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HomeMy WebLinkAbout030-1017-70-200 -0 CD (D q ti CD h 0 6-- 01 C O N y ti C N N ~L O m O ~L L •3 I z° a I LL o 0 3 _ x :n x Q ~ I I 3 ~ v N z H z w °o Z d d rn w a m LO z o I O Z d c Z o o U) c o m N N 11 N 0) I N G (mil t0 Z co z Z •o O O O w N Z co ; c N ~o E 0> N Lo > d d 10 ~T c co co 24 E, d O L 0 p o C G CL a y - Z N N N N > O FL LL 46 X000 z CL M (L N ° N } }y In J V = OOi Opi N :z z v CO p N N O - O E N = O O 'D O ~ C m N C a - M N N 9 p N Q } (n m O O C y C p 3 E r C*4 co O.' n d' ~ O O. C 0 0 L a c o 0 c N C v v 0 r N O O d O I~ 0 " d.. .y O~ C N ~ O O N l=yam,) ~ M N M CO O c E R U • ~1 O O ) S O z - '7 2 (n O ~ C~ C € a CL ` CL CL -6 4) `1v E c 3 A c0i as 2 l o (0) 1 1 Parcel 030-1017-70-200 02/18/2005 11:44 AM PAGE 1 OF 1 Alt. Parcel 5.29.19.741 030 - TOWN OF SAINT JOSEPH Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * ZEZZA, RICHARD J & SANDRA L RICHARD J & SANDRA L ZEZZA 1187 ROLLING HILLS TR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1187 ROLLING HILLS TR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.540 Plat: N/A-NOT AVAILABLE SEC 5 T29N R19W NE NE 10.74 AC THAT PART Block/Condo Bldg: OF LOT 2 CSM 6/1773 NOW KNOWN AS LOT 2 CSM 7/1812, NOW KNOWN AS LOT 2 CSM Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 8/2236 3.54 ACRES 05-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 880/110 07/23/1997 875/636 2004 SUMMARY Bill Fair Market Value: Assessed with: 4840 220,800 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.540 82,100 135,100 217,200 NO Totals for 2004: General Property 3.540 82,100 135,100 217,200 Woodland 0.000 0 0 Totals for 2003: General Property 3.540 48,100 103,800 151,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 s ` Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A TOWNSHIP SEC. T tZZN-R~1-9' W ADDRESS % Z ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT Z LOT SIZE PLAN VIEW D/ Z Z b Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ye, by s: T I~ Z Q e ' <-a a,. -e = 1,1,2 4Y W = le ;z 3 V Xe J X 71) 71 INDICATE NORTH ARROW - 6-6 f lfi • ~''e_4_ /190 •O r BENCHMARK: Describe the vertical reference point used fe-cs,_'tc~ s ,®0•,7 Elevation of vertical reference point: loe,e Proposed slope at site: 1,1 SEPTIC TANK: Manufacturer: Liquid Capacity: .LSO f Number of rings used: Tank manhole cover elevation: lppfp Tank Inlet Elevation: 7`'S~•~~ Tank Outlet Elevation: a'•3 Z Number of feet from nearest Road: Front10 Side 0 Rear, O > lea ~ feet -From nearest-property line .-,Front 10 Side 10 Rear,0 ~ tOD ! feet I Number of feet from: well :71 .SV building: 2 9 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SRF__FUFi3RF STDR r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: P p/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom o ank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from n est pro\bu line: Front, O Side, O Rear, 0 Ft. umber of feet well: Number of feet from lding: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: t~ Trench: Width: J 2 Length: 70 Number of Lines: 2- Area Built: ~yo Fill depth to top of pipe: Number of feet from nearest property line: Front,' O Side, O Rear, OPt. > -14. Number of feet from well: l -0 Number of feet from building: Z (Include distances on plot plan). SEEPAGE PIT Size: Number yBoom Diameter: Liquid depth: seepage pit elevation: Area Built: Has either a drop box O or distr ution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of b tom of tank: Elevation of inlet: Number of feet from nearest pr perty ine: Front, O Side, O Rear, 0Ft. Number of fee from well: Number of fee fro building: Number of feet om near at road: Alarm Manufacturer: Inspector: y'? Dated: 4~ d Plumber on job: License Number : 3/84:mj DEPARNENT OF INDUSTRY, SAFETY & BUILDING INSPECTION REPORT FOR LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION _IQISQ_N )t l 5707 State Plan I.D. Number: 4,'i~Vj~~4 i eC . 