Loading...
HomeMy WebLinkAbout040-1218-90-000 a> °o va O N > O C C r\ co O a) N N V ca O O 0 X O in f N p. a) CO L N ~ U 9 y C y E N (D 0-0 i I ro -o z° C C 7 C6 U. C C9 N O O a °0 I z E z o of v z a ) co H z i o z v a r o U) C a~ E 0 0) a) co • a) _ 00 o CD 6 N 0 D O c O T a O N z F z Z O N _ II in - > try a > co rS; 3 CL 'm LO iN- ~ ~ o U n LL 37 • a a a cu c N fA J U = Qi rn } ro o O O N T ,.O O ~ O O O 11~~ 2 ~S? a c` 'C U) N a) ro v ~1 C H O N O N C N - Y C In O O CQ p 'D O Y U O N O O O a~ o c a a c rn o C w o c E c V CC o (3) 75 c,4 izz o ~ ~ E m v O ~ cwt N d w k m _ • C~S a. d V N a C r"w~w i c C w u CL LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040-1218-90-000 Parcel Number 08.28.19.1060 OWNER NAME: First THOMAS E Last SLATER PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 420 RED BRICK RD SECTION 8 TOWN 28N RANGE 19W %160 '/440 Line Description Line Description TOTAL ACREAGE 2.120 PLAT LOT BLK 01 SEC 8 T28N R19W PT NW NW 15 02 BEING LOT 5 CLEARVIEW 16 03 ADDITION 2.12 ACRES 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, 177-Valuations, F8-History, F10-Exit I r t AS BUILT SANITARY SYSTEM REPORT OWNER ~ie L cG~t ~~SHIP y' SECTION T / NJ-R-2f-W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION l~ LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM fr3 ""^9 0 3S s.T r 6 INDICATE NORTH ARROW BENCHMARK: Elevation and description: l4d j,3 Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap._ 4 4272 Rings used: ,Manhole cover elev: /0.>. z Final grade elev: 2-,0 Tank inlet elev.: 1W.f Tank outlet elev.: /UD. S i No. of feet from nearest road:Front L~, Side , Rear From nearest prop. line:Front Side Rear Ft. ~2! .So No. of feet from: Well "e- , Building: _20 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 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 /.2 ~Number of Lines:--L-Area Built_,6~-'-10 Exist. Grade Elev._ /NO,y j Proposed Final Grade Elev. /©d,, Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side Rear Ft.> S0 No. feet from well: d7lC No. feet from building JW S~ 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: O PLUMBER ON JOB: ~~ZZZZ - LICENSE NUMBER:~1 ~GI 6/90:cj LOeA4ION• 420 RdEI BRICK ROAD OT 5 R Wisconsin Department of In us ry, PR&%~~'SF'111' z o Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary it GENERAL INFORMATION . Permit Holder's Name: ❑ City ❑ Village [Town of: State PlakMI.13 1: REUTER MARK TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: CST' ` TANK INFORMATION ELEVATION DATA A9200246 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark Ll ('1:1 0 y~ 0010 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet (o,Slo cj TANK SETBACK INFORMATION St/ Ht Outlet np,7 1 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic .5 - o ' oho i a NA Dt Bottom Dosing NA Header / Man. q,0 Aeration NA Dist. Pipe 1,;0 q 1, a 5 Holding Bot. System q (o,LL PUMP/ SIPHON INFORMATION Final Grade 35 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss ead Forcemain Length Dia. Ff Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a-`/ 12- DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER ~ 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 y Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench CenterO& Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No esent, etc 1, a COMMENTS: (Includ? discrepancies, persons pr ilk 7~ 31 Ll ILA jf Plan revision required? ❑ Yes ❑ No Use other side for additional information. Cl SBD-6710 (R 05/91) Date /Ir Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: o SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05, Wis. Adm. Code couN Now ` STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / 8% x 11 inches in size. c ec if revisio YF7 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 ar c 44L &14) '/a, S T ,'F, N, R E (or PROPERTY O ER'S AILING AgDRESS LOT # BLOCK # jZr CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER yew V.2 5- 11. TYPE OF BUILDING: Check one) CITY 11 NEAREST ROAD ( State Owned ❑ VILLAGE : ❑ Public P 1 or 2 Fam. Dwelling-# of bedrooms,- PAR EL AX. UMBE ) U g III. BUILDING USE: (If building type is public, check all that apply) Q Y O - 1Z40* 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 40 Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash 50 Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE ~OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 51'New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 L~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 ~TD REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 1-s- 1746 • /6. 