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HomeMy WebLinkAbout020-1018-60-000 Q c ' ~ I rn : C) N ~ I C I a a ~ P. O ~ L O N U N N L N (n O J .`S O U fy ~q > O Q a O N t6 III LO. O C O y c ca C N j O Q C m y -0 07) .N Q 00 C O rn C z 3 @= L LL C 7 ~ 2 O L 2 NN C p N co O to E Q F-~65 co N U O M a v ~ rn w ~ £ I M (L m c 0 c C7 '0 O z r_ w U r O N N H a Z c E N ~ M (D co a aa) c C O U O O O Q z ~ z O N Z cli CD r- V- E O N N 6 ; CS 0) N N /9 O h CL -~t a C w R O D D CL QI U Q z~> X333 FE 5 L z0 O O O -0 • ►.a o a a a a co U) } fn J V a' a) rn N 'D r ~ O O O A., X 1 N N = O tT] p- Q rn N O O C N C p N O C (p O L" 00 0O I.. O C O. C a O 00 G F m c E N o C - N O 5 r . 00 .0 O N a LO N G3 C 0) N • N vi :3 c ch co E rx u O m U) O V) v~ d m ~ a m a* a a rr~~,,• E d 'E d w C r1 y E O ~ A V a 2 O w 0 t * OMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 SST. CROIX COUNTY GOVERNMENT REPORT NO.* 53798/01 PAGE 1 CENTER REPORT DATES 12/09/93 1101 CARMICHAEL ROAD DATE RECEIVEDS 12/07/93 HUDSON, WI 54016 ATTNS THOMAS C. NELSON r OWNERS Stephen S Carolyn Stolbera LOCATIONS 902 Alexander Rd., Hudson COLLECTORS M. Jenkins DATE COLLECTEW 12-06-93 TIME COLLECTORS 11300am SOURCE OF SAMPLES Kitchen faucet DATE ANALYZEDSI2-07-93 TIME ANALYZED22200pm COLIFORM,MiFCC2 0 /100 mi !NTERPRETATION2 Bacteriotogicatly SAFE NITRATE-NS 5 ppm Above 10 Ppm exceeds the recommended Public .Drinking Water Standard. Coliform Bacteria/100 ml. Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gane .OF.\NDEFENpFHr `9p WI Approved Lab No. 19 z~a 5A < Means "LESS THAN" Detectable Level Approved by** 0 PROFESSIONAL LABORATORY SERVICES SINCE 1952 411 - 93' ST. CROIX COUNTY e WISCONSIN t 1 r Y .^z~ ZONING OFFICE _ ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 540116 (715) 386-4680; I ` J SEPTIC INSPECTION / WATER TEST REQUEST FORM y Specify desired test(s) & remit:a ppropriate fee with application. \ Outside water lines are often turned off during winter months, ~J making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. t~ yWater (VOC's) $185.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: CS, Requested by: Jenny Olson Address Address Century 21 Premier Group City & State: yam;,, City & St. Hudson, WI 54p16 Zip Code: ~ Vo I Zip Code: Telephone N°: Telephone N°: ( ) Property address (Fire N° & Street) : G02 AleXander ROad• Location: „ Sec. , T -N, R W, Town of St. Croix Co., WI. Tax ID N2 Parcel ID N2 - House color: te. Realty firm: C 21 Lock Box Combo: J L .D Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? Yes m;v If vacant, date last occupied: Septic system installed by: year `'A Septic tank last serviced by: Date ;,5 = Previous Owner's Name(s): Q k Have any of the following been observed?l ❑Y ❑N Slow,drainage from house. ❑Y ❑N Sewage Back=up into dwelling% ❑Y ❑N Sewage discharge to ground su ;te, road ditch or body of water. ❑Y ❑N Slow drainage from the dwelling.. ❑Y ❑N Foul odors. Other comments relative to system oparation: S I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: 2 DATE: 0L.P93 12/222/93 16:39 FAX 612 636 7178 SERCO LAB. COUNTY CLERK 1@004 SMCO Laboratories 1831 V%d QWM Road G2. St. Paul. Minn=ta 55113 RW* (612) 636 7173 rAY (612) 635.7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 3 of 3 12/22/93 SERCO SAMPLE NO: 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride,, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results ar ~-below the U. S. EPA's SDWA Maximum Contaminant Level of 1/30/91 for those requested compounds which are also on the SDWA MCL List. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. An erson Project Manager < means "not detected at this level". 