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Home My WebLink About030-2028-90-300 b r Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ l j ~ 2 Q a,0 Al TOWNSHIP SEC. 2Z-T 3N-R26 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE I PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t_ :J Eir .~T a AF/v 7, 7-,t Ij -,rff p7 lo, J~J s1 ' s r•` a INDICATE NORTH ARROW Qj Pole- BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: -5et-=- Ile Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side 0 Rear, O feet From nearest property line Front, O Side,O Rear, O feet Number of feet from: well -561 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ' s T PUMP CHAMBER facturer: Liquid Capacity: - _ Pump Size Pump Mod Pump/Siphon ManufactZanelevation: Elevation of in Bottom o Pump off switch elevation . Gallons per cycle: Alarm Manufacturer:_ Alarm Switch Type: Number of feet from ne st property line: Front, O Side, O Rear, 0 Ft. umber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: I quid depth: Bottom of seepage pit elevation: Area`:kuilt: Has either aY~Vop box O or distribution box O been used 7~0f the above soil absorbtion sytems-.,(Check one). HOLDING TANK / Manufacturer: acity: Number of rings used: C El ation of bottom of tank: Elevation of inlet: Number of feet from rest property 1 e: Front, O Side, O Rear, 0Ft. Number of feet from well., t} Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: / - Plumber on job: L)~r.01 _f License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS 'LABOR 4t HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.•BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 /~~/Iyt/~ Gov't Lot 4 S22,T30N-R20W 19CONVENTIONAL El ALTERNATIVE State Plan I.D. Number: (It assigned) Town of St. Joseph D Holding Tank El In-Ground Pressure O Mound Hwy. 35 NAME OF PERMIT HOLDER: DRESS OF PERMIT HOLDER: INSPECTION DATE: V. Studman, Inc. AD Route 2, Hudson, WI 54016 BENCH MARK (Permanent reference Point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Donavin Schmitt 3205 St, Croix 92558 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PR OVIDED. OYES ONO OYES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WA ER NUMBER OF ROAD: JPROPERTY WELL: BVE NT TO FRESH T FROM LINE R INLET. DYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO OYES ONO OYES ONO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY IWE LL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) PU OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING. COVER JINSIDE DIA. SPITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL' NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER: ELEV. INLET ELEV. END: PIPES: FEET FROM LINE: AIR INLET. NEAREST--► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES NO SOIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS OYES ONO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SODDED SEEDED. MU LCHED CENTER: EDGES: OYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.: DIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO OYES ❑No COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPER TV WELL: BUILDING: FEET FROM uNE: DYES ONO OYES ONO NEAREST V wJ(~ S Sketch System on Retain in county file for audit. Reverse Side. TITLEDILHR SBD 6710 (R. 01/82) 7777 Zoning Administrator DIL HE SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code x .~yr~" ~a . ~,,o . STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES 2 NO PROPERTY OWNER PROPERTY LOCATION tZ L5 ti C '/4 , S Z,2 T 30, N, R Zo E (or PROPERTY OWNER'S MAILING ADDRESS T NMBER BLOCK NUMBER SUBDIVISION NAME sr, 2 All I CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK f VILLAGE : - _ J 3 #U,Q SPA., If TOWN OFw 571 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR w Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ® Reconnection of e. E] Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. An Existing System has been inspected and soil conditions meet minimum requirements. 4. The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. E1 Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. V Seepage Bed b. ❑ Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet R F Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank El E] ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb 's Signature: (No Stamps) / W No.: Business Phone Number: ~ 6' - ✓ 1 dJCJ/1 Plumber's Address (Street, City, State, Zip Code): Name of Designer: r7- VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuin Agent Signature (No Stamps) pppp~~ urcharge Fee JAI Approved ❑ Owner Given Initial 4/X 00 ~ ~ Adverse Determination ~ O+ Co., X. C MENTSTEASONS FOR ISAPPROVAL: e. fS C JQr, KeL)*tLJ9oe 0~ ~o-,cs SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber i INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION , TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of-bed:- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained-The septic tank(s) should be pumped by a licensed - pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to tie installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license lumber with approprate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Y:> 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater - included the creation of surcharges (fees) for a number of regulated practi-.es which Wiscorfsin's e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure A is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, t 1 it's worth protecting. SBD-6398 (R.03/86) >L--/ ©l ~y do !_3, t~ Act 5 ©t~j7 2 J --T As p z--Iz ~P S f~ ~o Le r-ry 141/Tif//V SCf' pA~Nc* icy ` M P%~ DEP 47ng"o a CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 4, SECTION 22, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN S1/4 CORNER SECTIO/2 CENTER OF U N P L A T T E D L A N D S T30N, SECTION 22 S . T . H. " 3 5 " & " 6 4 " EAST LINE OF GOVERNMENT LOT 4 , - N0°35'20"E 743.60' _ S.T.H."35" V V- 580' 3 M NO'101 20"E GENT - - - - - q,-4 ]136.47 10 - ERLINE S•T•H. 641, NE CORNER COMMERCIAL 9 J~~ \ GOVERNMENT LOT 4 0~ 1 o H ZONING / 00 z [Westerly \ OWNER & SUBDIVIDER z z Right-of-way GEORGE HOLCOMB ^ o Line R.R. #l M M ST. JOSEPH, WI- 540$2 0 ~ - - Remains of Holcomb's I 10^ Supper Cau-b"`_ AI I '0 °o destroyed by fire w z1 I LOT 3 o - oo a 1 1 aai~ I C) 00 gal ( o of a. ^ 3 RESIDENTIAL - N W 4 C'41 SCALE IN FEET v Steel ° r-4 HI o - - ZONING Shed o `O ~ 1 I H w l o11 a z I 0' 200' 400' C14 o M 13.18TAc5 00 041 res± ~1 I z 4 ~ ~ 574, 060 S. F. ± 1 ~I z N0°40'20"E - - - N0°26'E 1I 130.00' 1 250.00 44 LOT 2 -`03 _ Note: Driveway 10/3 q,L~~ o wI ~/t Encroaches H D I Ca I a\ ~ v ' ~ rl a I wl o - 7 S ST. CROIX RIVER x-- ON N VALLEY ZONING w H HI ~D 44 E-If cni z 6A m HI r-q dl AI s1057 4011E R=80' .A ,2 ° 041 LOT 1 a1 zl 1121.07 ~N, o vl i Rpm 4 z1 al 1 LOT 4 7°04"W I LOT 6 ~I I C.S.M. 158.70 V.3,P.822 I V._p._ I LOT 2 I ' EASE'W NT i I I - - - I '1---___ I I I j PART j C.S.M. IV- LOT - P.822 I1 UNPLATTED TRUE BEARING V.3 P.882 I LANDS I I LEGEND I 1 • EXISTING IRON PIPE. 0 1"x24" IRON PIPE, WEIGHING 1.68#/'LINEAL FOOT, SET. 0 2"x30" IRON PIPE, WEIGHING 1.68#/LINEAL FOOT, SET. if EXISTING FENCE. COUNTY SECTION CORNER, BERNTSEN MONUMENT, FOUND. RAILROAD SPIKE FOUND. APPROVED Drafted by Brad Wittig DEC 2 91986 ST. C:~OI X COUNTY COMPSEIIENSIVE PARKS PLANNING AIJD ZONING COMMITTEE Volume 6 Page 1765 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR ANLI PERCOLATION TESTS (115) P.O. BOX 7969 H60AWAELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ XXXI~CX7 C LOT NO.:BLK. IN SUBDIVISION NAME: SE ')w'4 22 /T30 11111120i (or) W Josenh COUNTY: OldMM S BUY R'S NAME: MAILING ADDRESS: St. Croix Will Studtman !R.R.