HomeMy WebLinkAbout030-2092-10-000
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Ia:bor Ad Human Relations
Divisio4oi•6afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point.(BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. -C60
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVMEILBY - DATE
PROPERTY OWNER: PROPERTY LOCATION d
R char TU GOVT. LOT NVJ 1/4 STAT 1/4,s 26 T 30 N,R 1. ~11(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT~f BLACK # SUED. NAME OR CSM # f/`r
1353 Awatukee Tr. 11 n/a Bass 1,ake h j~
CITY, STATE ZIP CODE PHONE UMBER ❑CITY ❑VILLAGE UFOWN NEAREST ROAD
Hudson, WI. 54016 ( i~a St. Joseph 132nd. AVe.
JA New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 99.40 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a It
7Uunisuitable able for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
for system MG El U 56 11 U 06 El U Ca s [I U El S f U El S )MU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1'.i......' 1 0-9 10yr4/3 none L. 2/m/sbk mfr c/s ?./f .5 .6
2 9-17 7.5yr4/4 none sil. 1/f/sbk mfr g/W 1/f.. .2 .3
Ground 3 17-82 10yr5/4 none co.s. 0/sg 61 n/a /a .7 .8
elev.
101.2,(6t.
Depth to
limiting
factor
X87
Remarks:
Boring #
1 0--7 10yr4/3 none L. 2/m/sbk mfr C/s 2/f .5 .6
2 2 7-15 10yr4/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3
3 15-24 7.5yr4/4 none s1. 2/m/sbk mvfr g/w 1/f .5 .6
Ground
elev. 4 24-84 10yr5/4 none co.s. 0/sg ml n/a 1/a .7 j .8
103.401.
1110
Depth to
1 j'r~s -
limiting
factor p
>84
Remarks: c 7 N
CST Name:-Please Print e:
Gar L. Steel 715-24 62.00
Address: 1554 200 h. Av. e, P?ew ' chmond, WI. 54017 e' \
Signature: Date: CST Number:
4-5-93 2298
PROPERTYOWNER R-1-chard. STout SOIL DESCRIPTION REPORT Page_L~pf_3
PARCEL I.D. # t
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 0-9 10 r4 /3 none L. Z/m/sbk mfr g/w 2/f .5 .6
3 :s
2 a-21 7.5yr4/4 none Is. 0/sg m1_ g/w 1/f. .7 .8
Ground 3 21-82 10yr5/4 none co.s. 0/sg ml n/a n/a .7 .8
elev.
103.20t.
Depth to
limiting
factor
>8.2
Remarks:
Boring #
1 0-8 10yr4/2 none L. 2/m/sbk mfr- g/w 2/f .5 .6
2 8-25 7.5yr4/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3
2•
3 25-84 10yr5/4 none S. 0/sg r,1 n/a n/a .7 .8
Ground
elev.
102.40t.
Depth to
limiting
factor
>84
Remarks:
Boring #
1 0-9 10yr4/3 none L. 2/m/sbk mfr g/w 2/f .5 .6
5 2 9-18 10yr4/4 none §11. 1/f/sbk mfr g/w 1/f. .2 .3
3 18-35 7.5yr4/4 none sl. 2/m/sbk mfr g/w 1/f .5 .6
Ground
elev. 4 35-80 10yr5/4 none co.s. 0/sg ml n/.a n/a .7 .8
1(n-wt.