1 mg = 1000 ug. MEMBER 12/22/93 16:38 FAX 612 636 7178 SERCO LAB. 444 COUNTY CLERK 002 i SERCO Laboratories 1831 West County Road CZ St. Paul Minnesota 55113 Pnone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 1 of 3 12/22/93 St. Croix County Zoning DATE COLLECTED: 12/06/93 1101 Carmichael DATE RECEIVED: 12/07/93 Hudson, WI 54016 COLLECTED BY : CLIENT. DELIVERED BY : CLIENT SAMPLE TYPE : DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Stolber SERCO SAMPLE NO: 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: Benzene, ug/L <1.0 Bromobenzene,'ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tart-Butylbenzene, ug/L <0.5 carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chlorozathane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. MEMBER 12/22/93 16:38 FAX 612 636 7178 SERCO LAB. 444 COUNTY CLERK W003 { SERCO Laboratories 1931 west County P-W C2. St. Pate. Mmes M 66113 Phones (612) 636.7173 FAX (612) 636 7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 2 of 3 12/22/93 SERCO SAMPLE NO., 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1:1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 111-Dichloropropene, ug/L <0.2 cis-113-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ucj/L <1.0 Hexachlorobutadi.ene, ug/L <0.3 Isopropylbenzene, ug/L, (Cunene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0,2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. MEMBER 12/22493 16:38 FAX 612 636 7178 SERCO LAB. COUNTY CLERK IJ001 SMC4 Laboratories St. Paul, minnewta 1931 West County Road C2 St. Paul, Minnesota 55113 _p Phone: (612) 636-7173 FAX (612) 636-7178 I CONFIDENTIALITY NOTICE This facsimile transmission is intended only for the use of the individual or entity to which it is addressed, and may contain confidential infbnnadon belonging to the sender. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this transmission in error, please immediately notify us by telephone to arrange the return of these documents. DATE: /a2 & 3 Please deliver this fax TO: (9✓~4( transmittal immediately F'.QZNi: s4 Number of Pages FTmM: [C~r..k. (including cover sheet) BERM Laboratories tents-. If you do not receive all of the pages, please call (612)636-7173 as soon as possible. Wherr Quality and Seance Count l' SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 1 of 3 12/22/93 St. Croix County Zoning DATE COLLECTED: 12/06/93 1101 Carmichael DATE RECEIVED: 12/07/93 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins i CLIENT'S ID: Stolber SERCO SAMPLE NO: 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/ L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 ~R 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) „ 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. OZI), MEMBER SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 2 of 3 12/22/93 SERCO SAMPLE NO: 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <0.5 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 tr-ans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, uq/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L <1.0 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. J MEMBER SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 34603 PAGE 3 of 3 12/22/93 SERCO SAMPLE NO: 162823 SAMPLE DESCRIPTION: Stolber ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 C5 j 1 21 This sample's analytical results art below the U.S. EPA's SDWA Maximum Contaminant Level of 1/30/91 for those requested compounds which are also on the SDWA MCL List. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane J. An erson Project Manager < means "not detected at this level". 1 mg = 1000 ug. x'd~ § s';~p{ MEMBER NE 13 ye- r s STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER `STAtA01rV ADDRESS yOZ./~`X~~l~ fft~pso~ W ~S. Sf `o/ lv SUBDIVISION / CSMJ CS~`'1 ~EU.0 D 1,0 LOT SECTION. 19 T 2" (~N-R /00 W, Town of ST. CROIX'COUNTY, WISCONSI- PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SIP ps- i ORIGIN AL INDICATE NORTH ARROW Provide setback and elevation informal ion on reverse of this form - Provide , di.mens ions to center o: : ht? c tan, manhole cov~1 BENCBMARR• `rbP Of= W4~-jl 64S!A36- (ff"5APS7- ?^O-) 160•0 ALTERNATE BM: AJEw SEPTIC TANK / PUMP-effAMBER / HOLDING FORMATION Manufacturer: Gt1-EXS Liquid Capacity: 1000 Setback from: Well YZ~ House ZG Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 7`. A."0.0 f " Setback from: well: House > So Other 2yd. 0141 r~Ps ELEVATIONS < ~ Building Sewer ST Inlet: mil2.60 ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade la t 5 4 3 DATE OF INSTALLATION: PLUMBER ON JOB: -Po8e?