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HomeMy WebLinkAbout030-2009-90-004 STC - 104 AS BUILT SANITARY SYSTEM REPORT I OWNER ~ l ADDRESS SUBDIVISION / CSM# LOT # SECTION T~ N-R W, Town of 5~~f ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wic i ~C f i NCY v V-' r~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: ~7I'djjffj Liquid Capacity: Setback from: Well L~ House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ~ Length Number of trenches -y Distance & Direction to nearest prop. line: 75 / ZJ~S I 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: PLUMBER ON JOB: zt,~"h 4' Zc rGt r' /1 9 LICENSE NUMBER: INSPECTOR: 3/93:jt LO 's~+Q art rrto4q" ph. 34.30.1 `VAff'SEVAd%YSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings bivision ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 208922 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: nTANA T. St. Joseph ev.: ~ Insp. M Elev.: BM Description: ✓~I~-' G~"C.~ Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400043 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosl n9 Aeration Bldg. Sewer Holding St/Ht Inlet o 7s' TANK SETBACK INFORMATION St/ Ht Outlet /d 91- 7.0 Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic 5_6 O3 0 NA Dt Bottom n ; p Dosin NA Header/Man. S 06 Aeration NA Dist. Pipe ` ~ / 92 FHoIdTKg Bot. System Jr-~ PUMP/ SIPHON INFORMATION Final Grade M urer Demand T/~onS,7~ c ds~ s7s~ Model Number GPM TDH Lift Lrictio em TDH Ft Forc ength Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length 1 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~5~ DtMENSI SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA Manufacturer: SETBACK CHAMBER INFORMATION Type Of /It,,> >PdO Number. System: /J q;I 50 114" OR U DISTRIBUTION SYSTEM Header MiU Distribution Pipe(s) ~s x Hole Size x Hole Spacing Vent To Air Intake Length i Dia. Length -7::;7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over It It Depth Over z" odded xx Mulched Bed/ Trench Center 6 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.34.30.19W, SW, SE, Lo Plan revision required? ❑ Yes [/]~ftro✓ _ Use other side for additional information. a 5-- SBD-6710 (R 05/91) Date Inspector's Signature Cert- No. =LHR . SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouN ~i!2m STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ol09q Z Z 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 A / PROPERTY LOCATION ~lQ l'L C(Q fiD '/as %a, S T3~ , N, R E(odg~ P OPERTY OWNER'S ILING A RESS LOT # BLOCK # I ' t CI ATE ( ZIP CODE PHONE NUMBER VISI N QR JIM NUMB R 50 d /Urirl lI II. TYPE OF BUILDING: (Check one) CITY < NEAREST RPA12. ❑ State Owned VILLAGE J'~. SLo C7 ❑ Public ❑ 1 or 2 Fam. Dwellin of bedrooms A L 111. BUILDING USE: (If building type is public, check all that apply) ,q 2 1 ❑ Apt/Condo V .7 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1o ❑ 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. N New 2.E] 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 S Seepage Bed ffaXS a 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 (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION o~ 4/6 40. N Feet /cl o~• Feet -2 70? 