Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
022-1030-90-010
C) 0 a p 60 03 °� o 0 ct N E .2 .2 co o _ c 3 o _ E a) c ~ E c 2 � oar Q) H N.7 O OLL Q �L E Q.y ry c a o ti 3 2 ° � .� c c ° v ° 1 C @ ° @ aY .== ) E 3 y ° 3 0 0 c 'o N L 'O Q) 0 U a) 0 c ° V C N °j'�N C O _ U'O = c Z N' E'm E c a c °'0`0 > `0 >°cc° V U° N -8 01 U) to @ O Cl y O c E o o @ 3 o _ 'ZY rn c m a c @ t9 p N I °a00 aQw E m wa m a° a) o a z Q°c° ca�iE °o. z cNO � (n C - '6 O a) ui N Q) 7 a) O -O rn rn C a) 7 @ q _ - @ O L a) a1 C E C N T" - lL C O a) _O v) LL a) U 0.- d C: ao) m °o c = of c a�i aEi <° c c a��iw0) °- `m °° c a) c Ein c co 7t N M > Z E E C2 Z . 0 4i O O E 0 O L 'L6 CL m a m I c C7 I O z c N c m a O c N C O a N U) N U N •� a` L L I a` � L A c O c O o ° ° CN Cl) Z H Z Z F- Z N N E C 1p E E CD o a a 4 L LO 0 a 4 O) C O CK H H F- @ o 0 o a z � o 0 0 •N ;� 2- aa a. aa N O N a) ) iA J L) U OM) CO� 0 m m } M� n.0_ 6) a-) m o o O M O O N� Ir-- (O d E O O " 0 0 M M d O U')d d _ 4 Z a, 0 3 y c u—�i c © O H- 06 a6 6 CO 4) N () O CD ca c aU c c c ° c cn u d oO c) o \ Q1 aC 3 ° ° 3 N E @ CD N N N (n cn v OM Y W ,� C N a) W N a) O 7 n M M_ U) L m Z Z ui ( `a) Z c a°i ° `n c @ • ice.' No Y o FO- H o � H <n cz z a) M E a ` a t _a ! a V y w L:a) • •C� Q• a) . a) C M C U C C .d O C O ~1 A U a II O N U O N U �', � `� t�',�@ I �_'_"" i ry�� O a +T�� �'�-."" �� � �. 3 � Parcel #: 022-1030-90-010 11/25/2009 01:39 PM PAGE 1 OF 1 Alt. Parcel M 11.28.18.167A 022-TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 10/19/2007 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner EDWIN H & MARY PAUL ROSS O-ROSS, EDWIN H & MARY PAUL 470 OLD CEMETERY RD ROBERTS WI 54023 Districts: SC =School SP=Special Property Address(es): *=Primary Type Dist# Description *470 OLD CEMETERY RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 37.830 Plat: N/A-NOT AVAILABLE SEC 11 T28N R1 8W SW NW EXC AS DESC IN Block/Condo Bldg: DOCUMENTS 862720&862722 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-28N-18W SW NW Notes: Parcel History: Date Doc# Vol/Page Type 10/19/2007 862726 EZ 10/19/2007 862723 AFF 10/19/2007 862722 QC 10/19/2007 862721 AFF more... 2009 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/14/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 100,000 441,600 541,600 NO AGRICULTURAL G4 12.000 1,800 0 1,800 NO 00 UNDEVELOPED G5 7.000 21,000 0 21,000 NO 00 PRODUCTIVE FORST LANDS G6 13.830 83,000 0 83,000 NO Totals for 2009: General Property 37.830 205,800 441,600 647,400 Woodland 0.000 0 0 Totals for 2008: General Property 37.830 240,000 441,600 681,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 COMMERCIAL TESTING LABORATORY, INC. 5i4viala Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 a ST. CROIX ZONING REPORT N0.'# 05467/01 PAGE 1 ST. CROIX COUNTY REPORT DATE'# 5/25/90 COURTHOUSE DATE RECEIVED'# 5/23/90 HUDSON, WI 54016 ATTN'# THOMAS C. NELSON L1'J1AJ4J -3-7 Edwin 6 Mary Paul. Ross LOCATION: 470-130- t., Roberts 01� COLLECTOR'# M. Jenk i ns SOURCE OF SAMPLE'# Outside faucet COLIFORM'# 0 /100 ml INTERPRETATION'# Bacteriologically SAFE �t NITRATE-N'# 1 ppm { Under 10 ppm is safe for human consumption. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN'# Pam Gane WI Approved Lab No. 19 EVEN°FN 3� s° Means "LESS THAN" Detectable Level Approved by: �� ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 7 5-IJ-76 i q° V ST. CROIX COUNTY ZONING OFFICE ' St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning he service of Septic and water inspections to Lending Institutions Realty Firms, and , private individuals. cgnpletion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, _ along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) --FEE: $25.00 SEPTIC SYSTEM INSPECTION--------------- (Determines if system is pro p,�eJrly functioning at t e of inspection) Y /%l .� Property owner s name 4wa'lix Property owner's address `7�� �® _ � -e Legal Description 1/4 of the 1/4 of S c ion , T N-R Town of / Lot Number Subdivision Name FILM& EMER_- BOX NUMBER Color of house Realty sign by house? If so, list firm: U u A,ej PLBASS INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. l Firm or individual requesting services: fc/ai;-✓ Telephone Number 0 REPORT TO BE §1ENT TO: 470 130 it h Roberts WI 54023 r Clos nq date Signature ����i�-fie/��-r•�-� ���`� i4L E� G7� i .ri1 .. Guest P/✓ ST. CROIX COUNTY WISCONSIN i nr t ' { , `Ma ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 31, 1990 Edwin and Mary Paul Rose 470 130th St. Roberts, WI 54023 Dear Mr. & Mrs. Ross: On May 22, 1990 I collected a water sample from the mobile home on your property located SW 1/4 of the NW 1/4 of Section 11, T28N-R18W, Town of Kinnickinnic (470 - 130th St., Roberts). The sample was sent to the laboratory for testing, and the results of that testing are enclosed. There was also a request for a septic system inspection. In reviewing records at the Zoning Office, it was installed on the property during 1989. At the time the permit was issued for this installation, however, plans showed only a mobile home and the system was designed and sized for the mobile home. It is not evident that a permanent residence has been constructed on the property. At the time the septic system is connected to the permanent residence. A second inspection shall be required to determine that the connection between the septic tank and the newly erected structure meets code. There is a $25 fee for a reinspection. Please have your plumber call to schedule a time for the inspection and also be present for the inspection. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary Jenkins Assistant Zoning Administrator cj enclosure NO yo 3 ~ AV 4'a ~©o lei JJ6W II +v ~e rPYno d Se~~~c f Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER p TOWNSHIP k rAw~'c SEC. I~ T 2b N-R Q W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION YV LOT W LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i - ~V P~~p05#1 bah t~cK ~S 9 G oo a\ ~e~`~ c c 0,44 Z IV Bb I x 43 X a. S~ r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used To,n wacky >Tkk c Elevation of vertical reference point: JO o,p 6 Proposed slope at site: g al SEPTIC TANK: Manufacturer: C-_s Liquid Capacity: loo 0 Number of rings used: P Tank manhole cover elevation: 10 f 2 Tank Inlet Elevation: 1 0 3, 90 Tank Outlet Elevation: 10 3, 2~ Number of feet from nearest Road: Front 10 Side ,(D Rear, O a p feet From nearest property line Front,0 Side,O Rear, O 5 0 feet Number of feet from: well Sp building: 2 5 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: f7- Liquid Capacity: ~ Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: t: c Number of feet from nearest property line: Front, O Side, O Rear, Ft. =r' r Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: S Length: ) G d Number of Lines:-. , Area Built:-/ p 0 0 Fill depth to top of pipe: 070 - 9S Number of feet from nearest property line: Front, O Side, O Rear, 0lit.2s o Number of feet from well: VSO Number of feet from building: I '2s- r (Include distances on plot plan). q p,2 L g1,2g gj.08 SEEPAGE PIT z 84.21 Io,4D Ml- Size: yy 14 Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ea ~DCt~ License Number : 3 3 3/84:mj J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR-& f.JUMAN RELATIONS DIVISION P.O. BOX 7969 -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MA IS N, 15 707 /i State Plan I.D. Number: SW ,~TW4, ec.11,T28-R18 IQ,c6rintCAt` (If assigned) 44 Town o.f Kinnickinn *5CONVENTIO El ALTERATIVE Cemeter Rd. Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PER T HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ed Ross 470 130th St. Roberts WI 54023 D BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ErLE\k_ 9 S FIEF. PT. ELEV.: ci, Name of Plumber: MP/MPRSW N County: Sanitary Permit Number: Thomas Wan 3231 St. Qrj5jX1 SEPTIC TANK - nLAC'K MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: T NK OUTLE -LE WARNINOVER PROVIDYM ; V'41' G p Y56 NO BEDDING: bC?T DIA.: ACT MATL.: HIGH WATER NUMBER OF ROAD: PROPERT WFRESH C,ra FEET FROM 'L ❑ YES t NO YES NO NEAREST - DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES [__1 NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil isture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND M KING: or excavation. (If soil can be rolled into a wire, c struction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PIT LIQUID BED/TRENCH TRENCHES: MATERIAL: DEPTH: DIMENSIONS ELL: BUILDING: VENT TO FRESH PROPE W GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DIS . PIPE MATERIAL: NO. DISTR. NUML~~ BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LIN AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the xture o material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound s o make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO s the crit is for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/ DEPTH OVER TRENCH/BED OF TOPSOIL: DED: SEEDED: MULCHED: CENTER: EDGES: DEPTHS ES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURI D DISTRIBUTION SYSTEM: BED/TRE H WIDTH: LENGTH: NO. OF LATERAL SPACING GRAVEL DEPTH B W PIPE: FILL DEPTH ABOVE COVER: X TRENCHES: DIMENSI S MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DI IPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVA ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: O DISTRI TN ION AND HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL L ESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET 11, L INE FROM CO ❑YES ❑ NO ❑YES ❑ NO INEAREST--- / t e~j 11, P 4-7D I -_~,b +t, +S 022- 1D3o-'1o _ooo in county file for audit. Sketch System on Reverse Side. NA RE: TITLE: SBD-6710 (`R'. 