Depth to
limiting
factor
>80
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE 155420C'thAl
~
Gary L. Steel
C,S.T. 2298 Richard Stout New Richmond, WI 54017
MPRSW-3254 Bass Lake South (715) 246-6200
S26-TMT-RI911
town of St. Joseph
lot. #11
~~l = ;1
h
i
Parcel 030-2092-10-000 02/10/2005 11:45 AM
PAGE 1 OF 1
Alt. Parcel 26.30.19.772 030 - TOWN OF SAINT JOSEPH
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
KNEFELKAMP, BRADLEY J & MICHELLE D
BRADLEY J & MICHELLE D KNEFELKAMP
1358 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1358 AWATUKEE TR
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.210 Plat: 0078-BASS LAKE SOUTH
SEC 26 T30N R1 9W LOT 11 BASS LAKE SOUTH Block/Condo Bldg: LOT 11
3.21 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
11/07/2003 746097 2452/200 WD
07/23/1997 1079/87 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
6480 230,400
Valuations: st Changed: 07/12/2004
Description Class Acres Land ITotal State Reason
RESIDENTIAL G1 3.210 62,200 226,700 NO
Totals for 2004:
General Property 3.210 62,200 164,500 226,700
Woodland 0.000 0 0
Totals for 2003:
General Property 3.210 47,900 127,200 175,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 501
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER a
ADDRESS
SUBDIVISION / CSM# &:; ~C,a1t-B Sew ~i LO #
SECTION__2 4~ T_g.Q_N-R_ZT_W, Town of 5ZLZ
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
lv
41
r~
D~Vpv
1 66
K
i~
11
~o~So
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
i
BENCHMARK: 1-67"- GO,tj~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: f ~ Liquid Capacity: 1~7_"
Setback from: Well-S-0 " -Y'-' House Ot
Pump: Manufacturer2 dk 1,0f Model 0-2 Size -2:2
Float seperation /47' Gallons/cycle:rS~t~
Alarm Location
SOIL ABSORPTION SYSTEM
Width: j Length y Number of trenches
Distance & Direction to nearest prop. line: !;~S
Setback from: well: 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: Z!f
PLUMBER ON JOB:
LICENSE NUMBER: fj'j„b G3~"Z
INSPECTOR:~
3/93:jt
LvSMEb'rts n fart 2tatofYfi ~1. 26. 30 , MATESERAGMS4KA AWatt Ca County: -
Labo~ and Human Relations
Safety and buildings Division INSPECTION REPORT
qT-
k (ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village R Town of: fitate Plan ID No_„
TCHARD
Joseph I
CST BM 1ev.i Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9400095
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark / 160,
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet ay 9s,
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. A
irito ntake ROAD Dt Inlet
Ar rr~~ 61, r), l
Septic >Z5 5 0' lO ' >/O ' NA Dt Bottom 93, v/
Dosing >ael` 'J`'0' lU' >/O NA Header/Man. y 1V /c,;;,
Aeration NA Dist. Pipe u./v~ l` 4
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade 0 6 d, _51
Manufacturer Demand 7-2,
Model Number' GPM
TDH Lift~;),~ Friction System TDH(o,6~' Ft
Forcemain Length 4601 1 Dia. 'V Dist. To Well ~5D
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS M DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Typeof TV-TD- CHAMBER Model Number:
System: &AQ do' >SD >10 1q 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
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.)
t~
LOCATION: St. Joseph.26.30.19W, SE, NWT" Vii, Awa►tukee Trail
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. _diN
SBD-6710 (R 05/91) Date I pector's Signature Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code coytyT,Y I `r
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than Q09917-
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
:5 4C- '/4,4,14 %a, S ~211~' T j/ , N, R `e4 E (or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
6✓ / 0 t ~e Saw 7
=CITY
VILLAGE fir- s NEAREST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned
SI ✓(.t.~B td<w a~~~
QQWN OF:
❑ Public ®1 or 2 Fam. Dwellingf# of bedrooms ~ PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify.
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. Vq New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 ❑ Seepage 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 (s q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
C~ Fs 7 Q
76 y sv~ 1 f ~*I- Feet lda i 7 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New istin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank Iik
Lift Pump Tank/Si hon Chamber IjOJ~ W F-1 Fj F1 Fj
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number:
G~ .2 /S 3~6-3/z
Plumber's Address Street, City, State, Zip Code):
® r4 S~
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Age Signa S ps)
Approved ❑ Owner Given Initial Ad ~ Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.OS/93) 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 the 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 & 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 line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, 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 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
'c~ rah sTow~" % !J sal' ~ STtT /l a ~c`lesa~~i
~14)4L KBE rrr.~ 1
r
962
ov-
Scale ~
v
h
y~~ x
PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
VENT CAP
4"C.I. VEAIT PIPE APPROVED LOCKING
WEATHER PROOF
JUNCTION BOX MANHOLE COVER
- Z5' FRCM DOOR,
WIMDOW OR FRESH 12 M"`~' I
AIR INTAKE
GRADE I 4" MIAJ
(
18" M I IJ.
CONDUIT--
I®"MIN.
PROVIDE (
~T- AIRTIGHT SEAL
If I I
I
APPROVES JOINT A I III APPROVED JOINTS
W C.Z. PIPE. I I) W/C.I. PIPE
I
EXTENDIMC• 3' I II ALARM EXTENDING 3'
ONTO SOLID SCII. B I I ONTO SOLID SOIL.
