HomeMy WebLinkAbout028-1054-04-080
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,` DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 3707
HUMAN RELATIONS
(H63.0911) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION N ME:
1-3 /T2SN/R/71 (or W s .,Er y ` i'ce` /
COUNTY: OWNER'S BUYER'S NA E:`. AILIN ADDRESS:
rn'X E /Q AI
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE ES IPTIONS: R A ION TESTS:
Residence ❑New
I 14
RATING: S= Site suitable for system U= Site unsuitable for system
I
ros ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:( ptional)
❑U S ❑U S DU ❑ S 2U [:]S NU
-2a
If Percolation Tests are NOT required DESIGN RATE: ~O ( If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: A 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- ~y n"' .33 Qls;l° /33 Bns/I' •8s' eL,s~ s • 387~~,
B-
B-
B-~ ~~9~r 9L'S~ /~n/1P, •58 /si~.2-nrBr/,5/ ° /33/ ~0 u>
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 7 PERIOD2 PERIOD PERINCH
P- 3
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.
SYSTEM ELEVATION 90
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IN
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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:
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
J See. 13
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aZ~~ p63 Swy NW%
ax 87-5
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Own G r ;
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ass Cty, Rd, y
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lca/cv,'nJ w; , /Y))O G 19
S"y°aL. CST 3y l 3
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92 - 93.01
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F'l1 I 'n r ell o o-' sla 6 at
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so /O/W ,'n j a')," /'7 P 4(.12q
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Wiscpnsih De0artmentof Industry, PRIVATE SEWAGE SYSTEM County:
tabor and Human Relations INSPECTION REPORT St. Croix
Safety and Buildings Division /Ip p
SW a NW a ? 9„pgAp IT) Sanitary Permit No.:
GENERAL INFORMATION tS~Kl~ 149072
Permit Holder's Name: ❑ City ❑ Village gl Town of: State Plan ID No.:
Bill Findlay Rush River
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA pqio 0 2,011
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
irito ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Ar
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
Qss
Forcemain Length TD a. Fi 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
INFORMATION TypeO 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
- f
DlLHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code NTY
ZE MEMO 5-71,
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /
4~QlJ '7
8% X 11 inches in SIZ@. Check if revision to pre ous 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
~ A/ A14, S 2 T Z g, N, R % -7 Er (or W
PROPERTY OWNER'S ~
MAILING ~f RE LOT BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
13 71L
CITY NEAREST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE 7 cry Xd X
.Q ;QWN OF:
ARCEL TAX NUMBER(s)
❑ Public 0 1 or 2 Fam. Dwelling--# of bedrooms ~ P
111. BUILDING USE: (If building type is public, check all that apply) /x,314 })n - wl- go 0
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) 1.0 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 ❑ 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
7 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) , ELEVATION
/ 25 /5-7 ~5' j • -7T z 0 9a-o s'Feet Z `0 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 strutted
Septic Tank or Hold! n Tank i'DD yCl~ ! E~ S~ ✓ r n= ~ =01 El 1 1:1 1 0
Litt 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.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Businesp Phone Number:
_D11 h X__ A✓.,,W5-0r2 l~ r ` 7f
Plumber's Address (Street, City, State, Zip Code):
~Zzo 1;12 ,
l
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing ent Signature ( Stamps)
W Surcharge Pee)
Approved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
1
APPLICATION FOR SANITARY PERMIT
S T C - 100
r
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor.,(spec house), 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
Location of property -S-l-c-2 1/4 A11V 1/4, Section 12 T Z~? N-R (7 w
Township
Mailing address
Address of site ~Cvinc;
Subdivision name AIX
Lot number All-II,
Previous owner of property
Total size of parcel zll9
Date parcel was created
Are all corners and lot lines identifiable? es No
Is this property being developed for resale (spec house)? Yes No
Volume ff'e2 ~7 and Page Number -'70 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, and
the SEAL OF THE REGISTER OF DEEDS. In additionr 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 ~c~ccthlt'r^f /l~c~• 321IS6
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 warrant deed recorded in the Office of
the County Register of Deeds as Document No. 7i 9 - - 27c, ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly recorlded in the Office
of t Pe County Register of Deeds, as Document No. SD 't' Z--'~ 6 3 2-113 4-
- I'mn - A
Signatur o Owner Signature of Co-Owner (If Applicable)
~A-q A
Date of Signature Date of Signature
I
DOCUMENT NO. WARRANTY DEED
GTATZ OF W111CONRIN-FORM I
B00V 509 wA,r TNIe erAC! IISSt11Va0 FOII IKCOROINO DATA
270
321136
n lJ r [ THIS INDENTURE, Made this..._.lst day of...A~ril A. D. 19.-•7 REGISTERS OFFICE
ST. CROIX CO.. WIS.