29. VII. TANK CAPACITY Site INFORMATION in aRant ns Total # of Prefab. Fiber- Exper. New isin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks ks structed Septic Tank or Hoidin Tank Lift Pump Tank/Siphon Chamber obb I Wes re0G s VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er Signature: (No S mps) MP/ W Business Phone Number: 4 5~2? ohs 1 s0 P limber's Address (Street City, S to Zip Code): hAr IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Agent Signs ~ Surcharge Fee) ❑ Approved ❑ Owner Given Initipil •lf/~ 9 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety I£ Buildings Division, Owner, Plumber 1 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 renewE;i any new criteria in the Wisccnsin Administrative Code will be applicable. 3. All revisions to tl.is permit must be approved by the permit issuing authority. 4. Changes in own hip or plumber requires a Sanitary P. rmit TransiH? /Renewa; Form (SR-. 6399) to be F-ubrri `:ec3',o the :.aunty prior to installation. 5. Onsite sewage cyst-ms mss be properly maintained The septic tar!%(S) mist be put: , c: licensed pumper whenev €er recess.ary, usually every 2 to 3 years. 6. If you have. quey~t ors concerning your onsite sewage system, contact your local ,dir. nistrator 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. Provice the legal description and parcel tax number(s) of where the system is to be installed. ll. 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 replacarnent, .'e.connection, or repair. V. Type of system. Check appropriate box depending on system type. Vt. 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, dumber, of tanks and manufacturer's name. Indicate prefab or site coristructed and tank material. COM[-, ete for all septic, pump/siphon and holding tanks for this system. Check experimental approval cnly if t, uMks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with approvri~'. a 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 131/2 x 11 inches muSt be submitted to th _ county. The plans must include the followin : A) plot plan, drawn to scale or with (moiplete dimensions, ,cation of holding tank(s), septic tank(s) or other treatment tanks; building sE:we s; A/ells; water r: ai;:S,,vater service; streams and lakes; pump or siphon tanks; distribution boxes; soil .aoso~ t: ioofi systems; reola,;t>rnent system areas; and the location of the building served; 3 1, horizontal and vertical =Ievation reference points; C) complete specifications for pumps and controls; close volume, elevation differences; fricticn 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. - - - - - - - - - - - - - - - - - - - - - - - - GROUNDWATEIR SURCHARGE 1983 Wisconsin Act 410 included the creation .ol surcharges (fees) for a number of regulated practices which ran effect groundwater. The monses collected ihroagh these sl.:rchargc,-s aFE: used f ,-,,.r r7v)n;tor r a tiro'„-;writer, gi-?._rni.- water L-ontamination invest;gatimis and establishment of slkr~iards. SBD-6398 (R.11/88) pima ~ is tan S G,~ s Say 73D 9 l ~ 7, To s e ~1r~~ s~j . 160 Z-- , n = tSOLS ~O k steel rtpe ~ 6~artn~ QeS. Ibs riobo dal Se~~-~~ roo•o 7e' 4 3 0 3 41 At- R ~3 tie r. r 3`4 41- 64 Ss . ale v+ q a t9 N IIVUU Y ' • v.■ all ■ vMa vv~a~ rt~v■ ♦~i-iLiJ 1"~f ®LJ DIVISION L R AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS i 1l_w~ J po j MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LUCATSECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: 70 } a 3 /T30 N/R J? E (o sr. J"oScP hL .