3 Feet 99, D Feet -C-9 5- 1 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 a e 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. PI m is Name (Print): lumber's-Signature: (No Stamps MWMPRSW No.: Business Phone Number: P 9 7 l- umber's Address (Stre t, Ci to Zi Code): O o < w~ O1 IX. C UNTY/D PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing ent Si re N Sta Surcharge Fee) Approved ❑ Owner Given Initial /Qj~ dD/- 7 Adverse Determination DOVV 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 t . 1. A ,sanitary permit is valid for two (2) years. 2 Your sanitary, permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Saritary Permit Transfer/Renewal-€mrm fSED 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 ;I years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 668-266-3815. 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. Ill. 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. Vlll. 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; stream, and lakes; pump or siphon tanks: distribution boxes,- soil absorption systems; replacement system areas ;i;d Nhe location of he building served, B) horizontal and vertical elevation reference points; C) complete specifications for and controls, • dose vo. !tame; elevation difference.. _ i pumps s, fr.ction loss; pump ;performance c.lrve; pump model and purrep manufacturer; D) .,toss section Of the soli absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - GROUNDWATER SURCHARGE 1983 'Alisconsin Act 410 linc':.ded the creation of surcharges (fees) for a num'_~or _4 regulated practices which can effect groundwater. Th~+ monk°s uc!!ecteci throu(gh these; surcharges are used for monitoring groundwater, giound water ccon'tavoin ition investigations and establishinent of standar-as. SBD-6398 (R W88) STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. s development be intended for resale byowner/ ontr cptor C d 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 -T- A C_-F, 0Al Location of property, lWl/4 Sw1/4, Section 2-8 T- yN-R W ,Township P-o Hailing address C_ Address of site D subdivision name C L. F,q-P L11 e Lot no. other homes on property? es Y :No Previous owner of property A V l-- Total size of parcel Date parcel was created l g D Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ____No Volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAUTY DEED which includes a DOCUMENT NURBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE. I1EGISTtR OF DEEDS. on, a certified survey, if available; ;would be helpful I o asd 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 the property described in this information form, tby virtue sofoa warranty deed recorded in the office of the County Register of Deeds as Document Plo. own the proposed site for the sewage disposal t sI (we ystem) orr I e(we) obtained an easement, to run the above described propert, for construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. V , iD Signatur o applicant co-applicant Date of signature Date of Sig nature } UUCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA ' WARRANTY DEED 485319 STATE.1„48 OF T! ONSIN~1~ 2 - 1982 von REGISTERS OFFICE David R. Knighton ST. CROIX CO, WE a Recd for Record JUN3 01992 conveys and warrants to at 3:00 P . M Delta Construction Company, a MN Corporation Re9lstar of WIJ6& RETURN TO the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No: Lot No. 5, Clearview Addition Subject to Declaration Establishing Protective Covenants and other easements of record. 