06/8'8[)` f DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & 1-116!10!AN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON WI 53707 State Plan I.D. Number: SW,NW, 11, 28, 18W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Kinnickinni C Holding Tank ❑ In-Ground Pressure El Mound NAME OF PE MIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ed Ross 1642 3rd Street NW New Brighton,MN 3-$-5 1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: -55112 REF. PT. ELEV.: CST REF. PT. ELEV.: a~ Name of Plumber: Q I`~ MP/MPRSW No.: County: S y er r: 3258 St. Croix 119554 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER r r ~-4 PROVIDED: PROVIDED: I"~V f YES ❑NO ❑YE NO BEDDING: VENT DIA.: VENT ----THIGH WATER NUMBER OF ROAD: PROPERT W LL: BUILDING: VENT TO FRESH ALARM: FEET FROM E c~ ZC AIR INLET: ❑ YES E~NO~ ~1 I l ❑ YES ❑ NO NEAREST S J DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO FRESH GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT LET: (DIFFERENCE BETWEEN FEET FROM LINE AIR INTO PUMP ON AND OFF El YES ❑ NO NEAREST -110' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIT LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID : ~~lJ TRENCHES: MA JAL: PIT DEPTH DIMENSIONS / ' GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELO PIP~E$: ABOVE COVER: pELEV. INLET: LEV. END PIPES: FEET FROM LINE: ^ R ,INLET U ~ 5 IG. Z NEAREST Z S J ~(~~J /J MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO El YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES El NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST f t ~L DIZ, /0 0 1/ Z" Retai9Jh county file for audit. Sketch System on Reverse Side. SIGNATUR TITLE: SBD-6710 (R. 06/88) Zoning Administrator ~Thomas e son i , SANITARY PERMIT APPLICATION COUN ~DILrHR In accord with ILHR 83.05, Wis. Adm. Code ~~Rv STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than S 8% x 11 inches in size. ❑ ChU it rev sfon to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRW ER PROPERTY OCATION kos's s ur ~/4NU-f t/4, S T N, R ,5 E (or PROPERTY OWNER'S MAI G D ESS LOT # / BLOCK # X CITY, STAT ZIP C E PHONE NUMBER SUBDIVISION NNI/A/ME OR CSM NUMBER III. TYPE OF UILDING: (Check one) CITY NEAREST RO D ❑ State Owned ILLAGE Fri-or NU ER() El Public 2 Fam. Dwelling-#~ of bedroo EL TAX m , a _ 1030 _?0 111. BUILDING USE: (If building type is public, check all that apply) -7 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF ERMIT: (Check only one in line A. Check line B if applicable) A) 1. 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 0 4ftpage Bed 21 ❑ Mound 300 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.S EM LE V. 7. FIE GRADE REQUIRED (sq. ft. PROPOSED (sq. (Gals/day/sq. ft.) (Min./inch) `N 5E' L_ sG'®g p ~r f6 * Feet et VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App Tanks Tanks - AA Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pri ty Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Afidreis (Street, City State, Zip Code IX. COUNTY/DEPARTMENT USE ONLY Disapproved f~ary Permit Fee (Includes Groundwater Rate Issue Iss m Agent Sfgnature (No Stamps) ~pproved ❑ Owner Given Initial S Surcharge Fee) C Adverse De rminati on 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 j 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 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, usuakly every 2 to :3 years. 41. 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 appuration must include: a 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. 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; (Jose volume; elevation differences; friction loss; pump performance curve` pump model and pump manufacturer; D) cross section of the soil absorption system if 4 -requiredrby the county; E) soil test data on a 1151(rm; 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. A SBD-6398 R.11/86 =11jLt SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couN - STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Il a sh 8i4 x 11 inches in size. ch k if rev sion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PRO TY WNER PROPERTY k pS S ar 9114', S T N, R ,Y E (or PROPERTY OWNER'S MAI G D ESS , , / LOT # BLOCK # y W t -491 -3"34 CITY, STAT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER - 'Z 33-? 86 If. TYPE OF UILDING: (Check one) CITY NEAREST RO D ❑ State Owned ILLAGE ❑ Public R~Tl or 2 Fam. Dwelling--# of bedrooms.,. PARCEL TAX NUMBER(5) III. BUILDING USE: (If building type is public, check all that apply) -7 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 ERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3.E] Replacement of 4.0 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 ❑ page 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. S EM %V. 7. FINAL GRADE REQUIRED (sq. ft. PROPOSED (,q. Z. (Gals/day/sq. ft.) (M, iindinch) ~ 10. f WEr l /,goo r Feet et q5 7) 6 ' VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App cted Tanks Tanks stru A A I)j Septic Tank or Holdin Tank 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 (Pri tg Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's dress (Street, Ciry, State, Zip Code): ? fl w ~ 5- i- -14, Z1111" C IX. COUNTY/DEPARTMENT USE ONLY a Fee) Groundwater a e saue a n Agent signature (N tamps) Disapproved S nitory Permit Fee (includes Surcharge Fee) Approved ❑ Owner Given Initial I 3/-$a Adverse Determination / 4~~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber s e ~ a ~u G Q9 ~r/ r 0 7r t~ o m J ~4 76,4 I ;oie. SYSLEVATION -an~►1 ntt-L le"41- e L-i00,p W1 lK.3 >e a I . , rN oup .gTitlaC W~ L NTt a.S u~il ~ _ - S )T~' 4. Q4h'T'L'~~ 590 ` N • ; ~ 14 aFi EW) ~y - Nw 1 y 09 'mob` ~SQ~-U' N~.UF SIT~r 1. b c~lQ ~y LAC-~'ROt.