~o v ~f/o~PRE~ L_ COUNTY:, OWNER'S BUYER'S NAME: MAILING ADDRESS: 51 Gwix .ao,u N01?2, z_ Z_ RT' 3- vi//oav USE DATES OBSERVATIONS MADE N0. BEDRMS.: CM M R AL DESCRIPTION: T'RO I E DESCRIP Ps -PESTS: Residence 2 N11- XNew ❑Replace -7 11, _ J 51-. 1 O S~ RATING: S= Site suitable for system U= Site unsuitable for system ~S CONVENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ©so ©sou oSou ToSZu oSZ eoP'CxT'w4Z_ -2 0 3 -s0.f7 l~c0 00 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: fr PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-. -S CHARACTER OF SOIL WITH THICKNESS. COLOR, TEXTURE, AND DEPTH NUMBER DEPTH rol ELEVATION O'jB~SEERVcD EST. HIGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-/ ~iO ~~•~7 , 'O •SBN.L, r7s~L~QiJ.G~ f 7~'~7/QV.'SiL~ 43~L Qom, 90 74) >9Q •7f `D,~6~.~, /•Y1.' Ba,~. 1''3 ' Z/ - ;N,z-, SO' B- Z . cl~' ~t R. sa P /~u~ Oc,~.e tp 00°9o '8'U sG - B-3 f0 105'Iy` O 3 L {7?rCZ(/L, a~3 iw. SL .y/ L7.Qy}./rte'IX.s 94 Gk )7,aQ , S4, jD . B- D'() 10170' - Q •YZ`~`~v.t, /l.C,).>rw.e Tax CS . B-S 9,0 X00.70, 74 >~,0 'S`~~18U,G~,S~'Q.tI,L~ /,s~`L7`•~,.1.S,Lr-2./1`7k .0 B- Fj'• PERCOLATION TESTS TEST DEPTH' WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER rMe- ".S AFTERSWELLING INTERVAL-MIN. PFRI 1 PERIOD2 PERIOD PER INCH P_ P- /P- 2- CD. 2- LP 4 P- -3 Z7 1 J P_ I LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori ntal 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 fland slope. /,30TTO-1 Oe S,6I Z_XC-40-1710-0 TO G/E EXAC;y ~E60w ~f~(~j~~fL 126 f YSTEM ELEVATION ,PEFFXXE.f~ERo~~r- g~ /Evtr~ov o~ Fr - _ I I ~ i - IN I I i I ( I ~ , • I I 1 I I 1 ( i ~ I I I 1 i ; i I i i i. ! I I I I ! I the undersigned, hereby certify that the soil tests reported on this form were made by m,? in accord with the procedures and methods specified in the Wiiacon sin dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. AME (print): TESTS WERE COMPLETED ON: y-~ ' ,1ple ly /y~3 I DDRESS: r y ~I - CERTIFICA'rlOf1 NUMBER: Pi NUMBER;cption;i): v ~ 1s. CS-r SIGN.aTUHc: !ST<IBUTION: Original and one copy to Local Authority, Property O.vner and Soil Tes;.:r. !L.HR-SBD•6395 ;R. 02/82) f,) VF R .,REPORT ON SOIL BORiN&S PERCoLATIorV TESTS !1s . PLOT ✓ P L A~v . P ROS Ec 1 r- U. s_ ,7os~p1 7-kw s4 . 557- ~ ol; j)lg T-E !~4di,v¢ S = 7-,P St:oT • ~a - ,P2--v HOMESITE TESTING CO. PT. 3, O'NEIL ROAD B 0 B Ul,RRI +rlUDSON, WIS•..._ 5401 CST 5.~~ aZ y~~.. PROPOSED HOUSE MOS' LIE Z,; Fr. p,~ MpRE .QOM /3LL TEST f~~PE~S. P-o POSED WELL H vs r me 50 ~ r 6,e ,tio~P , F Acs TEsT ~tR'~~3S, = C3f}/f/oE PiT,S 0 = EXiST~.1J SELL ~E~G /OCgr/DrUf f fg.vP ~v9ERfD o e s4eaEL 134eF5 d r f~o,~iz . s m VtRrichl- ~EFERtiUc,~ f~oia)T" ,BASE of 'rte LE UE N D/EVgridv ~PEF. PT. /o o- o Fr - T 6~e 9,A~ ~o L oT " ~ GG EA,~ Imo' ~ elv t F2- 5 AITE QdAT~ o~ g x 5 5Y57eM 3y C/r ' r J B boa ' I 131 1 ~ Fr R/VJ SOUTH I/4 CORI`1E R UNPLATTED LANDS - tI SECTION 34 , T30N , R 19 W = - - 80,. + COUNTY MONUMENT WCST L,rNE SE V4 N r1 00°-_ 22 - 20 E 'z Q, 3S. `BSc ?T' '-L 595-.2 -5 0 n, C)a .3,~• 1 ~j ` U 1 l:3 0.(JO. 00 "F y (Op m Z r N 1. ~ 1( 'C .3.3, 0., m r g-0 0 0 e J m e--- , \ _ : D co ;rj rri p lr1 z C n 2 N O r 1 co "R nom x p o D 51? r~ ~nT o a w a~ N O r 'p x o w iv rn p n m e.' ° N O iv p A 14 r 7 0 TM N T O O Z g ' z1 n 1 fi N m $ (n O N b rrl c m 0 C) co G7 m = is fA' z 1 {3 1~ 0 is 0 Z (P U) 'O 'a )c z m o °OZ 74 ~F` vs `O L m 21 l7r N R x r j ~.