~ .
,
between ..._...C-las:epee...H4.mi2tmL..arid-.A1ma.._H=ilton•
husband and w?4f....1Q~.1~t..cilaT~.ts...at~d............
- Recd for Record this-- Wh-
na :aua...? -4......_...• 4
,part- e€--.. of the first part, and day of--- -il ---A.D.19_~
William ixtsl.].ay....... 0-aQ__&t, M. j
husband..?... wif..._as .loin ...t -
.(1.
Rsg tei of Deeds
» ..............._...part...ies. of the second part,
Witnesseth, That the said partAiM... of the first part, for and in consideration
of the sum of...». O. Dollar - ( 1 t 00~ and other valu~.ig•_,......._.•.., 1eT1RN 7O i
consderatons.z.......................................................... j
„to.._».th~..... in hand paid by the said part-? e$... of the second part, the receipts
whereof is hereby confessed and acknowledged, ha.Ve... 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.aes.. of the second part ......themselves,,,the Theirs and assigns forever, the following
described real estate, situated in the County ,Croix.................. and State of Wisconsin, to-wit:
j
A parcel of land located in the South West One-Quarter of the North West
One-Quarter (SWyi of NW1) of Section Thirteen (15), Township Twenty-Eight
j~ (28) North, Range Seventeen (17) West, more particularly described as li
f the West 375 feet of the North 900 feet of said description, being arNSFER Ii
acreage of approximately 7.7 acres. Township of Rush River.,
FEE j
y j This being a partial release from land contract, Document #319637, Book #505,
Page #586, Dated December 3, 1973, in the Register of Deeds Office, St. Croix
it County, Court House - Hudson, Wisconsin.
(IT NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE)
! Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise
appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part...~8.. of the
first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and
their hereditaments and appurtenances. i
To Have and to Hold the said premises as above described with the hereditaments and appurtenances, unto
the said part... M. of the second part, and to.. t7lP e1.X ~...the3x..._. heirs and assigns FOREVER.
i j And the said
•for..._.themselyes,„th~~,~; • . .
„ covenant, grant, bargain, and
. heirs, executors and administrators, do
j agree to and with the said part... e.s. of the econda part, heirs and assigns, that at the time of the
ensealing and delivery 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 incumbrances whatever,
and that the above bargained premises in the quiet and peaceable possession of the said part..AA§... of the second
part, ....their-....... heirs and assigns, against all and every person or persons lawfully claiming the whole or any part
thereof, they-........ will forever WARRANT AND DEFEND.
In Witness Whereof, the said part.. 0.6.. of the first part ha Ye.... hereunto set ......their-_ hand..s.. and
j seal 9this..._..JA.t day of....... ;U A. D 19...74_.. ',,c.-..-_.
SIGNED AND SEALED IN PRESENCE OF . . .(SEAL)
Clarence Hamilton
i
...to . G (.~C. - ....(SEAL)
Alma, Hamilton j .
Donald j-Daringer
_
(SEAL)
Naomi A. Deringer Q
(SEAL)
State of Wisconsin,
$t.....CTQix....... County. Personally came before me, this.............. day o___.A...>? .......ril A. D.,
CC1l 1st 71+
the above named enee Hamilton •_and a Hamilton '
. .
it 3
.
to me known to be the person.... wN.-4 iC* tb f egoi g instrumen and nowledged the same.
• ! 9 ...THIS INSTRUMENT WAS DRAFTED BV-- '4 ' T V James H. Deringer
otary Public, - St .C...............roix County, Wis.
t
James Deringer,Realdhi'► ,.t. hod My commission (expires) 7~f)...__...: UK
Z' '._70)...1l7~.
W ` s"),fj• : MORTGAGE FLB LOAN
VOLE 196 395775-7-0
i
REGISTERS OFFICE THIS MORTGAGE, Dated -.June-2-1,, 197-9 by
ST. CROIX CO., WIS.
Recd. for Recor4l this__ 2nd William M. Findlay and Ann L. Findlay, as his
day of July A.D. 19 79 wife and in her own right;
OT 3'P
R Nd•
mortgagor (whether one or more) to The Federal Land Bank of Saint Paul, a cor-
poration, 375 Jackson Street, St. Paul, Minn. 55101, mortgagee.
Recording Information Said mortgagor, for the purpose of securing payment of an indebtedness from
the mortgagor to the mortgagee in the principal sum of %8-000:00- i -
eluding committed obligatory future advances or readvances made by the
mortgagee to the mortgagor, not exceeding in the aggregate amount outstanding at any one time the said principal sum, with interest
thereon, hereby mortgages to said mortgagee the following described real estate in the County of -St- Croix State of
Wisconsin____
SWIG W%;
Sec. 13, T28N, R17W.
Subject to existing highways, easements, and rights of way of record.
