HomeMy WebLinkAbout030-2091-70-000
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AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
SECTION TN-R W
ADDRESS S'v ~"~Se7~ /J✓ ST. CROIX COUNTY, WISCONSIN
13101 na-a. -F~le~ G - ~luac .
SUBDIVISION 6,-39 fc, 7e LOT--,~7_LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'U
a SX 7 Txe s
~ I
1410 e-
d
I
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: 75-a/97e- 615' r / S
i
Alternate benchmark /e/t-
SEPTIC TANK:Manufacturer:Liquid Cap. lpc U
Rings used:-2--Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side X , Rear Ft.
From nearest prop. line:Front , Side _Z, Rear Ft. ?-i /
No. of feet from: Well Building: 1I o ~ Oewlgdf
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
III
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench:_ Seepage Pit:
Width: Length ~ Number of Lines: r2_ Area Built
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft._=?ff
No. feet from well: S2 No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
I
INSPECTOR:
DATE : PLUMBER ON JOB : •/l~7c~
LICENSE NUMBER:
6 90:c'
/ 7
I
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: G` Seepage Pit:
Width: 5" Length Number of Lines: ~_Area Built 75~
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: -1/ sr
No. feet from nearest prop. line:Front , Side , Rear % Ft._~?ff
No. feet from well: ,5-d No. feet from building ;2
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE : PLUMBER ON JOB : -•/l~~
LICENSE NER:~
6/90:cj
LWATJA$TpertFQ*ofJQWH.26.30.3A IVWWH&G :§JFiM County:
Labor and Human Relations INSPECTION REPORT
Safety%and Buildings Division
(ATTACH TO PERMIT) Sanitar;WrnitQR0TX
• GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village Town of: State PI
BM Description: Parcel Tax No.:
WROOT:' n l BM Elev.:
1 030 209t ?0-000
TANK INFORMATION ELEVATION DATA A9300227
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
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 DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System: 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: ST. JOSEPH.26.30.19 (AWATUKEE TRAIL)
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
0/ S/~IjIIT,(►RY 7#
-Attach complete plans (to the county copy only) for the system, on paper not less than /ZJ~dryd
8% x 11 inches in size. Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
c j2 T_10, N, R E (or) W
PROPERTY WNER'S MAILING ADDR SS LOT # BLOCK #
/3 A aat e. 57 1
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
s o~ 9 ~Q m t
I1. TYPE OF BUILDING: (Check One) CITY NEAREST ROAD
State Owned ❑ VILLAGE
❑ Public ~~((pp~~
lL'~L1 or 2 Fam. Dwelling-# of bedrooms .05-- PA EL TA . LIMB R(S)
III. BUILDING USE: (If building type is public, check all that apply) 43~~ a 091
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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. ER New 2. ❑ Replacement 3. ❑ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 N 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) f? 1hG l ELEVATION
Z1,50 '7 Sd 52) C. A1___ Feet /04 yG Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank W LSD y< co
Lift Pump Tank/Si hon Chamber I L-1 Ll El I El 1:1
VIII. RESPONSIBILITY STATEMENT
I, 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) P/ PRSW No.: 7B_usiness Phone Number:
Plumber's Address (Street, City, State, Zip Code):
+
lzi -,7a IX. C LINTY/DEPARTMENT USE ONLY
❑ Disapproved Sapjtary Permit Fee (Includes Groundwater a e ssue Issuing ent gnatur o Stam
7g~ Surcharge Feel
Approved ❑ owner Given initial Tf'
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 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
1 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 (5BD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this System. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding Lark(s), septic tank(s) or other treatment tarks; btj !Ming sewers; we ls; water mairs,'water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) hcrizonta; and vertical elevation reference points;
C) complete specifications for pumps and controls; (ios, 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 c
regulated practices which can effect groundwater.
The monies c;c,l'.acac d fhlough these surcharges are used for monitoring groundw,-iter, grotii?d
water contarnination investigations and establishment of standards.
SBD-6398 (6.11/88)
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Lnt I HDouman rartmentofln Relations du-try, SOIL AND SITE EVALUATION REPORT Page 1 'of3
Div;,,., f S,)rety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
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
Pick 1_aCa_sse GOVT. LOT N17 1/4S!1 1/4,S26 T 30 N,R 19 XXor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
13_5_6 Awa_tukee Trl. 7 Pass Lake South
Cl iY, STATF ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QWWN NEAREST ROAD
hIudson, jTI. 54016 (715) 549- St. Joseph Awatukee trl.
New Construction Use ] xk Residential ! Number of bedrooms 3 ( ] Addition to existing building
[ ] Replarnment [ ] Public or commercial describe
Code derived daily flow 450 _gpd Recommended design loading rate . 5 bed, gpd/ft2 •6 trench, gpd/ft2
Absorption area required 0,00 _ bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2.6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97.c46 It (as referred to site plan benchmark)
Additional design / site considerations n/a
Parent material pittedoutwash Flood plain elevation, if applicable n/a It
S -Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE IN FILL HOLDING TANK;
U=Unsuitable fors stem S❑ U US ❑ U US ❑ U ❑ S~ ~SYSTEM
❑ S 93du ❑ S! 1-MU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Thw di
1 1 0-10 10yr3/3 none L. 2/m/gr mfr c/s 2/m .5
2 10-31 10yr4/4 none J_s. 0/sg ml g/w 1/n .7
Ground 3 31-48 10yr4/4 none sil. 12/f/gr mfr g/w 1/m .5 .6
elev. -
102-02ft. 4 48-88 7.5yr4/4 none ls. 0/sg mvfr na/ na/ .7 8
' j
Depth to , I ;
limiting - - - -
factor
>88 - -
]
Remarks: ~
Boring #
1 0-12 10yr3/3 none L. 2/m/gr mfr c s~, NA .5
2 2-_ 12-36 10yr4/4 none ls. 2/m/sbk mfr g/w n .~5 .
3 36-66 7.5yr4/4 none sl. 2/m/sbk mfr w.5'•.' .y6
Ground - - '
elev. 4 66-88 10yr4/4 none S 0/sg n f .'8
101-5-2ft. -
f
Depth to - -
limiting
factor -
Remarks:
CST Name - Please Print Ph e'
_L.-Steel J_75-24~n-6200
llddress
155A-200t _ _ _aVe .-,,__New Richmond, 111. 54017
S~gnaturP Date: CST Number.
7-12-93 cstm 2298
PROPERIVOWNEftDick LaCasse _ SOIL DESCRIPTION REPORT Page
PARCEL I.D. #
Boring # 1 Iorizorr Depth Dorninant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft ,
in. Munsell Qu. Sz. Cont. Color Gr. S2. Sh. Bed
Tkirrh
3
1 -12 1 r3/2 none L. ?./m/¢r mfr c/s 7/n
5 1' . 6
- 2 12-36 J0yr4/4 none sl. 2./m/sbk rifr g/w 1./m .5 .'61
Ground 3 36-86 7.5 r4/4 none sl. ?./n/sblz mfr
na/ na/ .5 !.6
elev. - -
101 Lj6ft.
Depth to
limiting
factor i
)86" I
I
Remarks: i it
Boring # i
1 0-P, 1,?yr3/3 none nfr c/s ?./m .5
ra sbk Mfr w 1 n . 5
4 2-._ $-43 14L none sl. 1: [j :
Ground - _3 43-50 1C' r4/3 none sil. 1 f- sb1; nfr a w na 13 ~ 11
elev. 74. -4 50-8.6 7._5vr4A none S. 0/s ml na/ n/a .7 8 l
Depth to - - - : -
limiting 1
factor - - #
>86" 1 1
Remarks I
Boring #
1 0-15 10yr3/3 none sl. 2/n/ar r-1fr o/w 2/m .5 s`i6
5 2 15-49 10yr4/4 none sl. 2/n/sb-K r r P /W 1/m . 5 16
Iy ;
3 49-86 7.5yr4/4 none sl. 2/ra/sblc mfr na/ n~a .5
Ground -
elev. I r
98.52t. - I
Depth to - - : i
limiting
factor - - '
I
>86"
Remarks: Boring #
I
Ground
elev. ;
ft. - `
Depth to
limiting
factor -
i
Remarks:
CFtr1 R?~'!{R II~IOp~ ~ -
t
PRGPERrvOWNERPick LoCasse SOIL DESCRIPTION REPORT Page
PARCEL I.D. # T------- ~,I a
~I
Depth Dominant Color Mottles Structure GPO ft ,
Boring # I lorizon Texture Consistence Borxrary Roots . 13Bd Ir311d1
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. .
' 1 -12 10 3/2 none L. 2./m/gr mfr c/s 2/m .5
<a 3
2 12-36 10yr4/4 none sl. 2./m/sbk mfr g/w I/m .5 N6~
Ground 3 36-86 7.5 r4/4 none sl. 2,/M/sbk mfr na/ na/ .5 ;6'j.
elev.
101.4bft.