#2, Box 114, Hudson Wi 54016 USE r DATES OBSERVATIONS MADE ❑ PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: TO. BBEDRMS.: 1COMMERCIAL /a DESCRIPTION: [Re New pla00k Residence 4-22-87 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURErYSTEM71N-FI LLIHOLDI NG TANK: RECOMMENDED SYSTEM: (optional) FLIS ❑U ©S ❑U IS ❑U ❑ S ®U ❑ S a conventional 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/a Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS Da&e 33 HSB BORING DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL-WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Ili, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1.08bl.1. 1.17bn.sil.w/fff mot. 1.75bn.s.l.w f B- 1 11.0 100.40 none *4.00 ot.2.00bn. c.cob.gr. w/fffmot. 5.00bn.c.cob.gr. .75bn.1. 1.25bn.sil. 3.00bn.s.l. .33 bn.mot.s.l. B- 2 13.4 100.09 none *5.00 .83bn.s.l. .83y. ls. rt. 1.50bn.c b. B- 100.40 for location data only see Jans report of 4.22.87 B- 100.05 for location data only see Jans report of 4-22-87 B_ *2.83 duet 1.33bn. road material 50bl.1. 1.00bn. sil. w/m t 102.35 .75bn s silty mot. 5.4~ bn.c. cob.gr. 1.00 . ls. B particles. 1.50 bn.cob. gr. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD PER. INCH P_ -7- P- .f P_ i PLOT PLAN: Show locations of percolation tests, soil borings and the dimensio4,:o , suitaNf ta_'areas. Indjcat9e scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot' plaei' Show tFi~ surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION n/a 4 s l Y 9 [ I r J I 3 t I ~I [ F 1 ~t 7 1 r 0 2 Z-7 131 ..C_ f _.S T i e - "I 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: Gary L. Steel 4-22-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 88 N. Shore Dr. New Richmond Wi. 54017 2298 1715-246-6200 CST SIGNATU DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - I I TRUCTIOI S FOR COMPLETING FORM 115 - SBD - 6395 ' To be a c,r I accurate soil test, your report elude: 1. Comple 2. The use a<<rly inc nether this is ice or commercial project; 3, MAY,Ii f" ',f bedrooms nrnercial use pia, 1; 4. ri~,mt system; 5. rating boxe< SITE IS SUITABLE FOR A HOLDING TANI ALL YST1 LED Of 3ASED ON SOIL CONDITIONS; 6. ise the a>,i s shots for writing profile descriptio is I comp' i plot plan; A LEGISLF aecu IoGating your test locatior-- „1 to sca ret.9A ~rtefi ma, _ ~Si ~ E d vertical elevation reference point a + Dvwn an t; Y b( <es as to dates, names, addresses, floo(' :ernp- plain, elevation} does riot apply, lay:. the, apgl, u1 7x; 1 rent address and your certificati+ as recfiited. ALL SOIL TE-. FILED -'E 3ITY WITHIN 30 DAYS OF COMPLETION. .EVIATIONS FOR CERTIFIED SOIL. T° ~RS 00 Scl. Textures Other Sir ; <<.ils } RR -L 101 SS_S {;,r 3") LS tnwd - ,y Bldg B,n - try? f3l y _ Y - L,> am R - Loam rnot. - ay H VV L i-:. C" r'I 1PYtrl YI:S e t. ;posal Pm - P r _ VRP - ue crencc Poini TO THE,-' p"-mit. The county i.::cc. A t. to the approla to Kosted prior tot i. H z ST C- 105 r 9 ti SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County OWNER/BUYER- % A"",~ ROUTE/BOX NUMBER Fire Number CITY/STATE 5e~ ZIP JS~~ PROPERTY LOCATION:, ' Section_-Z-, T_3v N, R Zo W, Town of S--,P, - St. Croix County, Subdivision Lot number I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Crolx.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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, Journeyman 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. o I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- rv ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SICNED J DATE 7 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC-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 Location of Property 14, Section , T_]: d N-R Z~ W Township' Mailing Address .Sc= pj Address of Site ` dS Subdivision Name Lot Numbers Previous Owner of Property D-e zr1,f_ Total Size of Parcel 1.3. ) P . Date Parcel was Created 'Z~Z_ 2 Z ~So Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No 77r" , 71" Volume and Page Nu1er a~ 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) centi.6y that att statements on thi.6 6onm are true to the but o6 my (our) knowledge; that I (we) am (ate) the owner (s) o6 the pnopen ty des cA i.bed in this .in6oronation 6o4m, by viktue o6 a waAAanty deed neconded in the 066.ice o6 the County RegiAten o6 Deeds as Document No. 7 and that I (we) ptaentfy own the pitoposed sate bon the sewage di.spos .6y6 em (on I (we) have obtained an easement, to nun with the above desct bed paopeAty, bon the constn"ucti.on o6 said system, and the same has been duf neconded in the 066.ice o6 the County Reg.ia.ten o6 Veed6, ab Voctonent No SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATi SI DATE SIGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1982' ' THIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT (TO BE USED FOR ACTI 5' N CONSUMER 1 ~ and Cor TRAN ACTIONS) _ - - - - _ -1 $000 IS FINANCED L AND RN OTHER N ON REGISTERS OFFICE Contract, by and between GeorgF'__G._.k:..Q1Cf. 1b.arid--------- ST. CROIX Co.# WIS, E.._HQ_ usnnd _v,te Reed. for Record }hl315th Gladys ("Vendor", Y may A.D.1987 whether one or Imore) and- V7 __St;1. dtmn,._ I71C.._,__fi_Wiscons~..A._____ t 4:50 p • 4 (,Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- lMb1w D formance of this contract by Purchaser, the following property, together with the S rents, profits, fixtures and other appurtenant interests (all called the "Property"), i in-------------- St___Croix------------------------------------ County, State of Wisconsin RETURN TO Gwin & Mn P.O. Box 106 . I II Hudson, WI 54016 A parcel of land in Government Irot 4, Section 22, T30N, R20W, in the Town of St. Joseph, described as Tax Parcel No_ follows: Lot 5 of a Certified Survey Map dated October 21, 1986, filed December 31, 1986, in Vol. 6, at page 1765, as Document No. 420950, in the office of the Register of Deeds for St. Croix County. Subject to a green belt of trees and/or vegetation to provide natural screening in the Westerly 100 feet of the parcel, to continue as long as the Westerly 280 feet does not have residences built on it. Also together with and subject to the restrictions and easements shown thereon or referenced to on said Certified Survey Map, or any other easements, covenants, J reservations or restrictions of record. (I This ____1S not homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at Rt. 1, St. Joseph, WI 54082 the sum of $__180 000.00------------------------------------ in the following manner: (a) 2-, 000.00 at the execution of this Contract; and (b) the balance of $ 17-8-4-00..0.0 together with interest from date hereof on the balance outstanding from time to time at the rate of------ 10$ per cent per annum until paid. in full, as follows : In monthly installments of $1,000.00 beginning DeC,: 1, 1987 and continuing on the first of each month thereafter through March 1, 1989, then increasing to $2,000.00 per month with the payment due April 1, 1989 and continuing on the first of each month thereafter until paid in full. In addition to the monthly payments, there shall be an additional payment of $6,000.00 beginning July 1, 1988 and each July 1 thereafter during the term of this land contract. Interest shall be figured on a 1/365 day basis. Provided, however, the entire outstanding balance shall be paid in full on or before the___ 15 day of -_•____________________M~Y__________- 19__ 92__ ( the maturity date). Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, 4fi@2~18p1r, agrees to pay annual taxes, special assessments, fire and required insurance premiums when due. ~}tFBt~1$?~'3I~X "cr~offzx~e~finc$~x ~~s~~zxi3~zz~>~g~x~~~z~i3~c~gs~fax~xa~z~~i~z t~xaastasm~a3sza~~l~~e~~~~s~I~c2~ax~x~>~x~xt~;xt>xia~~ka~4~~~nz~ Payments shall be applied first to interest on the unpaid balance at'the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after Ma-y-.l5_..... 19B-7 zxao t~2}flHZK~~IE?~ST~{~➢X~rZ4~21~dRP~L~L~~B1~cZ~PC1Y,31~E?DI~~Z~~?L~~L• In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: NONE ~j Purchaser agrees to pay the cost future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full pug a price is paid. ,I Purchaser shall be entitled to take •ssion of the Property on----------- date--of..closing---------------- *Cross Out One. is LAND CONTRACT-Individual and _3TF :AR OF W SCONSIN Wisconsin Legal Blank Co. Inc. Corporate - F( - 4 No. A - 1982 Milwaukee, Wis. 778PA,,E 42 8 Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest 'in It and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of full insurable. Value-, but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: Vendors__are__not conVeying any-access-rights- to--priyate__roadway on_ the TAbst:erly- side- of--said Lot--5. Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 6Q... days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of --6Q.-.. days following written notice thereof by Vendor (delivered personally or mailed by certified snail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce.any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 15th day of - 1"lay 19.••.87• Vim.) Stud/ tTian, Inc. I / (SEAL) by V AX~ 44'_`t~-w~-•--•---------(SEAL) 41 George-G._-Holcomb-_•-_-__•-•________ * Verlin_Studtman,_ President -&-Sec~Treas. ---.(SEAL) - - - (SEAL) * Gladys E. Holcomb AUTHENTICATION ACKNOWLEDGMENT Signature (s) _____of George G. Holccrnb and STATE OF WISCONSIN Gladys Holcomb, his wife St. Croix ss• --------------------------------------County. - - - authent' d t 1 a of----------------- NJay.... 1987_- Personally came before me this _15th- day of May............ 19.$7--- the above named ` - - _Vert.in_.Studtman, _ Presiderit. and- Secretary/ Hugh.-- ..TreaSurer- -ef__V-._Studtnun,,.- and. hv the TITLE: MEMBER STATE BAR OF WISCONSIN aut,rlQrity_ Qf _sazd CQrpDrrltloI] (If not- authorized by § 706.06, Wis. Stats.) totmtf,kno to the er n who executed the str a and knowledge the same. THIS INSTRUMENT WAS DRAFTED BY L) , Attwy_._Hugh._El.--Bain.,--GW,In -&-.GW±n------•,•->.-- < H h w 430 2nd St. Hudson WI 54016 H --G win X = YVotry lic SO1X County, Wis. LU (Signatures may be authenticated or acknowledged. both Mj_ Com14lission is permanent. ~rf N-`~ + are not necessary.) ' . ...dacte - 19--------•) ~ *Names of persons signing in any capacity should be typed or printed below their signatures. LAND CONTRACT - Individual,,and Corporate - State Bar, of ,Wipconsin, Forme No., I1 - 1982 D.ESCRiPTION A parcel of land located in Government Lot 4, Section 22, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin, being part of Lot 3 of Certified Survey Map recorded in Volume 3, Page 822, Document Number 357960 of the St. Croix County Register of Deeds, described as follows: Commencing at the S1/4 corner of said Section 22; thence NO°35'20"E (True Bearing) 743.60' along the East line of said Government Lot 4; thence N89°19'40"W 52.43' to the point of beginning; thence N89°19'40"W 699.74'; thence NO°40'20"E 130.00'; thence N89°19'40"W 215.14'; thence Sl°57'40"E 121.07'; thence Southeasterly 129.45' along an 80.00' radius curve concave Southwesterly whose chord bears S45°36'20"E 115.78'; thence Southerly 168.15' along a 265.29' radius curve concave Westerly whose chord bears S18°54'30"W 165.35'; thence S37°04'W 127.32'; thence Southerly 279.66' along a 534.11' radius curve concave Easterly whose chord bears S22°04'W 276.48'; thence S7°04'W 158.70'; thence S89°15'E 416.50' along the South line of Government Lot 4; thence NO°26'E 250.00'; thence S89°20'40"E 612.88'; thence Northerly 363.33' along the Westerly right-of-way line of State Trunk Highway "35" and State Trunk Highway "64" on a 1382.69' radius curve concave Westerly whose chord bears N7°42'E 362.28'; thence N0°10'20"E 136.47' along said Westerly right-of-way line to the point of beginning. Contains 13.18 Acres, more or less, being 574,060 Square Feet, more or less. I certify that the above description and map are correct and that I have fully complied with the provisions of Sec.'236.34 of the Wisconsin Statutes and Section 5.4B of the St. Croix County Zoning Ordinance. Date: October 21, 1986. Revised: December 9, 1986 PJames T. Swanson S-1482 Job No. 86-1635 ~0%J111N10gN,, Ogden Engineering Co. ~~Go/VS 113 W. Walnut Street ~i` IF River Falls, Wisconsin 54022 a ~ ^S-I JAMES T. # OWNER AND SUBDIVIDER + SWANSON George Holcomb w RIVER1FALLS, 1 R. R. #1 WIS. f~ St. Joseph, Wisconsin 54082 CURVE DATA TABLE CURVE LOT RADIUS ARC CHORD CHORD CENTRAL TANGENT NO. NO. LENGTH LENGTH LENGTH BEARING ANGLE BEARINGS 6A-7 5 80.00' 129.45' 115.78' S45°36'20"E 92°42'40" N88°02'20"E S0°45'00"W 7-8 5 265.29' 168.15' 165.35' S18°54'30"W 36°19' S0°45'00"W S37°04'00"W 3-4 5 534.11' 279.66' 276.48' S22°04'W 30°00' S37°04'00"W S7°04'00"W 9-10 5 1382.69' 363.33' 362.28' N7°42'E 15°03'20" N15°13'40"E N0°10'20"E NOTE The roadway shown on this map is a private roadway. Any maintenance costs of the private roadway after its approval by the Zoning Administrator as a standard road, shall be shared pro-rata by the adjoining property owners. Should the roadway be taken over by a municipality as a public road, maintenance costs thereafter would be a public expense. Access to the above described property from the private road must be provided by a separate document. Volume 6 Pale 1765 O W O 7 . ~ of L Wiseonsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hunan Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI STUDTMAN, WILL X CST BM Elev.: Insp. BM Elev.: BM Description: St. Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/ Manifold I Distribution Pipe(s) I x Hole Size I 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.) LOCATION: St. Joseph.22.30.20W, SE, SW, Lot 11 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: + I SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Co r STATE SANITARY ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ , ~~-1!„ 8% x 11 inches in size. ❑ Check if revision to previous application wee reverse side for instructions for completing this application. STS P N I.ggr EN 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S U (J{p PROPERTY OWNER PROPERTY LOCATION Ui//-Z- %4cSlU %4,S Z,2 T_30 , N, R E(o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # h1Q13 &6&Y 3,5' 26 1 40 CITY, STATE ZIP CODE PHONE NUMBER / SUBDIVISION NAME OR CSM NUMBER r 1 6 - J 5-(p II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned ❑ VILLAGE : T ~pSEP 6 Y M IN TOWN OF: Lond Public ❑ l or 2 Fam. Dwelling- # of bedrooms - PARCEL TAX NUMBER(S) Ili. BUILDING USE: (If building type is public, check all that apply) D 300 1 ❑ Apt/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 El Mobile Home Park 12 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 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) 6l~C- _ Syl ih 'J 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 N 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 '73 913.7 If 913 3 Feet 35-Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New isting Gallons Tanks Concrete structed glass App. Tanks Tanks 1 ___n --Ri FT_ F-1 Septic Tank or Holding Tank Q(!9 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): Plum r' Signature, (NOS m s) MP PR Business Phone Number: 3 0 /5- 3 y~ Plumber's Address (Street, City, State, Zip Cod : GGk p IX. C NTY/DEPAR MENT USE ONLY ❑ Disapproved Sa nary Permit Fee (includes Groundwater Date Issued Issuing Age t Sig No mp Approved ❑ owner Given Initial J/ Surcharge Fee) Adverse Determin tion 7 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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. !X. 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) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations November 5, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 DONAVIN SCHMITT 586 VALLEY VIEW TRAIL SOMERSET WI 54025 RE: PLAN S93-02906 FEE RECEIVED: 425.00 STUDTMAN, WILL SE,SW,22,30,20W TOWN OF ST JOSEPH COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION ILHR 83.13(3). The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based ,on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All of the statements and supporting documentation included with the petition were considered. The petition is conditionally approved. The conditions are: 1) A vent cap shall be provided for the vent shown on the seepage pit structure. 2) A locking device shall be provided for the seepage pit structure manhole cover. 3) The existing septic tank shall be inspected for code compliance. 4) The maximum allowable wastewater load as indicated on the plans shall be 996 gallons per day. SUD-64291 K. OI /91) SAFETY & BUILDINGS DIVISION i State of Wisconsin Department of Industry, Labor and Human Relations DONAVIN SCHMITT S93-02906 Page 2 November 5, 1993 The petitioner requested permission to reconnect an existing seepage pit-type structure and a conventional drain field to an expanded-use public building. The seepage pit is a structure constructed with concrete blocks, with rectangular cross section having an effective area of 966 square feet, an open bottom, no aggregate occupying an annular space, a PVC vent, and an overflow outlet connected to a conventional drain field with 768 sq.ft. Soil borings have established code compliance with respect to any limiting factor for both absorption areas. The seepage pit structure has been inspected and found to be of sound construction. Finally. this system has been in use for many years and has shown no signs of failure. This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Prepared By: Peter E. Pagel (608) 266-2889 Sincerely, 641). Bennette D. Burks, P.E., Chief Private Sewage Section (608) 266-0056 2026L/ 2 cc: LEROY JANSKY ST. CROIX COUNTY Sill)-"23 (R. 01/91) l M ~ l INDEX Owner: Will Studtman Phone 715-549-6663 Address: 1243 Hwy. 35 Houlton, Wisconsin 54082 Site Location: SE1/4 Sec. 22 Twn. 30 R20W St. Joseph Township, St. Croix County Project Description: To reconnect buildings moved in to location of burned out Holcombe Restaurant site, Houlton, Wisconsin 54082 Page 1. Plot Plan Page 2. Soils Report Page 3. Inspection Report Page 4 Certification Statement. Page /5. Usage Information Plumber: Donavin L. Schmitt 586 Valley View Trail Somerset, Wisconsin 54025 715-549-6651 MPRSW 3205 4i'~FSGR 0 s N Q S93-02906 j. { C- 671V P e4 & Acr ~1f d 7"1 C10I+/v a J' /~LOta t2 ~ ~L%@d. y i3r 10#14 4K 06 "Wk I ! 40POW dbw root' include review of INV! SVANbk* WSWO M' of the septic/bolding *dL Set section -ILHR 82.201 Wis. Admin. his tv determine whether' plan submittal and. I ~ y t- 1s. tegµtrad,. tart- ttut piumbing, gal i E IC? x~--~ f 1 I oav, I /YG~lT f N i $o !fL 64 u r 1-1r I ( ~i,~ ~ \ l~~tfk'D 71 &1/14 Noi RIECENED SEP 1 'S 1993.. I I ~a , SAFFTY & BLDGS. DIV. #i7 g O 906 -5 7,4p 7, /Aye //2 19 3 ~ 5Ve U1ji_z,6F r cv I r . T 4'f I QNSM %wAoE SYSTEM J? OVE APP DEPARTMENT OF INDU Y BOR AND fl Loon DIVISIO F ETY ffiD BU ! S I Wd'ChRMAPON INDUSTRY, DIVISION LABOR 1 HUMAN NDLATION$ PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 (H63.090) & Chapter 145.045) b LOCATION : ION: TOWNSHIPOT NO..BLK. NO.: SUBDIVISION NAME: SE 'sw'/ 22 /-130 N/R201 (er) W • COUNTY: MNDLMS/BUYER'S NAME: MAW IN AU R SS. MIA St. Croix Will udt n R.R.412 Box 114, Hudson Wi 54016 USE DATES OBSERVATIONS MADE NO. BEDRrvS.: COMMERCIAL SCRIP710N ~e1~00k 1 DESCRIPTIONS : OLATl ESTS ❑Residence n/a n/8 ❑New eD ace I 4-22-87 n/a RATING: S- Site suitable for system U- Site unsuitable for system OMOUND: IN-GROUNDPRESSURE: M-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) ©J ❑u fjS OU ❑S ©U ❑S 2U conventional 11 Pertolation Tests are NOT repuired DESIGN RATE: If any portion of the tested area is in the under s.H63.09(6)(b), indicate: n/a Floodplain, indicate Floodpisin elevation: n/a r PROFILE DESCRIPTIONS T HI B BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WI H CKNESS, COLOR, EXTURE, AND DEPTH NUMBER DEPTH ELEVATION QBSERVEQ_ EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1.08bl.1. 1.17bn.sil.w/fff mot. 1. 5bn.s. .w B- 1 11. 4 none *4.00 t.2.00bn. c.cob.=r. w/fffmot. 5.00bn.c.cob.gr. .75bn.1. 1.25bn.sil. 3.00bn.s.1. .33 bn.mot.s.l. B- 2 13.4 100.09 none *5.00 s.l. .83Y. 1S. rt. 1.50bn.c b B 100.40 data nl see Jans report of 4.22.87 8- 4 100.05 for t n data only see Jansk report of 4-22-87 B- *2.83 duet 1 33bni road material1 .50b1.1. 1.00bn sil. w/ t 102.35 w 4~ n.c cob. r. 1. .00 Y. Is. B_ particles. 1.50 bn.cob. gr. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES WL"ER INCHES AF TER SWELLING INTERVAL-MIN. RI t ql PER INCH P. P- P. P- P. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sole or distances. Describe what are the hori rontal end vertical elevnion. reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percen, of land slope. SYSTEM ELEVATION n/a :T V },r11t 1 i10191'I: , .11, 1 ICr I I ~I ! TN rs Sa T. 2. f~l t\ :may- / L\ t~~,,tr I, the undersigned, hereby certify that the soil test reported on this form were made by me in accord with the procedures and methods sp-,fied in the Wisco ~>.n Admix isttative Code, and that the data recorded and the location of the tests are correct to the best o` my knowledge, and belief, - 'f: ?f lp-~n;l. TES fS VrERE COG4 f'~E7ED Gt; `--1 _.._Garv L. Steel 1 4-22-8i _ E F - - 988 N Sh'orO_Dr 've .'N6W Richmond Z298 715.24676200 .Wi54017 S93-02906 Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C: Libor and Human Relations Safety & Buile,ings Division REPORT 13 E. Spruce Street Bureaji of Riumbing Chippev.,a Falls, WI 54729 Inspection Date (715) 723.8786 Name of Premises Addreeo-or Legal Description Giy/Township County SW. Z2 , so, tq k1 S I J-0%R l..4 ST . c P,6 \X, Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. N pt- Sanitary Permit No. 0f Ps I: /Soil Tester Licensed Person's Name(s) and License Number(s) Et ptQ Owner's Nlkme and Address ° W ILL, S1ti1DTM1R~1t~ Rt Z fly . - F{MDSc~rJ ~ WI. S~-O 1 de--] I x 44A +d t 10v f A . fai4-54! I ut4i -2"o - - - - - - - - I 1 ! I ' vy 7 3 ~ rte' ~c 41") V G 2 t,~ (p 4A-e,,2 c rf ~u l 2P~c a-K~`o ~ ~ .G~ z~ ~l`~-l ,1~~ / - , S,93 02906 p, nP r,f I S'analu e of Res,),-),;1-1e Licensed Person (only one needed) ,iqn ;use of ;.a E -7 Lj Original: Copies 40' - - - L sBO-6192(A ie;es) District iL~i~ 'L'r:~rt,e ~~:ner _ County.1- aii _ Other_ _ Wisconsin Department of Industry, ILHR Labc-r and Human Relations INSPECTION Leroy Jansky P.S.C. Safety & Buildings Division REPORT 13 E. Spruce Street Burea~i o}PiJfTlbi'ng, Chippewa Falls, WI 54729 Inspectic~Date I- (715) 723.8786 Name of Premises Addrocc.or Legal Description ]7G*1Townsh1,p ounty , 3U, I q o T . J osk p~{ ST , cAD Uc Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. Nk Sanitary Permit No. /Soil Tester Licensed Person's Name(s) and License Number(s) N A 6AR STEEL _UA s~ _.C T rz9 a Owner's Name and Address WILL At L BMX 11 q 8e 0, S Nc•1z.t; M. saJ Y~/I s4o1 tJSA4 RIMmo"b Wt s40q Phi L ~ it gg, 8 s. Fr - O eJ )v E 00 X5, 4 t7 v wM _S i_ q3- D. µL 2 -A e-LSA _ ta, 8 v. 4 I, V i c3 - I D. _ g IR - .S _7' L3 c.. 6 I f , + l_ - - f_ t /fl~ .