5 , T29-R19 CONVENTIONAL El ALTERATIVE (lfassigned) Town of St. Jos Blue Bird Dr. . ep Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: TZ.31!Box ESS OF PERMIT HOLDER: INSPECTION DATE: Tom Hanson 168, River Falls WI 54022 d BENCH MARK (Permanent reference point) DESCpRIBE IF DIFFERENT ROM PLAN: REF. PT. ELE nC T REF. PT. ELE .:j U_ ~.(✓r.' D 1 6~ f ~/n ~rtoS~GirreY /!/O-Q Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: David B. Fogerty - 3289 St. Croix 128710 SEPTIC TANK Z z3 0 ~n`iDLe rsC-l = /O aS /4,410 1-T MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV- TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ~S Co66LJ e_7~5 v /D F, 3a YES ❑ NO [__1 YES NO BEDDING: U FAX DIA.: ~u1ATL.: HIGH WATER UMBER OF ROAD: PROPERTY' I WEL BUILDING: VENT TO FRESH _ LINE: / AIR INLE C, O, q C ~ALARM: FEET FROM > > 02 E:1 YES NO ❑ YES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAP Y: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: F-1 YES ❑ NO F-1 YES' F-1 NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET PUMP ON AND OFF ❑ YES ❑ NO NEAREST ~ I - 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 SYSTE ) o-. 61,' EL, a. & W -6, /U/, Flo WIDTH: LENGTH: NO. OF DISTR. PIPE PACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH i TRENCHES: / ,IERIAL: PIT DIMENSIONS /a _V V / DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE M TE~2~A NO TR. NUMBER OF PROPERTY WEL BUILDING: VENT TO FRESH BELOW PIPES: (ABOVE COVER: ELEV. INLET: ELEV. END: PI ES: LINE: r~ Z AIR INLET: ~ 7 e3 ~p7S` ,0 EET FROM 11 (oD " /O?. D T a NEAREST 7,21 }M MOUND SYSTEM: 9,110' 9~3 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 ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED SEEDED: MULCHED: CENTER: EDGES: ❑ YES O 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: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST O uo :vI c~ . a ¢ E .~J rn rirl.e~c.~!~ ita-cY /U~o. aft/*' Sketch System on etain county file for audit. Reverse Side. SIGNAT LE: TITLE: ~J~ SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STAWan -Attach complete plans (to the county copy only) for the system, on paper not less than ❑8% X 11 inches in size. application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION /pen .4r~,a-rr%- %a e %4, S S T,21? , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 ~ P y --l CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSMiftf MWR H2aO ez t e 17 CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) El y State Owned ~1 ❑ VILLAGE ~ .v ❑ Public 11 or 2 Fam. Dwelling-~# of bedrooms ? AgN QXRCEL TAX M ( ) 111. BUILDING USE: (If building type is public, check all that apply) -7 'G 0 3U ` /0/ -7- 7d 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. LJYNew 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 300 Specify Type 41 ❑ Holding Tank 12E] Seepage Trench 22 ❑ In-Ground 420 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) ELEVATION Z 19 vp 17_~ 3 /c/. S` Feet lo 3, > Feet t VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A Tanks Tanks structed pp' Septic Tank or Holdin Tank 2aG Zoe Q F] Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu is Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ZPlumber's Address Street, C119, State, ip Code): ~V eag IX. NTY/ EPA ENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A ent Signature (No S Approved ❑ Owner Given Initial Surcharge Fee) r in Advers X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD4M (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be .submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if. permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) 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 . 