I
I ON
C I I
I
PUMP -
~ OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED ONL.1 IF TANK MANUFACTURER HAS SUCH APPROVAL
SPEC.IFICATIQKJS
SEPTIC AND
DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy
TAMK :;IZE : ~z"d GALLONS DOSE VOLUME /
ALARM MANUFACTURER: INCLUDING BACKFI.OW: ~{1 GALLONS
MODEL ►JUMBER: CAPACITIES: A= 22-'' INCHES OR ~ GALLONS
SWITCH TYPE: B = INCHES OR GA'_LONS
PUMP MANUFACTURER: /1 ! C = C = v` j INCHES OR CALLOUS
MODEL NUMBER:r' D= <f INCHES OR •!jGALLONS
5W17CH TYPE: MOTE: PUMP AND ALARM ARE TO BE
-
PUMP OISCHA.R INSTALLED ON SEPARATE CIRCUITS
G.E RATE ~ G PM VERTICAL DIFFERENCE B 1'MIEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . FEET
r' FEET OF FORCE MAIN X , -5 F j
loo FTFRICTION FACTOR.. FEET
= TOTAL DtJ JAMIC. HEAD = l'~ FEET
INTERNAL DIMEWSIONG OF TAIJK: LENGTH ;WIDTH u ;LIQUID DEPTH /
SIGNED: Z-L'-2~~•-- LICEWSE "UMBER:. DATE: y~
-117-
wonsin Depman Rartment ofelations Industry, SOIL AND SITE EVALUATION REPORT Page of /
LaE»r and Hu
gNision of safer euiWings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PRO TY OWN R:- PROPERTY LOCATION
GOVT. LOT 1/4 tl )1/4,S Z,, eT 3 p N,R sirw W
PROPERTY OWNER':S MAILING ADDRESS LOT #
I )(1A 14 BLOCK # S D. NAME 0 CSM # ~
S f_. s t)
v + /t
CITY, STATE ZIP CODE PHONE NUMBER []CITY ILLA~E SEOWN NEAREST 0AD
[ANew Construction Use L>f Residential / Number of bedrooms Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived dally flow gpd Recommended design loading rate _ `•7 bed, gpolft2__,2_trench, gpd/ft2
Absorption area required bed, 112 Q trench, ft2 Maximum design loading rate ~ -bed, gpd/ft2_,6_trench, gpd1ft2
Recommended infiltration surface elevation(s) f,, - It (as referred to site plan benchmark)
Additional design / site considerations ,
Parent material 1-9 Flood plain elevation, if applicable IAZ±:-ft
7=UUnissluitable able for system CONVENTIONAL IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
fors stem t S ❑ U _ ❑ U ❑ U ❑ U ❑ S EXJ ❑ S EPL -
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxtda GPD/ft
ry Roots
in. Munsell QU. Sz. Cont Color Gr. Sz. Sh. Bed rertctt
. r
f vti~ 5 % - to
4/4- IV ct~ S/
Ground _ 5 o S t/
elev.,,, hi Depth to
limiting
factor
>
Remarks:
Boring #
13
Ground
elev.
It
Depth to
limiting
factor
Remarks:
CST Name:-Please Print j 77 I / Phone:
Address: JS j 1 f , ~C I (I I (/U v~ O r/l
Signature: ' Date: ~Number:
4 ~
PARCE10:4 - • - Page _ of
l
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture Structure .11 1
Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence 'GPD/ft
C ~ ~~Y Roots
Bed Tmnch
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
It.
Depth to
limiting
factor
Remarks:
Boring #
L,1w
Ground
elev.
ft.
Depth to
limiting
facts
Remarks:
Boring #
1, rm--111
Ground
elev.
ft. 9
Depth to
limiting
factor
Remarks:
W-8330(11.05/92)
Lot i I
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OMT ER/BUYER
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATES ~Soy
PROPERTY LOCATIONS 114,,1,14-' 1/4, Section T 34~r N-R___/ W
TOWN OF .sue fT psi ST. CROIX COUNTY, WI
SUBDIVISION ~Q SS /L, ~c~ Sew 7~4 LOT NUMBER
CERTIFIED SURVEY MAPS-0-0 7% VOLUME 1'e , PAGE S , LOT NUMBER I
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. Cro. County residents may be eligible to receive a grant for a maximum of 60%. of the cost,
of replacement f a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted is 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 yyear 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 G~s•-ol S to u.~
Location of propert 1141/4, Section -;;K ,T&d' N-R1y_W
Township ® sc Mailing address
Address of site
Subdivision name S jtm ij/. p Sv tv~l2 Lot no. r~
Other homes on property? Yes K No
Previous owner of property .Er ves'7- ,tie
Total size of property 3, Q.e_'L z r
Total size of parcel cE•c s
Date parcel was created ~/s U ?.,2 '?'N'
Are all corners and lot lines identifiable? Y.- Yes No
Is this property being developed for (spec house) ? Yes No
Volume L-X- and Page Number 5? as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOW N .
