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Parcel 040-1191-80-000 10/31/2005 04:25
PAGE 1 OF 1
F 1
Alt. Parcel M 24.28.20.854 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - OKAL, JULI
JULI OKAL C - OKAL, JONPAUL
JONPAULOKAL
230 PLAINVIEW DR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 230 PLAINVIEW DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.300 Plat: 0234-CROIXRIDGE
SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 08
8 ALSO PT OF LOT 7 DESC AS BEG NW COR
LOT 7; TH S 89 DEG E 143.50'; TH S 19 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG W 441.65'; TH N 00 DEG E 417.69' TO 24-28N-20W
POB
Notes: Parcel History:
Date Doc # Vol/Page Type
08/03/2005 802242 2857/212 QC
06/03/2004 764757 2588/334 WD
07/23/1997 1160/276 WD
07/23/1997 1156/615 WD
more
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.300 95,000 312,300 407,300 NO
Totals for 2005:
General Property 1.300 95,000 312,300 407,300
Woodland 0.000 0 0
Totals for 2004:
General Property 1.300 95,000 312,300 407,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
SAFETY & BUILDINGS
DEPARTMENT OF REPORT ON SOIL 60RINGS AND DIVISION
INDUSTRY, P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
NSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME:
LOCATION: SECTION: 7WTM
Y 8 xxx Croix Ridge
SE /T N/R E (or) TRO
COUNTY: Odd1d'E"VBUYER'S NAME: MAILING ADDR SS:
St, Croix Tom Bides ~35 E. Viking 1k. 0349, Little Canada, MN 55117
USE Phone : 484-1589 DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DE CRIPTIONS: PER OLATION TESTS:
Residence 3 New ❑Replace 4-28-91 4-28-91
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: ll -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TrVEC OMMEND ED SYSTEM:(optional)
S EIU 0 S ou❑ S EJu a S Q S Econventional 12' x 52'
Ilf Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: n~a I Floodplain indicate Floodplain elevation: None
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-1 86 96.5 none 86 1.5'Bkls l'Bnls 4.7'Bncs.
B-2 91 96.8 none 91 1.6'Bkls 6'Bncs. -
B-3 94 99.1 none 94 2'Bnls 1'Bnsl 4.8'Bncs.
g4 73 95.9 none 73 1.4'Bkls .8'Bnls 3.9'Bncs.
B-5 88 98.2 none 88 2'Bnl ' 'Bncs -
-4 95.8
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R I OD 3_ P
P_ 1 46 none 3
P-
P_ 2 49 none 3 1than 6" dro within P-
P- 4 38 none '
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 92.7'
49'
F 8CAI 1"'
w - .
Q BM top of nail at `bas4_ of .
_ _lo wh*te ioak tree, assume 100:,0'
~~r 6S1 ° perk_ 4-.._
I white 1oak tree.
_ cedar ,tree,'' A ~o~_
N
P" E: Lot Line
77.5 alt . ,
r
i
r
2 '2 D
:
W Plainview Dr.
I, the un ersigne , ere y certi y a e sod tests reported on is orm were-mace y me in accord with the proce ures an 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:
Dave Fogerty 4-28-91
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
Fogerty Hgts, Rd., Ihberts, WI 54023 3233 749-3656
C NATU
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
J
FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 2V TOWNSHIP
SECTION N-Ra W
ADDRESS ST. CROIX COUNTY, WISCONSIN
e ct S~/ J ,
SUBDIVISION LOT_ _F LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4
3r
\\~s, 3 ~ ~parr
/j-
INDICATE g~®Z INDICATE NORTH ARROW
BENCHMARK:Elevation and description:
Alternate benchmark
~ ~ l w
SEPTIC TANK:Manufacturer: 'tr~~- Liquid Cap.
Rings used: a manhole cover elev:ffiy~Final grade elev: 9,0.p
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front Side , Rear Ft.
From nearest prop. line:Front Si Rear Ft. >
No. of feet from: Well wiBuilding:
(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:--L-L-Length S ? Number of Lines:_ Area Built
Exist. Grade Elev. Proposed Final Grade Elev. / L7, '?K' -f
Fill depth to top of pipe: 8
No. feet from nearest prop. line:Front , Side fie, Rear Ft. 9M V r
No. feet from well:e1iWe- 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:
INSPECTOR:
DATE : 7-17-'?l PLUMBER ON JOB :
LICENSE NUMBER:9
6/90:cj
lqgl acs i 77
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. E.OX.7969 PRIVATE SEWAGE SYSTEMS DIVISION
BUREAU OF PLUMBING
MADISON, WI~53707
SE1,SW1jSec.24,T28-R20 ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number:
Town of Troy, Lot 8 El Holding Tank ❑ In-Ground Pressure ❑ Mound 111 assigned)
Plainview Dr.
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Tom Sides 235 D. Viking Dr. #349,Little Ca ada, MN
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.
Q~ I IS it ~Cuf° GQ~ f ~i°Sfl~nr ~ 1ao, v
Name of Plumber: MP/MPRSW No. Cnumy Sanitary Permit Number:
David Fogerty 3289 St. Croix 149057
SEPTIC TANK/HOLDING TANK: _
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
ED-
V% O L~ PROVIDED: PFY
BEDDING: e;5
VENT DIA.: VENT MATT NIGH WATER ~V q~ / ES r`TJ~NO ES 0NO
ALANM NUMBER ROAD: ]PRO PERTY WELL- BUILDING. VENT TO FRESH
L`/ /~/1Y FEET FROLINE AIR INLET
❑YES ~NO ❑YES 2NO N?56 DSO /J 3S'
DOSING CHAMBER:
MANUFACTURER BEDDING. LIOUIDCAPACITY IPIJMI'Moot1 1PuMP'SIPHON MANUf AC TUHEH WARNING LABEL JLOCKING COVER
PROVIDED: PROVIDED.
❑YES ❑NO ❑YES ❑NO ❑YES ❑ND
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 1PIII1PE HTV WELL BUILDIN(; V NT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) ❑YES ❑NO NEAREST-;L >
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE I I N ,11I FF.TE H JMATE HIAL AND MAHKIN(i
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry, enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH wlorH ILENGTN NO OI =111IPI SPACIN( COVER NSID! UIn -PIT S LIQUID
lam/ n+ENLs MATERIAL! PIT / 1- DEPT
DIMENSIONS 15 ?j' L S t~
GRAVEL DEPTH FILL DEPTH OISTN PIPE UISTN PIPE DISTR. PIPE MATERIAL NO DIS1T1 NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER EI EV INIf ( ELEV. END PIPES FEET FROM LINE AIR INLET
[0 3, ~l,3~4Y GZ3,~/Ll ~'r r~7 L NEAREST-►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES NO meets the criteria for medium sand. TIONS MEASURED.
❑
SOIL COVER TEXTURE 1,11 IIMANINIMA14KIHS 111115111 VATIONWELL5
_ ❑YES ❑NO ❑YES ❑NO
DEPTH OVER THE N(:II BED DE PT// OVF H THENCH HE U "up TII OF TOPg()IL SOI)DF 1) UfD MULCHED
CENTER EDGES
❑YES. ONO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH THE NCHES LATERAL SPACING (iHAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTN DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV. ELEV. DIA ELEV. PIPES DIA:
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CONHECILY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YE ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING:
FEET 'I LINE:
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710 (R. 01/82)
SANITARY PERMIT APPLICATION ~o~N
2 ILHR In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~to pr v--7
8% x 11 inches in size. A. s on ious 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
Tom Sides SE '/4 SW '/4, S 2 T 28, N, R E (or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
235 D. Viking Dr. #349
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR 88M NUMBER
Little Canada MN 55117 1484 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned ❑ VILLAGE : OY Plainview Dr.
❑ Public ❑ 1 or 2 Fam. Dwelling--# of bedrooms 3 AR EL NUM R( )
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo Yd _ - q0
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 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. El New 2. ❑ Replacement 3. ❑ 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 300 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 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) ELEVATION
450 615 615 .73 3 92 Feet 96.5 Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed I 1000 1 Weeks Concrete I I
Septic Tank or Holding Tank 1
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.
Plumber's Name (Print): 's Si nature: (No S ps) MP/MPRSW No.: Business Phone Number:
David 3289 749 3656
Plumber's Address (Street, City, State, Zip Code):
Fogerty Hgts. IN., Roberts, W1 54023
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved nary Permit Fee (includes Groundwater a e ssue Issuing A ent Signat a (No Stam
Approved El Surcharge Fee)
Owner Given Initial *7
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
• ti Y
+ APPLICATION FOR SANITARY PERMIT
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. 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 Section ,9--f_ , T -g( N-R PLO W
Township
Mailing Address
Address of Site
I 11Y
Subdivision Nameh 1~-►-•rvr
Lot Number
Previous Owner of Property
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
i
Volume - and Page Number as recorded with the Register of Deeds.
94c-)L C~p ICIO
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
I
A Warranty Deed which includes a Document number, volume and pa&e number, and 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTy OWNER CERTIFICATION
I (We) ceAti6y that att statements on this 6oun atte true to the best oS my (ou&)
knowledge; that I (we) am (ate) the owner (.s) o6 the pno peh ty des cA bed in this
inboAmafii.on 6ohm, by viAtue ob a waiAanty deed heco&ded in the 066ice ob the
County Reg.usten o4 Deeds a.5 Document No. 9,~r/_3j; and that I (we) ptes ent y
own the ptopod ed site 6o& the sewage diz po.a a t system ystem (o& I (we) have obtained an
easement, to nun with the above descA bed pnopeAty, Gott the covustnucfii,on o6 said
.system, and the name has been duty %eco&ded in the 046ice o6 the County Reg.c step ob
Deeds, asvcunx2nt No. 4
~4r/3 1.