-r ZJL13R i c(47- LICENSE NUMBER: MFRS 330? INSPECTOR: 3/93:jt ~5: zoo j STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# _ LOT # SECTION. T N-R W, Town.of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center"of septic tank manhole cover. As-OUiLT PLOT- PLAQ - c Lt uArrtok) s_ ,l II Y ~ sY51"5 ~~•o D' ,V 7- C'`ND NSPECS SGT • 1~2 S 17 t'ST p • pwvp Ise)( c- fj ~fiPE~'t TE` 4,0O re- c r !J 5M , l ° ~ \ ~ry it s ' 30 ~ ~ \ 1,ul~T ~ d ox vRop „0x Gbw-vF/olii . 3 p of G •-~t~ y~ ~y ~~AtiS~'Tiov NtW I ya r y5 /3E.~p I x lDO ~ N E W 5c~ , S tJ~ O yC7 p(JC " 'j X71 of "ISRAJ Gar if /-/OUT T~INt' ~O -1,4y ~/IPA! . SE wLR Top of \ ._I 3 /3Ej,1PM , • c~cD Teak ~vM pL A~ -te eovaT/ Sha ~ r i o•v l 1- 9 - q 3 c,~ CEO ,vEr v ~.~,~,r kl S i y„ ,P, st,p s /3E,vE 1 A M~t~v tfa iE +~b~s , part ~t • 29.18W, f KI' %:AYf §V' t , T S I M County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: De ription: L / Parcel Tax No.: G 1~r. GC)7BM TANK INFORMATION ELEVATION DATA A9300361 1O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosm g Aeration Bldg. Sewer Holding St/ Inlet 7 3S ' ~Z T' NK SETBACK INFORMATION St/ ~tf Outlet c~ Z, 9Y* TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosin NA Header. Aeration A Dist. Pipe 40 Holding Bot. System Al 60 PUMP/ SIPHON INFORMATION Final Grade 76~° 7114/ r Manufacturer Demand Model Numbe GPM KJ 3, TDH Lift Friction ilctpm Ft _ p L e (/Gcx o = ( /l?, 73 1. E7 Forcem ngth Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width p Lengtl-L / No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S DI E Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION Type O CHAMBER M umber: System: OR UNIT DISTRIBUTION SYSTEM Headers htt /I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length i_5_~ Dia. Length 5C Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over tf ,r Depth Over to it xx Depth Of xx ed xx Mulched Bed/ Trench Center _ 52 Bed/ Trench Edges _ . j 2. Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCCATION/:WARREN.18.29.18W, SW SW ALEXANDER RD. Plan revision required? ❑ Yes It -4b Use other side for additional information- /D 7,3 SBD-6710 (R 05/91) Date Inspector's Signatui4e Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i SANITARY PERMIT APPLICATION R In accord with ILHR 83.05 Wis. Adm. Code COUNTY STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than !!jj qql ~art-~ 8% x 11 inches in size. ❑ Check if revisibn 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 I PROPERTY LOCATION o~B Ito Y, sw ~4, S ig T 29, N, R /8 E (or) W PROPERTY OW ER'S MAILING ADDRESS LOT # BLOCK # O ~t~lFNOE7~ /2~ Cl0 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ?0P_n to t• 5 yo2 3 3 Sao 7 ~s.~I N br lrle-ea,PPe=22 y_--7- II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ CITY ~GE: NEAREST ROAD ~y 3 . wRep&?4 J41&-%AJ ~,e. ~ - ❑ Public LJ 1 or 2 Fam. Dwelling of bedrooms _ PARCEL TAX UM III. BUILDING USE: (If building type is public, check all that apply) ®y~ l Q Sv ' 0- 000 10 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 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Checck, only one in line A. Check line B if applicable) A) 1.0 New 2. L`_7Replacement 3. ❑ Replacement of 4.E1 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # _ Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 S!e page Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 L_TSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Z Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill 2 T~pF, j f.,( S 5"8 VI. ABSORPTION SYSTEM INFORMATION: ~S so , 000 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE >J~^O REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 472'0 ELEVATION 77 i 3 .157910 N~ p~~~ 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 Septic Tank or Holdin Tank W $ Lift Pump Tank/Si hon Chamber CD.Vi Q VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) *W/MPRSW No.: Business Phone Number: Tea, r Zr/6e% 7- 1,33 o 1(715 - ?~BS' Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary,Permit Fee (Includes Groundwater Date Issued Ming Agent Signature (No Stamps) /0 1 Approved ❑ Owner Given Initial 10 Surcharge Fee) 7 D Adverse Determination ~ jo I X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (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 Wiscowsin Administrative Code will be applicable. 3. All revisions to ,I-0s permit must be approved by the permit issuing authority. 4. Changes in owner hip or plumber requires a Sanitary Perrnit Transfer/Renewal Form k' SF-71 6399) to be submitted to the county prior to installation. 5. Ow-.ite sewage systems must be property maintained. Thr tank(s) must be pu!i ,ted by u °.icensed 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. IL Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. It 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 cf system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. Vil. Tank information. Fill in the capacity of ev-E~ry new rind/or existing to ii", ;st the total gallons, number of tanks and c:::gnu`acturer's name. indicate prefab or site constructed F:r:c: iank material. Comolete for all septic, pur-ip/siphon and holding tanks for this system. Check expE rinrt: ,fa+ r3~ proval only if anks received experimental product approval from DIL_HR. Vill. Responsibility statement. Installing plumber is to fill in name, license no-hb -r with appropri>te prefix (e.g. MP. etc.), address and phone number. Plumber must sign application fc;;rm. IX. County/ Department Use Only. X County/Department Use Only. Complete plans and speciflcation;=, not smaller than 8'/2 x 11 ini.f ez r t bF subrnittcrd to the county. The plans must inchude the folrnwi;;a, plot pian, drawn to scale 'ovation of holding tank(sl, septic tank(:.; or other treatment tanks; bu' .+cr C velis..tia er ;pia n -,eater service; streams and lakes, pump or siphon tanks; distribution box(--, r c•tic n systen ! rerd;. --rnreit system areas, and the ioca-,ion of the bui'cjing served B) horizontal elevation r ~,.~reru; ~ points; C) complete specifications for pumps and controls; dose vciume. elevation differences; trictisn 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 ^Juded the creation of surcharges (fees) for a nwr.,s,}r of regulated practices which ran effect groundwater. The monies coy ected through those surcharges i.,J used fir ^~on •or gr•nr-ndwater, g,,-;;iit,d- water contamination investigations and establishnte-pt 0 sa arhiarcls. SBD-6398 (R.11/88) Its W 0 0 a x Z o t 0 ~o N s ~ orn / S In C% -I ~ off. ~ ~ `rid v i Z ~ Q W N too, m C -4 00 ~ m ,p C } -x GJA TkE N C 4- Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12' Above • Final Grade Ly Above Pipe 4' Cast Iron " '70 Final Grade Vent foe' Synthetic Covering Min. 2' Aggregate Over Pipe Distribution Pipe 0 0 0 0 0 -Tee (o Aggregate 0 Beneath Pipe Pertbroted Pipe Below _ Coupling Terminating At Bottom Of System ~Q•0' Fresh Air Inlets And Observation Pipe Lo W T em c H.- R Q•~--- Approved Vent Cop Minimum 12' Above Final Grade 4 Cast Iron (p " Above Pipe - 1o Final Grade Vent pipe Synthetic Covering min. 2' Aggregate Over Pipe Distribution - " Tee pipe 0 0 0 0 0 Aggregate Beneath Pipe o Perforoled Pipe Below o -Coupling Terminalinq At s%STE.-i Bottom Of System ~s. sa • G O I-+O y e® 1 0 0 n E 000 O 0 I < 01 CI rt. I y.. o e E'1 .c N a. F © M O EL a~-. U A N M 1 N b n v f. N' o. o E7 v o H u•- O N 0'a I rt u ~i b o r N i^ O M G c .o n nr m rn fJ11'S O . rf. 0 Cm Y•r- fn I C u • b• T i j O IT ~r1J 1 to O~ oor~ C O O - x rt, y u T \ « JJ• i ~ ° IV a n fD it C Er) _,-S00058'2511E-244.251 - _.4 Eo rr ! Iii n K O O M I i .n rn Ily ` o ~ m '^v Ih r• En u rpm ° I L _ =1 En j m~ao n ~N Iri~; pr• I I• D m 7-°' L 7 7O i ` _ South line of the SY} of Section 800058'25°8 ~ / co, r Dk00°58'25"Y 3J0.04' 2290.65' _ 0^ ° o N Y ''E rr m rt a ~ti a r^' v O m O M P-h O ° c rt 7 -o : 2 new l 0 00' SJ ~ ~~7 • ro ~ / 300 O / JT f S' f „ m H/ ~r.n z O O I-h I-h N N b Q s N G (D 0 C' o d r n G "ern. gearing, are referenced to the w• ~•1y South line of the SN} of Section G ° ' ~ 16, assured to bear 800 5812511W. N H r bu z st'. rtm nof Industry, SOIL AND SITE EVALUATION REPORT page of an Relations of ty & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but G got, 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 STk pM Ea ' e_Av o yL,.) S+6 19EIP-6-- GOVT. LOT 5w 1/4 w 1/4,S 19 T -L N.R 18 E (06D PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # QoZ Ac.