~0,,~ VS D 4 O Q) O 00 N m to rri a) K) !P 1. j 41 cl\ oto -n a; 4, .0 O rZ. L U J o or) m o o 14 C= co r- kp m M G7 O ti C7 M C. D r tTr r~ V N o n v v~ m A U ~v CD n In v f" A Q In V Ln w n X O - W (D C \ I. n~ c, Cb ~p OO j~ C 01 A N O W A N Z C ' O 1 O w 1 C z Lf) ip rl \ f~j) ' V AD lD t l z -i m O o ~r9~°•4 0 CD z w In N is N w N - A -i ry 3 3 rr' N r) In r . r„ 0 rm O m C-D CD CD 7D 61 O O O O N u+ N U Q1 Fi D \ n R p ~Q z O O O X 4 w rn ^4 d O -4 C1 N CL c~ 4- (D Ul z O •A 0) O \ \ d IN z IW LA (0 - N O W 00 O ) 0O- w m A A O N \ ' N w u0+ io LA v in O t 0 lD G~ o ~r O O of tp O O Z O c \ x 1` G rr v'~ r v) V) N N N N N In N fl \ ~ z c r Sri w 0 A N 0 0 0 0 N N N ~ m ~ O ~ o m w w o o o o 00 0 0 co o .o o I° o o .o o o \ O A i C)7 p W W w Q d? ap ~n ti+ u+ W r~1 \ (q 7' v Z V) VL C) r) ~x g g 0 '1 - rn M rrn M~ n x G) r) O rn f 11 j ter m N co N `r ~I J O O O rl r N r o O O C CD ° c 0 e z D w 2 .0 0 + N W 01 O p v J v Z O 0 D , D O T O -4 A 7 - Lp O LP V A O O O O 0 O Z r 2 N ` Z Z • w m _ rn SEARIF7G ARE ASSUMED AS cn E6~~ w N N w tp w r N 00°-22'• 20 E ALONG THE WEST I/R SEC, 34 On -4 w N L? W m LIME OF T►IE E j N -r UI N Ll A W N O D: C~ -1 C~ V) Ir x U ^~+I ~~c SunRay Builders A Division of LCR Companies N. 7540 Cty. Rd River Falls. WI 54022 1 217 Come Averwe 03 Al SL Paul. Minnesota 551 (612) 488-2525 FAX (612) 488-9779 1 1 1 ~ it 1 , , 1 , 1 1 ' v 1 1 lam= /YI r -pro 1 , 1 1 ~ Georgia-Pacific Q COLONIAL CRAFT' I - I 11 1 1 , , 1 SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County ~ I-A O1dNER/ BUYER GQ Q w ROUTE/BOX NUMBER Fire Number„ CITY/ STATE ZIP C1 PROPERTY LOCATION:' .70 Section, T3© N, R~W, Town of St. Croix County, ~ Subdivision` r1l I, ArrezI E' Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prover maintenance con- sists of pumping out the septic tank every.three years or sooner, if needed, by a 1'iceris*ed *s'ept'ic tank pumper. What you put into the system can affect the function o. the-septic tank as a treat- ment-stage in the waste disposal system. St. Croix Count residents-MAX be eligible to recieve 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 County Zoning a certification form, signed by the owner and by a mater plumber, Iourneyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2).after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three ,year 'expiration. H I/WE, the undersigned have read the above requirements and agree i to maintain the private sewage disposal system in accordance with the standards set forth, herein, as..set by the Wisconsin Depart- w ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days of the three year expiration. date. Ail I)e - rejo.?A* SIGNED DATE. 3 St. Croix County Zoning Office 911 4th St. Hudson, WI 54010, 386-4680 Sign, date and return to the above address. STC-100 This application form is to be completed in full and signed by the oi.ner(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 l.J 0. vt 6L k a lo ' Location of propertyQ~1 1/4 1/4, Section 34 , T _„a N-R19 W Township Q g Mailing address Address of site M14 5,0 Subdivision name ID4 6 -Lot no. Other homes on property? yes Ne- No Previous owner of property ON, 4_4 /&r Total size of parcel Date parcel was created c? o Are all corners and lot lines identifiable? ?