SbGb 4TifR8 OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE' SID ' DATE SIGNED
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
469513
M2 r
VOL „ I6__=--
I-- REGISTER'S OFFICE
This Deed, made between AleX S. Koss REGISTER'S
Reed for Word
Grantor, i MAY 211991
and E. Sides and Nanc J. DoX _ Of 8:50 A M
and T
.X .
, Grantee, Reoate►oiDeeds
Witnesseth, That the said Grantor, for a valuable consideration--.-__ j
~
conveys to Grantee the following described real estate in __.___St . Croix 1 RETURN TO
County, State of Wisconsin:
qd~_
UL Pt Tax Parcel No:
Lot 8, Plat of CROIXRIDGE Addition located in the Southwest
Quarter of Section 24, T28N, R20W, in the Town of Troy.
Acceptance of this deed shall be indicated by its recording
with the Register of Deeds and shall automatically and
irrevocably make the Grantees, their successors and assigns
a member of a non-profit, non stock corporation known as
it CROIXRIDGE HOMEOWNERS ASSOCIATION and entitle them to the
benefits and privileges of said association and bind them to
the terms, conditions and obligations of said association.
I~
This deed is given in fulfillment of a certain land contract
between the above parties, dated April 26, 1991, and
recorded on April 29, 1991, in the office of the Register of
Deeds for St. Croix County in Vol. 900, page 318 as
document No. 468785.
N
This is*. not homestead property.
(is) (is not) UAL
Together with all and singular the hereditaments and appurtenances thereunto belonging;+
And......... A2_P-X___,S.s_..K.QSs3L..................................................
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to
recorded easements, reservations, covenants and except any liens or encumbrances created or suffered
to be created by acts or defaults of grantees.
and will warrant and defend the same.
Dated this 8t-h day of M1y 19.9,4...
(SEAL) (SEAL)
-Alex S. Kos,a
...............(SEAL)
(SEAL)
r
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
St. Croix County. 31170
Y•~b~X~!
authenticated this ........day of.......................... 119 Personally came before me this ...t, ~ - M~.Y-•----••---••••--•-•...._..•-___., 19.._1. the alf50W r~
-A1-ex---S-.---I::~a -r r
S
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) to me known to be the person who execute& the
i
foregoi instrument and ac nowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Alert S., Kosa, Attornev at Law
* ';dr L. os4
H.1343tln-,-..NIX_..__5,44.1JS Notary Public t,..--0ro-J'- -............County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. ([f not, state expiration
are not necessary.)
date- -------~Il1C1Q_._14.....................
19~~...._.)
*Names of persons signing in any capacity should be typed or printed below their signatures. II
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leda] Blank Co. Inc.
^lYR~' n Lrr. W;,.
H
z
m
H
a
STC - 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
l7
a
~ g H
OWNER/BUYER
A~f[,Lid cd~t~2
ROUTE/BOX NUMBER L,n{ ~`Vb~ ( J Fire Number
.CITY/STATE ZIPu
PROPERTY LOCATION:~~r., ~4, Section, TQjN, R.2~0_W,
Town of , St. Croix County,
Subdivision Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you pdt 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. yo
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ro
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.
$ GNED -r A
.DATE ~TZ I ~f
St. Croix County Zoning Office
P.O. Box 9S
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY,.. DIVISION P.O. BOX 7969
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/ OT NO.:BLK. NO.: SUBDIVISION NAME:
or) W TROY 8 xxx Croix Ridge 24 _Ft 7, I I
SE ~ s '/4 /T N/R E (
COUNTY: OWN'e"/BUYER'S NAME: MAILING ADDRESS:
St. Croix Tom Sides 35 E. Viking k. 0349, Little Canada, MN 55117
USE Phone' 484-1589 DATES OBSERVATIONS MADE
Residence NO. BEDRMS.: COMMERCIAL DESCRIPTION:
New ❑Replace I TESTS:
3 4-28-91 4-28-91
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
EIS DU 0 S EJU x0 S E]U NS oU 10S OU conventional 12' x 52'
[If Pcion Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
83.09(5)Ib1, indicate: n/8 I Floodplain, indicate Floodplain elevation: None
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH T R UNDWATER-INCH S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION OBSERVED TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.)
B-1 86 96.5 none 86 1.5'Bkls l'Bnls 4.7'Bncs.
B-2 91 96.8 none 91 1.6'Bkls 6'Bncs. .
B-3 94 99.1 none 94 2' Bnls 1' Bnsl 4.8' Bncs.
B-4 73 95.9 none 73 1.4'Bkls .8'Bnls 3.9'Bncs.
B5 88 98.2 none 88 2'Bnls 1,21Bnal 'Bncs.
-4 95.8
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD P RI PER INCH
P- 1 46 none 3 >
P-
P- 2 49 none 3 > than 6" dror within 3 min
>
P-
P- 4 38 none >
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 92.7'
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o white oat. tree, as9atlme 100.0'
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Plainview Dr. 9G'
I, the un ersigne , ere y certi y a the soil tests reported on is orm were made By me in actor with the procedures an 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:
Dave Fogerty 4-28-91
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
Fogerty Hgts. Rd., bberts, WI 54023 3233 749-3656
C NATO
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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