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. yY33 / 7 , 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 Date of Signature
i!
DOCUMENT No. WARRANTY DEED THIS S►.CE RESERVED FOR RECORDING DATA
A Y STATE BAR OF WISCONSIN FORM 2-1082
_ 443 17
a^^K 828 ;A% 57 REGISTER'S OFFICE
'j $r. CROIX CO., WI
ERNEST C.-. PETERSON and VANGIE PETERSON, Recd for Record
husband-and . 140V 23.1988
Grantors... d 8:30 AA
conveys and warrants to . RICHARD_O, STOUT. and JANET- P, -
STOiiT.,-_.a3_.survi.VorShip---Mari.tal..proner.ty-_,-.._.._...---.• $*1W9"1WWofDad&
..Grantees.--
. - .
RETURN TO
. . . .
the following described real estate in ._.S.t.. Cr.oix...... ..County, -
State of Wisconsin:
The SIB of the M.44 and the 1,AA4 of the SW% and Govt. Lots 6 Tax Parcel No:
f and 7, except two parcels recorded in the Office of the Register
of Deeds, St. Croix County, Wisconsin, Vol. 300, pg. 204, and Pg. 553, all in Sec. 26,
T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, further described as follows:
Cbmencing at the West a corner of said Sec. 26, said corner being the point of beginning
of this description; thence N00°42153"E along the West line of the NKN, 1304.60 feet;
theme 989°2814:3"E along the North lines of the SW'h of the PA and Govt. Lot 6, 2040.76
feet to a l" iron pipe located N89°28149"W, 13 feet more or less, from the water's edge
of Bass Lake, and is the beginning of the meander line along said Bass Lake; thence S42°
51115"E, 411.72 feet; thence S52°52132"E, 169.35 feet; thence S39°36'55"E, 223.90 feet;
thence S04035'00"E, 94.79 feet; thence S65°46'42"E, 143.47 feet; thence S11°46'33"W 114.07
feet; thence S30°39'41"E, 181.51 feet; thence S15°54'39"E, 279.17 feet; thence S43036'56"
E, 329.28 feet; thence S21"21'01"E, 117.09 feet; thence S04°53'36"W, 479.60 feet; thence
S70036125"W,175.50 feet; thence S87022128"W, 176.22 feet; thence S43051'36"W, 189.23 feet
to a 1" iron pipe at the end of the meanderline; said pipe being located N89°51'27"W, 13
feet, more or less, from the said water's edge of Bass Lake; thence N89°51127"W (Rec. as
East) 183.31 feet; thence S10°08133"W (Rec. as N100E), 300.00 feet; thence S00008'33"W
(Rec. as North), 45.97 feet (Rec. as 33 feet); thence N89054133"W along the South lines of
Govt. Lot 7 and the N64 of the S*4, 2414.97 feet; thence N00°00'17"W along the West line
of the S44;, 1337.75 feet to the ?point of beginning, above described parcel contains 165.44
acres including all lands lying between the meander line herein described and the
water's edge of Bass Lake, which lies between true extensions of the Northerly line (sur-
veyed as S89°29'48"E, 2040.76 feet) and the second most Southerly line (surveyed as N890
This .is..mt......---.- _ homestead property. (CONTINUED ON REVERSE SIDE)
(is) (is not)
THIS DE® GIVEN III SATISFACTION AND CONFI_RMATION OF THAT CERTAIN LAND CONTRACT BEMEN THE
ABOVE PARTIES DATED AL;^><JST 1, 1978, AND RECORDED IN THE OFFICE OF THE REGISTER OF DEEDS
FOR Sr. CROIX OJUNrY, WISCONSIN ON SEPTEIBER 21, 1978, IN VOL. 581, PAIGE 476, AS DOC. .
351882.
Dated this 3~.`~' day of r 1988
- (SEAL)
(S EA L,-., J 51 ~.~l Jl+-lk
$ 285.00 ;sinus $.161.00 previously_paijg Ernest C. Peterson
i
(SEAL)`-t"r (SEAL/
Vangiie Peterson
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF ARIZONA 1
- q_%/C
Ct- County.
1 S*"
authenticated this day of 19 Personally came before me this --day of
1988_. the abovetiamed
ncst- pA ~rse?n anc,- v3Tl,C
Z F'r
' Peterson his wife
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,.
authorized by § 706.06, Wis. Stats.) S who execated the
to me known to he the per<on
fore,uoin, instrument and :uknokledec't-, :am,c.