(lfttJ, .✓l ti, tr (1'v~ l~"•t~' L 'j"7s ^j. page of _ ( - / C'• -k all Siy ."_+re of F;u ,ino C. 17.,0aM Frr rite Sew- ge la,„ Original Copies to: t ) ' seostsz(R.1i;esi District XpIt HR DPIu ~~b O nef r) County. al nsp l~j Other 5 ST. CROIX COUNTY ZONING OFFICE ' CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the _ "t- S%L!/,T/'9it/iV , &O';-/tW saiMb a located at: _5x_1/4,_ .540 1/4, Sec. T_30 N, R_,goW Town of .57L e.teoAF Upon Inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity:APPro'g- 6000 GG.1 - Construction: Prefab oOther Manufacurer (if known): Age of Tank (if known): 1 r ~o hkt-s ( i'nature) (Na e) Please Print IR 4 900 (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition.. I certify that the tank to the best of my knowledge will conform tc the requirements of ILHR-83, Wis. Adm. Code (except for inspection -;per?ng over outlet baffle) 14 a m, e 5/88 r S9,3-02 9 Oaf a USAGE INFORMATION 60 Spaces Bar ~a 6 Employees 2~~ ZD 36-- p pK 24 Customers - At 1,000 square foot liquor store (1,000 ft .2 x70%) 30=24 6~ ,3 20 Car spaces at drive-in restaurant (All paper service) ,30 NOTE: 1,200 gal. grease interceptor in places used by existing ice cream parlor drive-in to be part of new complex. slo 0* 10AGO S93-02906. ICA i Tina ea ~ ids o 1 s6t Ij dais 4 , I I ~ V i i 041 I , ~o o oaf` - ST. CROIX COUNTY WISCONSIN OFFICE OF CORPORATION COUNSEL ~y 'nUif it NnnUK Y__ - ST. CROIX COUNTY GOVERNMENT CENTER xxx~" 1101 Carmichael Road Hudson, WI 54016-7710 (715) 381-4315 FAX (715) 381-4301 June 20, 1995 Camille Grant Clerk, Town of St. Joseph 1339 CO RD V Houlton, WI 54082 RE: Will Studtmann Dear Ms. Grant: On June 2, 1995 County Clerk Sue Nelson received a letter from you requesting an opinion concerning the issuing of a Class B beer and liquor license to property located at 1410 HWY 35. The building at that address is within 500 feet of the Cajun Club, and adult entertainment business. The St. Croix County Adult Entertainment Ordinance prohibits adult entertainment facilities from being within 500 feet of a business that distributes alcohol. I have reviewed Attorney Gwen Kuchevar's April 6, 1995 letter to you regarding the same issue. I am in agreement with her conclusion that you cannot grant a liquor license to Will Studtmann, the owner of 1410 HWY 35, without violating the St. Croix County Adult Entertainment Ordinance. Even though the Adult Entertainment Ordinance reads that an adult entertainment business is prohibited from locating within 500 feet of a business that distributes liquor, I believe the ordinance is applicable in reverse and prohibits the granting of a liquor license to someone who owns a building within 500 feet of an adult entertainment business. To conclude otherwise would result in the Town creating a violation in the Cajun Club, a legal, nonconforming use. (It is a legal nonconforming use because it existed before the passage of the adult entertainment ordinance.) That would be improper government action. This interpretation does not render Mr. Studtmann's property useless. It only prevents him from establishing certain uses. Therefore, a denial of a liquor license would not constitute an unlawful taking of his property. If you have any questions please do not hesitate to contact me. Sincerely yours, c Grego Timmerman Corporation Counsel St. Croix County, Wisconsin cc Gwen Kuchevar Will Studtmann ` v sconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of I'D, abor all Human Relations tb„ of Saf#ty & 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 s © 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 PROPERTY OWNER: PROPERTY LOCATION Z rn GOVT. LOT $C 1/4,$SO) 1/4,S 2,Z-T3 p N,R /,F 2(or) W PROPERTY OWNER':S ILIf G ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Z __75 nr A- rv 14- r VA CITY TAE ZIP CODE PHONE NUMBER []CITY []VILLAGE JgOWN NEAR ST 0AD Sorg ft2', ~i 6 (7 5) .S~ - GGG3 d ,sue- *3S 6y (j New Construction Use j Residential / Number of bedrooms [ Addition to existing building (j Replacement ",A Public or commercial describe n Ld Lt u Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed,'gpd/ft2 trench, gpd1ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U - Unsuitable fors stem [as ❑ U [I S ®11 as ❑ U S ❑ S t~Ii ❑ S 'MW 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. Bed Trench Clio 2.5y~a ~iw _ . Ground - 3 2- G K z, ,Z s1 •5 m S ~i riv ~.t. cJ S tr elev. 1oz L 75r2Y/ /V0 sc v ~DcJ Z ~3 Depth to 5 ,z 26o w S 0 =-2 _di s .ts- f~ 204 limiting factor~ 6- S(- 7s"•Z~i s s ►w,' j'` 'Y~J Vk ejA 8 Remarks: - Boring # y~ is ~M\M1ti~ 906 Ground elev. ft. _ i Depth to limiting Qti' J 3 factor SAFM 0 0140111t Remarks: T Name:-Please Print Phone: ' 2-4- & w Z C2> Address: (p nn 5 y ~_~Z~• f° ~ Can u~~. .S~OI Signature: n 1~6(jo 6 Date: CS Number: ,t:.' . Q 605 7' 'a ccc Cta4momr / GDa12 I ; ! /OV,9APOXI, 130VMIAD ftt d er i V. :a r-- i ! f i r lg~4 lin &AD (ya GLEgiYOu~'~' - ~ 4 V I I.( u D- G2 9 3 2 90 0 . z 9~ I I _7 i I i I , 3 1993 r AF1~ptiS. /3~ rle 4611 r , F FIL.ED Z OCT 211992&- 8 JAME-1 : rrr)NNELL ReDWe! 'r Lteds 2'79 ` o wl 4A J O CERTIFIED SURVEY MAP 9-2556' ti LOCATED IN GOVERNMENT LOT 4, SECTION 22, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. UNPLATTED LANDS S1/4 CORNER CENTER OF - - SECTION 22, SECTION 22 T30N, R20W S T H 1135" & "64" o EAST LINE OF GOVERNMENT LOT 4 w - - - - - - N0°35'20"E 743.60' 'a _ S.T.H. 0 580' 52.43' 0°10'20"E o "35„ u, NE CORNER OVERNMENT LOT 4 (POINT OF 1136.4 O7 30'y CENTERLINE G 0 1.30' (BEGINNING g ICE - `WEB \ \ \T64" I V I QI . ; CREAM RG ERLY l I/ I p i H I w I M- STOR LrNE T OF WAY El p 4 00 00 rl I CD 011 co CD of I GI ai a's .1 M REMAINS OF HOLCOMB'S 0 NI ;pplM~1'f L SUPPER CLUB 00 I I " ^ 3 DESTROYED BY FIRE w I ~I 0 ul) LOT 11 STEEL HI v~~ I 0-1 - `F-1 C3 I0, SHED ° ~I QI I H ~I MI r,rivMi l J I ° a l I a I ~-coll 00 z_ NO 26 06 E 00 zI I H - o Mr :~'d~~ I o l .J I st':x I 18 496.17, z 8 N1 I'D >I GARAGE g - - - 4 1! ~ LOT 10 N N0°26'E > ¢1 "1~"'° °40'20"E 1250.00' c°7 I F- I / 130.00' w I N I j l -iI . _ NOTE: DR-1V.EWAY q' o >I of c- I / ~ / ENCR~ES z ~I JI cys N I I 0d 0 u, ; 100' 10' O LOT 9 4 cu i c7l l QI f ~ - H 2 s~ ~o oh ---?Zo w ,._.,1 I W S l 57'40" 3 1°p ~,4 w H u I w - LL F-1 (DI 1 ~ 2> ti ~`O ^ o .1 z °I c-) ¢ 121.07'\ R=80' 4 o° ~1 ~I H co F- I I ~In-I V-1 00 w I I zl~ LOT 4 r LOT 6 wl o~ I ° o ~I Ivl0 I C.S.M, I C.S.M. I rOp\`M 04 W I Izi - I VOL._3, 1V.6 P.17661 ~RID~ X15=_ I<1:CD I P. 822 I PART-OF 'C.S.M.-VOL.13, P, 822 LOT 3 1 --T---- I LOT 2 1 LOT 1 IUNPLATTED TRUE BEARING I C. S. M. I 1 , LANDS V. 3, P. 822 I - - - LEGEND s ST. CROIX COUNTY SECTION CORNER MONUMENT, FOUND. • EXISTING IRON PIPE. 1"X24" IRON PIPE WEIGHING 1.68#/LINEAL FOOT, SET. I•y 2"X30" IRON PIPE WEIGHING 3.65#/LINEAL FOOT, SET. ,l1( WISCONSIN D.O.T. RIGHT-OF-WAY MARKER, 3/4" REINFORCING ROD WITH CAP, FOUND. 66' ROADWAY EASEMENT GRANTED TO THE OWNERS OF THE LOT DESCRIBED IN V. 879, P. 128 - - - CENTERLINE EXISTING DRIVEWAY. - BUILDING SETBACK LINE. OWNER AND SUBDIVIDER RAILROAD SPIKE, FOUND. V. STUDTMAN, INC. EXISTING FENCE. HIGHWAY 35-64 HOULTON, WISCONSIN 54082 715-549-5578 THIS INSTRUMENT DRAFTED BY CHRIS NEPERUD PAGE 1 OF SHEET 1 OF 2 SHEETS VOLUME 9 PAGE 2556 9SSZ 3OVd 6 3W(1'I0A of d~s~ is o n~rno1 SZSHHS Z dO T JLHSHS aO Z SOKd H„OZ,OT,ON H„Ob,£T,STN „Oz,£O,ST H,ZV,LN ,8Z'Z9£ ,££'£9£ 169'Z8£T TT L-9 M„OO,f7O,LS M„001f7OoL£S 100,0£ M,vO,ZZS ,8V'9LZ ,99'6LZ ,TT'V£S 6 S-V M„OO,VO,L£S M„OO,Sf7,OS 16T,9£ M„0£,f7S,8TS ,S£'S91_ ,ST'89T ,6Z'S9Z OT £-Z M„OO,St'oOS 21„OZ,ZOo88N ,OVaZ-V.Z6 H„OZ,9£oSbS ,8L'STT ,S6'6ZT 100'08 OT Z-T SONI2 vas H'IONV ONIUVaEl HSONS'I H,LONH'I HZONH'I '-ON --0 N ZNHONEIS rivuZNHO GHOH0 GHOHO OHV SDIQK2I LOrI SAWID H'ISVJ, VIVO SAHLID ns 8LSS 6VS STL 0 Z80VS UTSUOOSTM 'uo-4TnOH Q* 7/ V9-S£ AemOTH H3AR! • OUI uew,4Pn-4S *A H2GIAIQ9fIS QNV HaNMO Zen N3M a *H SONM ZZOVS UTSUOOSTM 'sTTEd 19AT*d 4a914S 4nulem 4sam £TT i 1*1' / ' Z66T edwo 6uT i aauT 6u uaP6 `r^I S~ u u O H O OO T£ ATnr Z66T-Z6 'oN qor Z99-S Uap60 •H sTOUSl3 :pasTnag Z661 181 aunr :area •awes auk 6uTddew pup 6uTpTATp '6uT ,Aanjns UT A4unoO xTojo •4S pus dTgsuMoy gdasor •4S JO SUOT-4sTn6ag UOTsTATpgns au4 pup sa4n4s4S uTSUOOSTM a114 J0 9£Z ja4deg0 go suoTsTnoid aq-4 ggTM paTTdwoo ATTn3 anew 14sg4 'apew 309lagq UOTsTAlpgns auq pus paAanins pueT 9u4 Jo saTispunoq .10TJagxa aqq TTs go uoT4uquasajdai 4Oaiioo e sT dew gons gsy4 'pusT pTeS 90 IaUMO a114 Jo UOT40aiTp aqq Aq dsW AanxnS paTjT4JaO pus UOTSTATp pueT 'AaAanS gons apew aney 14egq AJTg190 I •pjooai go s4uawassa o4 4OaCgnS •quawasea AsMpsoI 6uTpnT3x9 'ssaT jo a.zow 149ad ajenbS ZOS'S9S 6uTaq 'ssaT Jo aloes 'saJOV Z86'ZT Pus 4uawasea AeMpeoi 6uTpnTOUT 'ssaT 10 alow 14aad ajenbS 990'VLS 6uTaq 'ssaT 10 alow 'saJOV 8LT'£T sUTe4UOO Taojed sTUs •6uTUUT6aq go 4uTod au-4 04 auTT AsM-90-446TI ATla4saM pTes 6uoTe ,LV'9£T S„OZ,OT,ON aouau-4 :,8Z'Z9£ S,ZVoLN sisaq pjogo asoyM AT'a4s9M aneOUOO aAjno snTpsz ,69'Z8£T a uo „t,9„ AsMu6TH xunis a-4e4s pule „S£„ APmq 6TH xunjL a4e4S Jo aUTT AeM-Jo--4u6TJ ATJa4SaM aq4 6UOTe ,££'£9£ ATlaggjoN aouayq !,88'ZT9 H„OV,0Z,68S a0uag4 !,00'OSZ H,9Z,ON a0uag4 :V 40q 4uaWUJ9AOO To auTT g4nos aq4 6uoTe ,OS'9TV 9,STo689 90u9u4 s,OL'89T M,VO,LS aOuag4 !8V*9LZ M,VO,ZZS sjeaq PJogO •asouM ATJa-4seS ansOUOO anjn0 snTpeI TT'VES a 6uoTe ,99'6LZ ATjag4noS aouag4 d,Z£'LZT M,VO,L£S aOuag4 .,S£'S9T M„0£,'vS,8TS sieaq piogo asOgm ATIa-4saM ane0uo0 an-In0 snTpel ,6Z'S9Z s 6uoTe ,ST-89T ATjag4nos 90uag4 !,8L'STT 2„OZ,9£,SVS Saeaq pIogO asoyM ATJa4saMq-4noS ansOUOO anjnO snTpe1 ,00'08 us 6uoTe ,SV* 6ZT ATjagseagqnoS aouay-4 :,LO'TZT H„OV,LS,TS a0uaq'4 :,VT•STZ M„0f7,6T,68N aouag4 :,00'0£T S„OZ,Ot,,ON a0uauq :,VL'669 M„0V',6To68N a0uau-4 :6uTUUT6aq 90 -4uTod aq-4 o4 ,£V'ZS M„0V,6To68N aOU9144 !V 40q Wauma9AOO ptes go auTT -4seg auk. 6uoTe ,09'£bL (buTzeag anus) S„OZ,S£,ON 90u8u'4 QZ uOT'40aS preS JO JaUJOD V/TS a14-4 4s 6UTOUaww0O :sMOTTO3 se pagTIOSap 'Spaaa Jo Ja4ST6aH A-4unoO xTOIO '4S au-4 90 OS60ZV iagwnN quawnooQ 'S9LT a6ed 19 awnTOA uT papiooaj dew AaA S PaTJT-4Ja0 S 4oZ 6uTaq 'utsuoosTM 'A4uno0 xTOIO •-4S ;gdasor •qS go uMo,L 'MOZH 'NOES 'ZZ UOTgOaS 'V -40Z 4uawUJano0 UT pa4POOT deW AaAinS paTJT4la0 sTU4 paddew pus papTATp 'paAaAins aAVLI 14sy4 AjT4jao Agajau 'IoAanjnS pueZ paia4sT6aH 'uap60 •H STOUVJd 'I alLvDidijidaD S IUOAHAErns STC-105 SEPTIC TANK MAINTENANCE AGRFEMENT St. Croix County OWNER/BUYER MAILING ADDI? ;S-S PROPERTY ADDRESS locatio)ra of se is systtym) Please obtain from the Planning Depte CITY/STATE PROPERTY LOCATION 1/4, , S CU 1/4, Section T__30N-R_j fL_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP 56 VOLUME PAGE _gff LOT NUMBER Improper use and maintenance of yow -ptic: 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 taut into the system can affect the function of the septic tank as a treatmen" stage in the waste disposal systern, St. Croix County residents may be eligible to receive a grant for a maximum of 609/ of the cost of rep cemen '"f a. failing system, which was in operataor: pilot to July 1, 1978. St. Croix County accepted this progm,, 1~?84?> ith tb, b rem ire~rf--t fhit owners of all new systc-•r-z avree to keep, their system property maintained. TFie . r,-,lperry :ow-aer agrees to submit to st. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plummet, iestracted piumoer or a li«nsed pumper verifying that (1) the on-site wastewater disposal system is in proper operating (;oradition 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 require~r ants 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 beer, aintainefi -)"'-:t. be,:,omp.l. ed and returned to the St. Croix County Zoning Orn„e:r ithM 30 days of to ihr vex z!A(" t SIGNED: DATF: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WT 54016 11/93 S T C - 100 Tlfis 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 i-suance. Should this development be intended for sale by ~wner/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 k ic.r &--l- ' Location of property 1/4 1/4, Section ,T N-R W Township Mailing addres;a Jfi 141-Z'5 Address of site Subdivision name 5~~~n~,~1L• X-e-C' - Lot no. Other homes on property? Yes ✓ No Previous owner of property gen& ®~rc~ Total size of property / 17k i Total size of parcel s5,1.cl1r~ Z Lo-''yl~ Date parcel was created Are all corners and lot lines identifiable? L-~ Yes No Is this property being developed for (spec house) ? Yes ✓ No volume 1'7 and Page Number 11 ' 7 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. ar~d 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. lZyA 7 ? 1111'4- / iligignatur,o,'-'6f Applicant Co-Applicant ate f Sig ature Date of Signature .rte ~b 's^_ _ R.. ~.:1:3Y ,r.'✓<'-::-~.....,.~ _._r _ • ='~v • ~DOCUMENT NO WARRANTY DEED S SVA'-E RF SERV F.O FOq REGn HDIr:G DATA STATE BAR OF'WISSCONSINFORM 2-1982 47427-~? _ - REGISTER'S OFFICE - - ST. CROIX CO., W Gladys E. Holcomb, individually and as the Personal I R.,,;c'd for Recotd ~ Representative of the estate of George G. Holcomb 3 1991 - to of 4:30 P. IIMn coin .s and warrants to V• Stu--tmun, h1C , a W1SCOnSin eornoration Register of Deep t - - . RE f~ TUHN TO ~ , , _ f I, Jr C +iG 7A . i l t1 P~ 8 ~ CrOlX L~1_r GL~fs~ ~~~/4j - the following described real estate to State of Wisconsin: Tax Parcel No:.C.~~ A parcel of land in Government Lot 4, Section 22, T30N, R20W, in the Town of St. Joseph, described as follows: Lot 5 of a Certified Survey Map dated October 21, 1986, filed December 31, 1986, in Vol. 6, at page 1765, as Document No. 420950, in the office of the Register of Deeds for St. Croix County. Subject to a green belt of trees and/or vegetation to pro%ide natural screening in the Westerly 100 feet of the parcel, to continue as long as the Westerly 280 feet does not have residences built on it. Also together with and subject to the restrictions and easements shown thereon or referenced to on said Certified Survey-Map, or any other easements, covenants, reservations or restrictions of record. s~.oo This is -not- - homestead property. ot3Q (is not) Exception to warranties: 30th September 91 Dated tnis day of CF%. 1/! a(SEA',) ....