42-;, Location of property /y 1/4 V IC 1/4, Section, T2- N-R__LLW Township Mailing address DLO G(( ~jLl~/5 Address of site /(,U C ( ( N~ 1 `S Subdivision name ~U~l✓ N~=i s~Q(~WX Lot number Z 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 eY-Volume U ? ~ and Page Number ~ 3/ 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 Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deer r corded in the Office of the County Register of Deeds as Document No.~ 4 v ` a`7 ; 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 constructio of said system, and the same has been m y re~jorded in the Office o (j Count Register of Deeds, as Document No U 2 / Signature of owner Signature of Co-Owner (If Applicable) 3 Qv Date o Signature Date of Signature 'L I DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 REGISTERS OFFICE i ST. CROIX CO., WI j -Dean_ K.___Lindstrom___and- Linda-_- C_.___Lindstrom,.___-__ Recd for Record husband and wife JUL 121990 - of 11:30 A. conveys II_aHansonts_thusbandmandWwife--as nma.rtalnd---_-_- Register of D j survivor_sh.il)-..pr_apert.y----- eds RETURN TO___ . St ~rOlX the following described real estate in . County, State of Wisconsin: ~I ~i Tax Parcel No: ii it I1 Part of NE4 of NE'-4 of Section 5, Township 29 North, Range 19 West, St. Croix County,Wisconsin described as follows: Lot 2 of Certified Survey Map filed June 27, 1990 in Vol. 8, Page 2236, i Doc. No. 459967. i F- I' I I• This is-- n0't-------- homestead property. (is) (is not) i i Exception to warranties: easements, restrictions and rights-of-way of record, if any. ;I Dated this day of July - - 19.9-Q--. ~p e,•,.. 1 ---------(SEAL) (r~ (SEAL) --Dean---K_--Li-nd-strom------------------------ * --Linda.--C-•---Lind_atrom...... ii ---=------------------(SEAL) ---------------------------•-----------------(SEAL) 'I * AUTHENTICATION ACKNOWLEDGMENT i !i I Signature (s) __D2ar1___K.__ LlndstrOm,_-------------- STATE OF WISCONSIN Linda C. Lindstrom SS. l~ _____St . Cro1X County. authe -sated this ay of_______ J______ul_y----------- 199Q. Personally came before me this day of ii , s ' 19-------- the above named f *__Kri st ina__ Opland__ Lundeen TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §_'7'_0_6_._0__6_,__ 706.06, Wis. Stats.) to me known to be the person who executed the 1i foregoing instrument and acknowledge the same. I THIS INSTRUMENT WAS DRAFTED BY li Actor ea ag1 aw Llaxlsieen y Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) ,I date- 19-----••-•) i ii *Names of persons signing in any capacity should be typed or printed below their signatures. i I WARRANTY DEED STATE. BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inc. FORM L7 o. 2- 1982 Mihcnukoc. Wis. o C'~ ro 0 0 m O • d ~ n o r o. N a O N v rt .x.• c c rT'I rt~ CO C Bearings are referenced to the east line rt o x ' rr1 0 t= of the NE} of Section 5 assumed to bear z Cn N000491 1411E. o b n i n C O IC ro 'f 9 rt 7 0 CO 7 r-• o to r N 7 O -ff O fo '0 0 O N rn r• W r• C N O W 3C O V 7 0 d Z rt n N O d. O rM o N 0 o 0 1C N ro ' 0 -D O w Uf - T rt P CD r t.n o r I~~I~ o s M W Z a a N t 1• ~ rt to a W o n to n 0 Cr ° m 13 A C', N N m o T 0 r~•'~'1 to G 0 r i ! 03 O O M O~ O c < o rt rt N C" A C n MI V to p W P► x :3 m .n o n n a O 7 C c tr N O d Q W r O 7 , N -t O tG to N r+ to z x v z MC z Unplatted Lands w A UD _ - _ West line of the NE} of the NE} of Section 5 S00°5 '2411 - - ; - - - - 'r o ► T O O1 L _ 272.98' 48th 500.01' STREET a N 272.441 Cn 500.00' . 1 c N w - - co 5,S010291594 772.441 - - ro i n R r is rn N N N O I I- OO N i 3 trt, m. O Co r N C) '0 O `•C V 1 l7 r V w ~ O 2 N rn 00 to 'r r I 0 0 01 d S M ro 13 W O_ N cn' °a iC v+~ 130.001 r J. < CA 0 NON R I • CO o. 1 0l Ln rn - - cnW 0.001 ° to o x v NCD .~N - L) CO !10 o ° ••r.1 N CO N0102915911E rt I ? w a CO a V 2 N O C O_ I O1 p,. 