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AS BUILT FOM - S T•C - 106
. SANZT/IRY SYSTEM REPORT
OWNER
• _ r TOWNSHIP 1
SEC,
ADDRESS T N-R W
• MgT. CROIX COUNTY
• ~ • ,WISCONSIN
SUBDIVISION ,
LOT
_ LOT SIZE '
Diet PLAN VIEW • . .
• antes and dimensions to meet requirements
of TiLHR ` 83
Qv
SHOW EVERYTHING WITHIN 100 FEET OF
. SYSTEM
Amp r lot
%
r ~ • . Baia, ~ • . • • ~ .
1
. • • to INDICATE NORTH ARROW
DENCts peecribe
the vertical reference point use
Elevation o d
f vertical reference points ' - ' / 0,
SEPTLC T Proposed slop* at altos
i.•.•i•Numbef of ring. useds Liquid Capacity, _
--•Q~, - Tank manhole
Tank Inlet BleVettont cover elevation,
Tank outlet $levstlont r
Number of feet from
nearest Road:
' f ~ • . FrontOgide, Rear,
• Front nearest• O
property line , s Front ^ feet
Number of feet fromi well 081d. tV% r,O
• ' feet
(Include this info - • buildings
rmation Of ..the above . plot p. itn) (Z reference
dimensions to septic tank)
SEP, REVERSE Srnp
' w
PUMP CHAMBER
Manufacturer:, Liquid Capacity:
Manufacturer: Pump •Sis;e
Pump/Siphon Pump odel:
Elevation o nlets Bottom of elevation:
pump off switch e,. tiont Gallons per cycles
Alarm Manufacturers Alarm Switch Type:
's•• -Number of feet from;ne at property Front, O Side, O Rear,Q Ft•~_
ti.
umber of feet from well:
Number of feet from building:
Include distances•on plot plan).
SOIL ABSORPTION-SYSTEM `j' '
Trenchs
sea:~ • _ .
1
Width: • Lendth: r .--Number 'of Lines:` Area Built:
~r
Fill depth to to of pipet
Number of feet f~om nearest property line: Front, O Side. ( Rear,O It.~Q
:Number of feet from well: N Aber of feet from building:
(Include di lances on plot plan).
SEEPAGE PIT ;
ises Number of pites Diameters
Liqu depth: Bottom of seepage pit elevations
~
Area Builts
r
Has either a drop box or distribution box 0 been used on any of above soil
absorbtion sytems? (C eck
HOLDING TANK
Manufacturers Cape y: - -
Number of '.rings used s Eleva on bottom of tanks
• Elevation of inlets
Number of feet from.near property lines Front, Side, O Rear. 0It._,-
or of foot from wells
or of feet from building:
umber of feet from.nearest roads
A Manufacturer:
' Inspector:_*
i
Datedt. Plumber on jobs AVZM
License Number: _ -Yog'-3-.20
3/84nij
DEPARTMENT Of INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. B4X ++069 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
SE', tA KONSV,y ...F8 T3 ON-R 1 9W State assigned)
I.D. Number:
Town aj St. Jozeph CONVENTIONAL ❑ ALTERATIVE
PeAch Lake Rd ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Cha,tterz Geedan 8885 RiveA Heights Gray,Inver. Grave Ht.
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: Ktnn. 55075 REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Donavdn Schmitt 3205 St. cuix 135515
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ 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 ❑ NO NEAREST 11111-
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 WIDTH: LENGTH: NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
p TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS / ~ -
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
NEAREST
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 ❑ 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: ER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
El YES El NO COV ❑ YES ❑ NO
MBER OF PROPERTY WELL: BUILDING:
PERMANENT MARKERS: OBSERVATION WELLS: iAREST
COMMENTS: ET FROM LINE:
3 - GS ❑ YES ❑ NO ❑ YES ❑ NO
ZZ
s 9i
(9
Sketch System on Retain in county file for audit.
Reverse Side. . SIGNATURE: TITLE:
SBD-6710 (R. 06/88) Zoning AdministAato&
Thomas C. on
SANITARY PERMIT APPLICATION
T D LHR In accord with ILHR 83.05, Wis. Adm. Code couNTY
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / 4 ~
8% x 11 inches in size. C(ec if vis on to previous 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
_ L '/4 S Y4, S J; T JZ47 , N, R E (o r&
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 0 01
iA l
CITY, STATE / ///Y/V- ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned ❑ VILLAGE : e-&,,& 14 " RD
N OF:
AX UMBER( )
❑ Public VV 1 or 2 Fam. Dwelling-# of bedrooms PARCEL
III. BUILDING USE: (If building type is public, check all that apply) j® - -50 /d
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 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. LN New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 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 ~ Seepage Bed 21 El Mound 30 El Specify Type 41 El 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) ELEVATION
Z/ Feet a Feet
VII. TANK? CAPACITY Prefab. Site Fiber- Exper.
in gallons Total # of Manufacturer's Name Prefab. Con- Steel glass Plastic App
INFORMATION New istin Gallons Tanks strutted
Tanks Tanks
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber El I El Ll El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumbernature: (No Stamps /MPRSW N TBusiness Phone Number:
t / , S? -d
um is Address (Street, City, State, Zip Code):
IX. COUNTY/DEPA MENT USE ONLY
❑ Disapproved sanitary Permit Fee (Includes Groundwater SUS Is Uing Agent Signature (No Stamps)
A_r Surcharge Fee)
W Approved ❑ Owner Given Initial /D
Adve a Determination / `
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6396 (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 81/2 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; (lose 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
8TC-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 Lot resale by
owner/contractot,(spec house), than 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 ~A^~ s ca~r~,ti~ z j~•.✓
Location of property 1/4 S•F l/4, Section s' T 3 o N-RSV
Township ~`os~~ris
Mailing address
Address of site 4%-% t/ '2' h~! Wso;/
subdivision name
`s
Lot number
Previous owner of property j- ~!mss m,°-~~
Total else of pascal ac, o x X24 v3
Data parcel was created
Ate all cornets and lot lines identifiable? as No
Is this property being developed for resale (spec house)? Yes ~No
Volume and Page Number VIB/O as recora-A Later of Deeds.
A ,
•
A VA kaz Numan, and
the tied survey, if
avail ring process. If
the t Certified Survey
map ■
t(Ve) at of my (our)
this y described In
this the Office of
the Co end that t (we)
obtain 3t 1 (we) have
obtaini constrt Itty, for the
of th in the office
of !h
819natu _ -...,.r Signature of Co-Ownet (If Appllcabie)
Date of signature Date of Signature
Nw !A. Warraatir Ded-Common Form (STATE OF WISCONSIN) PaE1LMd by sag (wr Book i 6umwq oo.
H7 Corporation. (Sec 236.16, Wis.Statatss) Forte No.2
4kJ8921 871 PAGv.4 (o 0
This Indenture, Made this 24th day of May , A. D.,19 90 ,
between
li ERICKSMITH INC.
a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin,
located at Baldwin , Wisconsin, party of the first part, and
Charles.A. Geldon and Catherine F. Geldon, husband and wife '
• part ie s of the second part.
MitntoottD, That the said party of the first part, for and in consideration of the sum of
i
jl One Dollar and other valuable consideration
i
t to it paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowl-
edged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by
these presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said j
part ie s of the second part, their heirs and assigns forever, the following described real estate,
situated in the County of St. Croix and State of Wisconsin, to-wit:
ii
Lot 1, Volume 6, of St. Croix County Certified Survey Maps,
Page 1643, Document Number 410756.
Being a part of the SE4 of the SE4 of Section 28, T30N, R19W.
rtu.Ogetber. with all and singular the hereditaments and appurtenances thereunto belonging or in anywise
appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the
first part, either in law or equity, either in possession or expectancy of, in and to the above bargained
premises, and their hereditaments and appurtenances.
cZo )ebt OtiD to DORI the said premises as above described with the hereditaments and appurtenances, unto
the said part ie s of the second part, and to their heirs and assigns FOREVER.
An0 Me 4640 ERICKSMITH INC.
party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the
said part ies of the second part, their heirs and assigns, that at the time of the ensealing and
delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect,
absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear
from all incumbrances whatever,
and that the above bargained premises in the quiet and peaceable possession of the said part ie s of the
second part, their heirs and assigns, against all and every person or persons lawfully claiming the
whole or any part thereof, it will forever WARRANT and DEFEND.
Jtt =tntoo Ulbr tot, the said ERICKSMITH INC.
party of the first part, has caused these presents to be signed by Dennis W. Erickson
its President, and countersigned by Richard Reigh Smith , its Secretary,
at Lakeland , MN , FWaKwI, and its corporate seal to be hereunto affixed, this 24th
day of May A. D.,19 90 .
Signed and Sealed in Presence of ERICKSMITH INC.
Corporate Name
Preddent
Dennis W. Erickson
Cotta igned:
4
Zte,
Richard eigh Smith
--t :lY .tr'6f" talc-yrorldw~ht~la I=1aa~rom~ni~rir-1r-riicoraii=sliaU=ba~e~7p ♦[a77'D~~~'~r-~p~r-{r E4a-~eereac~t~ti'
grantees. witaasw and notary.)