(SEAL) ✓yLrZur~'' Gladys E. Holcomb , _ (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gladys E. Holcomb in1loALf,Ay STATE OF WISCONSIN - - - IF Ee c llct,.: - - - - -----County. SS. auth. cater i 20 of--- Se_tember._-, 19 _91 Personae} came before me- e this day of r 19....... the above named - - - - N/A gh H. Owin - TITLE: `TENIBF.R STATE BAR OF WISCONSIN* (If not. - authorized by 706.06, Wis. Stats.) to me known, to he the person who executed the fom,oin;T instruna Ilt :uul acknowledge the same. T-1:9 INSTRUMENT WAS DRAFi_D RY Atty. Hugh H. Owin, Owin & V:_rtheimer, S.C. - - s 430 Second St., Hudson, WI 54016 - - Notw v Pohlic County, Wis. (Si:~natcras may be authenticated or :ICkn~ncled~ed. Loth 11} ,wnd=sinn i> per:rlnent.(lf not, state e-piration are not necessary'.) date: _ 19 ) x 5~1 •Va„res of pnr. rn; ::Rn~^., .n nn. ~,rn~ity I,, ~.,'I 1~~~ r. ,~~1 , .,1 F..~ ~o th~ir -'c ~ . WARRANTY Di ED STAFF FAR 0 F RItiCCN S!N R.- r:. n i.-¢;+1 1'I:,, In, 7 "4- cc, 0, Ck C", cli C p v- C Lam,-oC~ S- S 1%t c Ckk LAC s ~s a- Y C( - A-~~ S s u'.) a's "sue- ~11 is coo _ h L 10 C-,3 L) (C~ V-0 ctt 14 . ~ o (ten - i ~5 • D. I . L. H. R. /isconsin Department of Industry, INSPECTION Leroy Jansky, P.S.C. abor and Human Relations j 13 E. Spruce Street afety & Buildings Division REPORT Chippewa Falls, WI 54729 ,ureau of Plumbing (715) 723-8786 spection D to !r1j E) S ame of emises Addree&w Legal Description eft/Township County V. S7-tbKA0, ZIJC-, ST • ~ r-l- 5 j „CRO Ix ?aster Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. OtDws ~ N/~VIr,3 St.I4M tt-'r Rt- Sanitary Permit At--L Bc~c aL9s A JaSS~ No. s o ,urneyman Plumber/So I Tester Licensed Person's Name(s) and License Number(s) wner's Name and Address AdA%d Coe, i -,4 ua A 4* U4,V V72'.,/7. in, C!" ft.4 ___1_ age of Signature of Responsible Licensed Person (only one needed) Sign atur Plumbing Consultant/ rivate Sewage Consultant Check all 1 Original: Copies to: `that apply/ 3D-6192 (R. 11/s5) District O DILHR O Plumber E)Ow r C u /Local Ins E)e -qqq DILHR Wisconsin Department of Industry, , INSPECTION Leroy Jansky P.S.C. Labor and Human Relations REPORT 13 E. Spruce Street Safety & Buildings Division Bureau of Plumbing Chippewa Falls, WI 54729 Inspection Date (715) 723-8786 "-87 Name of Premises Addessa,o;r Legal Description &W/Township County sz, Sw, zZ., 30119 Q %T - J oar: p~{ S-r . cROUK Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. NA Sanitary Permit No. NA /Soil Tester Licensed Person's Name(s) and License Number(s) GAR STIES GARS( s,~_ csT rZ98 Owner's Name and Address W tL,L .SI D Apj Rt Z Box 11 + _ ea5 ~ %AcfRr- flQ , HQ I stt0 VJ u3 RtC44wwb WI 5400 11 M _ t B 0C 6R. SI F - Ir liall (104 A. L R c. 3- 0 D. 4 P, I V L ai- ILO tJ y 6 tR *8-Ro- 01q-1f c 5 F U T G . v. N _I J_ 7W 00- I /Al . II - - -IQ N -1`4-9 WC 1 I "t, L 4A a_ iQAA' Pageaf _1- Signature of Responsible Licensed Person (only one needed) Signature of Plumbing C ns nt/Private S w go ultant Original: COPies tO: Check all ) ~tnatapply Sao-6192 (R. tt/s5) District DILHR 0 Plumber N Owner Count al nsp W Other I ( - I f I - i ' 12 TI- PA I ~ 3, Page~of Signature of Responsible Licensed Person (only one needed) (that Signature of Plumbing Consu to rivate Sewa a Co ultant Copies to: \ Check all 1 Original: apply / 3eo-6192(R.11/85) District CKDILHR 0Plumber Owner County/I-I Other 14 SYSTEM ELEVATION I {f 1 I y r 1 t L 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 pri : r TESTS WERE COMPLETED ON: ADDR CERTIFICATION NUMBER:, I PHONE NUMBER (optional): 2, z 8~ Z z CST SIG T E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - p Q, IdEP'A~il'M OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION 69, LABOR AND PERCOLATION TESTS 115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: TOWNSHIP/f 1Vkjdffi OT NO.: BLK. NO.: SUBDIVISION NAME: SE w '/4 22 /T N/R (or► W COUNTY: ER S AM : MAILING A St. Croix Will Studtman R. R. #2 Box 114, Hudson Wi 54016 USE DATES OBSERVATIONS MADE T: ❑Residence NO.6 DRMS.: COMMERCIAL DESCRIPTION: ❑New ~reep}~a (~e PROFILE DESCRIPTIONS: Ok I PEACOLATION E in/a n/a 4-22-87 n/a RATING: S- Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESS : S S EM-1N-FI LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) E1S❑ V ©S ❑ Q S❑ U ❑ S ®U ❑ S E U conventional If Percolation Tests are NOT required DESIGN RATE: lFloodplain, It any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a indicate Floodplain elevation: n/a t PROFILE DESCRIPTIONS BORING ELEVATION P H O GR UNDWATFR-INCHES CHARACT R O SOIL WI H THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Ki. B ER D EST.HIG H TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) 1.08bl.1. 1.17bn.sil.w/fff mot. 1.75bn.s.l.w/fff B- 1 11.00 100,40 none *4.00 ot.2.00bn. c.cob. r. w/fffmot. 5.00bn.c.cob.gr. .75bn.1. 1.25bn.sil. 3.00bn.s.1. .33 bn.mot.s.l. B- 2 13.4 100.09 none *5.00 .1. .83y. ls. art. 1.50bn.c b B- 100.40. for locatiin data onl see Jans re rt of 4.22.87 B- 100.05 for location to only see Jans report of 4-22-87 B- *2.83 duet 1,33bn. road material 50bl.1. 1.00bn. sil. w/ t ii.ool 102.35 4 bn.c. cob. r. 1.00 . ls. B- particles. 1.50 bn.cob. gr. PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTE NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. PER INCH P. P- P- P- P- a P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn 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 n/a I J.1 i ~16j In_fI YI_ 1 r - - I ~\J~1 L,y I P ? ► . F i i I E i I I T ? , . I I ' -hog 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: Gary L. Steel 4-22-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore Dr. New i hmond Wi. 54017 2298 1715-246-6200 CST SIGNATU I~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. i DILHR-SBD-6395 IR. 02/82) OVER -'JUN-30-'93 WED 12:15 ID:S&B CHIPPEWA FALLS TEL N0:715-726-2549 #062 P02 D. 1. L. H. R. Wisconsin Department of Industry, INSPECTION Leroy Jansky, P.S.C. Labor and Human Relations 13 E. Spruce Street Safety & Buildings Division REPORT Chippewa Falls, W1 54729 Bureau of Plumbing (715) 723-$786 Inspection to e$ Name of emises Addrees~' Legal Description tfi4yffownship County V. 5"7kDM wj, x4j- Sr • do 6a-PA- srr-cpo lac. Master Plumber Name and Addreea Master Plumber Firm Name and Address Plan I.D. No. 4bwis "Ck~`W AVI/+} S"M tr'y' Sanitary Permit No. RJL Ow a-U-A 9aS 0 Journeyman Plumber/Boll Tester Licensed Person's Name(s) and License Number(s) W LJL^ owner's Name and Address PAM N _ S 1116- IlAm I Law 1, 6 I wr _ mrxw I xvxnvx:xw xvnxr wxwxx wxnxw-•w••__ ••.awvxw•xx~rxn w• - Pa9s____~_of Nnsture of Responsible Licensed Person (only and needed) Signs tur Plumbing Conaultan rivate Sewage Cvnowttant Cool" to, (Check all 1 . riginal: that apply J------ sso-sta2(R.t+rm) District ODILHR. OPiumber ❑Qw r C u 1Locallns a .----.•JUN-30-193 WED 12:17 ID:S&B CHIPPEWA FALLS TEL NO:715-726-2549 #062 P04 DILHR r . Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S,C Labor and HumanRelatlons 13 E. Spruce Street Safety & Buildings Division REPORT W 154729 I Chippewa =SlIS' Bureau ofPlumbing anion (715) 723.8786 DM IA/6-7 Name of Premisies AddPosew Legal Description Oft/Townehlp County SWkZZISO,(qLoj ~t`A do l} S'r •Gpok?r. Master Plumber Name and Address Master Plumber Firm Name ;W- Address Plan I.D. No, N A- Unitary Permit No. dewaayaualrfiislhber/SoilTaeter Licensed Person's Name($) and LkxM se Number(s) Owner's Phm mW Address X111 LL, &)L IN WT S 1 t A 1 a I • I ~ rAfd t d4l 4A I . ~ 1 ea 6,14 .6 1 W- ai e0 4 ti i t.A r 1 !~..._.w.... . .......w. ,w._.~~..... w _ .w .n. r. ' I Page Qt Signature of Ros0005101e Licensed Person (only vno needed) rCheck all signature at Plumbing Consu rivate 3ewa Co IsItant Original: COPT"tO' lthatapply/ ""102^1116P District XDILMR D Plumber NOwner County/L I other .JUN-30-193 WED 12:16 ID:S&B CHIPPEWA FALLS TEL N0:715-726-2549 #062 P03 ' DILHR Wisconsin Department of Industry, INSPECTION Leroy Jansky P.S.C. Labor and Human Relations Safety & Buildings Division REPORT 13 E. Spruce Street Bureau of Plumbing Chippewa Fails, WI 54729 Inspection We (715) 723.8786 Name of Promises s&w Legal bescriptlon o t rrawwnship bounty se, sw, z~, 3v, f ST ' 409KP%4 Sr , c.Royt Master Plumber Name and Address Mgswr Plumber Firm Na" and Address Pled I.D. No. N#% SwIlAry Permit No. M 1~ /Boll Tooter Licensed `Person's Name(d) and License Number(s) 1. 41rAi`_JE~.. Zq Owner's Name and Address - . W t6ll. At 2- 186A a 8EA W. SAW" RUINSW YJL J%401 u R ►e~ Wt 34017 i.A -j of • A ~ y e, glil; 4- L A 0020 LA- 0% 14 GY40 is L 1 " b. `i , N. L t. i 110 e 1` u 3- 8 4 31 ,A, V-44 *a is ~,Tvr .1 , w r - 4 S] V. 19t! ~ Gti ~ N A IT' P-4 Q- 1. W-q N-i _ 14e- 4U. aI k i ....u i page of ~ Signature of Responsible Licensed Person (only one needed) Check all ftnattUrs Of Plumbing G ns ntlPrivate w ultant Original: Copies to; {thatapply~ Sao-e782(R.ii/soo) District JJDILHR 0Plumber JS OWnar Count al nm Other I JUN-30-193 WED 12:20 ID:S&B CHIPPEWA FALLS TEL NO:715-726-2549 #062 P06 EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (115) MADISON W 53707 (H63,09(i) & Chapter 145.045) LD ATI TOWNSHIP/ E/jo N0. I-IR BLK. NO,: 1 U/2 SUBDIVISION NAME: SE ACW % 22 /T30 N/R 2 (or) W COUNTY; S BUYER'S NAME: A L St. Croix Will d a R.R.#2 Box 114 Hudson Wi 54016 USE DATES OBSERVATIONS MADE N' ~eook I I Jur"'T ji-CHUOLATIUN ThS'T OResidence n/a n/a ONew ap 4-22-87 n/a RATING: S• Site suitable for system UW Site unsuitable for system ONVENTIONAL: MOUN N• 5 STEM•IN-FttII L MOL.pIccNG(~TAN l: RECOMMENDED SYSTEM: (optional) S ❑u ®J IS Ot' E: OS ~ Y ❑ J LyJ I Conventional If Percolation Tests are NOT required DESIGN RATS: if any portion of the tested area is in the under s.l163A9(5)(b), indicate: n/a Ffoodplain, indicate Floodplain elevation: n/a t PROFILE DESCRIPTIONS nasp. BORING ELEVATION D PTH A E - NCHE5 CHARACI L THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH O V D H T TO BEDROCK IF OSSRRVEo (sear ABBRV, ON BACK.) 1.08b1.1. 1.17bn.sil.w/fff mot, 1.75bn.s. .w B- 1 11.0 •40 none *4.40 t•2.00bn. c.cob.gr. w/fffmot. 5.00bn.c.oob.gr. .75bn.1. 1.25bn.sil. 3.00bn.s.1. .33 bn.mot.s.l. B• 2 13.4 100.09 none x'5.00, 83bn.s.l..83 • Is. part. 1.50bn.c b. 8• 100.40r location data only see sans report of 4.22.87 B• 100.05 for o e .T s report of 4-22-'87 B- *2.83.due t 1. 3bn. road materia 150bl.1. 1.00bn. sil. w/ t )One 1102. 9 W 7 bn s s'1w mot bn.e. cob. r. .00 • Is. B• particles. 1.50 bn.cob. gr. PERCOLATION TESTS -TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L AA7 MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN, P RIOO 1 g RIOD 2 w ~ PER INCH P. P. P- P. . P- p_ . PLOT PLAN: Show locations of percolation tests, sail borings and the dimensions of suitable soil areas, Indicate scale or distances. Describe what are the hori aontal 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 n/a 2,,....,.,Ari...:...,.,....4 ` . i W. . l.,,........ ilk c I r.............. 1. ' ....f.' x>.... r i i. r. _ - i........... i ' I t + ..,N . ~ y.. 1. , . ~ TN i , ,I ;err ~ 1 ' ~ ~.~Y•,.~: o W,.., gyps....... \ 4 w ~__._....r. ,Y.. At vi IN W14 1. the undersigned, hereby certify that the so![ testa reported on thtt form were made by me in accord with tho procceJurse and methgds specified in the Wisconsin Administrative Code, and that this date recorded and the location of the tests are correct to the bast of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON; Ga L. Steel 4-22-87 ADDRESS' ERTIFIGATION NUMBER; PHONE NUMBER(optionell: 988 1 Shore Dr. DIV- Richmond W'. 54017 2298 1715-246-6200 CST SIGNATU ; DIS'TIRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD•5395 (R, 02/82) OVER JUN-30-'93 ICED 12:18 I D : S&B CH I PPEWA FALLS TEL NO : 715-726-2549 ##062 P05 v . 4 -6EPARTMENT 6P'. REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR PERCOLATION TESTS {115 DIVISION P,O, BOX 7869 LA6f)R AND HUMAN RELATIONS MADISONi WI 537'07 (Ii63.09{1) & Chapear 145.045) TOWNSHIPIMLnwettitttTY: OT N04BLK. W.: U l SION NAM /T f! Rl DG1ri W yr COUNT : ER'8 AM USE DATES OBSERVATIONS MADE IA PR NS: DEUCRI NOB © QResideitce New Apeplaoe RATING. S- Site suitable for systarb Us 2410 unsultabte for sY+tOm ~p__ ~ ENTIONAL: `d ~17C N•oAUS []U ~ ~ •t -Fu 0S 0 TANK: RECQMMEtjClED, SYSTEM: (optional) W -1 an y portion of th.e tested area is in the If Percolation Tests are NOT r0q7r0d D S RATE: FFf, under s.H63.09(5)(b), indicate: oodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ~ BORING TOTAL t' f4 UNDWATER-INCHES HARA R IL W TMCKNESS, COLOR, TEXTURE, AND DEPTH NUB N, 1114VATION OBS V D TO9EDROCK IF OBSERVED {SEE ABBRV, ON BACK,) / 1 PA B- O B- PERCOLATION TESTS DEPTH WAT R IN HOLE T ST TI,MC^r. DROP N WXTEK L LIVEMNCRES RATE MINUTES NUMBER INCHES A TERSWELONG I RVAL-M PER INCH P. P. P. P P. 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• rontal 'and vertical elevation reference points and show t 'r to ation on the plot plan. Show the surface elevation at all borings and the direction and percent of I" slope. SYSTEM ELEVATION I I , f 4 ~ _ _ t -l 1, the undersigned, hereby certify that the soil teats 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. NAM pri : STS WERE PL FID ON: AOnR ERTIFItATION NUMSM PHONE NUM9ERIopttonsll: A +0.i, zm ) CSTSIGP(IfT E: a DISTRIBUTION. Original and one copy to Local Awhorlty, Property Owner and Soil Tester. DILHR•SOO-5395 (R. 02/82) - OVER - dI : O~. 1 DES' A Xi ~j(M ~ / ~ 1 C2 80Z 50 CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 4, SECTION 22, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN S1/4 CORNER SECTION 22 CENTER OF U N P L A T T E D L A N D S T30N, R2 - - - - - - - - - - - - - - SECTION 22 S.T.H. 0W ~~35~~&1164 ----11 EAST LINE OF GOVERNMENT LOT 4 - N0°35'20"E 743.60' S.T.H. 1135" 580' 3 Cn NO°10'20"E - CENTER! - - - - - o ~ X36.47 10 INE S'T•H, NE CORNER a, ~'4" -i COMMERCIAL 9 GOVERNMENT LOT 4 ° w z ZONING 01% C) 00 F-4 [!!Westerly Right-of-wa 1 OWNER & SUBDIVIDER z z ~ I a, GEORGE HOLCOMB 0 w t 1 Line / R.R.#l i w 1•~` I ST. JOSEPH, WI. 54082 0 Remains of Hol \ mb's _ Supper ^Clu-b , AI 'd CD destroyed by fire LOT 3 o - 00 a I I aui ~ I ~ 00 QI 1 0 o f SCALE IN FEET RESIDENTIAL o HI I a NI ZONIN teel r~ hed o -4I I E' ~I o, O~TJ5 ~ a4 1 w 1 of 200' 400' c. 0 o rn 13.1 res± ~I 1 ~I o 574, 060 S.F. + ( ~I ~ I N0°26'E 1 o QI N0°40'20"E 1 ~I 130.00' 0-11 25 o LOT 2 o - '-Note: Driveway y0`Si ' g`L~~ w 9I Encroaches 3 4~ z ~I ~ a I A I C, c, ~ Ln wl ° 7 S ~i?AT. CROIX RIVER x -w - - NI... z o VALLEY ZONING w wl E-' I cn I ° 6A 0 O c~-~ I -41 AI S1 5714011E R=80' ~ W1 LOT 1 ~l co ~I ai zl 1121.07 A \ 't^11,~^~\ ~~A cn wl -41 I I~~u I ~~OW\~~ zl al I LOT 4 ( LOT 6 ( 'r/ 4 S7°04"W C.S.M. I I ~"~~Zlp 15~8.~70 C.S.M. _ V.3,P.822 I V._p._ I LOT 2 AWAY I ( I - - - 1 _ _ MENT _ I PART OF I LOT 1 1 LOT 3 _ 1 C.S.M. IV.3, P.822 1UNPLATTED TRUE BEARING V.3 P.882 - - - - - i LANDS I LEGEND 1 1 • EXISTING IRON PIPE. 0 1"x24" IRON PIPE, WEIGHING 1.68#/LINEAL FOOT, SET. 0 2"x30" IRON PIPE, WEIGHING 1.68#/LINEAL FOOT, SET. EXISTING FENCE. ® COUNTY SECTION CORNER, BERNTSEN MONUMENT, FOUND. RAILROAD SPIKE FOUND. APPROVED Drafted by Brad Wittig D E C 9 1986 ST. C<C%iX COUrITY KAHPWIG AM G ZCNING COl tiR:iTEE ;ji71U!ii0 6 Pa, c~ 1765