horizon) Depth I'Dominant Color I Mottles Texture Structure Consistence Bourbary I Roots GPD/ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ITrerx~
:ti:4•iii:::
1 0-13 10yr3/3 none 1 2msbk mfr cs 2f .5 .6
3
2 13-35 7.5yr4/4 none is Osg mvfr gw if .7 1.8
Ground 3 35-84 7.5yr4/6 none cos Osg ml na na .7 .8
elev.
100.67 ft.
Depth to
limiting
f~Ctor
Remarks:
Boring #
1 0-9 10yr3/3 none sl 2mgr Imvfr cs 2f .5 .6
4<`» 2 9-34 10yr3/6 none cos Osg ml gw if .7 .8
3 34-46 7.5yr4/6 none =s_ Osg mvfr gw na 3 `.8
Ground
elev. 4 46-84 7.5yr4/6 none co s Osg ml na na .7 .8
98.27ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-12 10 r3/3 none 1 2msbk mfr cs 2f .5 .6
5 2 12-24 7.5yr4/4 none is Osg mvfr gw if .7 .8
HEM
3 24-84 7.5ry4/6 none cos Osg ml na na .7 .8
Ground
elev.
98.07 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
:XN
Ground
elev.
ft. ~
Depth to
limiting i
factor
Remarks:
SBD-8330(8.05/92)
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 _
PARCEL lb. # 030-2091-20
Boring # Horizon) Depth i Dominant Color Mottles Texture Structure Consistence Botrdary I Roots Bed GP iTrD/ftta
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
1 0-13 10yr3/3 none 1 2msbk mfr cs 2f .5 ;.6
3
.8
2. 13-35 7.5yr4/4 none is Osg mvfr gw if .7
Ground 3 35-84 7.5yr4/6 none cos Osg ml na na .7 .8
elev.
100.67 ft.
Depth to
limiting
+8 ° r
Remarks:
Boring #
1 0-9 10yr3/3 none sl 2mgr mvfr cs 2f .5 .6
2 9-34 10yr3/6 none cos Osg ml gw if .7 .8
3 34-46 7.5yr4/6 none =s Osg mvfr gw na .3 .8
Ground
elev. 4 46-84 7.5yr4/6 none co s Osg mi na na .7 .8
98.27ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0-12 10 r3/3 none 1 2msbk' mfr cs 2f .5 .6
S 2 12-24 7.5yr4/4 none is Osg mvfr 9w if 1.7 .8
3 24-84 7.5ry4/6 none cos Osg ml na na .7 .8
Ground
elev.
98.07 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev.
ft. ~
Depth to
limiting
factor
j
Remarks:
SBD-8330(R.05/92)
N
. III
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 Nw4SW4 S26-T30N-R19w New Richmond, WI 54017
MPRSW 3254 town of St. Joseph (715) 246-6200
lot #2-Bats LaKE South Major
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N
1"=40'
BM= top of 1" steel pipe at el. 100' w/marker
Alt. BM.= top of base of transformer at ne lot corner at el. 104.17
oGh r ZZi -Z zo, ' Z30' ~46
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Gary L. Steel
8-26-94
Jb~. c V EAJ 1 - WL51 1/4 LINE OF J
W'1/4 CORNER OF 1 8
SECTION 26 SMALL
LOT 5
VOL. 1008 ,
3.09 ACRES
134,520 SQ. FT.
. 9 SSt
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ro
° 83
oo, , N
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438 A 4 499'
14T4 41"Z9
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9 3.09 ACRES
00 134,520 SQ. FT. I
N Q I
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N89°51'27"W 520.00'
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M LOT 3
N 3.00 ACRES
N M I
130,722 SQ. FT. N I
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c~ V W O W Lo
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Q 0 N89'51' 27"W 520.00 I 0 0
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WI V) W
~I 3 3
t W ti
I- I W -
s 8' 0 W
0
QI
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_j U- - 00 n ~ O~ M _ LOT 2 M Z CA I
3.00 ACRES
z I W Lo
z - N 130,722 SQ. FT 0 N
O Q
O 3
W Q
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N89~51'27" W 520.00'
33 33
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130,722 SQ. FT. _
N........