The above described premises contain 40 acres, more or less.
TO HAVE AND TO HOLD THE SAME, Together with all the tenements, hereditaments and appurtenances thereunto belonging, or
in anywise appertaining, forever. Mortgagor covenants as follows: First, that he is lawfully seized of said premises; Second, that he has good
right to convey the same; Third, that the same are free from all encumbrances; Fourth, that the mortgagee shall quietly enjoy and possess the
same; and that mortgagor will WARRANT and DEFEND the title to the same against all lawful claims.
PROVIDED, NEVERTHELESS, That if the mortgagor shall pay to the mortgagee, at its banking office in the City of St. Paul, Min-
nesota, the suns loaned with interest thereon at the rate ofdpercent per annum (designated as the basic rate) according to the terms
of a promissory note bearing even date herewith, or subsequent notes, given to evidence obligatory future advances or readvances together
with the unpaid principal sum owed on the prior note, providing for installment payments over an amortization period, and permitting an
increase or decrease in the interest rate, the final installment being payable on _August 1,, 2004 and shall perform all the
covenants and agreements herein contained, then this mortgage shall be void.
Future advances or readvances which mortgagee is obligated to make to the mortgagor from time to time within the limits of said prin-
cipal sum, together with the unpaid principal sum owed on the prior note, shall be evidenced by a new promissory note given by the
mortgagor to the mortgagee which shall be secured by this mortgage.
The mortgagor shall pay simple interest at the rate of two percent per annum higher than the basic rate specified herein, or two percent
per annum higher than the rate then applicable if the interest rate has been increased or decreased, on all defaulted payments, both of prin-
cipal and of interest, and the lien of this mortgage shall extend to the same.
MORTGAGOR HEREBY COVENANTS AND AGREES WITH MORTGAGEE AS FOLLOWS:
1. To pay said principal sum and interest in the manner hereinbefore set forth, and to pay when due all taxes, liens, judgments, or assessments which
may be lawfully assessed or levied against the property herein mortgaged.
2. To insure and keep insured buildings and other improvements now on, or which may hereafter be placed on, said premises, against loss or
damage by lire and/or tornado, in companies and amounts satisfactory to mortgagee, any policy evidencing such insurance to be deposited with,
and loss thereunder to be payable to, mortgagee as its interest may appear. At the option of mortgagee, sums so received by mortgagee may be used
to pay for reconstruction of the destroyed improvement(s), or, if not so applied, may be applied in payment of any indebtedness secured by this
mortgage.
3. In the event mortgagor fails to pay when due any taxes, liens, judgments, or assessments lawfully assessed against property herein
mortgaged, or fails to maintain insurance as hereinbefore provided, mortgagee may make such payment or provide such insurance, and the
anunuitf s) paid therefor shall become a part of the indebtedness secured hereby and bear interest from the date of payment at the rate of two
percent per annum higher than the basic rate specified herein or two percent per annum higher than the rate then applicable if the interest
rate has been increased or decreased.
4. To use the loan proceeds solely for (a) the purposes specified in mortgagor's application or, (b) for other purposes mortgagee may require or
agree to in writing.
5. To complete forthwith any improvements which are, or may hereafter be under construction thereon, and to pay any expenses and attorney's
fees incurred by the mortgagee for the protection of the lien of this mortgage.
6. Should the premises herein described be not worked in a good and husbandlike manner or be abandoned or cease to be used for farm purposes,
or should the buildings on said premises become vacant or unoccupied or be not maintained in reasonably good repair, or in the event of the actual
or threatened demolition or removal of any of said buildings, or upon the cutting or removal of wood or timber from said premises except for
domestic use, or in the event of such acts which would amount to equitable waste being committed thereon or substantial injury being suffered or
permitted to said premises, the whole of the mortgage indebtedness shall become due and payable at the option of the mortgagee.
7. This mortgage is subject to the Farm Credit Act of 1971, and all amendments or supplements thereto.
8. If all, or any part, of the premises described herein be sold or transferred, without the written consent of the mortgagee, then said mortgagee may,
at its option, declare the entire indebtedness hereby secured due and payable.
4726 2/79
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SEPTIC TANK MAINTENANCE AGREEMENT CD
St. Croix County z
d
OWNER/BUYER `
ROUTE/BOX NUMBER S~~ ~t y~~ y Fire Number
CITY/ STATE Z IP S-Ooz,
PROPERTY LOCATION: _S_Ct) 14, A)eV 14, Section 12 T ZT N, R. / % W,
Town of 11 `y' St. Croix County,
Subdivision Lot number AIX
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 1) er. What you put into
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. Croix 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.
0
I/WE, the undersigned, have read the above requirements and agree N
to maintain,the.private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- n
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
i
DATE_ 24/Q/
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.