~ S~'~`CH• S Q tt~ 1- o ~--4~ boo I C_J y o d I, the undersigned, hereby certify that the soil tests reported on this form were Trade 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) WEGERER SOIL TESTING TESTS WERE COMPLETED ON: AND 6 ' Z 5? ADDRESS: DESIGN SERVICE CERTIFICATION NUMBER: PHONE NUMBER (optional): caT 576 _)IS_ L/ZS- a/( 5 P'O. CST SIGNAT RE: BOX 74 421 N, MAIN ST, RIVER FALLS; 1AfI 54022 rf 715-425.0165 OF DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - -7 SANITARY PERMIT (Js`C,rfLh/J COUNTY ~ DILHR TRANSFER/RENEWAL UNIF RM PERMIT # IT (PLB 67-T) 9 S PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINALPERMI ~SSUANCE DATE: STATE PLAN I.D. NUMBER: PR RTIY LOCATION: ~jrJ` d(~ CITY: 33 SS 99 0,T.AV N,R ~ E (o W OWN OF: 1- L T NUMBER: BLOCK NUMBER: SUBDIVISION NAME: REFS,T ROAD, LAKE OR LANDMARK: PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO: NAME: SIGNATURE: NAME: PHONE NUMBER: ADDRESS: PHONE NUMBER: ADDRESS: I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLU R'S SIGNATUR : P IOUS PLUMBER' NAME (IF CHANGED): RE ~er7 t C r t° r PLUMBER' A DRESS: PREVIOUS PL MBER'S ADDRE : 0h12 64& sVo z z 96 S - e be r As GJj, ~~f Z3 'JjP MP/MPRSW NUMBER: PHONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER: 3 -77-8 (S, ~Zs =a/3Xs (/s►~9-3 3 z 2~ SIGNATURE OF ISSUIN.G AGENT: JDAPPROV D: DISTRIBUTION: Original - County Copy -Bureau of Plumbing Copy - Owner DILHR-SBD66399 (R. ) Copy - Plumber DOCUMENT No. WARRANTY DEED THIS S►AcE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1988 ` 1439234 _ 1000 $1~_Pp ~1J Q_ REGISTER'S OFFICE ~I ST. CROIX CO., WI j B. Dean Fisk and Gloria Fisk, husband and wife, Recd for Record I holdinCJ__as..survivorship arial..pro erty. -JUL 7 1988 i. at 1:00 PM conveys and warrants to Edwin- H._.-Ross and Marv Paul Ross usband..aASl..F11.2 C~t~X I of D"& !i 'i RETURN TO i. the following described real estate in St Croix- ---•••.•••--,,..County, - II II State of Wisconsin: j Tax Parcel No j %I South 165 feet of Northwest Quarter of Northwest Quarter (NW} of NWV and the Southwest Quarter of the Northwest Quarter (SW} of the NW}) of Section Eleven (11), Township Twenty Eight (28) North, Range Eighteen (18) West, St. Croix County. j TRANSF "O O FEE j it . i' This . iS nOt homestead property. XM (is not) Exception to warranties: easements, restrictions and rights-of-way of record, j . I 19.8$.... Dated this - .._.AT i....f any day of !'~..Y................. (SEAL) ,G.19!r.!......._................ (SEAL) B..... Dean ...Fzsk............. . i ..........................(SEAL) ic!. . .....(SEAL) i Gloria Fisk-_._ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. ......................................County. authenticated this ........day of 19...... erso ally cak me before me this ....5~......day of 19.9.q.- the above named • I ..B... .8 ..Fis...an d..Glo.~ria..F-~~-- • TITLE: MEMBER STATE BAR OF WISCONSIN (If not . authorized by § 706.06, Wis. State.) ~~ry vy. VAo wn to be the persons........... who executed the `►~r~ Y U rpg ' g instru nt and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ry~yt hl~ 'tly(,t i . rAttorney.. .('et; Leo A. Besk a f ` RODLI, BESKAR & BOLES, S.C. ....--ICKtEC--4.. ER 9-Nortkl Mal w%tr. Notary Public County, Wis. ( IYait~res may be'authenticated or Beknowledged. Both My Commission is perm/anent. (If not, state expiration are not necessary.) date: l.~l.......... , 199 •Nanee of person aignlna in any capacity should be typed cr printed below their sianetures. ij WARRANTY DEED STATE BAR OF WISCONSIN Wi--in I.,vM nLwk C,,. Inr. FORM No. a- 1982 :U J..eu kar, Wis. Lth e#' SAL d SPEC O1NIN6 rug topv oin II MASTER 0j KITCHEN LIVINGROOM BEDROOM j low, S'-2' .-g. 1 B'-0' 17'-9' 1470 2B FB OU147001 DINING y- a MASTER BEDROOM ©I~ LIVINOROOM f'. oiM dATlI- KITCHEN Q ur s W-4* - 6'-2' 4'-9' 12'-0' 1T-6' 1 1470 2B F8 2B FC DU 147=4 DINING THHW BEDROOM MASTER BEDROOM OPT © SECOND a LIVINGROOM agog ' BATH BEDROOM KITCHEN 10'-O { 5'-2' 1 e'-4' 12- 4" 1470 3B FS W141W3 ` DINING THIMlp OPT PAN MASTER BECGNi~ LIVINGROOM B ROOM soon BATIi BEDROOM KITCHEN uw 9'-2' 1470 3B FB 2B FC X31#70t MASTER BEDROOM t1 THIRD s., oooa BATH 66011160W BEDROOM;. S t OtNtl y s 10'-0 01.5'-2- ,~g. 9 -4 E = 14'-9'' 12 '-2" 77 1470 3B FK DU14*0 !{t e' 3~ ~ 'zL ~ Knapp Mobile H es It WAQY 12, P,6: Box, 378 3 ~'15~86521T1 ' Model NMOW N+oblMs I waW ma Mr Baer of ft to . wotW al~p~1~~' Iu tlf►1i11I~ _ El~''Y BUiL.T MEJAAIS 1J8EfCfY 8J4 - aoMls.nr oMwr 8ot~o *'m "haft mW to rM aI1K Win. ftw **a a W*w x+11 i.1w ~e saw for cowyouds, -0 r .,6-7-89 SANITARY PERMIT APPLICATION A DILHR In accord with ILHR 83.05, Wis. Adm. Code C4!!!: STATE SANITA Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than E] Q 1 8% x 11 inches in size. ch .t r iston to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS TY WNER PROPERTY LOCATION f &j t/s S TO N, R E (0r W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK C TY, STAT ~ , ZIP CODE PHONE NUMBER SUBDIVISION NAME OFj,Cpm NUMBER I it II. TYPE OF BUILDING: (Check one) o}~ NEAR EST R71D ❑ State Owned VILL GE : I 1 C C( k C JOWN Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms - 'MCELTAX UM ) III. BUILDING USE: (If building type is public, check T11 that apply) 1 ❑ Apt/Condo 20 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicabi A) 1. ft New 2. ❑ Replacement 3. ❑ Replacement f 4. [LI Reconnection of 5.01 epair of an System System Tank Only Existing System isting System B) ❑ A Sanitary Permit was previously issued. Permit l Date Issued 3 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ eepage 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min.//inch) Z/ ELEVATION D C~ h=" 000 6a j -P Q Feet / 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 strutted Septic Tank or Holdin Tank o Pg / l° S Lift Pump Tank/Si hon Chamber 1 0 1 F1 Ej I El F VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plum Signature: TS S mps) MP/ RSW Business Phone Number: Plumber's Address (Street, City, State, Zip Code). IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) pproved ❑ Owner Given Initial Surcharge Fee) Adverse De / termination L ~_o low_ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: L_ I SBD-6398 (formerly Plb-67) (R. 11188) 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 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 seveage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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 differer,ces; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number 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) + 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 7 A/ 7~0 Location of property -JQ 1/9 /U 1/9, Section Township .-A) ~tlZ C K2 AJ/(I T Mailing address 1 02 3, 17 c w ~~~~dt/~7 X21 G ~f i "d A, Z--- Address of site Subdivision name Lot number Previous owner of property DC A Total size of parcel y Date parcel was created yz_ >t 7 l ~l Are all corners and lot lines identifiable? 1,~Ves No Is this property being developed for resale (spec house)? Yes 't--'No Volume _and Page Number 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 addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Nap shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge.; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. _ 2. 3 and that`I (We) presently own the proposed site for the sewage disposal sy tem (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 recorded in the Office of t my eg of Deeds, as Document No. Signature of owner Signature of Co-Owner (If Applicable) Dat of gnature Date of Signature Alei~ yJ ~ ~ o 5~,7 f r~ Yw D a- 30 G - 3 1 l C~? I'I DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA ~ ty4i /G STATE BAR OF WISCONSIN FORM 2-1982 3 X39234 NK REGISTER'S OFFICE j jt = - - ST. CROIX CO., WI (}~~4030-,~O B. Dean Fisk and Gloria Fisk, husband and wife, Recd for Record holdng__as survivorship. marital._roerty________________ . I JUL 7 1988 II . at 1:00 PM conveys and warrants to Edwin-_H.--- Ross - and_.Mary Pdul ROSS husban.d - and .Wife - Rw m of 0"& Itt it _ - RETURN TO \Y II the following described real estate in .._St• _Croix__......__........County, - State of Wisconsin: Tax Parcel No: South 165 feet of Northwest Quarter of Northwest Quarter (NW} of NW0 and the Southwest Quarter of the Northwest Quarter (SW} of the NW}) of Section Eleven (11), Township Twenty Eight (28) North, Range Eighteen (18) West, St. Croix County. i I i TR!ANSF 'O O FEE I~ II ;I. f This is not homestead property. I X" (is not) I! Exception to warranties: easements, restrictions and rights-of-way of record, j if any. 19.8I~.... Dated this /T - ` - - day of --------.u- .....(SEAL) .Llfli^'- (SEAL) - --(SEAL) . i - *.Gloria Fisk - - i li AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. -------County. authenticated this day of___________________________ 19 erso ally came before me this S........ day of 19.88_. the above named ..B.._ _e _.F'is-k---and_.G].or? a-- i.*k---------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. State.) - 1- ~-r~y C S - - gCg~paekl~own to be the person who executed the D. ~prleit ' instru nt and acknowledge the same. r~~ pVR~ THIS INSTRUMENT WAS DRAFTED BY ~is7 qt1' ~1yL( Leo--A.-- Beskar-,---Attorney RODLI, BhhESKAR & BOLES, S.C. * _._._.1 Ay.jrA allbsa~ IBt'tO27 - Notary Public . County, Wis. ( 1g a ores may a au enticate or a nowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date 19........ 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisronsin Legal Blw,k C,,. Ins. FORM No. 2- 1982 .lid-ukce, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /T.®I C ROUTE/BOX NUMBER ~w :2 FIRE NO. CITY/STATE 10 ZIP c~ S ) l W 1/4 1/4, Section, T~1N, R~ PROPERTY LOCATION:.20 Town of St. Croix Count , Subdivision 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 County Zoning Office within 30 days of the three year expiration date. ti SIGNED DATE 7- 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 'DEPAR11M.ENT•OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS • INDUSTRY; DIVISION .LABOR AN-D, PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: UN ICI PALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: slo 1/ NUJ I/ 1 TZWR )bE (or X .AQ) ` - COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: 6y I ST, N L-/ ~!T. CAZz 1k ~D lr~° R.O NC11J ~'-P I G14-MQ Pi JV SS) ! 2 USE DATES OBSERVATIONS MADE rr~~ NO. BEDRMS.: COMMERCIAL DESCRIPTION: I R DESCRIPTIONS: TESTS: EgResidence j~• New ❑Replace / - g4 6~ 7 Z„ ~C~ RATING: S= Site suitable for system U= Site unsuitable for system CONV NTIONAL: MOUND: Q~ IN-GROUND-l URE: SYSTEM-I®ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S ~U S ®S U EIS U OS J([~~JU Z-C~~- ~RC.~{ S ~>C ! 9~~ If Percolation Tests are NO DESIGN RATE: T required I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: V PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 -7 3 4 Z 8 o w- 3 Z -~~1 9i°s S SE o~ -B -77 qs.-, -~y B- 4 ~9 q~,o , it 66 s as.6 L49 B- B- 0 9 0° 1/ > 80 B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 PERI PERINCH P- ) Z 1.-)o WV 3/,/ 11/1-6 L4 P_ Z 7Z.4 UZ 30 -)/g 1S/I~ We, 3q P- 3 Z tvo 30 II ~3/~6 131 /6 37 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. j q O 2 g g ~y rT (O 1 v 1 C" ~L.1 :.j L. O f F~ SYSTEM ELEVATION cz) lb ct.i ~ S' csL ~►j°~'- ~Rb1~ET<'l'y Lllut<~ RSh~+1 l en~Z _ + _g31-l~1..-'tst°.1J0•p .ca►J Xj.3l~ Z SN AM ' W Obt~ STfi tt~ W ! ~-pm) e4 s:3 woo 'mks WA4.1-NT14 _ ' I _ ~ 3pp+ W , OFTTtE SE 3 © 5, P•Z° \Sp 2Ao' N+ OF SITE. 1 1, +_6 , LO GR1'iptJ S Cho s - ao 'P Uv~ S _ . WL - m Scr~~E 4 0• _ s LTc 1 ~ 1, 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) WEGERER SOIL TESTING TESTS WERE COMPLETED ON: AND 68? ADDRESS: DESIGN SERVICE CERTIFICATION NUMBER: PHONE NUMBER (optional): ear noo S76 L/IS- of 65 CST SIGNAT RE: P.O. BOX 74 421 N, MAIN ST, I p ~ RIVER FALLS, W154022 a~ 715-425-0185 OF DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ) DILHR-SBD-6395 (R. 10/83) - OVER - L e SOIL DESCRIPTION FORM Attach Soil Prof llo LocaL ion map On a Sv arate Sheet) CLIENT: ~ D ~ • (gyp g S INEAR LOADING RATE: 5 °/o T-o 8% VA1..vA'T10N FOR SAIL r3S0RPT10U S`~STEy~► SLOPE: DESCRIPTION BY:-Ato.TH vR L W ECo E2~R ASPECT S l 0° E . . -T~~►VE= Z1 148 q CURRENT LAND USE ~ DATE: VkT~D ~ _ - - - - ST. cp-tswc c6j"7,~f I L J l _ COVER: COLINTY/ST AT m ss c.uczTv VEGETATIVE LOT SCRIPTION: P?'•O~ Sw ~/y-N W ~i SEC.I I,7Z~ ~ i Q► wDRAINAGE CLASS: W EL,L D~i i1~LTU o . 6o t•-1Iw . ~eo>7~6v tTo LOCATION: TC~) PJ O~ 1U ~ I`1 1 C arc 1~)~ 1 C GALLONS- PER S0• FT. PER DAYt O! ~I S DC'S 61 SOIL SERIES: 1.c r l`1 L-oAm PARENT MATERIAL(S)/DEPTH •8011N0ARY REMARKS Ii0RI10N DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PH Sh INGS in. mist C Sz. COA ~ Bow ~ t 11-Z,-► 1o~tT2 3/y - L Z>n sblz rYT~Tr• C``J 27-~I1 10 `-(R 31 - S 1 wL Sb1L v V- C LV ~G - aS 0-10 It4~RZ-!~ 1p -3p t o -f 2 31 L z, m s bk ttil c w 3C~ ~`f to" IZ G!6 LS r O ~ X16 p_ Iw-l 21Z - S• 1 3m P I- tg -L4 -30 ~R 31 - S 1 1 b>z >r s 30~ t~`t2 6l(0 - 3 O s m w! 3S% //Zk ` L P ezes s ) Opt R 8 A j'►') oT 7 Ll--)- ~ -I rt. B I? C 3 P S O S -m v wzal N 6 aS o -lo LtWlZ 2-1 - s i 3 rn p1 m'E'►- 10 -mob wl Q 31V L Z Slk 36_b~- )u-tTz 31 - S 1 1 Yn 3blz m r C S 66= 9 l0`t2 1 C 3 Q 9 C~ S 1^n V i.. ~o~t R Sl8 McT 3 N S o-Lo lwym Z/L - S 1 '~1vT p~ C g - L 2rm 6 r• g to-i6 to~rR IN Z6--I 10`1R 31Y hl bk v Fr L' S lo`Im " - O S )•`1 I 30°~ ►~ZV 2,`' L5 PIC QS CS 3Z- 49-~3 i6`1lz_S/I c3P S © S Mv~~- l~`ilt S/8 Mor - Sj) 3 m P1 wT h 0-10 tt,4pt 2.lZ S 1~ l0 ~t R 31 - L Z wi S bk C~ Z7 3 lu 3T - S) 1 Tnsblc yo V c-S 3'Z-')S 1o4Z 6/6 - S O S m I ~J /'2`~//z~• S p+ ~ ~ '8012.1A,16S 11u S `r ST~''1 ~'4A OTHER SITE FEATURES/NOTES: ~i:~ n~• G-23-8q 000576 Pnse? of 3 LIMITING FACTORS/DEPTH: Signature' Date CST X L ~a 1KIRl20N OEP111 MATRIX COLORS MOTTLES TEXTURE GSTRUCTURE CONSISTENCE CLAY[KGNS/ PORES ROOTS PII BOUNDARY REMARKS in, nnist p -1 O tnT?-. 21 Z s j Z m. PI L Z9- 3 t0~-1R 3 j~ - S l 1 ra Sbk Yn v 3S % //Z - Zt~ L P~ -3 3s-~s~n~r2 6/~ - -Fs o s m I B a $ ~ ~ s i 1 z ~ 1 rYI r• ~ s Q, - L I Lo', tZ Lp - L Zrn Sty ~1..3Z `~R31 - .~S 3Z_S~ l~`t231 - S 1 ~iSl, M v g O h'1 30% /~i - ZL S PI s sy-~o l0`?2 ~ j6 - " I - 5T-,&-. TE FEATURES/NOTES: L%~~~/'~Z G- 2 'j-$9' 000 S7Ga n/1G~ ~ of 3 Signature Date CST Y LIMITING FACTORS/OEPTHW. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022-1030-80-100 Parcel Number 11.28.18.166B OWNER NAME: First EDWIN H & MARY PAUL Last ROSS PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 11 TOWN 28N RANGE 18W 1/4160 1/440 Line Description Line Description TOTAL ACREAGE 5.000 PLAT LOT BLK 01 SEC 11 T28N R18W S 165' OF 15 02 NW NW 16 03 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, 175-Next Parcel, 177-Valuations, F8-History, F10-Exit ♦ n In Q n Cl) Q -0 0 d C .2 3 (D 3 CD CD ID m d Cp vj A 3 Cn rn z o N ;o z rn z o A T p x 3 0 p OD y 3 o c o co CA 'i ? N N • ID --I CD CD d S z t7i CO N Z CD Ch CJt y n CO p (A, E L, C „g O (D N a CD (D 3 Om. 7 W 3 u) in w CA Q0 °o ro o n o n or I' " rn o Q N 3 7 O a- O 0-4 00 to w m W g o p cn (n o 0) cn CD ( O y G N (D CD y d C ro ICrn m c co CCD 0 0 ci o o N 3 O! O 1 O O Co Co CD W w CCD hr CL _ w co (D y 1 co m y n r cn y o (0 (D o H m CD O a :E (a M N Z 0C 0C 0C N 0C 0 0 N /vy~~• O G G G Cl) z -D G W A - ~f 3 s 3 ca vi (A ~ Q M v q < 'D v q o o d o m (D y D N t~r1i 3 y m CD m_ N lw N 3 d ~ 3 m i d O Z =0 D p z :1 0 Q w O z~ O D>> o !wl o E; h • m fD rn m N C CD COD C a) m a) C CO CL C co CD d 3 m= I 3 0 7 z CD C6 CD (6 -1 U7 .P z 0 o N a m CD (D z 0 3 0 3 a 0 o z a ch y z CD w 3 w 7 U) ~nni a o I ~o m N.? N a- m co 3 cD n~ m 2 0 ° CD W Q? (O o CD ' y 3 CD o W' m m `y ? y o v <omyav o• z a -oDNO 0o Z tU .yO O. - O: y o m 3 CD y OD C O O. -a 8 j C) O O CD d (oa S O C D Q Co 7 CD (y d O O CD o v Co CD CD 7 n 0 ~-0c mmCL (n CD o-am0(7 ay°~CD m °a~ i 7 D1 O ti W (D CD o 3 3 x 3 ! 7 `Z ~L D t0 4 O 0 _ (D O CD p~ ~ 0 CD 7 _3 O O a y a N 0 D .C C cr =r S Cn N CD N O j O CD -0 ! C) CD N m o CD 'CO C N U, < n A C y CD v 0 0 CO/r 5, 7 3 d O 01 3 CCA 7 CCDD CD 'a CD F CD d= C) CD O CL V 3 y CD 3 N A v O 0 A CD (D w va O to O a O : O * ya 6 CD CD 0 i O ! DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRh", DIVISION LAf#QR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53709 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: UNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 3101/ Nw 1/ t1 TAN/R 18E or Offi ~.I~,~IeK ~AJ - - COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: O6q L 7S h Sr, /V w S.T. CZrjxy' alb N . R.iJS S NUJ F1R! Gf~Tnl~ MN Ss))-;_' USE DATES OBSERVATIONS MADE I NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLAT10N TESTS: Residence 1V - New ❑ Replace I 6-7,1-9c? RATING: S= Site suitable for system U= Site unsuitable for system CONTI . M. IN GRO ND-PRESSURE: 11YSTEM-1~I LL HOLDING TA~j :RECOMMENDED SYSTEM: (optional) S ❑U I MS OU S aU I S U S J(d~J 2.T '4. lJCHE~- eV_ 14 5 ~X ! 00~ If Percolation Tests are NOT required DESIGN RATE: I If an A` any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: V .1\. 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.) 1 3 4 Z. 8 ti cz, Z ~L{ az.s SSE t~RC~E Z ot= 3 -77 q S B- 4 -~9 a%,o 64, S -_3_ OIS. 6 Lf q B -6 7S b4.3 ' S . _ 7 -7S 9!-Z >Is L_'Ea tJINGE=- 3 of 3 B-- - © 9 u. u > ev B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R D PER INCH P- 1 Z "o :~"0 3/L/ 11/1.6 11 P_ z z.` L3 Q) 3 0 1S/16 We, 3 q P- 3 2 ~O 3D 15/1 13~~6 13116 3-7 P- P- P-EEJ 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. 11JITIPR%_- , `ZElp-nc-11ZM &J T =~„'~(o C,>u}J Lo^xi SYSTEM ELEVATION C?] ~g.a' ( 8~•s' 69*4 B:3 - 1'rX3'r ~I JE E 1T 1-0 ow ito o_ P• ~ Stl- 2Ao' N. of slrE b a S IN Wes _ ~ € ~~~1-j-tYCL. T ~'S, 6 ~~O ~ ',LOq•►\T'fOA1e S~.'SCti4 1 ter" U 1. I @,~ 5 S1TC Yt_ 'r V `s ..w l _ j _ ! i l E , f m Scr~L E 401 _ s ec, ! ~ I, the undersigned, hereby certify that the soil tests reported on this fo i~vvere made b e ~ ~ with th procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the t M are coN o e o my k6;w dge and belief. NAME (print) WEGERER SOIL TESTING ;OUN TESTS ERE COMPLETED ON: AND ';t)!PlGO~FtC{ 6 - 2.Z- 8 q ADDRESS: DESIGN SERVICE CERTIFICATION NUMBER: PHONE NUMBER (optional): asr 00(ZI 5-)6 CIS- L/ZS- 01 65 P.O. BOX 74 421 N • MAIN ST, CSTSIGNAT RE: RIVER MAILS; WI 54022 715-425-0165 I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. / of DILHR-SBD-6395 (R. 10/83) - OVER - IONS I `MPLST 1 ORM 1 `I - S ~ 6595 To be xs 1. Co ~p . 2. Th 3.I=1IX4 4, is tiais . a' 12. ti _ s) ~.k3 -H THE. LC _ Lt FOR E,RP . I S i Tie' 5 d TO THE OWNER: This soil test report is the first step in aent may request verification of this soil in as for the private sewage system and n -rity in order to obtain a permit. T' n nstrcaction. SOIL DESCRIPTION FORM Attach Soil Prof iW Local ion Ma On a Su arate Sheet) Q g s LINEAR LOADING RATE: CLIENT: 8 PURPOSE.E otJ FOR solL_ PcxssvxP om S`? ZTE)'°1 SLOPE: 5-,/, w~-n vA DESCRIPTION BY: A2Tt•~~JR L. WEB E ASPECT: S l d~ _ ~UIV~ 2t ; I9la 7 CURRENT LAND USE: DATE: COUNTY/STATE: S~• Tej"-T~ t LAJ 1 VEGETATIVE COVER: GTZrfSS ~CiN LOT DESCRIPTION:p~•O~SW/iy_SEr TZ(aQ,RI%1-DRAINAGE CLASS! L•WE.L-l.. D"J)IJ~ inliv. LOCATION: ~C ) ►J Q F }tl ?J ti 12. !J T GALLONS PER S q. FT. PER DAY: O • U S S N SOIL SERIES; r.-~ `G1rjN) LoA"1 PARENT MATERIAL s /DEPTIf: ENAMOR HORIZON DEPIII MATRIX COLORS MOTTLES IEXTUFE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS Pit BOUNDARY REMARKS in. moist Gr. Sz. Shp COATINGS 0-11 1D`-iCZ Z/z. s i 3 m p ~ tr, ~'h G S 11-'2.'► lo`'[R 3/y - L Z)n Sb1'c M~r CkJ 7-47 1o y R 31 s I 1 m s'w Inn v -fir C w 6A. - Q s sa(j ►,lG - p_lp 10~-tfR~lZ - S•~ 3n^ P~ M'~~tt- L 5 to t o `-(ii 31 - L.. 2, m S b>•c 'h1 TL- C 3v 11~~-1 tz GA6 - s9 m w 30 //z~ Z'f Ls r c - t o -t 2f Z - a m p t- S q _ -Z l~ `-1. R 3 / - L Z rn s hk m-c t~ C Lv Z4 -30 ~u ~z 3) - S 1 ~ wJ ~ bk vn c s 30-~~ ~o`t2bl~ - S O S m~ w/ 3S% 11z°- ` L P ASS I Ok R. ~ -7 y-?_ 8A Cl? 'FS S ~rnv l8 Yn oT o-Io 1.rN fTz 2-/z S i l 3 m p1 m~'►- L S )0-~6 10-tQ31y - L I*sbk 3b_t~ Ib~('2 31 - S ~ 1 vn 3blt h~f r C S 66=)9 10`ttc~/1 C3P g S°~ h~V lo`[R8/8 vrDr 3u N S lb-Z6 lo~rt2 3/ - L 7L b wt S Z6-32. 