Depth to
limiting
factor a
8> 6,1 - - - -
Remarks:
Boring #
1 0-8 10yr3/3 none L. /m/gr rnfr c/s 2/m .5 3X64
} m 4
4... 2 8-43, 1 4 4 none S1. 2/n. sbk rifr w 1/n .5 1;6
Ground - -3 43-50 1 . 4 3 none sil. 1 f sbk: mfr v /w na 2. [ 13 t'
elev.
4 50-8.6 7.5yr, none 0 s ml na/ n/a .7 f~
Depth to
limiting
factor
>86" I
i {
F
Remarks:
Boring #
1 0-15 10yr3/3 none S1. 2/r1/c;r rift o/w 2/m .5 16
5 2 15-49 10yr4/4 none Sl. 2/m/sb'_c raft g/w 1/m' . 5 ~h
3 49-86 7.5yr4/4 none sl. 2/ra/sbk mfr na/
Ground -
9R 521.
Depth to
limiting ~ _
factor
~z
Remarks:
Boring,#
I
i
Ground ~
;I'
elev. it.
Depth to
limiting it I rJ
factor - -
I I
Remarks: - -
STEEL'S SOIL SERVICE
t554 200th.
Gary L. Steel
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 Dick LaCrosse (715) 246-6200
S26-T30N-Rl9W
town of St. Joseph
lot #7-Bass Lake South
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30 a r~
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17-
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Gary L. Steel
7-12-93
DAVESCHAVE
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SALES REPRESENTATIVE
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612) 4,24-3503
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DATE: , -T
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ~AhV•~l l7r~lV o G►is,dyC~ 1YIAJP k
ADDRESS AL a 4L tf 4- #r. A,qIRE NUMBER
CITY/STATE_ 9 LLA 6c",~ ( ZIP_ ~O (n
PROPERTY LOCATION: 1_1/4,,01/4, SECTION a(g , T N-R~-W
TOWN 0F_ St. Croix County,
SUBDIVISION ~SA 4 LOT NUMBER_ Z
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.
c~
SIGNED:
DATE:
3 J
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
5TC-100
This application form is to be completed in full and signed by
fthe owner(s) of the property being developed. Any inadequacies
will only result ~n delays of the permit issuance. ,should this
development be intended for resale by owner/contractor,(spec
house), thenla second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property BArr~/ IAA /.~;T~ ~ MNZe N
Location of property_4l)1/4 4h,&21/4, Section J~? T 3b N-R_/Q W
Township
Mailing address ~3:p aa- 1"d "-jz. 64 ~o1•G rn n ,,oz
Address of site ,q q k,.e_ . Y- nzo
subdivision name. 12 45 LA 1'6p SO Lot no. • 7
other homes on property? yes No
Previous owner of property ~j G 1~,4o u f
Total size of parcel
Date parcel-was created
'Are all corners and lot lines identifiable? Yes No
'i
is this property being developed for (spec house)? Yes ---o
volume_ and,Page Number _236 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 i the office of the County Register of
Deeds as Document No. 5014905' , 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. .
(~2
gnatu a applicant o- pplicant
Date of Signature Date of Si nature
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
0905
'VOL
10 Pa GE588
r;`CISTER,
S OFFICE
7^ac'd for Rewrd
Richard O stout and Janet P. Stout.
hushand and wi f e, SEP 2 1993
st s:oo A.
conveys and warrants to Barry C.Davidson and Joyce
R_ Malpk, hushand and wife, Survivorship
Marital Property pcciswnioamik
RETURN TO
the following described real estate in St - C''ro i x County,
State of Wisconsin:
Lot 7, Plat of Bass Lake South, Town of Tax Parcel No:
St. Joseph.
' A1"T F
64-
This.. is nni- homestead property.
(is) (is not)
Exception to Warranties: easements, restrictions and rights-of-way of record,
if any.
Dated this A 31St day of Aiiglis;t , 1993_
l~-'C ~~17 (SEAL) (SEAL)
Ri rhard 0 ,t-c)ut Janet P. Stout
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St . Croix County.
authenticated this day of -19 Personally came before me this 31St day of
August '19 93 the above named
Richard O. Stout and Janet P.
Stout
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person S who executed the
authorized by § 706.06, Wis. Stats.) foregoing instrument and acknowledge the same.
THIS INSTR
UTSNTrp~S lgyL(TtbLED BY
1Q L u 12C
O
f Iudson, WI 54016
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary,) date:_ Co 19q~?-)
' Names of persons signing in any capacity should be typed or printed below their signatures. S82 NTF 0021
WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208
Form No.2 - 1982
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, G DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/lam Y: LOT NO.:BLK. NO.: SUBDIVISION NAME:
ST3 1/44.i1/ 26 /T30 N/R19xE (or)W St. Joseph 7 n/a Bass Lake South
COUNTY: OWNER' S NAME: MAILING ADDRESS:
St. Croix Richard Stout 11353 Awatukee Trl., TTudson, Wi. 54016
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER LATION TESTS:
I~Residence 3 n/a New ❑Replace I 4-23-92 4-24-92
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑S QU ®s ❑U ❑S ❑S ®U EIS QU mound
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5) (b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
101.60 1.08, 10yr3/2, 1., .58, 10yr4/4, s.sil., 1.17,-
6-1 5.66 4.33 2.83 7,5 4/4 s.l. 1.83 7.5 not. s.l. 1.00 mot.-
10yr5/4-5yr4/4 sil.
B-
2 5.08 101.60 4.17 2,83 1.08, 10yr3/2, 1., .75, 10yr4/4, sil., 1.00, 7.5 -
B- 4/4, s.l. 2.25 7.5 r4 4 not. s.l.
B_ 3 4.41 102.50 4.33 2,41 1.08, 10yr4/2, 1., 1.08, 10yr4/4, s.sil. 2.00-
B-
B-
decima1' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER ' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P-1 2.00 none 2 1'z 1 % 20
P none 30 2 k 2 2 15
P_ none 30 -2 1-2 20
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 103.50 '
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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 4-24- 2
ADDRESS: CERTIFICAT ON NUMBER: PHONE NUMBER (optional):
1554 200th. Ave. New Riclynond-, Wi. 54017 ? If 71 -
CST SIG E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
l♦
V
INSTRUCTIONS FOR COMPLETING FORM 115 - SBQ - 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 thi, ^ :replacement
5. C 1 iitability rating t A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
C ._l '-MS ARE RULED _UT BASED ON SOIL CONDITIONS;
6. Pt = abbreviations s' here for writing profile descriptions and completing the plot plan;
7. 'BLE diagram ac( fr y locating your test locations. Drawing to scale is preferred. A
-y be rise(] if de.ir,I;
8. N ke sur )chmark and vert I elevation reference point are clearly shown, and are permanent;
9_ Complete it .~;%riate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, ;
10. If the inic i Lich as flood plain, elevation) does not place N.A. in the appropriate box;
11. Sign the fore:. place your current address and your cert,fic, <zn number;
12. Make legible pies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
So'l _ e d Textures Other Symbols
st (over 10") BR rock
col; (3 - 10") SS - dstone
gr - Gi; (under 3") LS L + estone
*s S I HGW - roundwater
c.~ o"'id Perc Jon Rate
need s Sand W
fs - Bldg - I r 1
Is - I ",and > Greater Than
sl Loam < - Less Than
Bn - Brown
*sil - Si'" Loarrn BI Black
si - Silt. Gy Gray
*el - Clay Loam Y Yellow
scl- Sandy Clay Loam R Red
,F
sicl - Silty Clay Loam mot - tips
sc Sanely Clay w/ -
sic - Silty Clay fff t faint
c Clay cc - r c )arse
pt: - Peat mm - I y, medium
rn Muck d - dis : cC
p - prominent
HWL High water level,
Six general soil textures 'z;? surface water
for liquid waste disposal BM - Bench Mark
1 VRP Vertical Reference Point
ti
,a
TO THE OWNER.
T` is soil test report is the first step in securing a sanitary permit. The cour y or the Department may request
t ~ition of this soil test in the field prior to permit issuance. A cr- 'ete set of plans for the private
s, ;tern and a permit application must be sw~)rnitted to the a, , local authority in order to
( i a permit. The sanitary permit must be obtained and posted prior t the start of any construction.
Parcel 030-2091-70-000 02/08/2005 11:56 AM
PAGE 1 OF 1
Alt. Parcel 26.30.19.768 030 - TOWN OF SAINT JOSEPH
I" I
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* DULON, SCOTT J & CRYSTAL C
SCOTT J & CRYSTAL C DULON
1369 AWATUKEE TR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1369 AWATUKEE TR
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.470 Plat: 0078-BASS LAKE SOUTH
SEC 26 T30N R19W LOT 7 BASS LAKE SOUTH Block/Condo Bldg: LOT 7
3.47 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
26-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/23/1999 609118 1451/150 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
6475 343,000
Valuations: Last Changed: 07/12/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.470 80,100 257,300 337,400 NO
Totals for 2004:
General Property 3.470 80,100 257,300 337,400
Woodland 0.000 0 0
Totals for 2003:
General Property 3.470 56,100 197,100 253,200
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