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IN
RTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
NDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/NlALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME:
W 1145B1/ 5 /T30 N/R184(or) ry Richmond 2 n/a n/a
COUNTY: OWNER'S BXXU$NAME: MAILING ADDRESS:
St. Croix Halle Builders 11767 115th. St., New Richmond, Wi. 54017
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPR0FI E DES RIPTIONS: ER O ATION TESTS:
Residence 3 n/a 7PAew ❑Replace 7-15-92 a
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING~~TxxA~~1N'~K: RECOMMENDED SYSTEM: (optional)
® S ❑ll ~ S ❑I S ❑U S ❑U ❑ S DU trench split level
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS awe 27 SIB
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 84 104.40 none >84 0-5, 10yr3/3, L.; 5-20, 10yr4/4, sil.;
20-84 1 4/4 ls.
B 2 84 104.55 none >84 0-9, 10yr3/2, L.;' 9-24, 10yr4/4, sil.; 24-44,-
3 84 102.90 none >84 0-8, 10yr4 3, L.;' -25, 1 4, ls., 25-843,
6- -
^yr4/4, stratified ls. & gr.
80 101.00 none >80 0-9,410yr4/3, L.; 9-30, 10yr4/4, ls. ; 30-80,-
B6 5 4 82 101.25 none >82 0-7, 10yr3/3, L.; 7-17, 10yr4/4, sil.; 17-45,-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH
P-
P-
P-
P-_
P-
P- _
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
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. 100.65=upper trench
SYSTEM ELEVATION 99.40 = lower trench ib f
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 7-15-92
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 715- -6200
CST SIGNAT
STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
HR-SBD-6395 (R. 02/82) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To b a cornplete and accurate soil test, your report must include:
1. Corn .-gal description;
2. The L ion must clearly indicate wheth _ his is a residence or commercial project;
3. MAXI number of bedrooms or cornuse planned;
4. Is this a r or replacernent system;
5. Compl.. _ _ uitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TAI.'" ONLY IF ALL
OTHER SYSTEMS A RULED OUT LASE! ON SOIL CONDITIONS;
6. PLEASE use the `ins shown here for writing profile descriptions and c; the plot plan;
7. MAKE A LEGIBI am accurately locatiig your test locations. Drawing tc eferred. A
separate sheet may _ :f desired;
S. Make sure your I" id vertical elevation reference point are clearly shmnrn, and are permanent;
9. Complete all apprr 17xes as to dates, na nes, addresses, flood plain data, percolation test exemp-
tion, it al
10, If th(inf :food pl~.i:, '=rvation) does nf` place N.A. in the appropriate box;
11. Sian the _ current. ;ss and your , can number;
12. Make le( sc' )ute as r .'luired. ALL TESTS MUST BE FILED tNITH THE
LOCAL AL O Y ",IN 30 DAYS OF COMPLI
AL i, V'IATIO S FOR CERTIFIED SOIL. TESTERS
Sail 1 nd Textures Other Symbols
st - kr 10") BR - Irock
Coh - C. '3- 10"} S dstone
gr Gr-',el (under 3") LS - ~estone
HC Groundwater
Sand rtion Rate
Iitt ii Sand
s - L _ n
I all,
Lan -
BI
Gy -
- Clay Loam Y
- S idy Clay Loarn -
Clay Loam n
Clay
:y Clay
y
p - p : lit
HVJL I
xtures vti
~Jsposa, BM k
VRP - Rcterem
TO THE GUNNER.
Apo V {i p in !Cursntl a san::G,i y I rnrt. TI} county Departr, -it - y ~ tuest
~ :I prior to p,.-f- ICI
1 and
'rinit,
c •
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER W,0'0
ADDRESS J 7fo'1 i
IV - k.
SUBDIVISION / CSM# A LOT #
SECTION S T JO N-R W, Town of~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF YSTE
R
s.
3
INDICATE NORTH ARROW
i
f
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
• p
BENCHMARK: 5, Gt)(.b H n t/Y` ).a t Xaif
ALTERNATE BM:
SEPTIC TANK / PUMP :CHAMBER / HOLDING -TANK INFORMATION
Manufacturer: ~Q~.~~...Liquid Capacity: /Oz D
Setback from: Well House a 9-Other
Pump: Manufacturer Model# Size
Float seperation i Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: 5 Length X3 Number of trenches
Distanc & Direction'to nearest prop. line:
Setback from: well: House Other
/v ELEVATIONS
X09. 3 S"
building Sewer ST Inlet. ST outlet %SIM
PC inlet I PJ PC bottom Pump Off
Header/Manifold Bottom of system /DOS
Existing Grade .14)-31 _ Final grade /d' 3L ~9~
DATE OF INSTALLATION: 00 ✓ / 3
PLUMBER ON JOB: C)a
LICENSE NUMBERI,e 4.5&3
INSPECTOR:
3/93:jt
LC)UQ'iA'd1~i0NepaZXQ i. 30.18.60ft~?r A9G?4YSftMHWY. "64"County:
Labora uman -Relations
INSPECTION REPORT
Safety and Buildings Buildingsgs Division
(ATTACH TO PERMIT) sanitary ermit o.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village X0 Town of: State Pan IA No.:
v.: Insp. lev.: BM Description: ~i Parcel Tax No.:
` t
TANK INFORMATION ELEVATION DATA A9300169
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark C; 14 # +I; /00, 0
Dosing
Aeration Bldg. Sewer r`0,i8
Holding St/Ht Inlet ~.JA /uj.14
TANK SETBACK INFORMATION St / Ht Outlet 6-75 , a a, s 3
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic Sao ' So NA Dt Bottom
Dosing NA Header / Man. $,7 I u o.
Aeration NA Dist. Pip z.~ a 7. 4 (s I L) o I. C3
Holding Bot. System 9R r 2.
:S t ov.~5
PUMP/ SIPHON INFORMATION Final Grade c .O ~ 103, Aj
Manufacturer Demand !CZ. ) o® ,
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth
DIMENSIONS 1Z- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O rt/eA,, CHAMBER _ Model Number:
System: .7!u-, .l - g 5 3S > 7 S 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: RICHMOND 5.30.18.68A,NW,SE,LOT , ST. HWY. "64"
(D C)
es u
Plan revision required? ❑ Yes ❑ Nr d
Use other side for additional information. e,cL,kj, V.v b
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: T
as e =
„LHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATES ITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ f r\L/. p vious 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
W A,-, L-'\ C , /1JUJ% S~"' %a, S S T 3q N, R Ik 40) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
1 F
/S FT 5 f ,
CITY, STA ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM 1JUMBER
M_aW (n Shot 7 a ,G,~i ~p
13 CITY NEAREST ROAD
II. TYPE OF BUILDING. (Check one) State Owned ❑ VILLAGE R =N QF:
C_kM0r41A 0. '4,y
/ 4 ~O
❑ Public 1 or 2 Fam. Dwelling4 of bedrooms AR NU
111. BUILDING USE: (If building type is public, check all that apply) (a _ ~D/ y -moo
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. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 0 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
n REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 160,&S ELEVATION
~ 50 8 0)_ 5 811;~5 N I~sS1~ 9. y Feet /D Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App'
Tanks Tanks
Septic Tank or Holdin Tank /ODU W_2.~
Lift Pump Tank/Siphon Chamber. VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Na 76 Print): Plumber's Sign tur No Stamps) *P/MPRSW No.: Business Phone Number:
C4 ~ U t h U_~-2 r.5 /3 6 3 21f ,)P -312S
Plumber's Address (Street, City„State, Zip Code):
1767 (z ,A-p- 60r~ 5!P0'17
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued issuing Agent simm~ tamps)
❑ Approved ❑ Owner Given initial Surcharge Fee)
7-/1-93 Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
La
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 W'iscorsin 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 Perm;+: Transfer/Renewal For>-l SBD 6399; to be
supgtted to the c n,mty prior to installation.