1 Oti 2 3/l/ - S ►n s ~k v t! S O S Y►1 ` 300 /Zv 2r CS PtC ~S C~ 49-~3 io~tZ BSI SIR' S% U s MU`F>^ 6o~iR 8/8~T $e Jv G o-tt, t~~tz 2Iz. - s~;1 ~ m P1 wt-Fh cs lo=g-~ to"R 31Y z7 3 tL~`q~ 3/ - S 1 S~1c r~ y r c s 32= ~S 1 o y~ 6 / 6 - S S w1 30 J 'f2 - I "/2' S PI ~E' ~_~N_ CAS $OTt1~'J6S IN S S7'~1 !'~1~'~> OTHER SITE FEATURES/NOTES: / _'23_8 q o00 5~b Z ~h nn GC of LIMITING FACTORS/DEPTH: Signature' Date CST # TIDR120N OEPTII MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII -BOUNDARY REMARKS COATINGS in. moist Gr. Si. Sn s' ~ Z n, Pl ~1-- G s O-L~ ID~cR 2/Z - l ~0-2 ~a~Z 31 - L Z~, ra~~ c►-~ c S 2-9-3 io'-f~ 31 - s l 1 sb~ 1rTv V- S 3S % /~Z - Z'L PT ~ 3s-~s~o~2 6A. - -~s o ml c~-tl 10`t2 'z/ - S! ~ Zm P1 ►"1'F~' cS c S L zm S6F~ X1_3-2. lR31 - 3z-Sy Lr-,,-f231 _ S 1 1 jns1~ cS Sy-~ 10`7R ~ ~o - ~g O ~ h'1 30% /~Z 'ZL S Pt 5 OTHER SITE FEATURES/NOTES: ppp S'7 nn GH 3 oR 3 Signature Date CST N LIMITING FACTORS/DEPTH: DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B INDUSTRY', PERCOLATION TESTS (115) P.O LA~bR AND MADISON, HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTI N: UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: Nw /4 t 1 TZs N/R IbE (or `rz, c c k l l`V.ss - SIB '/4 COUNTY: WNER•S UYER'S NAME: MAILIN ADDR SS: ~16~J 7 ST, /V L~j SID 1A, 72,L1S 3 1''1N SS z USE DATES OBSERVATIONS MADE NO. BEDRMS,: 7RCIAL DESCRIPTION: OFIL ESC "OLATION S. / _ 99 6•- +~Residence i J•- New ,Replace 777 71 RATING: S= Site suitable for system U= Site unsuitable for system rNS ONYNTI NAL: MOUND: IN-GRO ND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑U ZS❑U S❑U ❑SOU ❑S0 z,-~ sx1 DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: • . Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 3 a z.. a ti o>v_- _ > 3 I, 3 -77 q S. -I q --7(./ B- 4 9 cit.0 ~r 6( S 73 01 S.6 yq B_ '7 '7 5 13- 12S0 Cl C~l L/ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATPER INCH NUTES RI D2 R NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PE P_ ) -LiJO 30 3l~ -.a ll/l1, L4 P_ z z.q tJV 30 isAL -7/ P- 3 2 KS0 3O 37 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 E?~ n g g y `7 (o i\l 1 C1ti1 Z, QAY7 of land slope. O t qp 2 , a W SYSTEM ELEVATION c7 ~g 3' g~ S' w'6F'1i►1 ~ ~ ~~~~n~~ CuvT hR®t'~lt'(y~ LLI~~ ~ ~t , ~z _xg~t~kl ~..a.ll4.0 .ot~a l "~4 3'r s 3 ~A--- 2 St f - • W wt STh *6 -*I 'VVS?~0 ,~T'SS!RC Iti1/C.t~7TF ~ `3pQ' W • Of=ll}E. SE CD1~V~ki ©P-.T_ji-e. Sw ~y ll ~ S e-- b - , - ~ • ~ t c~~ tY °LOq.>RT1C»= S`►c~'Cli i _ 2 6 ~ 'NAT 5 x , i SGr\~E 40` stTC 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) WEGERER SOIL TESTING TESTS WERE COMPLETED ON: AND 6 I Z- 8? ADDRESS: DESIGN SERVICE CERTIFICATION NUMBER: PHONE NUMBER (optional): C%7 t5o0 S-)6 7lS- L/ZS- 0165 P.O, BOX 74 421 N. MAIN ST. CST S AT RE: RIVER FALLS, WI 54022 715-425-0165 ~ O DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ' F DILHR-SBD-6395 (R. 10/83) - OVER - b SOIL DESCRIPTION FORM A tac Soil Prof to Loca ion Ma -On* Su caste Shee 1 Ogs E IN 5 °/o To 8% Pun Pos• Vl4LUA-R01~1 FOR StJ~I. ~C3S0RPTi01J S~-! S1'E,)"1 SLOPE: DW,ntrT[oN BY: A2TNuR L WEG'E2-~R AsrLt: S t l~~ E _ ~UNF- 2) t4~ 7 CURRENT AN0 1~~"~-D - ~)t-TT 1~ DATE (,V _ GTZ~S NTY/S ST. CRIJ\X CRyJ ~f t VEGETATIVE COVER: S LOT OESCRI TION: •o~Sw~/y-NW~i SECJ ),-rVaQ, R19wDRAINAC CLASS, -b 0.6 0 1-116W lzE~v -7 F-7 aTD LOCATION: TC:w IJ C5 F 1-j > 3 T C 1R 1IJ►J 1 GALLONS PER S . FT. PER DAY: O • S rD,` SOIL SERIESt t~3 lc ruP,3 WA" PARENT MATERIAL (s)/OEPTII HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CCLATINGSS/ PORES ROOTS PII •BOUNDARY REMARKS n, (001st) G Ss. Shp new ~ . l O- I1 lp~-i[i_ Z/Z S z) 3 m Pl h► G S L Z)n sbh ~o~ttz Sly - 7-141 IO `9 R 31 S 1rL S~1Z v C lv .m I Wiio~ 1/2'~ '2N L.s PT~3 l~`7 3 10 `1 R 6 ~(o g Q s p_l0 ~~~-1LRZlZ - S•1 ~ 3M P~ ~~1^ . L 2msb~c W, Cw 1p-3p 1o`'[[Z 31 3cs )O~-t T2 ~!6 - d s rv~ w / 30 /2F Z `I LS r $d~ ~ 6 Ztz - S, I 3m p ~ C,s C w q -Z to H [z 3/ - L Z m s bk in f z4- o ~~~c~3~ - S I 1 vn sb>z m c s 30--2 1~`i1Z bl(o g O S m I w/ 3s~o ~i2~ L P eC@-S IO~tRSI~ kmOT- 7 \0 `t t: 9 C 3 P S C> S •hn v h o -Io Lo,-cTr- zlz. - s i I 3 >n p1 m'E'►- cS 10-~6 1oHQ 31V - L 2.+4 gbk C S 36-&(. )u -tv- 3! - S 1 m sbk r 1oK it a/8 mor 66=9 102 ~ C 3 P 9 ~ S ~ V r ~ N S Cg O-LO lo`C2 ZlZ - SO ' ~m PI -mSL- Z m ° 9 - L Z6-32 ICY-f R 3/l/ 5' i ►h bk vf+^ - d S - ~Z. lo-fm Vii' ''S O S ►h 30% I/2v I'L5 PtC %.r C3 Lo%-fA We mar 49--)l ib lVA/) CIP S O MV~r b u6L cS o-t~ toga. zlZ. - s~ I ~ m pl 10 z7 to `-t TL ~ 1. - L Z M S bk ~ Ok.,! S H c s zr)3 lt, r, 31 m3 vk YYT v - 32 7S 10 y-t 6/( S O S w1 O l ~i2 - I /z~ S PI ~ ~l].XSTgS ~?0121N6S IN S`tST~"I - OTHER SITE FEATURES/NOTES: ooo 5-)6 , Z 3 G -~3-$ 9• I*n c,e of - Signature' Date CST # LIMITING FACTORS/DEPTH: (KNTt20N OEP111 MATRIX COLORS MOTTLES TEXTURE STRS TORE CONSISTENCE CLAATSNGNS/ PORES ROOTS PII BOUNDARY REMARKS in. nnist x'30 " c s 0-10 1042 2!Z s j 1 Z m P~ . {0-iu-m- 3j - G S Z9-3 i~`-1~ 3l4~ - S) 1 vh S~k ~v ~ g 3S% -2"L -3 3 S . ~ S ~o tz 6l~ - -F s O ~ ~ s ii a '3 c S ~ Zrri Sb1c h C S sl ImI% ~s 3Z-`;(/ 10,lQ31 - Sy- 3~ 10`12 ~ /6 g O S i"Yl 30% /~a `ZL S PI s i i OTHER SITE FEATURES/NOTES: L/' `,~'l~l~'/LL~//•~ G - 2 3- O~~ S 7 ~o ni1 GE: of 3 Signature Date CST I LIMITING FACTORS/DEPTH.