&x,4,aDER l2D • . C,sM CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE N NEAREST ROAD {{UflSo.d Z-0I S. WRReE-1 ,4,:.4r.-z4A3DE,,e_ [ j New Construction Use ( Residential / Number of bedrooms 3 (j Addition to existing building (Replacement ( I Public or commercial describe Code derived daily flow ysD gpd Recommended design loading rate • - bed, gpd/ft2 • trench, gpd/ft2 trench, 1`12 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required Gy3 bed, ft2 -16-3 Recommended infiltration surface elevation(s) ' Z~ -ej • 3 ft (as referred to site plan benchmark) Additional design/ site considerations use` 7,t'rA.)4i 5 ''off PV-02 day, Dr'SrjQ#'/30Tr Parent material SR --S S1 - R U R k In A R1>l 5 Flood plain elevation, if applicable W •4 ft ;a 0 L_'Tt4j 01A if S = Suitable for system C~ONy ENTIOIK MOUND INN--GROG PRESSURE AT-GRADE SYSTEM IN Fly HOLDING TANK U = Unsuitable fors stem ~S 11 U ❑ S a6 fi~S L7 U ❑ S ❑ S [3 t7 Fitt .4,h7'"j*Al5 /1-10' SOIL DESCRIPTION REPORT - idt MA-re t'AJS AT- -13f Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tret-0 -fill MAT-E-le, . AL A -2~ /dYR 311- SuRrFD4a 51 1•f. S6>; /w►~ tC-5 2.F. 4 .5 51 z,µ►, sbk y~f R_ GS if . S . ~ Ground (3 kq-qg 'lSyl; . 7 elev. ft. C, -loci SyR y~~ 1-5 CS Depth to a 1_ 60-118 10 v e 519 f miling ,r „ ,o y~ sly oar S oFa 1 s o, , - Remarks: Boring # A 04 o y~ 3/ 3 - 5 2,A..n54K ,,O_F p C5 3„~ . S (o t: } • z~ 7 S' ye y/ sl 2.A", skk n,, I.Pf 9~ c s 3f^ . s . G r Ground c/ r / i . elev. C r -7 • sYA S C co s dr ~t , S GQJ~- . 7 ft. CL Y y0 ~ y/e 5/,F Depth to limiting i factor0 7 Remarks: CST Name:-Please Print oQ~QT 211 1• C kT Phone: s _ ~4, g [ g 5 Address: ' 2Ff~• t~u1USU,.I W l S . 11 - 2g -~(3 CST/-t Cc SS QNCPC D-'f~~--- Sgnature: s LI N C? Date: CST Number: NOTES ce43-r P.5 uCED itslfolptle T~~T cC►~UtTloa s 2Et~o frzosT- Dt Ppox a f~' TOP soil 406)e APEA- aF 8,-133 /41 Ay to EEv To Pe- eu T O F l- S r4M E ~l EU S r~rar n,,.e t~ v,V_ . PROPERTY OWNER SOIL DESCRIPTION REPORT r PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPDlft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench - s 6X 4n r/fR S a . S 0 2 3/.,;, +:jy S1 2 A., 4.1 Vf)P- F~3 3,~ TSW Ground C ~-G • S YR y Ce /S ~~,w► , y,~ G{ f~ C cv elev. ft. C Z /o fie d M4 Depth to limiting factor „ > (10 Remarks: Boring # •h Ground elev. ft. Depth to limiting factor Remarks: Boring # iW:+TYnY.t~ ~hik{{{<Lti2Jh~~ r Ground elev. ft. Depth to limiting factor Remarks: Boring # Y{'~ s . .l0i ti{ri~v tiv Ground elev. ft. Depth to limiting factor Remarks: eon ooonio ncrnrn t ,t of S ~ w 0 a of ~ o o I' 00, ti IS96 S 7b c 70 m (lam vi Q Lo N - rn ~h m a -Cr I< 00, -4 ~ O N 00 o O ~m I S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/oUYER_ 4AX0X441 J ADDRESS FIRE NUMBER 7 CITY/STATE4013 r5 Lu/'S . ZIP Z 3 PROPERTY LOCATION:' 56o 1/4, 54U 1/4, SECTION jg , T Z f N-R 'W TOWN OF St. Croix County, SUBDIVISION LOT NUMBER 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. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary) . the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: Thai/aN~. 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 in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenia 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 y£'~ 6~rl'y Location of* property S~ 1/4 Sw 1/4 , Section 1 p , T N-R W Township Mailing address PAW- ~~~T~ Gv~~ Spa?-3 Address of site Subdivision name d P46-VP/'V CLot no. Other homes on property? _yes /No Previous owner of property Total size of parcel 'y.1 S Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes L 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 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 %he office of the county Register of Deeds as Document No. 11.E , and that I (we) presently own the proposed sitee sewage disposal system or I (we) obtained an easement, to run the above described ro ert the construction of said system, p P Y• for and the same has, been duly recorded in the office of County Register of deeds as Document No. o aAe ign ure of appl cant o-a pelican V Date of Signature Date of Signature 7~ . .DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1--1982 THIa canes RaasRVSO FoR IMCOMINO DATA Y WARRANTY DEED 461133 • ' REGISTER'S OFFICE This Deed, made between ...Nter..& 41mey__aAl ST. CROIX 00.1 WI .Y17cgiA H.- qgy,.. usbanc~..and_.wif~ Reed for Rewrd - t*4 061990 and tephen Lr. Stolberg and' Z'arol'yn'lYa RtoY )er 'husband and wife as survfvorehip_maritaY :pioperty CA~^+~.JVC bplM9rdOwd~ • Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... i conveys to Grantee the following described real estate in ~t . Lroix RtruRN TO County, State of Wisconsin: The West One-Half of the Southwest One-Quarter (W1/2 of the SW 1/4) Section eighteen (18), Township Twenty-Nine Tax Parcel No (29) North, Range Eighteen (18) West, and also a parcel of land described as follows: Commencing at the South East (SE) corner the South East One-Quarter of the South East One-Quarter (SE 1/4 of the SE 1/4) of Section Thirteen (13), Township Twenty-Nine (29), Range Nineteen (19) West, thence North Twenty (20) rods, thence West Eight (8) rods, thence South Twenty (20) rods, and thence East to the place of beginning. -R .Also all the part of the Northwest One-Quarter of the North West One-Quarter (NW 1/4 of NW 1/4), Section Nineteen (19), Township Twenty-Nine (29) North, Range Eighteen (18) West, lying North of U.S. Highway 12 and the right-of-way of the Chicago, St. Paul, Minneapolis lk,.id Omaha Railway Company as now located and established and containing 6.2 acres more or less, and also all that part of the North West One-Quarter of the North West One-Quarter (NW114 of NWI/4) of Section Nineteen (19), Township Twenty-Nine (29) North, Range Eighteen (18) West,` lying North of U.S. Highway 12 and South of the Chicago, St. Paul, Minneapolis and Omaha Railway Company right-of-way as now located and established containing 2.5 acres more or less. St. Croix County, Wisconsin. . This --i8 II--°--- homestead property. *W'68 not) Together with all and singul1ar th hereditai eny and a purte antes there, nto belon -n l And.____grantOTBPeter. E. Malvey and Virginia Malvey, huand an~ wife warrants that the title is ce ' - good, indefeasible in fee simple and free and clear of encumbrances except easements, protective covenants and restrictions of record, if any, and will warrant and defend the 9 am~ Dated this day of August , 19 90. ...._.....---.(SEAL) (SEAL) Peter E..Nalvey • ' - ;---......(SEAL) l~'c!'~ (SEAL) Virg i aii lvey - _ ' A61i1THNNTICATION ACENOWLEDGMBNT I Signature (s) Peter E. Malgex and _ - _ STATE OF WISCONSIN 4inLx!is Nalvey es• --County. snthentieated this - ay of -U St - 1990 _ Personally came before me this ----------------day of 19..--..._ the above named - TITLE: STATE BAIT OF WISCONSIN (If not, -:g antharized by 706.08. Wis. Stets) to me known to be the person who executed the foregoing instrument and acknowledge the same. r. THIS INSTRUMENT WAS DRAFTED BY I YGjOOD _ and . CARI i~ by Samuel R. Carl • 11 . • • PSQ:--3or-329•---11adsm- -V1----_-5'481fr--------------- Notary Public County, Wis. i a>r(Signatures a y Ige authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration i necessary.) date: 41famas of persona sisnins in any capacity should be typed or printed below their signatures. WARRANT! DRLD sTATR BAR OF WISCONSIN Wisconsin Legal Blank Co. Ina. FORM No. 1-1962 binwaukee• Wis. Parcel 020-1018-60-000 06/21/2005 04:03 PM PAGE 7OF 7 Alt. Parcel M 13.29.19.88B 020 - TOWN OF HUDSON Current k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * FREDERICK, THOMAS J & MISTY L THOMAS J & MISTY L FREDERICK 902 ALEXANDER RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 902 ALEXANDER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.870 Plat: N/A-NOT AVAILABLE SEC 13 T29N R1 9W PT SE SE BEING PT OF Block/Condo Bldg: LOT 1 CSM 10/2725 (THE OTHER PT OF THIS CSM IS P283A & P294A-10 TN OF WARREN) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1063/393 WD 07/23/1997 877/604 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.870 4,400 22,300 26,700 NO Totals for 2005: General Property 0.870 4,400 22,300 26,700 Woodland 0.000 0 0 Totals for 2004: General Property 0.870 4,400 22,300 26,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 042-1050-10-100 05/16/2005 05:09 PM PAGE 1 OF 1 Alt. Parcel 18.29.18.283A 042 - TOWN OF WARREN Current k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * FREDERICK, THOMAS J & MISTY L THOMAS J & MISTY L FREDERICK 902 ALEXANDER RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 902 ALEXANDER RD SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.760 Plat: N/A-NOT AVAILABLE SEC 18 T29N R18W PT SW SW BEING PT OF Block/Condo Bldg: LOT 1 OF HUDS )INCLUDES 042-1052-20-100 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 18-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1063/393 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.760 34,600 69,100 103,700 NO Totals for 2005: General Property 1.760 34,600 69,100 103,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.760 34,600 69,100 103,700 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 Parcel 042-1052-20-100 05/16/2005 05:07 PM PAGE 1 OF 1 Alt. Parcel 19.29.18.294A-10 042 - TOWN OF WARREN Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * FREDERICK, THOMAS J & MISTY L THOMAS J & MISTY L FREDERICK 902 ALEXANDER RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 19 T29N R18W PT NW NW BEING PT OF Block/Condo Bldg: LOT 1 CSM 10/2725(PT OF CSM TN HUDSON) ASSESSED W/042-1050-10-100 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 19-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 10631393 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r SURVEYOR'S RENO D 512311 0 a d -1 =r M a (7 H ~J t+ w I O 0 A m u a d c E co 0 c a 7 O 0/ N O (D ('f rt N II OD I-• (D ('h V A 11 0 (D w• rh N 7 II O, O, r• tG W (9 d N N !G rn V x E P ° m .r- d r o ® Z rn i N u q I 7 d 7 d V O N w - (D a N L C) O O, O O to o b rt. - oc o Oc r to t+/ O 1 h a of o v o N %~j ~t <n rn rr rj D7 CO r'r M -0 •c rt N _ w Cr v o to w c m C7, ro ro m rt ~i h•h CD x- ti a rt O 'V C r- e r o /O~ n ~ % ~ N 0 En s e OOp IL) 0~A k rt En 16 r c C s f~ 7 I Z~ p O Z G O hfi J P. a°o o° N M I l`7 1-~ °o "o rn T ~ C 'r'1 N T CIL N 33, 0 •n o I°z c (D -n 0 33' I 00 G Cn 0 N. / 00 5812511E_244.25' to rt 4r ~y n '•G O % O a I I> I' En z coo I L? I Z- N N N o to tD rt 0~ S N CC n 0 O rf 0 n. T N w Ir7 ~ N. 0 to 0 C--) a N N rn M L r 00058-2511W / West line of the SW} of Section 18 CO DNOOo5812511W 3300.041 2290.651 #4 p, w m ~ N rt Cl) d 7 lb CD E~l - CD rt r / CIO 0 C= co ~n 0 -0 w ° -1 Go mo~ rt rr rn (l1 O N ("r / 79 G N O m m O D o O 3 7- 9-3A Jai ---rte i i :3' (D O tD tLI 4-r O •y O ~y J ~ A /O NI9 c S / I-h / 03/15n :i t a r p L c ;4 + n / < i1 Lt cn ~y O 1D 11 W 0. O7 -p C) tel. r ,1 Q.. 0 hh c o rt ,~q~Cc~dp 1 r r I fi~ Q (n (D u~i ni v r4l 0 (D o z ,bb 0 rt tzj O 0 d f'f V•C ~ t~ r rt C Id r IFx'11. r H S U r' CD --q Bearings are referenced to the W . rt r ~~yrt) West line of the SW} of Section 18, assumed to bear NOO0581251'W. H ~r.Br re •b , ''41 • ~ CQ H N z This instrument drafted by Michael Erickson Job No. 92-43 VOLUME 10 PAGE 2725 .r _ rV -mil . iX c~ ~ Dyz 1dj_d ID &r Co z / os'Z 2 29YA &rll AI46 ~ FILED ~ ot't adz los'o /a ioo ~'3A 1 '-JAN 2 71494 ► 8 Pd'2,r` ! es~ to/2z~ ism ~/a zz,s~ .LAMES aCONNELL Register 0f Desds 512311 s~ craxco• wi n n n z C7 1-3 :h t" co a) -3 i O • a' u:3 0~ G O 1-- O :C 00 n CD ,n n a c a N C G E iu '`T rt r) II CO - (D (y' 7 (D C) CD ro :M. 0 0 x o, o Ln © 0 0 pyJ to r- o r -3 a z u y- N rv v I C G G (D IN U) 47, (D a A = r+ ' C, C7 v o N w oD C2, rt. / -3 o 4 w ° ON U) 0 'U ~ a v coi o y' / v o V 0" 0) N N co CAD (11 W (t rF .n r , / o+ a m c m / rM rn (n F1 0 o X" N a r~r m rt t•'I f f1 o ► . (D 3 M = ((D IC _ 0 En T e - 00 p ILA O A X' (t (n rt. v ° Ir- IrIJ c 0 = £ 5 -k z Ij>I, i_'o (717 o ° M0 oz 0 Pi 0 co n° m Il_7I-~ v G 0 ht c o U)~ I~r'Irij $om rt X rr .r 1 L4 y 33, Z -n v Ir_'7 0 0 cto N 33 ; 0° E G / SOO058'25"E-244.251 ; (n rrt A n 0, 0 o ~oiy N I~ Ir- 00 .7 hh I> E o ~Op I It? IZ~ N• N• Cn U) (D ~1j a 0O N L' i l r i 0 (t • ,e I =E r N 0 C-~ n . N G r„ L NOOo58'25"W West line of the SW__-Lo f Section 0 DNOO658125"W 330.04' 2290.65' r" : M #4- rp rt n o J r ~ ° FJ C1+ ,•r o -3 j/ O .r`~ O A 2 p p O X C A O O r o V n o Ootr p I i r t rTl O 0. 0 • _ `0 N O M O F'h rt _0 Z -Z y o /O N19 0311 Fh ~h v' rt „ "t Z:;' (D V CTJ A`t c O rt 'm~~~'G G'l~D rt. tp X h'h cf) C1. 4- M -1 (D 0 Z b'► a n rr t7j Fj / ;TJJ T. 41 N. 0 ^6` F l0 M Bearings are referenced to the v w. rt "N~ C° .'S``}rt West line of the SW} of Section 18, assumed to bear NOO05812511W. y I__ 1W 1-3 1-` Ili Ez This instrument drafted by Michael Erickson Job No. 92-43 VOLUME 10 PAGE 2725 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST G R~ 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 GATE PROPERTY OWNER: PROPERTY LOCATION 5Tjjpk Ea LAR O yLA7 -Crf e 19 ERG GOVT. LOT Sou 1/4 sw 1/4,S 19 T 2q N.R 18 E (0& PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. `NAME OR CSM a QoZ AL&-XA.aDaR 'R>D • / C M / L9 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WN NEAREST ROAD f'oD.SOAJ ZJtS. 511014, ( ) WAIteE-), A(-,Qx4z1)s-,e- [ ] New Construction Use [-KResidential / Number of bedrooms 3 [ ] Addition to existing building j#I'Replacement [ ] Public or commercial describe Code derived daily flow K 4P gpd Recommended design loading rate bed, gpd/ft2 • trench, gpd/ft2 Absorption area required 413 bed, ft2 563 trench, 112 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s)- Py • 3 ft (as referred to site plan benchmark) Additional design / site considerations ZCSE' w 1A P WP 4 8 X D y S rA, A 0 T-, o,v Parent material SC S 51 - R u (Z k (n A RD I 5 Flood plain elevation, if applicable ?'1.4 • It rSu== Su itable for system C~ONyENTIONAL MOUND IN~GRO PRESSURE AT GRADE SYSTEM IN FIy HOLDING TANK Unsuitable fors stem US ❑ U S BV IBS L7 U ❑ S S C~7 ❑ S FN I, M AT"i Af 5 r►>` SOIL DESCRIPTION REPORT f ilk MAT-k-ei t X415 AT- Imo- 1 ,47- 13, Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mach I O -IL r----• S 1 S. i I I rt `I'~,L° ►•h C S x ,q LI-21 /p yP 3/2 SuR/t?oa SI 1 •`F, 56K /w•~ t~ C S Zf - I . S 1 0E/1y Ground 13 y-Hg l.Syi; yl~ 5 sbk g f9- GS ifi, , S elev. . I SYR y1(e (s , , 9p C S . 17 Depth to (f1- 60-118 10 Y9 519 ^ S , A,", Mn I 0 limiting fac~-,1 ~ /0 y(I 5/0"', S o F'► 15 0"", /p DQ'Q- • d Remarks: Boring # 3f A 0-9 OVA 3/ 3 5 ( 2• , 54g ,~v-F f2 cs s,~ 5 .6, 5 3f . C. k t3 - zp ? s y,e y/ s~ 2.,v" slk L~f , s eev nd C, 2,8-6 ?.Syp `l~~Cv - 15 0,,w, fie ~ Ccc.9 q9.9 ft. if 1; 10 /0 YX 5-1 A" #S Depth to limiting factor *7 To _ 7• S • Remarks: CST Name:-Please Print D 51.Q T- SLR I* C 1'17- Phone: 11 s _ g4, S g 5 Address: &SS D' N [-'r[ 12f~• ~c~► S ' ZS ~~13 05T,4 Signature: Date: CST Number: 40, a, OTC- S TesrUtrccas z 5000y z 2EPo fRosr s~t-pd~s ~pPyeox . a f-►' Top Sole eot-D3 /1 Ay ;RIGINA~~ ~E~v rb ~ CuT-O~1c SO TP E,u66,,E75 C^N u01'PbR,-<L-y s1 'T->:p hr SAME- F-(EFUAT-1.0"-5 r4S pr~~asv &A-) P~ . 3 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch ,a. 0' A 0 „g o 2 3 - - S1 2 s 6X rho - S a . S t3 9-3'y 7,50 y/ S/ 2 &1 skc- trF~e e s „ S . Ground C-G "1. s yl2 y/le /s C7,"+ , y/r; G~ f~ C 4~ / '1 elev. Depth to , limiting „ faUctor 7 /0- D Remarks: Boring # Ground elev. ft. Depth to limiting factor 171 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ri i••t Ground elev. ft. Depth to oo~ limiting factor Remarks: Con 0.3 •l AID nrinn% r NI rN 0 0 O K o ~ i o 0 o I N O O / a \ T d Q w / O N N. is ! i , a o C, E L's / rn L ~ cJ~ c~ ~ rn / L L, N \y rn a - o co 040 J 00 °o ul - d o asi ~ N uJ l~l W W y r e ~ i I I r- 0 nt I / / v'a " i i n rt E CO E01 N t~ I O ~ ® J 1 d 6 7 c C ~ z a I p Yf A N 1 W N ~ ~ rt' u u W t••1 / p r• P v Y D 1 O ni -4: Cl O ;t o m r o i i c 1 1 1 G~ 7 N ~ ? Y _ N n• t A O N P O O m 0 . R Y b o r_ W O M a s rt v w C-1 _ a o .o ' n. m rn E/f h O Y c rt f1 M ^ T 7 / O n 0 7 N W Il_ nZ W O& r1 n i ~ Imo: ; a i o' K $ eT A Ir IrU n - ar . b O Ii1 I H V:O n n , . O i V I(7 1~~ 0 0 2 G O 0 e O0 a o Q Ir ~Ir_~ ~P rV X N I y,nl 2 it I in t F / ,-SOO058125"E_244.251 I':- N rr ai' I ' I Icy 0 < I ,i O O M I i / a~ U fly Ir N '-I ' _ b w o Irk ,__t ' En ry anti .v rn I 1--' 0 n Q 11 N O r7 South line of the Su} of Section 8 L NOCo58t25"Y o a O'N00 58'25"A 330.04' / 2290.65' 00 a C err m -G 0 r Ni o„ M M D' C, rt "r m ° O t 7. /r r. fn i M &r r8'SJ~ OI M rp, rt ::r O i ^ n to Ma't' - :r 0 O rn c r tr CK ~{!y: ~~~i'. M En V) (D P. 0 x1 M Q Z ''1''•~ I N ~ y~ 1, t O 7 G rn Bearings are referenced to the v E. ~•i Z South line of the SW' of Section 18, assured to bear 110005812511W. F-' ~l H • Fl CJ ab LO i ~z