J'.-
5. OnSite sewage vy-_tems must be properiy maintained. The tank(s) must be ;:.wi:ped by 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.
111. 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
VII. Tank mfor oration. Fill in the capacity of every new and/or excstir~., +e total gallons; number of
tanks and manufacturer s name. Indicate prefab or site consrru_:.: anct is ik nraterial Cor,}f., -4 for all
sep ic; purnp/siphon and holding tanks for :his system. Check e:•c jerimentai approval an!y it tanks received
exper i-m- oral product anpr,.;z,al from DI 'P;
VIII. ResponFibility statement. installing plumb, r it to fill in name; i;,•. ,.Ue number with appropriae prefix (e.g.
MP, etc.}, :address and phone number. Plumber must sign applica.,tinn form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specif~cation~ not smaller than 8'/ V I 1 inr;f°es -!;J-:!t be :Ubmifted to the county. The '
plans must include the following: 10 , !r,t riian, drawn to scale ;IpleTe di_oe:ns,ons, location of
ho!dir+g ?ank(s) ;ep'!c tank(s) or ::t tier treatment tanks: t)uildir ti;~ l!-;: wai(,:: jy); ns. eater service;
streams and lakes, pump or siphon tank; distribution boxes L.;rrti,:n systeniS rFpiar:en'ert system
areas 9 'he building ) hUri~ 1' and I. vgticr reference pclnt:>•
; and the iacatior~ o.. er
C) complete specifications for pumps and controls; dose volume; eleva ot, d,fferences; friction loss; pump
performance curve; pump model and pump manufa,-,turer; 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 r;reation of surcharge: y! for a number of
regulated practices can effect groundwater
The mon es :oi,Facted trio,, 1c :horse slsrcharges are used for o;-.,_
water contanwiatiorn, investi+gat,ons and establishment of star dards
S8 D-6398 (R.11/88)
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/ PAGE OF
C.rrJSS SectJon o SyJcen b
I ~{vn o n ~I
Fresh Air Inlets And Observation Pipe
,^•_-Approved Vent Cap
Minimum 12" Above
Final Grade
20- 42" Above Pipe _ 4" Cast Iron
To Final Grade Vent Pipe
Mash Hoy Or Synthetic Covering
min. 2" Aggregate
Over Pipe .
0141(lbu
Pipetlon_- 0 0 0 0 -Tee
i 6" Aggregate o Perforated Pipe Below
BeneotA Plpe
Coupling Terminating At
Bottom of system
proPoSe~ Pin-, gre.clt
SOIL FILL
DISTK15UTIO1J PIPE APPROVED SIMPETIC COVER
144TRRIAI- OR q" OF STRAW
r OF AGGREGATTE OR MARSH NAy
IOO~ 6s (e OF 12 -2 /2 AGGREGATE %A
V.LEV, OF-FEET-._
Dib-I-RIgUTIrJA1 PIPE TO BE AT LEAST INCHES BELOW ORIGIUAL GRADE
All AT LE.JI INCHES BUT 110 MORE THAM 42 ILICHES BELOW FIIUAL GRADE
MMIMUM DEPTH OF F-XCAVATloo FKOM QRIr`NALWOR WILL BE ~ INCHES
3R49E WILL. BE INCHES
/'UtfIMUl4 BEPTtt OF EXCAv/1T1®N FROM 01'ltI&tbAL C
SIGHED:
LUGEMSE DUMBER:
DATE.
, i
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR BOX H OMAN NDATIONS PERCOLATION TESTS (115) MADISON WI 7969
REL (H63.090) & Chapter 145.045)
LOCA-1 ION' SECTION: TOWNSHIP/NfCp64ClXX1ptALITY: LOT NO.: BLK. NO.: SUBDI VISION NAME:
NW 1149r1/ 5 /T30 N/R18*(.,) yy Richmond 2 n/a n/a
COUNTY: OWNER'S BKYJM R NAME: MAILING, ADDRESS:
St. Croix Halle Builders 11767 115th. St., New Richmond, Wi. 54017
USE DATES OBSERVATIONS MADE
NO. BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
llosidence 3 n/a [Nyqew ❑Replace ( 7-15-92 n/a
it I ING: S= Site suitable for system U=_ Site unsuitable for system
'6NVENTIONAL: MOUND: _
I-GR~OIUND-PRESSUR : S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
~ HS ❑U S 0~ S ❑U ❑ S Du S DU trench split level
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: class 2 Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS awe 27 SIB
kBORING TOTAL -DEPTHTOGROU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
DEPTH IN, ELEVATION OBSERVED EST. GHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
84 104.40 none >84 0-5, 10yr3/3, L.; 5-20, 10yr4/4, sil.;
20-84 1 r4/4 Is84 104.55 none >84 0-9, 10yr3/2, L.;' 9-24, 10yr4/4, sil.; 24-44,-
3 84 102.90 none >84 0-8, 10yr4 3, L.;' -25, 1 yr , Is., 25--N,-
13- 10yr4/4, stratified Is. & gr.
B 4 80 101.00 none >80 0-9, 10yr4/3, L.; 9-30, 10yr4/4, Is.; 30-80,-
10 r4 4 1
B-5 82 101.25 none >82 0-7, 10yr3/3, L.; 7-17, 10yr4/4, sil.; 17-45,-
4-
if
PERCOLATION TESTS
f f f'_ ;f DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCVIES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI o PERI0 D2 PER PERINCH
i'-
P-
P-
P-
P-
: p_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
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. 100.65=upper trench
SYSTEM ELEVATION 99.40 = lower trench 6 ~2
,
:
`
Sty. ~
A < <11 I l
,
i ~
AOk(i i ! I 1
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 COMPLETED ON:
Gary L. Steel 7-15-92
AI)DRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. Ave., New Richmond, Wi. 54017 2298 1715-1;6-6200
CST Sl INAT J_~:
/ .1~
1".180TION: Oi iginal and nne copy to Local Authority, Property Owner and Soil Tester.
;Y
V
48861,4 ccV
CERTIFIED SURVE
o~=
Located in part of the NW4 of the SE 4 of Section 5,
W :4
T30N, R18W, Town of Richmond, St. Croix County, 0
Wisconsin. o 0
9- d Co
N} Corner kLC w.,~~, a, r z
Section 5
W
W _1 C. ,q K,, t t
,APPROVED
IV 7 a~+
Ln CO NY C
• % C W
i W rn _14C"7
115 92 x CU _
C_ fft
Y HUlO:044 d O N
> >v m z A
vjts.
CROIX COUNTY <
.
.,oirlpreh*nsive Planning
Zoning and
Pdrks-Committee
1UNPL HTTED _ " N"S
if not retarded V ~ -
66,1 s'
withip30:days of East-West I line of Section 5
approvatdato I ~ S89053'32"E 311.32' s' 2255.91' E} Corner
aWmval shall be I c S89o53' 3211E Section 5
mi '&'•void LOT 1 0
2.20 Acres
0 0=>95,988 Sq. Ft.
`2 66 Foot Wide -
Iy -Private Road Easement
~-G o x W
~1> I ? to v i~>
i oo'- 311.32' S890531 3211E 316.77'
!Fri o, 9053 32" 628.09' ~
ICJ o CD OUTLOT S89053' 32"E 628.09' 1 - ;C-J
_ I y w 311.32' 316.77' ) ir-
~Z> LOT 2 W LOT 3
2.19 Acres c 0 2.19 Acres to W it
~O ?95,347 Sq. Ft.~ 95,347 Sq. Ft. m
N 9! C2
W
W O)
M F
I33 33' co
ioo'--i 311.28' 316.72' OUTLOT 1 AREA
l S89008'4711W 628.00' ' 41,448 Sq. Ft.
I I
P'C~`® T~ n ~^T 0.95 Acres
33.00' ~r~
0 SEP1619924. 4 N89008'4711E
JAMES O'CONNEL!
ft*orof OW o OWNER LEGEND
s o
6 SIL Cft CO.,
co Halle Builders Aluminum Count Section Monument
o - y
0.
W 'co 1767 115th St. Found
_ - New Richmond, WI 54017
0 _ 1" x 24" Iron Pipe Set, weighing
1.68 lbs. per linear foot
- - Fenceline
- Roadway setback line
- Proposed Drive Location
SJ Corner
Section 5
SCALE IN FEET
This instrument drafted by Craig Nukert Job no. 87-27-192 0 100 200 400
Vol. 9 Page 2540
' S T C - 105
SEPTLC TANK MAINTENANCE AGREEMENT
St. Croix County
c
OWNER/BUYER
I
ROUTE/BOX NUMBERS Fire Number /3i
CITY/STATE ZIP f~/r!!7
PROPERTY LOCATION: /O& 14, SCk, Section cS T 26 N, R-I_iW, l
Town of St. Croix County,
Subdivision I~ Lot number.
I
Improper use and maintenance of your septic system could result in
its premature failure..to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
i
the system can affect the function of the septic tank as a treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St. Cr'bix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
G
L
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 IT
and returned to the St. Croix County Zoning 0 f c wit n 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
APPLICATION FOR SANITARY PERMIT C!,
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 lie 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 X lee s A -/'I?
Property 3L4~ _3L. Section S~ T 7G N - R~W
Location of fAinship SKr o~
Mailing Address Ql //111, y G y
Subdivision Name
Lot Number o2
Previous Owner of Property G
Total Size of Parcel
Date Parcel was Created 7~~3~9a
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
1. Other recordings filed with the Register of Deeds Office o as to In addition, a certified survey, if woulrefd CertifiediSurveyys
of the reviewing process. If the deed d p
Map, the the Certified Survey Map shall also be required.
- - - - ~ _
PROPERTY OWNER CERTIFICATION
I (We) eeAt4y that a.U statements on this 6onm aAe true to the best of my (ouA)
knowledge; that I (we) am (are) the owner(s) o6 the pnopeJety desehibed tn this
in6onmation 6onm, by v4htue o6 a waAAanty d ed neeonded in the 066ice o6 the
County RegisteA o6 Deeds as Document No. 63 ag ; and that 1 (we)
pnesenatey own the proposed site 6on the sewage posy system Ian. 1 (we) have
obtained an easement, to nun uv''.th the above des embed pnopehty, Jon the.
con.stn.uatLon o6. said system, and the same has been du.Cy neeonded in the 06J.ice
o6 the RegtzteA Deeds, as Document No. 1
SIGNATU OF 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
1
DATE SIGNED DATE SIGNED
it DOCUMENT NO. WARRANTY DEED *N19 SPACE RESERVED FOR RECORDING DATA
4833~U STATE BAR OF WISCONSIN FORD[ 2-19821
O `L
REGISTER'S OFFICE
ST MLX Co., VW
Douglas ..E-.- Blackmcn and Kathleen C. Blackmatix.•husband I j Reed for Record
~i and wif e _ as point.. tenants
MAY 14 1992
- - -
conveys and warrants to Hslle--Bu-3ldeYSi•.-InC.. 8'30 A' M
Ii Regl ~ofC'Deeds
' RETURN TO
the following described real estate in S.t.,.-Cxq!x...---_-_- .County,
State of Wisconsin:
Tax Parcel No:
The North Half of the Southeast Quarter (N} of SE}) of Section Five (5), Trwnship
Thirty (30) North, of Range Eighteen (18) West, EXCEPT the following parcels:
1, Cnrtified Survey Map recorded in Volume "2" of C-rtified Survey Map, pagr'
536, being a part of the Northwest Quarter of t7-1e Southeast Quarter (NW} of SEI) of
above Section, Town and Range.
2. Part of the Northwest Quarter of the Southeast Quarter of above Section, Tort
and Range, rlPscriW aG fol.r_ota,:;: Cncinq at t--e °otit- -ast r-orne•- o` t'---~ par-el.
described in Certifier] Sir-vev Mar, Volume paq° 1;36; t' ^nCP Fact paralle' wit'; th
South ling of said parcel a 4istanc . of 120 fe^t; t`-ence North, pa-a" le" wit, tt,e East
line of Bairl parcel, a distance of 24n F--Pt; thenr'r' W--t, parallel with t' e No-t', Linn
of said parcel , a distance of 120 feet; t''nnce Sout-, a' once t`'e Fast I in- o` saitl
parcel, a distance of 240 feet to tl-- Point of heginnirq of t'Ti~ t'eF!cription.
3. Part of the Southeast Quarte- o° ahovP c:---ti-n, Taan an' Ranq, descrih-d as
follows: Corrmencinq at the Northeast corner of the parcel describers by ttie Warrantv
Deed recorded in Volume 1159611, page 33; thence East, paralle' wit', the Nort" "-in,-- o`
said parcel, 176 feet; thence South 660 fPPt, paral'e' ~-Iith t''e Fa-!t line of sairl
parcel; thence West 660 feet, paral le' wit', t"(1 Sotlt'' ' inn of sail nrarrwl; t'•ence Nort'~
420 feet to the Southwest corner of t'--e pal-rPl r'lescrihe<t by Certi`ip' Su-vev Map
rprord,-1 in `,olume- "2", pace 916; t'~nnce Fast
This - is. not homestead property. c t. F p
484 feet to t' , out east corner o t'parr:e'
(is) (is not)
dasc.,-i.!-x-l ''sv Warrant- 13-1 rxorderl in Vo't-.-r.
Exception for warranties: 196Q611, page 33; t}`Price Nm-tt, 240 Feet to t'•^
point of lxninninq of t'+is t?escrintinn.
Dated thi; 11th day rr' May 1:+92
/!1 n~ (SEAL) x j 1-. tcF.Ai.t
Douglas E. Blackman
Wow
(~EA1.1 Y (SEAL)
Kathleen C. Blackman
AUTHENTICATION ACKNOWLEDGMENT
WASHINGTON
Signature(s) STATE OF %1X12f18l1`1FXN '
. . -
- Co,:nty.
authenticated this - day of - 19 Personally came before me this day of
May _ _ , 1992 . the above named
.
Douglas_ E.,_ Blackman-. and Kathleen-C.-.1---
-
Blackman -
TITLE: MEMBER STATE BAR OF WISCONSIN
-
(If not. - -
authori.-d by 3 706.06, Wis. stats.) to me known to be the person -5..-..- wh.o executed the
it re_nir, ~ -t r::n+c'?\\:.vtd :irlc!u:m•b•1,c U e •;1,"..
Reinstra, Van Dyk 5 Needham, S.C.
201 South Knowles Avenue, Box 127 t"' s ` 1 rapi
• C
New. Richmond, Wi 5401: rt..: 1' - O 1 1 ('rwnty. !$1iYWA•
\I, t' }I.- ~r~j, state t ~l .r :rf,,.,
(Sivnah;r(< r,ray he a;:6cnticatrri ur r.F.m loJ.'ed. :',,f ~j 0/
• *N0 GF~•
:.re not r.ecc>-arv.( drh•. I:1 .I
•N-- of pen:,r; s:W-n4 in nri v :..-its' . ....1 .I 1. 1. ':r- -
WARRANTY DF'ED tiTAIM BAR OF WN4I)% i% i-.,rr,w
_ V,)PA N. 2 - 1