<",_Y.es . -No Is this property being developed for (spec house)? Yes , 5< No Volume and Page Number /</(q/ 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 & THE SEAL OF THE REGISTCR OF DEEDS. In addition, a certified survey, if available; ;would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded i th / ice of the county Register of Deeds as Document No. S , 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 record die office of County Register of deeds as Document No. e C S gnature of aprl can Co-applicant Date of S gna ure Date of Signature DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982! THIS SPACE RESERVED ►oR RECORDING DATA 455413 I WARRANTY DEED I w... 862PASE _ 186 This Deed, made between Donald E....... Nore11 and REGISTER'S OFFICE Beat•tit e.•.A. Norell, both single ~.ersons and-* $T. CROIXCO., WI tormor-ly__•hu-sband-•.and wife 'd for Record ~ ReC , Grantor, and..... Diana L. Clayton, a single woman, Ol JA 2 19030 3:45 ~P. ~M~ , Grantee, ReplsllfCfOeed! Witnesseth, That the said Grantor, for a valuable consideration...... of ne dollar and other valuable consideration conveys to Grantee the following described real estate in C r o i x RETURN •o - County, State of Wisconsin: i Tax Parcel No : . Part of Southwest Quarter of Southeast Quarter (SW 1/4 of SE 1/4) of Section 34-30-19 described as follows: Lot 4 of Certified Survey Map filed May 3, 1984 in Volume "511, page 1415. TOGETHER WITH and SUBJECT TO private road easement as shown on said Certified Survey Map. t~~Cr ~ • ~~RE-P~T~ EXEMPT ~i This deed is given in satisfaction parties dated October 7, 1988candnreof the cordedlOctober t11, 1988winn the j Volume "824", page 581 et. seq., as document number 4421.47. f _ n7~ C This s not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belon in I Ard..... Donald E. Norell and Beatrice A, Norell_ g g' warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record, if any, and will warrant and defend the same. Dated this " • .............(SEAL) - ----..._-.tf (SEAL) . Donald E. Norell (SEAL) ' (SEAL) i * Beatrice A. Norell I, AUTHENTICATION if ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN Ss. i S t. Croix authenticated this day of -County. 19 Per onalIy came before me this _12 _ - -----~----day of Dona d Norell°andyBeatr~cenred • NoraTI------------ TITLE: MEMBER STATE BAR OF WISCONSIN u (If not, authorized by § 706.06, Wis. Stats) to me known to be the person S........... who executed the foregoing instrument and *nowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall y 41A-LL._.&._IiA8R1.S 522 Second Street *._Iy1~~Y-•A M , L _ - S t. C r o ix i~ Hudsnn ,..W.z 5.4Q_1.5- I t -c- - D•------------- Notary mi ton, . i_. C Wis. (Signatures may be authenticated or acknowledged. Both lily Commis s permanent. {If not, state expiration are not necessary.) (i - date: _ 19..1..) *Names of persons signing in any capacity should be typed or printed below their signatures. - WARRANTY DRED STATE BAR OF WISCONSIN FOR31 Nn. I-1982 Wi--in Leval Blank Co- Inc. 1[i kee, Wis Wis. ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants qz/ 3-~~-17 2o,~~N a0 s poi k 34. TLOoy $ -z (GD A, T rA d-- 1 ~n ~4 S A-e - ~ S 6a U-sue J e4,~ - nM 1' S S I* M5 A ~v CA, - 0-4- S ~ 8 L) %U f`Stc-) ` I -6 ca~ O A D A S S&,3k b Llt-,- i `f' . dt-e... W~ S-p-+ a- A,-P~ A/-A I a a- I~ t-t 4+- D, &-e s v S4dk-ga i -aeo- D I2. i i L_ 3 ,ter /Lt s I o 2 A,~ Y,~: v~ni vsu vv~a._ vv~~s1UI~J J>`~1U1.! DIVISIOI AND ~G-Yoe PERCOLATION A.TION VESTS (115) Qo~ MADISP.O. BOX 76 REL ATIO 0 ON W1537 (HV.09(1) & Chapter 145.045) LUCATR SE TION: k77 OWNSHIP/MUNICIPALITY: TLOTNO.:BLK.NO.: SUBDIVISION ~NAWIE: • 14) Y4_ ~/4 3 /T30N/R ' / E t o j-oSc P h`- J?OA) IVOI ~'6'1 000NTY:, OWNER'S BUYER'S NAME: MAILIN ADDRESS: 51 etolx 170.U ND/I/EEL L !IT ~ ~i//aGv .11V. 1SE _ DATES OBSERVATIONS MADE NO.BEDRMS,: COMM R AL DES RIPTION: TH~ FIL'-U-ESRI~IONS: P-~_F~^`l.UE_A T ~I(ES1S: Residence j New ❑Replaca -7 1 O _ r': .J d_ IATING: S= Site suitable for system U= Site unsuitable for system 5,45f :ONVENTI NAL: MOUND: I -GROUND-PRE URE: SYSTEM•IN•FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) D S OU ©S ou ©S ❑U EIS Z)U 0 S EU ovc'EOri~ygG , ,12 05"SO F7 l~cn,2t~o,r-) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ender s,H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: Fr PROFILE DESCRIPTIONS IORING TOTAL PT14 TO GROL'ND'PJnTE9• -S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH JJMBER DEPTH t~ ELEVATON ~7BSERVED EST. HIGHE TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) 6-/ ~iO /-0.) 7y I7 / /'•U" > ?D •s~N.L. .7f ~L7~Qv.L~ ~Jj ~~~QJ.'SiG, ,8,~' L Q~J. ~G~ 3.2, YL ,e. t-,5 0.0 ~o } '84; sL 3 3 fo ,oy,y ) o '83'o~./jv. • ?3'B V. . 33 . SL , y/ c>'.4,,. a.s , 75 3- (3 •C~ /o/ Jo > g Ge. Gv.~~ e L, o - Ta>.L CS . L/) 100•'70'--. g,o '5 '4e64" Y 'Q.11 Lr /,YJ ~LyP)nl. SrLr .~.lJ~ 3- A,v / C 7- 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES DUMBER S AFTERSWELLING INTERVAL-MIN. PFR100 I PER 1O' P PER INCH 's 2 / -0 7- L (D. 2- Cr 1 I OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori ttal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and perceni land slope. /,3pTT0-" 1 ~F ~El7 EXCs>'(J~4j/D fJ TD G%E EXAc7i y 1Z6 fl• ,BELOW (fE,Q~',~ L YSTEM ELEVATION AT c/ Fr. FT. I r-~ 1 1-4, • I I I . he undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procudures and methods specified in the Wisconsin ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. n r Y :m ME (print): TESTS WERE COMPLETED ON C -Z 'DRESS: - - JI 3, ~,r • CERTIFICATION NUMBER: PHONI NUMBERicption~l); o) b RIBUTION: Original and one Copy to Local Authority, Propp.rty 0.• ner and Soil Tes: ~r. HR•SBD-6393 ;R. 03/82) - 7 , ~p REPORT ON SOIL C30RINUS ~ PERCOLATION TESTS lIS • DoT y pew ltlol?x°5-l-z PLOT PL-AM PR03-ECT S. D. V. j'os6-pA 7-49uS4 57•Gro/x ~ DATE IYW 06- S = h -~.z ~o - R HOMESITE TESTING CO. 11-1- 3, O'NEIL ROAD BOB UI.1;hlG'~.; 4 Auusora, WIS....- 54016 C.57- OZ y~Z PROPOSED HOUSE MUST" LIE Z,~ Fr O~ MORE FiPOM ALL TEST f~rPe.45, } PF-oPoSE D WALL M V5T LIE ,r o,~ F5 p OfE /Pom AEG TEST A/PZ,4 S, I . • = Qf c"es- Pirs, =EXIST/~tl 6- 404-14 _ /DES d ` f/cr;z . s m (IERT%C~L ,~£FERt~c,F- Pour ~AS~ di A4 5, PIIP~6- 5:6-7- LEGEND ~lEV~ro~v o` 1/Er iPEF, T Fr. Jr C4EA el A)6 C STi~t )-~(~L IPA -7 eel/ 3'1 05 i ~ U y 1101 T E V . I 1 l,(/ DL ivL Qs 5,0 B ' ` o IT / 1 ~V p I~ 3t RITE?dATr b~o`oy B x IS 5y574M A~Eh /00 / B r3 A 2- IT L 112ADIE7. EU A'rfo, = 10 A . F0 S Tt )-i leuhrl•oAj s k&ac Q e H A,',.j j -r 'T 75" yo f /*lozo 1311 #Z. ffwy