7• 76 This is not homestead property. (is) (is not) Exception to warranties: , Dat this day of July '19 92 (SEAL) (SEAL) * David R. Knighton (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGEMENT Signature(s) STATE OF VOSCONSM Minneso ss. Hennepin County. Personally came before me this 1st day of authenticated this day of .19 July .19 92 the above named David R. Knighton TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me know o be the person who executed the authorized by § 706.06, Wis. Slats.) foregoing i ument apd ck the same THIS INSTRUMENT WAS DRAFTED BY David J. Butler, Attorney * David J. Butl 6625 yn a e Ave o, Suite 526 Richfield, MV 55423 Notary Public Hennepin County). YIN (Signatures may be authenticated or acknowledged. Both My Co rr1 OKI o expiration are not necessary.) date: ) 'Names of persons signing in any capacity should be typed or printed below their signatures. NY WARRANTY DEED STATE BAR OF WISCONSIN. RSa ASSOCIATION FORM No. 2 - 1982 4801 Hayes Road, Madison, Wisconsin 53704 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER c-: - r k c- O/✓ s `Z -c 1- l D Al 0- ROUTE/BOX NUMBER 2 D - ,,J- Z -7-' FIRE NO. CITY/STATE S Lary l.tJ ( ZIPfl PROPERTY LOCATION: Std 1/4 S GO 1/4, Section )~-,V, T W L N, R~W, Town of St. Croix County, Subdivision C.L~.aI~C. Lc) , Lot No. 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 $3000 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. 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix Count Zoning Office within 30 days of the three year expiration date. J SIGNED V ✓ DATE 4l St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address WB44 Counter-Offer, Approved bj the Wisconsin Department of Regulation and Licensing 7/30/91 (optional use date) 1/01/92 (mandatory use date) ' Counter-Offer No. by (Buyer/Seller) GrJ, C ~-c COUNTER-OFFER j2,174.4 1 The Offer to Purchase dated I`larch Vii. 1992 2 and signed by Buyer, T)r*1ta Construct3en 3 for purchase of real estate at _C1x►.8rrisau Addition, ffndanni Wi,gcnnuin 4 is countered. 5 All terms and conditions remain the same as stated In the Offer to Purchase except the following: 6 [Caution: This Counter-Offer does not Include the terms or conditions In any other Counter-Offer unless Incorporated by 7 reference.] 8 9 11 - - 12 $300 worn Mgt 940"a R"4 Lot" 3 6"d 5 eq or before 13 14 fton'r nn ilnt 3 (nr lat that olosea an or before .TulTl- lo9-ZTand 15 snob earnest money an lot 5 Car lot that c1aaes: Att . boforo 16 Sevtomber 1. 1992)w upon acceptance vith prJejo-an *home lat* At, 17 $ 900 each. 18 in iennr4l 20 the 3 1ato at closinT~ Thin cra41t would be 1A Una of Solletr 21 pa! .ring for Juntalfation of driyewmy siy%4 cu_1_y*rt__ 22 to 41a non S-n-bor4lasitten 23 0%4 then* lots- 24 25 Royer to 4-adicatca by Rigninq boal4a his -1646ce of Chain* 1: 26 27 28 n haI ae1_ E~-;~ L 29 Any warranties and representations made in s ounfer~-O f"er survvrv MIT osing of this transaction. All other termx of original offair Recepted as Written. 30 This Counter-Offer is binding upon Seller and Buyer only if a copy of the accepted Counter-Offer is delivered to the party making the 31 Counter-Offer on or before "farch Ill, 1992 (Time is of the Etsence). Delivery of the accepted 32 Counter-Offer may be made in the following ways: (1) by depositing a copy of the accepted Counter-Offer postage or fees prepaid in the 33 U.S. mail or a commercial delivery system addressed to Lourr Real Hatate, 1201 Never Road, Undo 34 at ui4eonais1 54014 , 35 (2) by personal delivery to the parry making the Counter-Offer, or (3) by electronic transmission of the accepted Counter-Offer to the following 36 telephone number: 11 !j 36-5593 37 The party making this Counter-Offer may withdraw the Counter-Offer prior to acceptance and delivery as provided in lines 31-36. 38 Date: 31 rj 1 (13 Time: arty hlln./p.m. tr ` i . I -r r 39 - (Seller/Buyer) 40 This Counter-Offer was drafted by (Licensee and Firm): Social Security No. 41 1b&M I.. LOW42 43 iXMW ff~"! ~tarm (Seller/Buyer) 44 Social Security No. Acceptance of Counter-Offer 45 The above Counter-Offer is accepted. 46 Date: Time: a.m./p.m. 47 (Buyer/Seller) 48 This Counter-Offer was presented by (Licensee and Firm): 49 50 on (Buyer/Seller) 51 Date: Time: a.m./p.m. ATTACH THIS COUNTER-OFFER TO THE OFFER TO PURCHASE Note: Provisions from a previous Counter-Offer may be included by reproduction of the entire provision or incorporation by reference. Provisions incorporated by reference may be indicated in the subsequent Counter-Offer by specifying the number of the provision or the lines containing the provision. In transactions involving more than one Counter-Offer, the Counter Offer referred to should be clearly specified. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ` i 16 M.sa it3.CS' ` v r-- ~ g N M io 4q 0 f " AV C7 7r I r ~C u • y Tv CD I # ~ ~ 05y ~ . H G __e'- OCR U3 s DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY,' DIVISION LABOR AND' P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHIP/ LOT NO.:BLK. NO.: SUBD VISION NAME: '/a /T N/R E (o 'r v COUNTY-~ OWNER'S/BUYER'S NAME: MAI ING ZAI-si -36 USE o , W--,f ,7DATES BSERVATIONS MAD NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES R PTIONS: ER OLATION TESTS: Residence ERI~ew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MODUyN~•D: IN_ -GR[,JS OUND-PRESSURE: SYSTEM-IN-FILLHOLDIING TANK: RECOMMENDE SYSTEM optional L~J ❑U UJ OU OU IE]S [al ❑S L2Y ° If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO 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- e'( Ord, > I /S~ 7, l nl , ZIl3n~f ht B- Z ~3 ©o.S ~~/S l~n S 9 sss Nj> B- 3 ~3 9,d e ? ~3 '!3 f/ • 6 "6'~ c ~S w c -7.4, B- < <1 9 7 P/ S/ /•/'/fin /.3 /Zcs w d [6 ?.Z' .,cs ~ "A" B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PER D PERINCH P- P- P- P_ P- 0 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 V'""~ z E E E I +c o~ 77 4i I"W E 4Q , : 1 [ ,Tai `v{ yy 1•lrJrl a ~~s e~ ridar./e-ti- i i ~ r t m . 77' 4 aCovistr s l-a kc_ /7- 1 ] i 6 I, t un ersigne hereby certify that the soil tests reported6n this form were made by mein accord with the procedures an methods speci ie in the is nsin A inistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. /PrHrr _ 4. - NAME ~oUtn NAME (print): DAVE' TESTS WERE COMPLETED ON: Licensed Perk Tester & Plumber 2~ .Z ADDRESS: 0323-V ft289 CERTIFI ATI N NUMBER: JPHONE NUMBER (optional): f rty He 'ONhtS Road SiN 54023 '14 1 Phone 749-3555 CST ATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - I >TIONS FOR OMPLETIN FORM 115 - SBD - 6395 To tie _j accurate soil test, you; rep r. elude- 1, 2. The tv' ~'Iction must clearly whether V sidence or commercial project; 3, MAXI i, J °;I €;uniber of bedi o. commercial :Fined; 4. Is re e rTient sys' 5, Comp3. t rating b: A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHFR RULEI:~ " SED CAN SOIL CONDITIONS; 6_ PLEASE u, eviations showi writing profile descriptions and comp. ing'the plot plan; 7, MAKE A diagram accura i your test locations. Drawing ~ is preferred. A separate used if desirrrl° 8, Make sur, )chniark and v i reference point are clearly shown,, ~d art- permanent; 9. Complete a" ~riat:e boxes as t:r tes, addresses, flood plain data, percolation test exemp- tion, if ap - 103 If the inforn3i ich as flood plain, is 1) does not apply, place N.A. in the ap,,,r. -,.e box; 11. Sign the form a _ p`'ice your current _ _ d your certification number; 12. Make legible: { and distribute as uhed. ALL SOIL. TESTS MUST RE FILED WITH THE LOCAL AUT Y WITHIN 30 DAYS OF COMPLETION. ABBREVI T,- -)R CERTIF E SOIL TESTERS So s and Tee Symbols st i (over 1C L 3rock cols - {3 - 10") tore I gr Gravel (undei' 3") ;t:rstont: s Sand f j, Cr WSU Sand F_ 'c - airy F Medium Sand F`ne Sand 33Idd g i, iy Sand > Than Lcrrii~ < T arr Bn 00-'.1 - ! Lnani 'ai Gy y -?1 y r R - I L, Mot f) ( y ,i V, fine Clay F Many, m Y.. distinct h promin High v - 6:1 S surfs Ii Giant vertica fe'ence point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the d{~Prrtpl¢litl~r~rtyl order to obtain a permit. The sanitary permit must be obtained and posted prior To thestart a~f ai4 construction. a 4) FOGERTY PLUMBING & PERK TESTING, INC. P-0- X ROBERTS, OWl130 023 .r o s 1J I a 77 i ~s /3s zoo Gl/ ~o ~a...~ f=ew 77 i ror r~ ~®l~ ~ 'r~3 X . ~or,N7 X ~2 = we//' ~i { ~ r yz' 2A) 'rd I ~I I r ~ F j~ R* J m x N ~p OR s. m ~ V o. REPT131• TROY ST. CROIX COUNTY ZONING PAGE 1 09%21/912'13:22 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/21/92 AREA: MJ Activity: A9200246 9/21/92 Type: CONVSEPT Status: PENDING Constr: Address: 420 RED BRICK ROAD TTRO Location: 420 RED BRICK ROAD TTRO,NE,NW,SEC.8,LOT 5, RED BRICK RD. Parcel: 040-1218-90-000 Occ: Use: Description: 171481 Applicant: REUTER, MARK Phone: Owner: REUTER, MARK Phone: Contractor: FOGERTY, DAVID B. Phone: 749-3656 Inspection Request Information..... Requestor: FOGERTY, DAVE Phone: Req Time: 13:09 Comments:' Items requested to be Inspected... Action Comments y Time Exp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION