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HomeMy WebLinkAbout018-1051-70-000 4 0 3 o c III p ~ d a~ m ~ a Y , n c N v a a I ~ o I y w y L E c r j C N N I CL) a I' ~ t 3 I .0 O 7 N O > LL O Q Cz 'O C - O N Z} ' E Q N (9 N U ~ M v a _ a) 3 E (A ; O i' c z m N Cl) N a m c o , O z c 0) Z d' ! ~ O I N F- ~ ~ O Z I c ~ -o N O O O C N y N 7 ~ U) C ►i d O co © o aa) Q yU-_ z co z o N z Cl) CN '0 d I E N lC C' I 10 m C' L E a G w w O C O O O O N_ ` O O O O O O d L O Co N N N >O j O O O Z> > d> - N N N z 0 0 0 0. E E co co w _o~ m J U= rn rn } O N o '0 0) N O N O O O O 7- N N L 7 N N to !zp 0) - O d Q ~ f.1a N d {0 w- O C O ~Y U) U) 0 O C co N C Q i O O H m C C 5 d 0 0 0 O \ y Cl? -p y Y Y - N N N N C C C N f~ v 4 ~ C C5 O O N 7 N N N (yam, C O E Z N p ~~ll y O N 2 O N Cn I R L: a. • a m d d c tt`N~ E L c "~1 A U a O m U r Parcel 018-1051-70-000 04/09/2007 03:31 PAGE 1 OF 1 F 1 Alt. Parcel 23.29.17.360B 018 - TOWN OF HAMMOND 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 - RAMBERG, BRIAN L & JOAN L BRIAN L & JOAN L RAMBERG 845 190TH ST HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 845 190TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 23 T29N R1 7W 5 AC NW SW LOT 1 OF CSM Block/Condo Bldg: 5/1432 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 691/107 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/30/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 36,800 126,100 162,900 NO Totals for 2007: General Property 5.000 36,800 126,100 162,900 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 36,800 126,100 162,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 210 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Y t ~ WPAR-rMENT OF REPORT ON SOIL BORINGS LAND SAFETY & B DI SON LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 3.0911) & Chapter 145) LOCATION: SECTION: #TOWN UNICIP LITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: ~ /T N/R(?E (or f COUNTY: MAILING ADDRESS- x, I b Q a bt" Q S- f /a jYl {~1~►D~? U ~t~ f USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL ESCRIPTION: PROFILE DESCRIPTIONS: PERQOI~ATION TESTS: Residence ❑ New Replace 9 / cq t1 RATING: S= Site suitable for system U= Site unsuitable for system b / ONVENTiONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optio I) 0 S ❑U ❑ S ©U 0 S ©U ID S DU El S R1 U C(4sS'a I Lu".cler Percolation Tests are NOT re uireDESIGN RATE: 9 If any portion of the tested area is in the s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED E T. GHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 9g"• d /V811 7~' I " (S i x''-34'` h 5 1 B- r, B- o_ I a "n s i lo"--3411 6n s i 36 1-6 "Bn M ej B- :SaptA B- 3 96,o s; /a,- av/6,Si 'hn Aecl B- S Gr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ 1 31P, D a 1 P- a 36 i/ Q /D IfIA / I ! 01 P_ 3 AD M, P99 .2 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- 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 za_ e I 1, t A3i TO-1 . _ _ - - - -i . - J i j I ~Q I l Poll l ( ! 10 A h bn r# q r ~ i - 111 -w i -f- I _ i I , I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the pro s s 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 belie . NAME (print): TESTS WERE COMPLETED ON: D ADDRES CERTIFICATION N MBER: PHONE NUMBER( G~ a a a~ p 72 tional): filu / A 5~ Yo CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - r 'a INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent: 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than •1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 44 DUCI~RY, DIVISION LABOR AND. PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 a e ( 3:09(11'& Chapter 145) LOCATION: SECT ON: OW UNICIP LITY: LOT NO.: BLK. NO.: SUBDI VISION NAME: a /T N/R/''7E (or COUNTY: MAILING ADDRES ' ~r Q > . 90 t S-t USE DATES OBSERVATIONS MADE NO. BEDR_W_- COMM R A DESCRIPTION: PROFIL~DESCRIfTIONS: PIER~06ATION TS: 0New Replace / n Residence RATING: S- Site suitable for system U- Site unsuitable for system b U / ONVENTI NAL: MOUND: IN-GROUND.PRESSUR : S TEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEMaoptio q SOU ❑SDU 0S [SA 0S ©U 0S EA CfaSS ~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83:09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL _QLPZH T R UNDWATER-INCHES CHARACTER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED - ST.HfGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I( B- B- B- a 9S 78'l` 0-19 "6 Si /a''-•36`bnsi /-6 "tan hQd B- S &k. B- 3 $w' 96.© >Sy" o~lall S, a,~ av`enS ~_av~gy'hn~lecl B- S Gr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP I WATER LEVEL-INCHES RAT MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. D 1 RI D PER INCH P_ ! 3 6 p 1_ 911A a I 7 P- a :3611 o ~o , l o P- s Ar 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- 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 ~~.0 _eTl 611 1A Ad- It, 14 10 fC e S ~N P~ se A _ _ 1, the undersigned, hereby certify that the soil tests reported on this form were made by me, in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE CO PLE E••+??D ON: ALn4 VIC 2 7R ADDRES : CERTIFICATI N NUMBER: PHONE NUMBER( ptional): 2 '.~oaa CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - - I STC - 104 AS BUILT SANITARY SYSTEM REPORT n r OWNER n ADDRESS A/11 lla,#zxicla l SUBDIVISION/ / SM# LOT SECTIONGCJ T.J N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ao y f\ v~ t -7) A /Xt O INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~6 O t ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: r16 j Liquid Capacity: Setback from: Well House G/ © Other Pump: Manufacturer Model# Size Float seperation Gallons/.cycle: Alarm Location SOIL ABSORPTION SYSTEM -Width: / Length j 7 Number of trenches r Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 4~ PLUMBER ON JOB: n LICENSE NUMBER: 3v 3 INSPECTOR: 3/93:jt l+~i lpa~ str 3.29.17. 3MATE SEWAGE SYSTEM county: tSa an d Human Relations INSPECTION REPORT Safety ety anngs Division T C: OIX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 199925 Permit Holder's Name: ❑ City ❑ Village k Town of: State Plan ID No.: OND E ev.: 71nsp. BM Elev.: tBM Description: Parcel Tax No.: Q' &-D > ✓ ;I'YYlv__ /b, 0181051-60-000 TANK INFORMATION IF f ELEVATION DATA A9300324 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark /0012 /4 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet $~/y C(oa TANK SETBACK INFORMATION St/ Ht Outlet ~~S ~l 7S Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic jf C;~v NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe G,& ,59 Holding Bot. System o PUMP/ SIPHON INFORMATION Final Grade Manufacturer Jrrj,tu Demand Model Number kpo GPM TDH Lift i~ Friction Syestem TDH Ft oss Forcemain Length Dia. F,4 Dist.Towell SOIL ABSORPTION SYSTEM 0 6-1 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width qq Length DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of f CHAMBER Model Number: System: o oi 4 s'~I OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND 23.29.17.360A / 11.11 v. 1E, 1110 Plan revision requireiO Yes ❑ No ~f} t Use other side for additional information. SBD-6710(R 05/91) Date nspectffr'sSignature , Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I :1Z IY t~ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE IT Y ERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8t% z x 11 inches in size. c di vi on o previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP RTY OWNER PROPERTY LOCATION y J'/4 5`e j'/4, S c~ T~ , N, R E (or) W PROPE TY OW ERVMAILING RESS LOT # BLOC 'k6m, r I , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER C IL TYPE OF BUILDING: (Check one NE , ST RO D F1 State Owned L:I CITY VILLAGE : d f ❑ Public VS(1 or 2 Fam. Dwelling-# of bedrooms - P R LTAX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) - k `5/ 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. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ;SReplacement 3.E1 Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 RSeepage Bed /a5 %9' 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) pELEVATION q:~~ o I / O 16 L 3 - e) Feet / 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 -290 1 1 Septic Tank or Holdin Tank tl I Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst Ilation of the onsite sewage system shown on the attached plans. IPlu ber's Name (Print): Plu Signature: (No tamps) M M Business Phone Number: Plumber's Address (Street, City, te, Zip C d ) r? IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Pe it Fee (includes Groundwater Date Issued Is ing Agent Signs ure (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial IA&Zd Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11188) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber 1 INSTRUCTIONS T , 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. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the locatioi 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) Pei p m m a lo A~ l p- 3,93/ `7L )00,0 V p ~a.iyl• ~o G~~ ~icli~t~ (~•lrW f~G4S'e DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ` INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 1 MADISON, WI 53707 3.0911)& Chapter 145) LOCATION: SECTION: TOW UNICIP LITY: LOT NO.:BLK. NO.: SUBDIVISIO NAME: Y4 /T' N/RAE (or a o, , COUNTY: MAILING ADDRES CJs 1k p ~t groq t USE DATES OBSERVATIONS MADE NO. 3R : 1COMMERCIAL DESCRIPTION: ES S: Residence ❑ New Replace C l~ RATING: Sa Site suitable for system U= Site unsuitable for system O` b ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optio I) IsS ❑U ❑S DU ❑S ER U ❑S ©U ❑S DU ckss C9 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83:09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS - BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGR-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- " B- G r. B- 0-19 "6 S i /a'`-• 3 4 "b m i S611 "Bn M Q~ B- S B- 3 $ ~i 9 6, o S~1' o-la r( s a'` av'~3ns r j~ a~gy'l~n ~lecl B- S Gr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P I D 1 J PER INCH P_ 1 3 Z O / P 3 if O /o / Q 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- 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 20.0 Ile, Cal _ - + i2 A t Al. the a a - rc d s. IN frest 3L( t'6 be C cl, -=E- _=7 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 CO PLE ED ON: 9b 7/15? ADDRES CERTIFICATI N N MBER: PHONE NUMBER( ptional): 177o AoE~ fly" .~da~ CST SIGN E: i,~~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - THIS SPACE RESERVED FOR RECORDING DATA ` DOCUMENT No. WARRANTY DEED i~ STATE BAR OF WISCONSIN FORM 2-1982 ' i 424246 eng 774 PAGE381 REGISTERS OFFICE ST. CROIX CO., WIS. Eunice Fedie f/k/a Eunice Grotenhui.s...... Betty....... Rec'd. for Record this 8th Schmidt f/kJa ..B.e.tty Ellen Swenson, and day of yloril AD. 19 S7 Donna Deneen f/k/a Donna Mae Wisse _ 8. 30 A elh . conveys and warrants to __J3r1dil..L.,- ..Ramberg... and_J.Oan-.L...... Ra.mherg.,_..husband..and...wi.fe-,._a-s-.sur.V.iVo.r-sh1PL.•-----.- ..mari.ta.l...proper.ty..... . RETVAN TO . . . -...St... .C ..1. . - . roix the following described real estate in ...............................................County, State of Wisconsin: Tax Parcel No:........ North Half of Southwest Quarter (N% of SW4) of Section Twenty-three (23) Township Twenty-nine North (T29N) of Range Seventeen West (R17W), EXCEPT Lot 1 of certified survey maps filed June 13, 1984 in Volume 5 of Certified Survey Maps, Page 1432, as Document No. 394063, in the office of the Register of Deeds for St. Croix County, Wisconsin. IRANS ~L?bo This is not - homestead property. (is not) Exception to warranties: Easements and restrictions of record, 19. . Dated this 3 day of April 87 p ~-C K ~ ....(SEAL) C_u~'YLC car -'....(SEAL) Betty Schmidt Eu t.ce_.Fedie - l (SEAL) .(SEAL) Donna Deneen ACKNOWLEDGMENT ACFCIOWLEDGMENT Florida STATE OF 3 iXX 1STX State Of Wisconsin ) ss. J, )SS ------County. ,4 ~ .6 ST. CTO1X County ) Pgr onally came before me this of Personally came before me this 3 Day 19--.8 ~1 a•;abeAV•pam~ . - Of A g r i 1 , 1987 the above named Eunice Mtp;~_• Fedie f/k/a Eunice Grotenhuis, and Betty ----Wz-ss.e Schmidt f/k/a Betty Ellen Swenson to me n known to be the persons who executed the foregoing instrument -,pd acknowledge the - ow -o be - e T " xe ~ t j to me known to be the per=on a'exdtiutgd~the f Scene ) foregoing instrument and acknowledge the sarnt~.", * Spent bdernlund ~ - Notary Public St. Croix CQlsrlty, is. 4 M Y commission is permanent. {If c~q~jt state Notary Public WV&KFLA expiration date: March-f9k%* 9 C~ My Commission is permaUtent.(lf not, state expiration c I^TAR7 DJRLIC !ST-Arc !r f ',Rxk~ L 1 O date: 9 w t v MT CIW Tr Iv Elp. MAr li•13d~ This instrument was draftec-'• , Q Thomas A. McCormack ?^ti Eo +~?o c<<_ A_ Iy;. ° QJ =tom- ,h.: Baldwin, WI 54002 It OF WISCONsiv I No. 2 - i , 2 Stock No. 13002 SEPTIC TANK MAINTENANCE AGREMIENT 0 St. Croix County I-A • o0 OWNER/BUYER c Fire Number ROUTE/BOX NUMBER ' d 0 CITY/STATE AdmjT C i. ZIP n PROPERTY LOCATION:J',~`~~ k, Section TN, RZLW, Town of A X~~'Izw St. Croix County, Subdivision `Lot number. Improper use and maintenance of your septic system could result in failure to handle wastes. Proper maintenance con- premature its sists of pumping out the septic tank every three years or sooner, if needed, by a licen ed'septic_tank pumper. What you put into the system can aTFect the •unct on o. the-septic tank as a treat- ment-stage in the waste disposal system.. St. Croix County residents m„_a~ be eligible to recieve a grant for a maximum of 60% of the cost-of replacement of a failing system, which was in operation prior to-July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new .systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, 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. Pi I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- 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. SIGNED ` DATE. ? St. Croix County Zoning Office 911 4th St. Hudson, WI 5401k 386-4680 Sign, date and return to the above address. 1 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 prop rty ' 1/4 S~^✓1/4, Section ?J? Township Mailing address 11G 1` fr Address of site Subdivision name no. Other homes on property? --Yes---y No .Previous owner of property Lalt I CIO- Total size of parcel() Date parcel was created Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)? Yes ?,_,No Volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OIL 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 Tice of the County Register of Deeds as Document No. l-/ , 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. Signature of ap 1 ant Co-applicant ll/ j r DaE i nature 5 Date of Signature r