T-1 S INSTRUMENT WAS DRAFTED BY
Robert W. Mud e, Attorney
GILBERT, SOW ....PORTER& LUNDEEN
of ri,ona
Hutson, WI - 54~J6-- - - - 1ot::••- rIh.I~ State o~
(Signatures may he authenticated or acknowledged. 13oth M, Cw.,mii;~inn is n(rnu:l:• 1'. L It not. state e_-:n `ration
are not necessary.) date: My Cony sion ExpreS Jwy 1], 190 19 .1
'Names of persons signing in airy car- ity -w, j d ''I I. 'h li
WARRANTY DEED STA"rE BAR OF W'I CO\fSV K'.+- ,:_.L•gnl I.
ND Y - OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
I(~L DIVISION
LABOR AND - PERCOLATION 15) P.O. BOX 7969
HUMAN, RELATIONS (H63.090) & Ch / MADISON, WI 53707
~
~ds ~C /+I` LO VBLj/N0,j NAMEc l-r
LOCATION: SECTION: T3oH/R~q~(o TOWNSHIP/-1
COUNTY: OWNER'S BUYER'S NAME: MAILI DDRE : ~i K ~[O O 77
USE ` D OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL/pESCRIPTION: t~ ILE DES RIPTIONS: L TION TESTS:
Residence ~ :4 JXI\Ie a eplace ~a .S^ Y a . Y `fJ /
/7
4r 4L.,
0: MA h C . ~io ~°dk.~ I
RATING: S= Site suitable for system U= Site unsuitable for system All& x .u
[CONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK: RECOMMENDE SYSTEM: (optional)
~S ❑U 9S ❑U ®S ❑U ❑S WU ❑S ®U,~v~..4-I Bd.. Ca " 36 `
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: N Floodplain, indicate Floodplain elevation: /''s' A
P eFF LE DESCRIPTIONS
BORING TOTAL, DEPTH TO GROUNDWATER 1R1GHC-9 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTFM+t; ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- o . 3' ~la,ue. 7 J~d .6 A;// l W. a /s
B-2- •0' /0/.7' /bile. 7 o, t $A/ I.c7aAr V 4',3 04 AV
B- 740' A4ule_. 7 .d' 6 B// s U0,54 4f on s Y B °-Iels
n
B- , o' /0Y.Y' -2.C) 1 yys~
B-
PERCOLATION TESTS
TEST DEPTH# WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER aNPPIFE!6 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P_ 3x ' a 0 • .t , _ S'
P- d2 2.3' No 3' 3 3 .2
P- .o• o L3
P-_
FPP--
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 q9• •C-~ _
i i Q 14
4*AO -C,
3
7~0
let y, =
.m
- /
I, 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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
r. so;~ I.tJ , S'~o/G Q 11= /
CST ATU E:
t ~
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
R-SBD-6395 (R. 02/82) - OVER -
r •E ~
+ y
INSTRUCTIONS FOR COMPLETING; vr)RM 115 - SBD - 6395
To F , ccurate soil test, your report m r<.ir~:
1. Come ~ ription;
2. The € clearly °s %cate'vvhether this is a residence or cornmercial project;
3, NIAXI(Vlu . ` bed or commercial u 1( 1;
4. Is this a
5. Cornplete t! A SITE IS SUiTA~?LE FOR A H_ LEJNG TANK ONLY IF ALL
OTHER SYSTEI C BASED ON SOIL CONDITI
5. PLE,~SF use the -i here for writineq profile descript. ;s rd comp! ~ tl. E`':)t plan;
A LEGIBLE P'i n dr irdceiy locating your test locations. I--= «tg to sc< e` . A
sheet may I <<sir
sure your bencho,, _ k and vertical elevaticrr reference paint sa y shown, an rent;
9. C plele all appropriate boxes as to dates, names, addresses, flgo ':;in data, p'.= exernp
mn, if appropriate;
10, If tho sr=t a~i,,*r (such as flood plain, elevatio=r) does riot a°~ in tl rte box;
11 . F the d glace. your current address and yornV certifi
I rd distribul:e as required. ALL SOIL UST B VITH THE
L `THORITY WITHIN 30 CLAYS OF COMPLETION.
A136HE1iIATIONS FOR CERTIFIED SOIL TESTERS
Soil S I .Textures rbols + .
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Cr)h - C: (3- 10") M
gr - C ider 3") P _ Lij
E3Idq
is - S, Id . _ en
r` - L am L .a,
Bn
Mfr BI -
Gy
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3
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'id BIVI F
V R F e
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G3WNER 4
+ 3 in ::'.CIPYI(itJ a san' P " (l n t. r 1