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HomeMy WebLinkAbout040-1189-30-200 ' ~ g 10 % AS BUILT SANITARY SYSTEM REPORT ti OWNER TOWNSHIP 7 ~ SECTION_~T N-RAW. q Q'3cp ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT--L?-LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a ~r ~.4.~F ~3 • ~ pro 91 •S 91,r ~ d = yr, ,~sua.-r ea7.O weft ~ ~ sz 71 y/ I, INDICA E NORTH ARROW BENCHMARK:Elevation and description: P V 61 SEPTIC TANK: Manuf acturer : 4~'ee,13 Liquid Cap. 1.10a Rings used:-Manhole cover elev:~3,3~Final grade elev: 9S•0 Tank inlet elev.: Tank outlet elev.: PA 41 No. of feet from nearest road:Front , Side , Rear ~Ft. >/SO From nearest prop. line:Front , Side ✓ , Rear Ft. >'Sn No. of feet from: Welly ~y , Building: it (Include this information in the above plot plan) (2 reference dimensions to septic tank) - SEE REVERSE SIDE tom: , PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pum /Siphon Manufact.: Pump Size Elevation of inlet: B tom of tank elevation Pump on elev.: Pump o elev.: Gallons/cycle: Alarm: Man.: witch Type: Location Distance from nearest'prop. li e: Front-, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: I Width: .L Length /3j~' Number of Lines: Area Built Exist. Grade Elev. X7.3 Proposed Final Grade Elev. 96.0 Fill depth to top of pipe: 3.5- No. feet from nearest prop. line:Front , Side Rear✓ Ft. No. feet from well:> 7s No. feet from building Ao HOLDING TANK Manufacturer: Capacity: No. of rings used: lev ion of bottom tank: Elevation of inlet: No. feet from nearest prop. ine:Front Side Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: r INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj LWQA'r ertUWln~Ary!28.19.784 pKNA ESf*AH~YgI EME. WOODR oun~y: Laboragd Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village li Town of: State Plan ID No.: e Insp. BM Elev.: , BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300020 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark' r~ Do4ng- &2 r Aeration Bldg. Sewer gi/ r ~ Holding St/W Inlet TANK SETBACK INFORMATION St/ W Outlet 7 /2~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake _ ?j r J Septic NA Dt Bottom " i p NA Header / Man. 00 Aeration NA Dist. Pipe r( r Holding Bot. System ,05 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand e Number GPM TDH Lift Friction S stem TDH Ft Forcemain Length Dia. Ds . I SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length 7 No. Of Trenches PIT Pie. 8 141&. Inside Dia. Liquid Depth DIMENSIONS S DIM SI N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING anufacturer: SETBACK CHAMBER INFORMATION Type O (_!c7 Mo I Number: System: + 7). OR UNIT DISTRIBUTION SYSTEM Header /aaao4&1d Distribution Pipe(s) x Hole Size x Hole Spacing Ven ntake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over rr Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched BELL/Trench Center yfo Red+9Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) E,NW, L QT 83, E XOODRIDGE D . LOCATION: TROY 36.9$.19.784 785,S / t.a~,e., r - roc G r. (e J , 'y; G ~ci ~J If' Co. 7, 7~ 3> iiI rt- Play~ revlslon required? 2- e~ No Use other side for additional information. ,2/ Cert ' Da I I77 ZOO !Y7 1Gt~,-, s _ r/Mo u rCctw 1 ~2 ' Nacd'C ~"y - . 710 ~.1Ff / .uG P /v ~7 rs2 T ADDITIONAL COMMENTS AND SKETCH - - SANITARY PERMIT NUMBER: 6 (AML H SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CouNTY STATE SA RY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than e sw toevwus application 8% x 11 inches in size. check r [%/"f~ ~fr _ -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 h V ~e par%peo?5 .5e % '/4, S T N, R E (o OPERTY OWNER'S MAILING ADD ESS LOT # BLOCK # Aoo~ 0 T G* CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAVE OR CSM NUMBE v joa e r . L E3 CITY II. TYPE OF BUILDING: (Check One) El State Owned ❑ VILLAGE : NEAREST ROAD 4 ❑ Public ~ or 2 Fam. Dwelling-## of bedrooms 3 PARCEL AX NUMBER() l~•r// III. BUILDING USE: (If building type is public, check all that apply) fob r ~ A0o® 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 II OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. i7' 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 8 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 t~Y1 STEM sFLEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 3 691, _7 9 Feet "Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank O ZA7 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. ) WMPRSW No.: Business Phone Number: er's Name (Print): Plum is Signature: (No S dA Plumber's Addre Street, ity, State, !p Cc e, l.