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040-1073-70-200
0 f»n O 3 •O 0 0 y C N O (D F ro v m • K (D ~ 4 # C 3 d I O S 3 c co M. N Q CD O m CO W N C_ 7• Z O O C) o v rl; O CD O oo (O 'J3 3 U1 N a :E N W -z O O t0 h 7 (D OD 0 0 (O A N O O C 0 Q O W ~I ,3 N ~ Q K O 3 Q0 ~ 7 N O m N cn m m ° w ~ j N - O o0 o c qo- (N`o o O 0co CD 00 o Z m v o • OOO !v A A A o N -U CC G C C I -q -4 G G a < w Z /Yr~ O O O "O C Ch CO) B C D V `j 3 a 'o D O y o CD 0 (3) m 0) 0) G) (D Z 42 w 3 a ° °t rn -A Q C> N A o Z -i z N co O D p 5 3 0 -0 p j N m A CD C m '0 N c n a w m m a 3 ET z m o j Z O O p m o A C) 0 W Z N) ° o z 0 9 A Cl) o to to z CD A O c O Fr a C N CD co N Q G N CD Q~ CLy 0 T N N D N G CD mo ° z a o T v O a, N m 0 m ~ cn O xa;,r moos y 0 ,A ''6 Ul 4) N (n o x N 3 'o, N ~ f0 O » N O r' 7 SU a (D (o fp 3 ~ m o I moo; ~ o P CD i o v s m D o 3 • ° Z,i (OD O o o C a o m 0 0- Parcel 040-1073-70-200 09/07/2007 10:30 AM PAGE 1 OF 1 Alt. Parcel 18.28.19.280J 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner. C = Current Co-Owner O - GRISWOLD, GARY L & SANDRA J GARY L & SANDRA J GRISWOLD 318 N COVE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 318 N COVE RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 10.280 Plat: N/A-NOT AVAILABLE SEC 18 T28N R19W PART OF NE SW LOT 3 CSM Block/Condo Bldg: 6/1697 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1041/146 WD 07/23/1997 863/453 07/23/1997 794/178 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.282 63,200 55,100 118,300 NO UNDEVELOPED G5 7.000 14,000 0 14,000 NO • Totals for 2007: General Property 10.282 77,200 55,100 132,300 Woodland 0.000 0 0 Totals for 2006: General Property 10.282 77,200 55,100 132,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I~ . STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER. ~/P/S c✓o,C/) ADDRESS 3/ tr ,+,e7 L i~yE iP~ A10SOn1 SUBDIVISION / CSM# LOT # SECTION Z< T_r _N-RAW, Town of To y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM BEST ~irsT 4&ery 4/,\lE iooo roht. SEOrr c iii vr( W irN S1c#110 PVC (r4,ZXA 0Ur Zt PV'(T A-No Alf T&,q7- ~u(o '--7Sa7 DD i? z/" .5,#qj he `~EwEP S/~E a igo, - -/~"-/QpcIrXlNE 6r'.v WnI q& - ~ • ~ 33. 5d'P i "a poi PoF z-5icv. /oo.oo' /~ys - - - - - /o. G.? f1j GJE(( P o aas~o DR, v w~v ~f~~Pr~i~'rY r ~/E INDICATE NORTH ARROW /vo 5~-,f[ 6- Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. 1 1 BENCHMARK. ~ o v E /'ot.✓r )004,e / 1E47Ev.=/00_ocl, ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~iESE~P Liquid Capacity: /ooo ~44 Setback from: Well House 33 Other Pump: Manufacturer - Modell Size Float seperation - Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: s Length S!y" Number of trenches Setback from: well: /o' House l ro' Other ELEVATIONS Building Sewer - ST Inlet; /GAS. &o' ST outlet PC inlet PC bottom - Pump Off _ Header/Manifold f::~,~-V' Bottom of system `IS,oo' Existing Grade .?S Final grade act ` DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LaborandMumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 2 pp, P(TKi SW&aameGARY ❑ City ❑ Village X Town of: State Plan o.: CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: AQAQQ2Q3 'o lam. C~-, Q TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic 60/ ~s--,- C6wc_- Z. Benchmark Dosing Aeration Bldg. Sewer Holdin St/ Inlet 5, /aS.95~ TANK SETBACK INFORMATION St/ Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic //'j,4 NA Dt Bottom Dosing NA HeaderiMifl. Aeration NA Dist. Pipe <7 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Ma ac Demand 77 Model Number TDH Lift Friction m Ft Fot Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ; No. Of T enches PI No. Of Pits Inside Dia. Liquid Depth 4/ DIMENSIONS DIMENSIONS S LEACH Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK INFORMATION Type O fle~o c j. ~j7~ i CHAMBER a r: System: ~re,~ S -4_ - jOV >r-o DISTRIBUTION SYSTEM Header /Manifold Distribution Pip (s) i x Hole Size x Hole Spacing t To Air Intake Length Dia. Length Dia. ~ Spacing , i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys my Depth Ove Depth Ove 3 xx Depth Of xx See d / Sodde xx Mulched /Trench Center- 50 82&J-Trench Edges Topsoil- C7 Yes ❑ No No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.18.28.I9W, NE, SW,Lot 3, East Cove Road Plan revision required? ❑ Yes 2-r4o Use other side for additional information. 7~7 ~SBD-710 05/91) Date / spector'sSigna urge Q Cert. NO. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: z DIt.HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN e STATE SANITAR ERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than 0) '9 ) g 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - PROPERTY OWNER PROPERTY LOCATION E % %,S TN,R E(Or PROPER OWNER'S MAILING ADDRESS LOT # BLOCK # d 12 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : 2 0?6/ 71 ❑ Public ❑ 1 or 2 Fam. Dwelling4 of bedrooms - PAR L A NU BE ) 111. BUILDING USE: (If building type is public, check all that apply) C) _ 0 n _ - 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 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPPEI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. LEI New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ' RS 00 Feet E.Pa Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank L` of Lift Pump Tank/Si hon Chamber F1 El El 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Business Phone Number: Plumber's Name (Print): Plumber's Si ature: (No Stamps) 4AP/MPRSW No.: tSd _ZOAP.4 00-0 '2300 umber's Address (Street, City, State, Zip Code): ~J /,8_ P7, All IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Age tamps) Dv Surcharge Fee) y - ~L- Approved ❑ owner Given Initial Adverse D termination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb$7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will) be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted. to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be,complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains: cater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorrtion 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; elevatio,° differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross secliun of the soil absor;tion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE `0-93 VV;sconsir Act 410 included the creation of surcharges (fees) for a nijm ,:~r of regulated practices which can effect groundwater. T Et f r,:; !fCtru thrt,ugh tneSf,, surcharges arE r.isad fo%- monitoring 9roi.; ;dv.1iAer, fit') ftC - .wle:r contarnir cation investigations and establishment ;)f standards, SBD-6398 (8.11'88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 22, 1994 2226 Rose Street La Crosse WI 54603 ZAPPA BROTHERS 715 SIXTH ST N HUDSON WI 54016 RE: PLAN S94-40576 FEE RECEIVED: 110.00 GRISWOLD, GARY SE,SW,18,28,19W TOWN OF TROY COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM 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 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. Sincerely, Dennis Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 8HD-64231 N. 01191) N g m r a A m Q, m -Wb p r~ o bbbb ~ ~ m N ut o ~y w W N 7 ~ -t 4 Z c y VA~ L'A o y ~ Z n e ft~ C A o ~ o y ~ n -As 4AJ ~.t SPY Coo Ri S w~~ Q S i OVER VXO X 70 AIOR-04 Alt- 5 A ~y [itvic T ~FticIS~ES P~ E ~v~E 915 ~2 700~R /14r 74 e, tJrr// /O' Sc~/ /o A/c A¢T + i A,%* Ti~//7 W4(44 B, . ,-J~..rrs /"/wc SO 3s /_t~4,u~~ 1'Fw ! ~lJ~GIF LinrE ' O. ~s 5 , t QA o ~------~8 jp, t I A?AAII i Vc t.✓.t Y - q - ~ S8 '/,1, ~~i1GE N 4~n?Ksiloj0 AY, A;~ -5cve ^C Z ~ ~ D o -s 8 y y ? a G 1 ~ Lei *tz 46 o -Ni z i~ e R~ a G ~ A n e~ `wz Hwy Fy{ ~ a ~ aa v` Ix b t~~ M , ~ N H y n i"t! ~ . p O 1.wY Ca. ~ X k W by A~l M a o -0 \ k J. CVO4 O o V- C A u p p p 0 Q r ~ r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEMS Private Sewage Section Labor and`Human Relations 201 E. Washington Ave., Rm. 141 Safety and Buildings Division PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 Bureau of Building Water Systems (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 2 wth T,aorntonAve~P.~B 784 , Madison, WI 53707, Telephone (608) 266-3358. Lj- Plan Review Appointment Date Plan Identification um r 1. PROJECT INFORMATION (Type or print clearly) 06/17/94 Qj'S94-40576 Name of Submitting Party (plans returned to same) Project Name Za a Brothers Inc. Gar Griswold Street Address, P.O. Box # or Rural Route Project Address or Legal Description 715 Sixth St. N. 321 North Cove Rd Hu o W City or Village State Zip Code City ❑ County Hudson -W 54016 Village ❑ of Troy. St. Croix Telephone No. (include area code) 715 3\96-2850 Town Designer Name of Owner Mark Stahnke Gar Griswold Telephone No. (include area code) Telephone No. (include area code) (715) 386-2850 (715) 386-3332 Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route 715 Sixt-b Street . 318 North Cove Rd. City or Village State Zip Code City or Village State Zip Code 2. APPLICATION FOR: ❑ Experiment ❑ Mound System ❑ Holding Tank New Construction ❑ Large System (over 8,0 0 gpd) IN Conventional System ❑ Groundwater Monitoring ❑ Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ In-Ground Pressure ❑ System in Flood Plain (attach SBD-66.98) ❑ Other 3. FEE COMPUTATIONS (include existing tan FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS IVIS N. [ a. 750- 1,500 gallon septic tank $1 0.0 u $110.00 b. 1,501- 2,500 gallon septic tank $ 1 .0 f 1 C. 2,501- 5,000 gallon septic tank $16 .00 d. 5,001- 9,000 gallon septic tank $20 0,0 e. 9,001- 15,000 gallon septic tank $ 300. 0 f. Over 15,000 gallon septic tank $500. 0 g. 500- 1,000 gallon dose chamber $ 70.0 h. 1,001- 2,000 gallon dose chamber $ 80.00 i. 2,001- 4,000 gallon dose chamber $100.00 j. 4,001- 8,000 gallon dose chamber $120.00 k. 8,001- 12,000 gallon dose chamber $140.00 1. Over 12,000 gallon dose chamber $160.00 REGEIVED m. 500- 5,000 gallon holding tank $ 60.00 n. 5,001- 10,000 gallon holding tank $100.00 IFIU a Over 10,000 gallon holding tank $150.00 JUN 16 IN p. Revisions $ 50.00 SAFETY & 11M. dv. q. Groundwater Monitoring - Per Site $ 60.00 (other than a proposed subdivision) r. Petition For Variance: Setback $100.00 Site Evaluation $225.00 Plumbing $225.00 S. Experimental System (additional fee) $300.00 Subtotal: $110-00 t. Priority Review: Enter same amount as Subtotal Total Fee: 110.0 0 NOTE: Plan reviews should be scheduled prior to submittal. ne of the offices listed below. Hayward Office LaCrosse Office Madison Office Shawano Office Waukesha Office 209 W 1st Street 2226 rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633 SBD-6748 (R. 05/92) NOTE:Fees are pursuant to Wis. Adm. Code, Chapter ILHR. 2, and OVER . are subject to change annually. The following information is required for plan review. An index page or each page of the plans must be signed, sealed and dated by the designer., 4. MOUNDS & IN-GROUND PRESSURE DISTRIBUTION SYSTEMS a. County verification of soil conditions. b. Soil data. Report on Soil Borings and Percolation Tests (form SBD-6395, 115 form) or Soil Description Report (form SBD-8330) signed and dated by a certified soil tester (CST), with license number. For new construction of in-ground pressure system, sufficient data for a replacement system (i.e., additional borings). C. Plot plans- Dimensioned plans or plans drawn to scale (scale indicated) and parcel size or all property boundaries cleared marked, distances from the system to buildings, wells, watercourses, etc. Slope percent and direction in system area, two foot contours must be included if drawn to scale. Benchmark and north arrow. Location information (reference to readily available map, nearest road intersection, subdivision map, etc.); legal description of parcel must be noted. For new construction of an in-ground pressure system, show replacement area. d. Plan view of system with observation pipes and permanent lateral markers (TWO COPIES). e. System cross section - provide system elevation (TWO COPIES). f. Pipe lateral layout (TWO COPIES). g. Construction details of septic tanks if site-constructed, or State approved manufacturer and size if prefabricated (TWO COPIES). h. Prefabricated pump or siphon tanks: Sketch of tank showing internal dimensions, the maximum liquid volume, and the volume in gallons per inch of liquid depth (TWO COPIES). i. Site-constructed pump or siphon tanks: Complete construction details including internal dimensions, the maximum liquid volume, and the volume in gallons per inch of liquid depth. J_ If the site is suitable for a conventional private sewage system, item a. from this section is not generally required. k. Provide system sizing information for public buildings (TWO COPIES). 5. CONVENTIONAL PRIVATE SEWAGE SYSTEMS a. Report on Soil Borings and Percolation Tests (form SBD-6395, 115 form) or Soil Description Report (form SBD-8330) signed and dated by a certified soil tester (CST), with license number. For new construction, supply data for a replacement soil absorption area. b. Dimensioned plans or plans drawn to scale (scale indicated) and parcel size or all property boundaries cleared marked, distances from the system to buildings, wells, watercourses, etc., and slope percent and direction in system area. Two foot contours must be included if plan is drawn to scale. Benchmark and north arrow. Location information (reference to readily available map, nearest road intersection, subdivision map, etc.); legal description of parcel must be noted. For new construction, show area for replacement system. C. Plan view of soil absorption system showing all dimensions, pipe lengths, spacing, etc. (TWO COPIES). d. Cross section of soil absorption system showing system elevation, aggregate,cover material, depths, etc. (TWO COPIES) e. Construction details of septic tank if site-constructed, or State approved manufacturer and size if prefabricated (TWO COPIES). f. Prefabricated pump or siphon tanks: Sketch of tank showing internal dimensions, the maximum liquid volume, and the volume in gallons per inch of liquid depth (TWO COPIES). g. Site-constructed pump or siphon tanks: Complete construction details including internal dimensions, the maximum liquid volume, and the volume in gallons per inch of liquid depth. h. Provide system sizing information for public buildings (TWO COPIES). 6. HOLDING TANKS a. Report on Soil Borings and Percolation Tests (form SBD-6395, 115 form) or Soil Description Report (form SBD-8330) signed and dated by a certified soil tester (CST), with license number, unless exempted. b. Photocopy of agreement docl&jjnt,gtvilgisn: owner and local unit of government, properly notarized and recorded in reference to the deed. This agreement must include a statement about the semi -annual pumping report and pumping contract. C. Plot plan showing location of 4M gAa* V11 lateral distances to any buildings, well, water service piping, watercourses, lot lines, etc. Provide horizontal and verticiI rencd p6iiritsf. Include all-weather service road distance to service manhole or service port, location information (reference to readily available map, nearest road intersection, subdivision map, etc); legal description of parcel, location of any existing system. (TWO COPIQ -Z'ZQ.18 3 4 ' fjti w d. Holding tank profile showing vent, manhole, alarm and State approved manufacturer and size if prefabricated. Provide complete construction details if site-constructed (TWO COPIES). e. Provide all sizing information (TWO COPIES). This is not required for residential installations where the number of bedrooms is indicated on the plans. 7. SYSTEMS IN FILL a. Systems in fill must include an Onsite Investigation form (SBD-6196), as well as all the appropriate items listed in section S. 8. GROUNDWATER MONITORING Contactthe Private Sewage Section for specific guidelines. 9. PETITION FOR VARIANCE a. The original Petition For Variance form (SB-8), signed and properly notarized. If any portion of a private sewage system is in a floodplain, form SBD-6698 is required. -A-31f C& /or (/o .fceE.s) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTR.Y,, C DIVISION LABOR AN P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 + s (H63.090) & Chapter 145.045► LO t _,tL 3 LOCATION: SEC ION: TOWNSHIPAM44V+6FLA+-+TY: LOT NO.:BLK. NO.::"SUBDIVISION NAME: A,v 1/ 1/ /T2,? N/R /9 E (or T. O y ..vG- COUNTY: OWNER'S S NAME: MAILING ADDRESS: 57 CA1 1 MAJC G/4A,1,P1 ESSEe R72- k,1;14, USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL IALDESCRIPTION: PROFILE DESCRIPTIONS: R A ION TESTS: Residence 0 N 4. New ❑ Replace ~(jl D IfP6 a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) _ 14S ❑u K IS ❑u ©s ❑u o S ©u a S ©u 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: s.S I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS /;v BORING TOTAL DEPTH TO GROUNDWATER-IN- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / f 5 /7r /Z' )t,11" > 0.S' a.o' ~A~. s, 4. 5 ' Ti1'v cf B- Z S B_ 3 lo. to S aN S .ZS of 5- 7~ti U'7 C B- oo 14 .1 7 . s ' 5 N , , .1,7 r4A1 B- s s 97.76 > S-5, s - I P~ B- f, Io 9y/6 S!G " 3-S ~.d W"r a/k , y c eff-v ,rte No w rdt- 000 /&p sr~~-,o 4 Uo~1~ n QF 13e. % Ile- 4) PERCOLATION TESTS O TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER IN( AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH P- -3. Aedxro WR P- ~Al i C U Ao> P- Z -Z ST P- < PT < Z /N& 'f 1 U PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. pO-77 OM oT 95, 0 ' SYSTEM ELEVATION E E Ile, w/ b Itl h ARr~ ' _ % _ ' Go' 4 'Ims i z ~ # 7sz~► 60 O~ ~ i y ; • ] k tel: 7~0.. ~ •-F 4 = I x ' j _ i f Po ~v 1 -75-;7 pp 1, the undersigned, hereby certify that the soil tests reported on this form r@ _ ade by me in with the procedures and methods specified in the Wisconsin Code, and that the data recorded and the location of the tes ib correcttg. bes knowledge and belief. NAME (print): CYJ 1 S WERE OMPLETED ON: HOMESITE SEPTIC PLUMBING CO. ADDRESS: MBSett. W137 TIFICATION NUMBER: PHONE NUMB R(o tional): ROBERT UIBRICHT 2 y.'Z INS. MA IVIINN. INSTALLER & DESIGNER LIC. N0. Q0663 CSI' ST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - °K}'zTRUTIONS FOR OMPLETI , ORM 115 - SRC? - 6395 • To 1 :1 soil ur rep include: 1. E 2. T1 I indicate th i, sidence or < project, E 3. P" rooms or u;=-d; 4. t system; 5, ing boxes. ABLE FOR A HOLDING TANK ONLY IF ALL O r _ULED OUT BASF _L CONDITIONS; 6, ise tI s sh( in here for w ,g profile descriptions and completing i; A LE( B=r +tt"y locati g your test locations. Drawing to scat A y d ic;al elevation reference poin ply shown, n anent; iate boxes as to dates, names, addresses, flood ;t exemp- "'i ris flood p(air), W-wfion) does riot apply, place N.A. in e box; your c urgent dd- Id your cv~rtification number; distribute as re:n~irerl. ALL SOIL TESTS MU-F TFl THE t ITNIN 30 DAYS OF COMPLETION, .'IATIONS FOR CERTIFIED SOIL. TESTERS r Textures mbols st 101i BR _ 'wdrock cols 10") SS Sandstone 7r - G car leg 3") ES - Li E L Bn Silt Loa Bl F a, E: t Gy - C - L -an) Y - 4 4;lay Loam - f - :I Cray Loam not - _ ; dy Clay w' I y Clay fff iy cc _ d trim - d - c P - p HWL - I, ~d # BM VRP y c , >E?i;?t TO THE O'"t wt is fi ? :~'ary per, pit. The cot, , r i I ~gR;rMTIT OF ~ c SAFETY & BUILDINGS DIVISION IUSTRY, REPORT ON - SOIL BORING TT 6.0. BOX 7969 1A AND • PERCOLATION TESTS (1 1AA N RELATIONS MADISON, WI 53707 • (H63.09(1) & Chapter 145.045) LO f 3 ;A TOWNSHIPAMW# HNfArL+TY: OT NO.: LK. NO.: SUBDIVISION NAME: E 1% 1/ /8 %Tz,?N/R /9 E (or TROY cs~f f4 ON 1NTY: -OWNER'SAROftWSNAM . MAILING ADDRESS: ~%D~E~ JJ~~JG.SOt,~ ~%•S. SI'~G~t~O C~t°N x T0Nc L/f A401V 4-4 Z'i 2 4 l&//a 4j DATES OBSERVATIONS MADE TESTS: Residence 3 N New ❑Replece IRvy p --Fr6 OV IfA4 ra 'ING: Sm Site suitable for system U- Site unsuitable for system IVEN MOUND: IN-GROUND: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ~S au gJS ou a S au DS ©u a S ®u 60NaEwrow"fl 3rcolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the er s,H63.0915)Ib), indicate: C`~1 s'S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS %.t/ 3t0iyAG af~• 11NG TOTAL DEPTH T R NDWATER-IN - HARA R O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH IBER DEPTH IN, ELEVATION -OBSERVED EST. H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) t > S aN . IS, . s it aN s, . S cs • . S ,8N • S •sS dS Tfv U,ziy G 3 lo. o /00 ./6 ~4r >16.0 / y o 99 yo • //O • ' D,f a . d 7i1•(i ~/%7 Cf C5 - 0 0 o ~y/~' 3, s . ~t ,rNo or 360, HAW I PERCOLATION TESTS - •O ' ST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L VEL-INCHES RATE MINUTES ABER IN( AFTER SWELLING INTERVAL-MIN. PERIOD PERIOD - PER INCH E A0 7v Z ~L ST 20 Z i /Nl t t PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori I 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 id slope. STEM ELEVATION '9.07r0^,1 of 95. o " I I 1 I _ • 8 / low I s _ i - - - - - - s .7 I ~ . 1 I ~ I 7521 Ob/ 1 I I I , !irS 735 t. t . SO O d !26 The o► •ercolati n Tests are NOT required DESIGN RATE: S I It any portion of the tested area it in the ~ I der s.H83.09(6)(b), indicate: Floodplain, indicate Floodplain elevation: c 6 PROFILE DESCRIPTIONS %t/ ~.