9 C4 7 N r 0, O V O rt ' 7 O tD 0 d N O Ln 0 O I C ~ CO . O N N O e M w 'n to - ❑ o z ~ cn r•• T r - r I I tD v In O - N r I ~ - n I y M x n n d 661 I W y, to Un 44- a d 1--1, N0102915911E 350.00' is 1 < ~ O O 7 Im I 1 t~ - ~ to to 2 IO 10 I. • I I C'f r,. O 1 1 N we 3C r O 1C'7 N 1• 1 Z 10 I~ m - H I~ t4- Ito I + ~ I S I rr I 1o " Im I 110 I < 41 1 10 Itp I I I r 1 w r 1• 1 0 I ~ N I rI ;v 1 1 t0 w Iv CO o It2 CO ??9.55 CO w&I I N07°5?12811E 18?.871 i N r 1 r I 12014'561, f : C.S.M. vol . I 6, !9.-_1638 to rn ` ~ to a N rv ~•1•• N t0 rM n to n ? •rt.. p x rt n o x > > z > > ~ re 4-M -3 l~O un ~ x ell- 513.001 East line of the NE} of Section 5 S0004911411W Z?, -3(41'7 SURVEYOR'S CERTIFICATE I Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Dean Lindstrom, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NE4 of the NE4 of Section 5, T29N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being Lot 1 of Certified Survey Map recorded in Volume 6, Page 1773 and Lot 2 of Certified Survey Map record in Volume , Page at the St. Croix County Register of Deeds office; further described as follows: u Commencing at the NE corner of said Section 5; thence S00049' 14 W the south- along the east line of the NE4 of said section, 513.00 feet to erly rigth-of-way of town road (Bluebird Drive); thence N8804214411W, along said right-of-way, 738.82 feet to the point of beginning of this description; thence continuing N88042144"W, along said right-of-way, of the NEI, of said section; 580.90 feet to the west line of the NEa thence S00053'24"W, along said west line, 772.99 feet; thence 589039118"E, along the south line of the NE4 of the NEa of said section, 936.16 feet; thence N0705212811E, along the westerly line of Certified Survey Map recorded in Volume 6, Page 1638 at said office, 229.55 feet; thence N12014156"E, along said westerly line, 182.87 feet; thence N88042144"W, along the south line`of Lot 1 of Certified Survey Map recorded in Volume , Page at said office, 422.89 feet; thence N01029159"E, along the west line of said Lot 1, 350.00 feet to the point of beginning. Above desribed parcel is subject to right-of-way for town roads (48th Street and Bluebird Drive) as shown on this map and subject to all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have with the current provisions of Chapter 236.34 of the fully complied Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT ~ St. Croix County OWNER/BUYER ~y'~ae dJl C~C I~~ Cam-- ro 0 g.,C Tire Plumber v 2 / o ROUTE/BOX NUMBER I e CITY/ STATE " I-Iock ZIP L ZO 2 rt m PROPERTY LOCATION:', IUD, Section S T N, R 19 W, Town of ~ 1P St. Croix County, Subdivision D 1U N Sj PAW",, Lot number Z Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 'se t'ic tank um er. What you put into the system can affect t e function o the-septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to recieve 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 's'tems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater 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. H I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- FA- ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix Cotpft"X Zoning Office within 30 days of the three year expiration dal-A SIGN DATE 3 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. DEPARTMENT OF REPORT-ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION .LABOR AND PERCOLATION TESTS (115) MADISON WI 533;0; HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION TOWNSHIP/MUNICIPALITY: OT NO.