~ S o IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved San! it Fee (Includes Groundwater Date Issued Issuing gent Sig lure (No m pproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 1X,fONDITIONS OF APPROVAL/ ASONA FOR ISAPPR VAL: 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 perenit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be ••gubmitted to the county prior to installation. 5. Onsite sewage systems must Ue properly maintained. The septic tank(s) must be pumped by d licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code'adrriinistratoe or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. 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 sbrved. Check'onfy'onb and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/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) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil. absorption system if required by the county; E) soll,tegt data on a_115 form; and F) all suing information- GROUNDWATER-SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) y a ai m u = -r v oar 6W1a©9 = x ~ p•oa/ -2, Whfs~ 14 1 z1 ~ S ca Ohl 1 J~, i 191V 9 14f E4- -C* ~ S I# ~ d0 d J# r DI„~HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITA ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 't~ 8% x 11 inches in size. ch k i re onto previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION a rSort S 2-: S 36 T 28, N, R / E (or ROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME R M NUMB II. TYPE OF BUILDING: : (Check one CITY NEAREST ROAD I~ ) State Owned ❑ ILLAGE 4OWN EPARCEL Ax N NUMBER(S) BER(S) ❑ Public L-1 or 2 Fam. Dwelling-# of bedrooms 3 III. BUILDING USE: (If building type is public, check all that apply) O O 1 El 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 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYMew PERMIT: (Check only one in line A. Check line B if applicable) A 1. 2. ❑ Replacement 3. El Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 M 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) 9275 ELEVATION 0 S-4 3 r ,7 . 8 Feet % . ! Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank r__T_ If Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu is Name (Print): Piumbe ignature: (No Statnpet- *W/MPRSW No.: Business Phone Number: Plumber's Address ( reet, Ci , S te, Code): G!/UL-7 o -23 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee (Includes Groundwater ate Issued Issuing Agent Sign tura,4Nb Stamps) Approved ❑ Owner Given Initial Surcharge Fee) 3 Adverse D termin ti n kO 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. Yo-ur sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed . pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be insta)feo. II. Type of building beihd,served. Check o'Pfiy o60-And complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location' of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/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) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance cb'tve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by'-te:"runty; E) soil test data on a 115 ,form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment'of standards. I SBD-6398 (R.11/88) SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~Y0 k n t -Of bb ADDRESS: F41 JJJ ( d!rC it FIRE NO: LOCATION: S 1/4, IV 1/4, SEC. 3Co T_AN-R-L2 W, TOWN OF: finu ST. CROIX COUNTY-_ SUBDIVISION: ( Q ,,res LOT NO. I 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : ^3 _ _3 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 APPLICATION FOR GAUTART PERMIT • 9TC-100 This application form Is to bo conplntod In full and signed by tha ovntr(t) of the property belnq developed, hny lnadoquacles will only result In delays of till pit rAlt IszuancQ - -Should thin development be lntended for rttalt by ovntr/contractot,(eptc houa%), than a second Lorm should bt retained and coomplettd vhan the ptopetty is sold and submitted to thla afflca with the ■pproprlatt deed rtcordlnq. Omar of property __30A_n -the( b e ~a✓snn Location of property 114 fJ 1/~~ Bsctlon T-2g-„1l-RV Township hang addttsa IAJ qty /T)2 Address at IlLe j/1 Subdivision nas►*_ 6tgt- R~n~a~ • Lot number PttvlouI avntr at prapttty _ ~oi r~l Vin,! Total slit of ptrctl ~ C)O e Data patrol vas created IF - /9l5 - Ate all corntts and lot 11nta Identifiable? yes No Is this pro petty being developed for resale (spec house)?