N
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- -
- - - - 520.00' 66.00
N 89°51' 27"W
M _ DEDICATED TO
132ND
~ -
M N8S°54'33"W
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.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS l 3 S'-3r.✓c~~K /le 717~ else .G~ 4f l ~y6f
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION,,( G✓ 1/4, S'c.J 1/4, Section Q C T 311 N-R_L? __W
TOWN OF 5_7` -7-6 ST. CROIX COUNTY, WI
SUBDIVISION ,(~a ps .y-e Sv wtL LOT NUMBER
CERTIFIED SURVEY MAP , VOLUMEPAGE , LOT NUM 3ER _
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 - 10 0
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 ,4; dA, d -T7';-,,,7-
Location of property 64d 1/4 Suf 1/4, Section T ,?-C N-R__Z?_W
Township LS~T .36fo~ J/ Mailing/a/ddress ,5'.3
Address of site a
Subdivision name 44L--5- , A-a k-P S',-e„ 7'~< Lot no.
Other homes on property? Yes N/- No
Previous owner of property
Total size of property ZA t-
Total size of parcel 2 y a-c r Gs
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? _pr Yes / No
volume 5-97 and Page Number s 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. 911-y,.?-2 q , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co-Applicant
Date of Signature natP cif Sian itiira
At SA
9
'sa`9,„y°w~'k.'vr,K
DOCUMENT !'0. STATE BAR OF WiscoNSIN-FORM 2
l MARRANTV DEED
1 f pn~~r6 THIS RESERVED FOR RECORDING DATA
354329 do JVVV L
REGISTERS OFFICE
BY THIS DEED, ERNEST C. PETERSON and VAN_GIE _
PETERSON husband and wife as_ joint tenants ST. CRON CO., WIS.
Rac'd. for Record this 3rdd_
day of Jan A.D. 19 79
Grantor conveys and warrants to RICHARD 0. STOUT and JANE'S P+
STOUT, husband and wife as tenants in common at (':Oo
and not as joint tenants 1
S
------Grantee
RETURN TO
for a valuable consideration _
$t. CroiX County, State of Wisconsin:
the following described real estde in
Tax Bey R
That part of Governr(ent Wt 6 of Section 26, T30N, R19W, Town This is not homestead property.
of St. Joseph, St. Croix County, Wisconsin, further described as
follows: Oo(mpncing at the W 1/4 corner of the said Sec. 26; thence on an assumed bearing
thee,cy 1,189031'10" E,
N 00042153" East along the West line of the SWo of the W-14,337.60 ft;
2047.00 feet to the Westerly Right-of-Say line of a 66 ft proposed private road easement;
thence N 63°44'13" E, 66.00 feet to the Ely Right-of-Way line of said proposed road
easement and the point of beginning; thence continuing N 63°44'13" E, 565.62 ft and is the
beginning of a meander line along Bass Lake; thence S04035'00" E, 11.79 ft; thenceOSfeet
65°46'42" E, 143.47 ft; thence S 11046'33" W, 114.07 ft; thence S30°39'41" E, 10.
to the end of the meander line along Bass Lake; thence S64°52'14" W, 579.93 ft to the Ely
Ric[it-of-jaa1 line of the said proposed roast easement; thence N27°08'22" W along said Ely
Right-of4lay line, 210.00 ft to the point of beginning. Including all lards lying between
the meander line herein described and the water's edge of Bass Lake, which lies between
true extensions of the Northerly and Southerly boundary lines of the parcel herein
This deed is given in partial fulfillment of the Lard Contract between the parties dated
51E8~R
August 1, 1978, Recorded September 21, 1978 in Volume 581, page 476, n
Exception to warranties: ~[9r 1.
See reverse for balance of description. $ ~J. r
FEE
20th day of Dec ~ 1978 -
Executed at _Huds hn,_N&r_ona1 this '
(SEAL)
SIGNED AND SEALED IN PRESENCE OF
ERNEST C. PETERSON
N/A - (SEAL)
VANGIZE PETERSON
(SEAL)
N/A
(SEAL)
N/A
q Signatures of -
~ 19_.
authenticated this day of N/A
4
Title: Member State Bar of Wisconsin or Other Party
Authorized under Sec. 706.06 viz_ -
STATE OF WISCONSIN
-
Croix- .County. } • 19-7A
20th - day of Dece"1ber
_ Personally came before me, this-
the above named Ernest C. Peterson and Vangi-e_Peterso~_ his wife - to me known to be the person--s- who executed the foregos^g instrument and ac ro edged the same-,,
t
This instrument was drafted by Kendall B. Priest9r
~ - - _
sy Hugh F. Gwin, Attorney _ St..Croix County, Wis.
G:aIN GILBERT & G`gIN Notary Public__
My Commission (Expires) (Z~j -Z------
R
The use of witnESSes is optional.
Names of parsons signing in any capacity sho,ild be typ-d or printed below their sigh._t vres- s+,,,,~c rnrr,HC co., cwu c+~+e, .,s.
-i
WARRANTY DEED--STATE BAR OF WISCOSSiN, FORM NO- T - 1971
f ,r 2
r .
DEPARTML'NT of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, , DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 4~ft HUMAN RELATIONS MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. N SUBDIVISI N NAME:
SE 11CIN~14 26 /T30 N/R19)&(.,) W St . Joseph 2 n/a ?bass Lake South
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Richard Stout 1353 Awatukee Trl., Hudson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: [4-23-92 ROFIL DESCRIPTIONS: ER OLATION TESTS:
aResidence 3 n/a New ❑Replace n/a
RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: r YSTEM-IN-FILLIHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®s ❑U ElS ❑U ®S ❑U ❑ S EA ❑ S ~U conventional split level trench
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5) (b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a
deciaml' PROFILE DESCRIPTIONS page 42 0nC2
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH= ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 7.01 none >7.01 •67, 10yr4/2, l., 1.42, 10yr5/4, sil., 1. 2, 7.5 -
98.10 4/4, s.l., 3.50, 7.5yr5/6, l.s.
98.30 .75, 10yr4/2, l., 1.17, 10yr5/4, sil. 5.33, 7.5-
B- 2 7.25 none >7.25 4 4 co.s.
B_ 3 7.42 97.10 none >7,42 •75, 10yr4/3, 1., 1.42, 10yr5/4, sil., 2.00, 10yr
/4, co.S., .75, 7.5 4/4, s.l., 2.50,7.5yr4/6, 1. .
B- 4 6.91 94.00 none >6.91 .58, 10yr4/3, l., .83,7.5yr4/4, l.s., 2.00, 10yr
B- 5 6.67 94.20 none >6.67 •67, 10yr4/3, 1., .75, 7.5yr4/4, s.l., 5.25,-
10yr4/4, Ls
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI002 P R PER INCH
P-
P-
P- see desl rate
P-_
PP-
-
PLOT T 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. 94.10= upper trench
SYSTEM ELEVATION 93.10= lower trench
- - - - ;
s
i - t f
i j
r
' i
E
I
. i I i a.~_ 3 -._._.w_
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 4-23-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave. New Richmond Wi. 54017 2-29,9 1 5k46-6200,
CST SI URE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
1
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test, your, report must include:
1. Complete I at description;
2. The us must clearly indicate whether this is a residence or commercial project;
1 MAXIP_ _ x of bedrooms or commercial use planned;
4. Is this a lacement system;
5. Comf', _ 'lity rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER -fV ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent;
Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
ti# >priate;
10. rs Jorrr -`;°-'n (such as flood plain, elevation) does not apply, place N.A. in the appropriate box;
11. rl.~ 1 and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED kNITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob Cobble (3 - 10") SS - Sandstone
gr - Gravel (under 3") LS - Limestone
1XIs - Sand HGW - High Groundwater
cs - Coarse Sand Perc Percolation Rate
med s - Medium Sand W - Weli
fs - Fine Sand Bldg - Building
Is - Loamy Sand > - Greater Than
sl - Sandy Loam < - Less Than
"I - Loam Bn Brown
sil Silt Loam Bl Black
si - Silt Gy - Gray
cl - Clay Loam Y Yellow
scl - Sandy Clay Loam R - Red
sicl- Silty Clay Loam mot - Mottles
sc; _ Sandy Clay w1 - vvith
sic - Silty Clay fff few, fine, faint
Y
C Clay cc; - cornmon, coarse
pl Peat mm Many, medium
m - Muck d distinct
p prominent -
HWL - High water level,
Six general soil textures surface water
for liquid waste disposal BM - Bench Mark
VRP Vertical Reference Point
TO THE OWNER;
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
ver`ic ition of this soil test in the field prior to permit. issuance. A complete set of plans for the private
seen system and a permit application must be submitted to the appropriatL local authority in order to
opt ''n a permit. The sanitary permit must be obtained and posted prior to the start of any construction.