• BLK. NO.: SUBDIVISION NAME: /T22 N/Rig, E(or)WI ; NE -r, COUNTY: WNE S /BUYER'S NAME: MAILING ADDRESS: St. Croix Tom Hanson Rt. 3 Box 168, River Falls WI 54022 USE vbone 425-8355 DATES OBSERVATIONS MADE NO. B 1coMIREACIAL DESCRIPTION: I R TS: CbRe:.dence g n /a ®New ❑ReplaCe 4-30-90 6i9=9•0 ' RATING: S- Site suitable for system U- Site unsuitable for system ONVE : MOUND: IN-GROUND-PR MIRE: ISYSTEM-1 FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) s ©s au a s au ©s ❑u OS ®u OS ou I conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: xx Floodplain, indicate Floodpiain elevation: sons PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES HARACTER SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 75 103.6 e B-2 109 106.0 none 109 .8 bnts 1.5 6.8 bpi vj arl- ' B-3 71 104.1 none 71 .9 bkts 1.8 rdal War 1 rdas t2 bnIss, B-4 108 105.3 none 108 .7 bkts 2.6 rdls War 5.7 bms. i; B- B- PERCOLATION TESTSi TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH P.1 25 none r. P- 21 none 5 3 3/4 3 3/4 3 314 1 P P- 46 none 3 6 6 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 I of land slope. SYSTEM ELEVATION 117111. S rollin8 hills trail S , lu b rd e Boa h- At Dina i 7 TV ...v i ei o s C I _ - _ - - - - v LL NOTE : -see - re~ri s- er t' at (a ta~che) o -a tie h(e~_. rt~lii _ n a _ _ . • I, the undersigned, ereby 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: Lkenied Perk Teter & Plumber ADDRESS: Fogerty Weights Road CERTIFICATI UMBER: PHONE NUMBER(optionalF + ROBERTS WI N ORB 749-3656 CST SI A UR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - I N,SAFETY&,U1LDI NWS RY T of ` EMU., " ON SOIL,BORINGS 'AND ~ NRUSTRY, ~ DIVISION LABOR AND PERCOLATION TESTS P.O. BOX 7969 HUMAN RELATIONS (115), MADISON, W~ 637 t IH63.0911) & Chapte045.046 ) LOCATION. TOWNSHIP/M OT. NO :BtX. NO.: S BDI !S N AME-~ )(V 9 E'/ . ~ ` %T.z9N/R/qll ~ f p COUNTY: OWNE S M' JM µ l.' i1 a; 4,,l.i: . ~ C` ^`-t 5~~' ~ s~ 1~a'~t . USE D TES OBSERVATIONS MADE, 4 NQBEDRMS CQIV~ A RIPTIO PROFILE DESC RIPTIONS: Residence New X Af ~,Q ❑Replace ~0 ~'.2 ' 3 O G l0 ~•.1~ RATING: S' Site suitable for system - U. Site unsuitable for systems / C lax ii ONVENTI N :MOUND: IN-GROUNDEM- -FILL OLDING TANK: REC,QIYJJNENDE SYSTEM:(opuonaq ,l ®s Ou ERs 0u os 0u Os, u 0s u.~ ill*AA If Percolation Teas are NOT required DESIGN RATE If any portion of the tested area is in the under c.H83.09(5)Ibl, indicate: ,Aj Floodplain, indicate Floodplain elevation. PRQFI E.DESCRIPTIONS, a ! s ,+k 4~ BORING TOTALr DEPTH T R UND ATER--~N CHARAC ER O SOIL WITH I KNESS, COL R; TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) B- !Q' Q OI o l h st+ a.' is s } . ;JA B= 3 0' /off. o.I e. o n s r rC7 V b~0,u2. tQ s~tll • t S S ~<31, B- 7 Aft %:o- PERCOLATION TESTS ss TEST DEPTH • WATER IN HOLE TEST TIME DROP IN WATER L V INCH S RATE MINUTES 4 NUMBER IiIEH£9 AFTER SWELLING INTERVAL-MIN. PER INCH P. c• n 6 G P- r,k p P- r c'S `A . PLOT PLAN: Show locations of Percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are tM,ho(rf zontal and vertical elevation raterence points and show their location on the plot plan; Show the surface elevation at all borings and the'dlrection'anb percent of land slope. Y " r SYSTEM ELEVATION y~Y 1~ rr ~ ~ # FW 49,1 :A -77- 7 iM: / _ 7*7 go, P-A 'ey i ~oy. '~6`' ~ t` ,"~l`-"~• - ~/1 .2Z..! , F, ~•~,,•l ':~n e'~t. h • /TLL.~/ •J 4 I, the undersigned, hereby certify that the soil tests reported on this form were ma44 by Ine in accord with the procedures and methods specified In the,Wisotunin Administrative Code, and that the data recorded and the location of the tests are c4gett to the best of my:knowledge and belief. NAME print : r , TESTS WERE COMPLETED ON e, r, r ADDRESS:; CERTIFICATION NUMBER: PHONE NUMBER optiotMl lj; CS TORE: • , DISTRIBUTION: Original and one co " , . r f x PY'to Local Authority; Property Owner and Soil Taster. DILHR•SBD.6395 (R. 02/82) - OVER - ~,x 1 r e 'e i ~ Y t ti S ~y 4 v., i r f a ~r M(~© "f O ~ .Q l M ~ . - • n ~ i - 1 S "i • • ~ 0 1 ~ i _ ~ ~ 4 ~ a 4~ ~ ~ i j ~ i ~ 1 ' ' W ~ ~ I i ~ _ - i ~ ~ l r Y v ~ ~•O'~., r o ,M ~ •