- 4A 0 Yolnr.a 36aS`] and Ps go tturnber7 /g as recorded with the Register of Deeds. - - - - - - - - w - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - w - w - w - - - - - - - - - - - - - - - - - - - - - - - - - - - - INCLUD9 WITH THIS XPPLICATION Tint POLLOVINCI 11 VAARKXTr D!!D which Includes a DOCUHSHT IM01R, VOLIMQ AYD PA02 NLrMll R, and tilt 9LkL OT T11 RROI©TRR OF DUDS. In addItIan, a etrtlfIed survey, If available, vould be helpful so as the to avoid delays of the reviewing peeress. it Hap rdehaaldl da also b be e r reequuirreredencas to a CettlLled Butvty Hap, the Ctttlfled Survey , , PROPERTY MIER CKRTIPICATIoH---- I(Vs) eettlty that all statements on Lhle form are true to the best of ■y (our) knovltdgtl that I (We) am (ere) the owner(s) of the property desctlbtd In this In(ntmatl0n Corm, by virtue at at warranty~I deed recorded In the Ottice of the County Reglstet of Det~1s as Document Ito. N1126 ^ j00 presently own the proposed elta Lot rho newage disposal a steal and that I (ve) obtaIntd an easement, to run with Lila above described ptop (or I erty,(vIar htave he construction of sold nystetn, and the some has been dul recorded in the otIIca of the County Register of beads, as Document Ho. ~_`ft7/I ll nature of owner SLgnaturs oL Co-O%ntr (IL Applicable) 3 - 1- 9-3 Data of Signature Data of Signature DOCUMENT NO. VOL 417 pv-F 514 WARRANTY DEED STATE OF WISCONSIN-FORM 1 TNIS SPACE RESERVED FOR RECORDING DATA 8 e2 eI 2 31 r• r)n r THIS INDENTURE, Made this.....137-t-_ dal of REGISTERS OFFICE A. D., 19--F r between..... J5: ,_-Yh. ~n ST. CROIX CO.. WIG. - Recd for Record this.. M__ . day of__L(ztgh_e,_r_ -A.D. 196-5 T r - Part.. of the first part and 8t_ Il, M e'n~ G y ,n Z~ . - eglsr f (7eeds part...: ^..of the second part, W i t n e s s e t h That the said art RETURN TO p _of the first part for and in consideration , nn) a of the sum of. - - - _ - . - _ to----- in hand paid by the said part, of the second part, the receipt whereof is hereby confessed and acknowledged ha -1 given granted, bargained, sold, remised, released, aliened, conveyed and confirmed' {and by these presents do_._ ....give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part `i__of the second part,_........ heirs and assigns forever, the following described real estate situated in the County of-_ -.and State of Wisconsin, to-wit: r - fo?J~ - n n -4 4' r t a_ ti, i _n ' I i I (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; anal all the estate right, title, interest, claim or demand whatsoever, of the said part.-_` .:.',:of the first part, either in law or equity, either in pu,se-ion or expectancy of, in and to the above bargained premises, and their hereditaments and ;rppurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said part. "of the second part, and to ---heirs and assigns FORFVER. And the said. ii - for. hear, executors and adnunititrators do_ - covenant, ),rant bargain, uul agree to uul with the said part.of the second u- part, heirs and .assgns, that at the tune of the cnscalmg and dclnor}' of these presents well seized of the premises above described, as of a good sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incurubrances whatever- - - - - - - - - - - and that the above bargained prennses in the quiet and peace able posses,ion of the said p art . ..[~_of the second part -heir, and a signs, against all and every person or persons lawfully claiming the whole or any part thereof,.. will forever WARRANT AND DEFEND. In Witness Whereof, the said part: r3_._of the first part hal:. .-_-hereunto set -hand- ; day of C I: / and seal the A. D 19 - SIGNED AND SEALED IN PRESENCE OF (SEAL) T (SEAL) Lac J (sl•:A1.) OF WISCONSIN, - - - „ } ss. - County j Personally came before me, this day of r R - - A. D., 19. the above named... - o nae known to be the person..': who executed the foregoing.;ffw"rneat and acknowledged thyme. tl~ NOTARY This instrument drafted by SEAL T.. Notary Public....... ' " ' A l ' - r I i , tv : My Commission (FWi fr s) (Is) n { of the (Section 59.51 (1) of the Wisconsin Statutes provides tha grantors, grantees, witnesses and notary). a be recorded shell have plainly printed or typewritten thereon the names WARRANTY DEED-STATE OF WISCONSIN, FORAI,NO. 1 N. C. Mill[H CO., MIIWAUEEdi ~ Jj1`i✓ a~-?~ 1 I ~ QC LM 3~ co 4 t M - ~ ~I II ~I a II Nv- n v V ~ I ~ G I, 3 0 A\ ~ r'VisconsinDapartmentof Industry, SOIL AND SITE EVALUATION REPORT Page._._. 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. Croix 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 [ .t: PROPERTY OWNER: PROPERTY LOCATION Dick Fox (John Parsons - Buyer) GOVT. LOT SE 114 NW 1/4,S 36T28 N,R 19 XXX-XW PROPERTY OWNERS MAILING ADDRESS LOT ~ BLOCK # SUBD. NAME OR CSM a 84 West Woodridge Drive 83 Oak Ride Acres CITY, STATE ZIP CODE PHONE NUMBER QCITY (]VILLAGE MOWN NEAREST ROAJ River Falls WI 54022 (71$ 425-2100 'I'r'o New Construction Use tK ] Residential / Number of bedrooms 3 ( J Addition to existing building (J Replacement Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate . 7 bed, gpd/ft2 .8 trench, gpa-ll' Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpa n:' Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations - Parenl material Flood plain elevation, if applicable NONE It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM iN ILL hCi: X U Unsuitable for s stem EN S O U INS O u f3 S 01.1 KI S❑ U 0S Z U EI IX SOIL DESCRIPTION REPORT Csoring 4 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourta:ry Roots - <.r t in. Munsell feu. Sz. Cont. Color Gr. Sz. Sh. to : i ..r 1 0-10 10YR 2/1 NONE sil 2 m sbk m fr as 2m .5 !.6 _ 2 10-14 10YR 4/2 NONE sil 2 m sbk m fr as 1f .5 .6 Ground 3 14-24 10YR 4/6 NONE s.gr 0 - gr ml as lvf .7 .8 t)ieV. 97.- Qft. 4 24-47 10YR 6/6 NONE s 0 - ml as 7 !.8 Depth to 5 47-51 10 6/6 - limiting factor 6 51-10 10YR 6/6 NONE s 0 - nil .7 .8 None Remarks: - boring # 1 0-42 10YR 2/1 NONE sil 2 m sbk m fr as 2m .5 .6 2 2 42-65 10YR 4/6 NONE m ml as 1f ._7 3 3 65-10 10YR 6/6 N 9 0 m ml .7 .8 around ulev. ~ 9E.25ft. N ~ I )epth to I,miting `~o~ f 0 rv lector Remarks: (CST Nano-Plaasa Print Phone: pail] r-. I- nar (715) 495-5544 AddrecN8230 Hi hwa 65 South; -River Signature: Q Date: CST Nxmbvi G,,.C ~ q ~ I to I g Z. PROPERTY OWNER Dick Fox SOIL DESCRIPTION REPORT PARCEL I.D. ti_ Boring n Horizon Depth Dominant Color Mottles Texture Structure Consistence Elwtay {Boots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. u 3 1 0-17 10YR 2/1 None sil 2 m sbk m fr as 2m .5 .6 2 17-23 10YR 4/2 None sil 2 m sbk m fr as 2f .5 .6 . C;round 3 23-65 10YR 4/6 None s,gr 0 m ml as if .7 eiev. 96.50ft. 4 65-10 10YR 6/6 None s 0 m - ml .7 ,s Dapth to iirniting I,aclor Remarks: >oring 1 0-10 10YR 2/1 None sil 2 m sbk m fr as 2m 5 .0 4 2 10-24 10YR 4/2 None sil 2 m sbk m fr as 2f .5 .6 3 24-37 10YR 4/6 None s,gr 0 m mi as if .7 .8 Ground elev. 4 37-10 10YR 6/6 None s 0 m ml i .7 , 8 97.80 ft. 11 Depth to limiting taC10f - Remarks: Goring 1 0-10 10YR 2/1 None sil 2 m sbk m fr as 2m -.-5 .6 _.5 .6 5' 2 10-21 10YR 4/4 None sil 2 m sbk m fr as if Ground 3 21-52 10 5/3 None s 0 m ml as If 7, 8 elev. - 4 32-10 10 6/4 None s 0 m ml .7 .8 96.3511. Depth to limiting f.,elar _ _ Remarks: Boring # Ground elav. it. Oepth to limiting t~iCtOr Remr,rks' • _ U a r,' `a I:J W c. O ti h )V i C ;r " N r !:?,sr Wooa~r~~l~~ t car REPT131 troy ST. CROIX COUNTY ZONING PAGE 1 104/19/93 10:03 REQUESTS FOR INSPECTION WORK SHEETS FOR: 4/19/93 AREA: JT Activity: A9300020 4/19/93 Type: CONV93 Status: PENDING Constr: Address: TROY 36.28.19.784.785,SE,NW, LOT 83, E. WOODRIDGE DR. Parcel: 040-1186-60-000 Occ: Use: Description: 193360 Applicant: PARSON, JOHN Phone: Owner: PARSONS, JOHN Phone: Contractor: FOGERTY; DAVID B. Phone: 749-3656 Inspection Request Information..... Requestor: Dave Fogerty Phone: Req Time: 16:04 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION