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02/28/2005 02:24 PM
Parcel 030-1015-40-000 PAGE 1 OF 1
Alt. Parcel M 04.29.19.64B 030 - TOWN OF SAINT JOSEPH
ST. CROIX COUNTY, WISCONSIN
Current X'
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* JOHNSON, EARL J & VICKY L
EARL J & VICKY L JOHNSON
1176 SUNDANCE PASS
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1176 SUNDANCE PASS
SC 2611 SCH D OF HUDSON x
SP 1700 WITC I 6
Legal Description: Acres: 3.000 Plat: N/A-NOT AVAILABLE
SEC 4 T29N R1 9W SW NW LOT 4 CSM 5/1476 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 876/156
2004 SUMMARY Bill M Fair Market Value: Assessed with:
4816 230,500
Valuations: Last Changed: 07/07/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 75,500 151,300 226,800 NO
Totals for 2004:
General Property 3.000 75,500 151,300 226,8000
Woodland 0.000 0
Totals for 2003:
General Property 3.000 44,300 134,500 178,8000
Woodland 0.000 0
Lottery Credit: Batch 130
~ Claim Count: 1 Certification Date:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
;L4
0
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE W 1/2 OF THE NW 1/4 OF SECTION 4, T29N, R19W,
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
small tracts
SUBJECT TO N.S.P. DEED
NW CORNER NORTH LINE - NW 1/4 volume 149, page 355.
SECTION 4 S88054'5611E
w 358.51' - d H z
S88o54'56"E 0 to
CO. MON. Co 358.51' Co 130,680 s N y
I V or o
r
LOT W OD 0) -r'
r z
TOTAL
160,301 sq.ft. '4 AREA LOT 1 EXCUDING t=i d
3.68 acres - EASEMENT+ 3.00 AC. ao
130,680 q.ft. r
S8804214411E S880 4214411E
358.52' 8.02'
TO~i1N $0$D rn L, ( T r+ S01017'16"W
66.00
S88°42'44"E
z
300.00' SCA - ° IN F FT
o
I 1 100 0 200
W LOT 2 W
41, t, 0 O
N ~ 0 N OWNER
it N 130,680 sq.ft. Vl WILLIAM E MARILYN FEYEREISEN
3.00 acres RT. 2.= BOX 250
BLUEBIRD DRIVE
N N88°42'44 W o o HUDSON, WI. 54016 En In t
307.05 o 0
t
W LEGEND
L4 ►1
4
r LOT 3 ,Ct 0 1" IRON PIPE FOUND.
V
~ - Cl 1" x 24" IRON PIPE WEIGHING
130,680 sq.ft.• lD lD c
Ln 1.68 LBS/LIN. FT. SET.
3.00 acres o • o v
18900315911E 140.00' N IN
Ng3O
Sp,
0 346 4S''~Y
0 w .6S' 66 FOOT ROAD DEDICATED TO THE PUBLIC
LOT 4
130,680 sq.ft.
3.00 acres cn Ybl s,Z O 4y
0o w' ALLEN C. 4
458.15' NYHAGEN
N89 13'04"W z Co S-1407
0 Co
or HUDSON,, r
proRosed_CSM 0 -4 44 o IS. f~ Q • lf6
W 114 CORNER N00°49'14"g S89 5310111W 'siod ~O ,'►L
957 66.00'
S1-:CTTON 4 .00 \ \
1~-
t
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE W 1/2 OF THE NW 1/4 OF SECTION 4, T29N, R19W,
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
small tracts
SUBJECT TO N.S.P. DEED
NORTH LINE - NW 1/4 volume 149, page 355.
NW CORNER
SECTION 4 588°54'56"E
rljli
CO. MON. w 358.51' ° N C y
w 358.51' d rri
S880541 5611E 0° z t7~ N
0) r OD ~ °4 ftl
LOT 1 z
Ln N 0
'-N TOTAL cn g 1y
160,301 sq.ft. '4 AREA LOT 1 EXCUDING b
3.68 acres EASEMENT+ 3.00 AC. o
130,680 sq.ft. r
S8804214411E S880 4214411E
358.52' 8.02'
°gN ROAD rn SO1°17'16"W
a_' t~Q~l YC ~Y , 66.00
S88°42'44"E
300.001
0 SCALE IN FEET
°0
100 0 200
, LOT 2 W
r L4 °
IN 0 N OWNER
C2 -
' N 130,680 sq.ft. N WILLIAM 6 MARILYN FEYEREISEN
ni a 3.00 acres RT. 2 BOX 250
y BLUEBIRD DRIVE
N N88042-4411W o o HUDSON, WI. 54016
307.05' o 0
A ~ I LEGEND
r L4 LOT 3 rcot • 1" IRON PIPE FOUND.
V
ICLD 1" x 24" IRON PIPE WEIGHING
130,680 sq.ft.• l0 C 'o
cn 0 v 1.68 LBS/LIN. FT. SET.
3.00 acres 0 • A.
to IM
00'
389003159"E 7(uA
411, o so,
0 348 4S''!y
p.61 66 FOOT ROAD DEDICATED TO THE PUBLIC
LOT 4
130,
680 sq.ft. o fi "(a,..~,of~. 0 3.00 acres Yb~ 4`
° w. ALLEN C. IWO
458.15' , NYHAGEN
N89 13' 04"W z OD S-1407
HUDSONp s
roed CSM °
--Do-s------ ° IS. ,.4 Q k+~
W 1/4 CORNER TN0004911411E N S89°53' 01"W `
;t,:CTION 4 957.00' \ \ 66.00'
FORM - STC 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Ck,, 5~1/I TOWNSHIP t .a
SECTION___:2'/_T Z J N-R /j W
ADDRESS 1176 Luc-!i~ r ST. CROIX COUNTY, WISCONSIN
SUBDIVISION ~"wor G nct ~s ~s LOT SLOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,r..
C' f,
INDICATE NORTH ARROW
S~~~d~r~t~ tlcc55
L0
7 CA~~I Fr
BENCHMARK:Elevation and description: '~7c 100
Alternate benchmark
SEPTIC TANK:Manufacturer: Ju s P Liquid Cap. /dao 6
Rings used:!) Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side A , Rear Ft. /,b'`
From nearest prop. line:Front , Side , Rear X Ft. 106-1
No. of feet from: Well Yl , Building: /5'
(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 SYSTRM
Bed: Trench: X Seepage Pit:
Width: 5 Length k(p Number of Lines: 2 Area Built 66c)
Exist. Grade Elev. lo Y, o~ Proposed Final Grade Elev. /o y,of
Fill depth to top of pipe: 2.S
No. feet from nearest prop. line:Front , Side , Rear_.L_Ft. 1"o
No. feet from well: /Do t No. feet from building 05
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: Jo- 2z ; je2 PLUMBER ON JOB: ~ cc~r
LICENSE NUMBER:
6/90:cj
avoo Wz
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR TY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
W 2 , NW 4 ,Sec . 4 , T 29 -R19 (If assigned)
Town of St. Joseph ~ CONVENTIONAL ❑ ALTERATIVE
S Holding Tank El In-Ground Pressure ❑ Mound
NA E OF ERMIT H OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Hudson, 11
WI v
BENCH MARK (Permanent ref rence point) DESCRIBE IF DIFFERENT FROM PLAN: REF. P7 ELE . CST REF. PT.
4oP C~c_ alc a~ AlGCC .e O 3 ' ~,U d
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
'x 128720
Rc)gL-r Timm
-k q (e Ca - S y `
SEPTIC TANK/! 1,01160INGTANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK OUTL ARNING LABEL LOCKING COVER
~ PROVIDED: PROVIDED:
1~J2.~ S O r O YES ❑ NO E:] YES No
BEDDING:R1T~IA.: VENT-MATL.: HIGH WATER UMBER OF ROAD: PROPER WEL / BUILDING: VENT T FRESH
C.•CJ. ALARM: FEET FROM - LINE: AIR IN T
V- I ❑ YES NO NEAREST-~ >2 8a
❑ YES NO
D HAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO
k GALLONS PER CYCLE: PUMP AND CON PERATI0 AL NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE NGTH: 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 6;P w.' 5 --"/-e-trra ECGv a -
BED/TRENCH WIDTH: L T . NO. OF- - ~ DISTR. PE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
i TRENCHES: MATERIAL: DEPTH:
DIMENSIONS `j ceQ 1 2- _
PROPERTY
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: NOAMSTR. NUMBER OF WEL ) BUILDING: VENT TO FRESH
BELOW PIPS: ABOVE/COVER) ELEV. INLET; ELEV. END: 5/<',c~„/J✓~ PIPES: FEET FROM LINE: , / , AIR INLET:'
;t- ~ NEAREST 33 S., N160 D
-
MOUND SYSTEM: / d
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 H/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 SPAC EPTH BELOW PIPE: FILL DEPTH ABOVEjWd R:
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
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
40&46~ '4 ~e r QI/n
Sketch System on et n in county file for audit.
Reverse Side. SIGNA RE: TITLE: / _k,77~
SBD-6710 (R. 06/88)
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CouN
~~Ra
STATE SANITARY PERMI #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Wplous 8% x 11 inches in size. Ch k re sio 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
Iir,3 AJ Mlk, S T ZN, R (or)
PROPERTY OWNER'S MAILIN ADD SS LOT # BLOCK # w'n
CITY, TATE ZIP C PHONE NUMBER SUBDIVISICIN NAME OR CSM NUMBER
/
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) 11 State Owned VILLAGE
J ~s Sun.
❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms PARCEL TAX ER
111. BUILDING USE: (If building type is public, check all that apply) (!jam i~ j l~~
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. PN New 2. El Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED AREA
ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
660 16 la!~) b CJV 10 5 / Feet 5,6'5~eet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tanks f
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.
Plu®mber's Name (Print): Plumber's Signature: (N Stamps) MP/MPRSWAG.: Business Phone Number:
d / '3Z~ 7 772 32I
Plumber' Adr (Street, City, S
&"C Iq _Z I
tate, Zip Code): W1 0~0 2- 7
IX. COUN ((TYYIDDEPARTMENT USE ONLY Gl
F-1 Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Issuing A ent Signature No Stam
Kproved El Owner Given Initial Surcharge Fee)
7 a
10 7
Adverse Determination ~Y5- ✓ L
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
f
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 fhe
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.
Il. 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.
Vill. 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)
.:.:+r ,..ter... w .,.-..~..~..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/contractQV,("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 rwt" U
Location of Property W I M ~4, Section. T Z~ N- R W
r
Township ~'r• S f -F Vt
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property IN 1 w I A,11 ~
301
Total Size of Parcel IP80
Date Parcel was Created YOL F~~
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes` No
Volume and Page Numbe K-Zas xecorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
out
~cvLti6y that atatement6 on thia ohm ~e t oeto the
4
edbeAt ed6~.n thi.
k.na Zedge; that 1 fy od- (0(t4 the owneA 6 ~d ~ A xhe O~ ee a the
~,n6ohmat%on Gahm, vcAtue o6 a wanAanty deed neeande 66
4 '1249&,
W and~.tha t `C i have
County RegUta o6 Deedb ab Document No. e
pn"ent!' y own the phope.ti e.d s4 to joit. the g Jno
obtained an eaaement., to hun wLdL the above de,6cAibed phopetcty, bon .the
conethucti.on,o6 eaid 4&y6tem, a,ad the name hab been duty hecohded in the 066ice
o6 the County' Regia-teh o6 Deeds, ab Document 'No. 1
SIGN TURF 0 OWN R SIGNATURE 0 0-OWNER (IF APPLICABLE)
-71
DATE SIGNED DATE SIGNED
n, IEPIT NO. STATE BAR OF WISWNSiN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
- 4W14 rw~ 1W6 REGI
SWS OFFICE
ST. cwoac 000.; WI
Reed for Recill
r JUL 161990
1:00 P~. #A
otal
n G.
' nwys and w to Fay-] j. -j a lam gillm (A
P Reo4lar~~ ,
x
RETURN TO
the following described red estate in C'"'i g County, 1
State of Wisconsin: 630-
Tax Parcel No:o & )
cli
.
Crg 1,41'7&
rr
FEE
. This t S hot homestead property.
. ice) (iS7atll)
Exception to Warranties:
'bc. .
Dated this b ' day of
(SEAL) (SEAL)
(SEAL.) -(SEAL)
AUTHENTICATION ACKNOWLEDGMENT-
Signature(S) STATE OF WISCONSIN
ss.
- County.
authenticated this day of 19 Personally came before me this day of
the above named
40
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ to me known to be the person _who executed the
authorized by § 706.06. Wis. Stats.) foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS acTr08y
Notary Public-
County, Wis. ~I
(Signatures may be authenticated or acknowledged Both My Commission is permanent. (If not, state expiration i
are not necessary.)
_ I
'Names of persons signing in any ca040ty should be typed or printed below their signatures - S62 N1F 7774
WARRANTY DEED STATE BAR OF WISCONSIN Nedco Tax Forms, P.O. Box 10208, Grow Bay. WI SM7-0208 ~I
Form No 2 - 19A2
CJ
STC - 105 r
y
H
SEPTIC TANK MAINTENANCE AGREEMEN'T' o
St. Croix County
v
rX1
UWNEIt /BUYE,it V
ROUTE/BOX NUMBER ~~1(p ~tAFire Number
C I TY / STAT AT, 54!
'I'N, R__!l...W+ .
1'ROP1iK`'Y LUCA`'IUN:_~' Scctic)n 4_1
'luwn ul: St. Croix County,
Subd i v is iun"!5mj Ok-ek ~&6f *f *t,? Lot number 4
- I
Improper use and maintenance of your suptic 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 pcit into
the system can affect the function of the septic Lank as a treat-
. ,
ment stage in the waste disposal system.
St.-Croix County residents iuaX be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was ln.operation prior to .July 1, 1978. St. Croix County
accepted this program in August of 1980, witli the require went Ithat
owners of all new systems agree to keep their systems properly
maintained. The The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
,journ.eyman 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; (it 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
H
three year expiration. o
• :4
I/WE, the undersigned, have read the above requirements and agree u,
to maintain the private sewage disposal system in accordance with x
H
the standards sec forth, he•rei.n, as scat by the Wisconsin Depart- 'd
menu of Natural Resources. CerCifieatioct form must be completed
and returned to the St. Croix County Zoning Offkce within 30.days
of the three year expiration date.
SIGNED
uA"E 7 23~c~
St. C;,oix County Zoning 'Office
P.O. ilox 95.
llammo'j}d; WI 54015
715-7 16-2239 or 715-425-8363
Sign, date and return to above address.
1
JT OF REPG _ .T ON SOIL BORINGS I ID SAFETY & BUILDINGS
DIVISION
P.O. BOX 7969
.JD PERCOLATION TESTS (115) MADISON, WI 53707
,iELATiONS (H63.090) & Chapter 145.045)
1 U SECTION: TOWNSHIP/MVt1tCtPAt+,TY: ruT 0.: BLK. NO.: SUBDIVISION NAME:
!/4 u)'/ /T 7cjN/RrjA(or)W
s:
J 7 i r =4r/ A• a i 5£ {'f 7• Z S!J Lied j'.SCk/
c DATES OBSERVATIONS MADE
NO. BEDRMS,: rOMMERMA-EDESCRIPTION: I1 TLE 00`0U ST :
~iesidence J r) (®New ❑Replace
TING: S- Site suitable for system U- Site unsuitable for system
,NVENTIONAL: MOUND: i14-GROUN UR- : S S E - N-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional)
S au ZS sus au os u as 01
A) 14~
OPJ
Percolation Tests are NOT required DESIGN RATE: rFloodplain, any portion of the tested area is in the
der s.H63.09(5)(b), indicate: `,n/4_ indicate Fioodplain elevation:
SI MA I r PROFILE DESCRIPTIONS
HARA TER F SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
)RING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER-
IMBER N, ELEVATION B E E k5l. HI TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
I 1
o~ ~?,y 00 I"7 1?
,5 WO r)
00 to 1~1
2e or 7 /7-1( 121
' S ,ran. G.
f
IQY-!f- A-20 A) S Ph
No A) z
!>7A,PERCOLATION TESTS / 'o MINU TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LE -IN HES RATER INCHES
UMBER AFTER SWELLING INTERVAL-MIN.
35 1
NP
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
ital 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
land slope. C
YSTEM ELEVATION
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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
dministrative Code,.and that the data recorded and the location of the tests are correct to the best of my knowledge and belief,
)AME print rll~ ` TESTS WERE COMPLETED ON:
V e`/
p PHONE NUMBERloptional):
,DDREFIS: CERTIFICATION NUMBER:
8, 94
CST blGNAd7UFfV
.p
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)ISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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- • - TIMM EXCAVATING SHEET NO. 4 OF
Route 1 Box 192 a t
WILSON, WISCONSIN 54027 CALCULATED BY DATE c'
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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TIMM EXCAVATING SHEET NO. / OF
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE 7- Z5- J~V
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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