«%H~G fir• HARA T R OV-SOIL WITH THICKNESS, COLOR, TEXTURE. AND DEPTH RING TOTAL -QEPTH T GROUNDWATER-IN " Y1BER DEPTH IN, ELEVATION OBSERVED HIGHEsf- TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) rQ 5 • ~L ~ > S a.o' c~f3+• IS, $ ' Tihv G j / Cf z S /e/ ~p ? S S aN. s, . s aN s, . s :~A' ` cs 71 3 s ..2 V, , 5- rr.~ /r.~, c 7' low .11 S s 97..76 ke, s S cs 6A* /J1 Xv, 77 •~7 ray, &ffi/,uit M AND ' e 1W.-or .3/ 'Awd t PERCOLATION TESTS •O 4voi~ ~ of DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES AMBER IN( AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD i I PER INCH Wle Tv / I1 4e 2, E~ v v ~L ST .c s 0 Z /NC- Cal .0~ .ar! u IT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori :al 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 3nd slope. ~O~ opt o f /,S ~e,~ = 95. o !STEM ELEVATION 1 , $ 1 I i ?p L ARC' 34 ceAe F Bo~f Tt, N szrz, P J y ! SDI of V 0 . 735 ! -f- - -do, This test-efts app fob a €tOYS , -`---T~;conventjggaj: set ti i ,f'~o 1 - af~I 1527 0~ z i -r system. ,e 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 ninistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ME print : TESl,~ WERE OMPLETED ON: HOMESITE SEPTIC PLUMBING CO. X41 cp- /9 j6 DRESS: R08D-, UHUDOW LBRICH, MS; 54016 T CERTIFICATION NUMBER: PHONE NUMBER( tional): WIS. MA 1 y~Z 3 p MINN. INSTALLER & DESIGNER LIC. N0.00663 CST SIGNATURE: ;TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. .HR-SRD4396 (R. 02/82) - OVER - ~ wr ~ r I ~I ~ ~v y~~ ~d 1 1 j 41(;067 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NEI OF THE SWI OF SECTION 16, T28N, RION, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN APPROVED OWNER LEGEND JUNE LANOMESSER ST. CROIX COUNTY SECTION CORNER MONUMENT AU G 15 1986 P.O. a0X 6 HUDSON, W1. 54016 • 1" IRON PIPE FOUND U Ckm Cowry ewe "I" RAOWWO O 1" x 2411 IRON PIPE WEIGHING 1.68 LOS/LINEAR FOOT, SET, uw aww M COW~ 8 ,~go0/1N/0611yPP~ PILED ° Q1 ca 211986 ALLEN C. AUG y NYHAGEN SDMMA MAW wad S•1407 ! .r.....a.+ - - N m lf7 z 54 0104a~ ` HUDSON, WIS. SCALE x o<q -L~ 200 100 0 00 ,Ilff 66bS~~ N *"NOTE*** DOES NOT AGREE WITH THEORETICAL unplattad_lands•ownad by-""oth "ers° POSITIOy ' CENTER OF SECTION 18 NOU H LINE OF THE SWI _ WEST _ NORTH COVE ROAD 535.84' , I WEST 601,85 66' 551 0 ' LOT 1 I 1 O I N l cres ft')INClUOING EASEMENT c c w c °I 4'002a40 sq. c' small tract g ,r W N 155,097 sq. ft.) EXCLUDING EASEMENT " I v 3.56 acres ) , I NEST 533.67' = EA51 599.88' WEST I 560.07' _ Y T f y, s PRIVATE ROAD EASEMENT i w I A SEE BACK FOR ROADWAY STATEMENT N LOT 2 N m I II° o ~ ° 219,824 sq. ft.) S89°10' 3"W 'w S°c m : 6.05 acres ) 10.001 SO C 0 1 0. A V O V ( LOT 3 eo 45 1~ s o _ 690.071 I 1 n N V CAST N N I.1 W 447,703 sq, ft. 10.28 acres *NOTE* GARAGE OF ADJOINING OWNER c C2 ENCROACHES UPON LOT 2 small tract, y1., p N ' O ~ S - v 7 594,811 found iron pipe lies 589046140"E S89°4614011E, 0.88' of computed position. !!All tracts S} CORNER SECTION 18 Volume 6 Page 1697 this Instrument drafted by Dour!.Is Zahler job no. 86-13 1 1 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER .9'i4.+'0 A-4- T,* aA-t S`wc,a ADDRESS 3 $ IVA 400m- FIRE NUMBER CITY/STATE IdG y QSe .,r !i✓,~J ZIP Sg alb PROPERTY LOCATION : N~1/4 , wl/4 , SECTION T E N-R J J W TOWN OF T'e'a y , St. Croix County, SUBDIVISION C 's LOT NUMBER •3 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Cr ix zoning a certification form, signed by the owner and by a mAer plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1), the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/Ile, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration dat . SIGNED:- DATE: _ St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result ~n delays of the permit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), thenla second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. ~-►~-Y G . 6.c~ S Leo cr D owner of property si4+•.rO,c~,q ;0, a o L,4 Location of property Ltl/4 S ~ 1/4 , Section 'T_N-R 9 W Township Mailing address O s a •~r tom- s ~j . O Flo Address of site SAC/ /L~Ir7 r0L, F /?r1 Subdivision name Lot no. Other homes on property? yes No Previous owner of property L.p r~ eS s p.c. Total size of parcel Date parcel -was created /~vG ys -r Z•h / S~6 'Are all corners and lot lines identifiable? .Yes _______No + Is this property 1peing developed for (spec house)? Yes _,~SNo Volume O I land . Page Number /4"4 of Deeds. as recorded with the Register INCLUDE WITH THIS APPLICA'T'ION THE FOLLOWING : A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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. - S c)7 / 3 B , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of county Register of deeds as Document No. • i qAjjA Signat a of applicant -appl a 3o , 99 Dat of Signature Dat o gnat e Y _ DOCUMENT No. STATE BAR OF WISCONSIN FORM 1- 1982 THIS arAGE RESERVED FOR RECORDING DATA 507138 WARRANTY DEED PAGE 146 041 1 June Ellen Landmesser, REGISTER'S OFFICE formerly-June E. Bacbetweenhhub----•e-r•-------------------------------------------- $T.CROIXC0.,1M Wd6aRKWd ! Grantor, and.... ary . Grswoan-ara_-....r-•-iswold,___---_ OCT1 21993 husband and wife, as survivorship marital Gt 9;15 A. M .....Property-1----------------------------------------------------- - Grantee, Witnesseth, That the said Grantor, for a valuable consideration---.-_ _ - - of one dollar and other valuable consideration - RETURN TO conveys to Grantee the following described real estate in t.OlX I, County, State of Wisconsin: Tax Parcel No- Part of the NE 1/4 of SW 1/4 of Section 10, Township 28 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed August 21, 1986 in Vol. "6", Page 1697. TOGETHER WITH the private road easement over Lot 1 of said Certified Survey Map. FED I~ ! not i This homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; June Ellen Landmesser ' And-•--...................................................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except li f~f and will warrant and defend the same. I( 11th October 93 Dated this day of 19... ii (SEAL) June Ellen Landmesser j • II ........................................•................(SEAL) ...---"--...............--•-••--•••--•......--•--•-_................(SEAL) * « AUTHENTICATION ACKNOWLEDGMENT li Signature (a) STATE OF WISCONSIN ii ST. CROIX es. County. R. 31rtk~ authenticated this day of___________________________ 19 Personally came before am this .._.__.....`~-day of October '1.9___.9.3-the aVy4Aamed June EITen Lancamesger = J ......wc~..[....y.~..__•- i.. ~.......°ii...i~:.VV(Ll ,.N - TITLE: MEMBER STATE BAR OF WISCONSIN fir- • (If not. i 4--------- authorized by § 706.06, Wis. Stats.) to me known to be the erson - who r. Melited the for rument and aclino die the ,game. HIS INST UME T 5 DRAFTED BY R0 ert ' . ~ifa~~ WALL & MILLER -t F, Wall 522"-"Sec-- ori3 S£"reet-------""""-"""""-"""-°""""""-Rober - - Hudson, WI 54016 Notary Public CrOX County, Wis. 6---------------------------------- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration !I are not necessary.) ) date: . 19 *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORA! No. 1 --1093 mu" "40.