YC; 871PASK
` .
Oft
%tatt of mun-o oul
~ inne sota ss.
'dashington County.
Personally came before me, this day of r•.ay A. D., 1990 ,
Dennis W. Erickson President,and Richard Reich Sniith ,Secretary
of the above named Corporation, to me known to be the persons who executed the foregoing instrument,
and to me known to be such President and Secretary of said Corporation, and acknowledged that they
executed the foregoing instrument as such officers as the deed of said Corporation, by ifs authority.
K JOAN S. MIRANDA
!1 NOTARY PUBLIC - MINNESOTA
I, WASHINGTON COUNTY Notary Public, •,,dashinj>ton County, Wis.
' My Commission Expires July 23. 1903
My commission expires 7 A 3 , A. D., 199,3 .
Drifted by Dennis tel. Erickson 0. Box 201, Lakeland, NN 55043
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STC - 105
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SEPTIC TANK MAINTENANCE AGREEMENT ~
St. Croix County
r
OWNER/ BUYER
ROUTE/BOX NUMBER''Z s~
r~ Fire Plumber
CITY/ STATE W k d g .O J LU ~t ZIP •S
rt
0
PROPERTY LOCATION: f. Section a? T 3o N, R1_ fW,
Town of ' 6°r _3-:,-s St. Croix County, -
SubdivisionSubdivisionC Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed 'se tic tank pumper. What you put into
the system can a ect the .unction 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 'sys'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 o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources, Certification form must be completed .y'
and returned to the St. Croix County Zogin Office ithin 30 days
of the three year expiration date. Cyc~~
vL
SIGNED 4f
f
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016,
386-4680
Sign, date and return to the above address.
INDUST OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS VISION
INDUSTRY, ,
LABOR AND P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/QTY: LOT NO.: BLK. NO.: SUBDIVISION NA,t,E
s~ IY4 1/4 Zg /T3D N/R /QE (o W sr. J•Ose-P
COUNTY: OWNER'S BUY R'S NAME: MAILING ADDRESS:
Sl• C,i°D%X Nt,P. CI,pS. ?i 41 ,4SPERs6tJ 7/5 M,a,1_r1rdA) S-} /Vo• //uplcv ~%1 SYoi
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIPTION: OFILEDESCRIPTIONS: P I LA ION TESTS:
f (Residence ? N tl XNew ❑Replace I
l 1 /I
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
oS ❑u aS au ( as auIos au as au ~ /..2 S2 (3 q.X '
IIf Percolation Tests are NOT required DESIGN RATE: S- If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: CGitS S Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS fT. 161<4 Tom P~/ED 7-0 M25:;t OF
_ Rope- l3oRe ?r '2-
BORING TOTAL DEPTH TO GROUNDWATER-INCHES_ 61ARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN. ELEVATION QBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
is ?y0' .S "/•1~•
S r / '~B- 00.06, /10' > S W ;OK T tr Dt'S7 064.41 te5'417 4t- UA)
?~.u v c s
' - - - D~ -fs Sr . S- N -4y s, , . N , , 79
B-2-- 7.0 Ito- 9 0 ~N. 5"/ . (0& ~N Hott(FD f// yo'' r,f ti c S
3 9~,, /o1•/lr > ' .93'4A) s•~~ .2.s (BN• Si/f lo./'T~ v cs
.
.2.3 ' 4N - J/ N • r~t,v v
B-3 10. 103. 7y - > 16. S OS
B-~ 0" 1 %-,30 _4'_0 ~2 o w r:/
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN, -PERIOD! PERIOD PER INCH
P_ -2, ael Z 46
. r
P_ f /1 c s k-' s 7<#.S
P_ y 7.1 Ito,- z
P_ 40,t7-6AI 'aejVA-J,_-0 4X5
P_ .3" -7iw j
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. $ y STEM Ta /9iPEi¢- ' Q /4S f/vR
SYSTEM ELEVATION -kr S poses I ate . 3 y - s
. Cv Z FT ' Tr
h N
O
.
STN
LIN
1, the undersigned, hereuy 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.
I
INAME (print): HOMESITE SEPTIC PLUMBING TESTS WERE COMPLETED ON:
655 OWEIL.Rn.i, HUDSOt4, viIS. X916 'yRct' 3~ /Y F("
PHONE NUMBER (optional):
ADDRESS: CERTIFICATION NUMBER.
_?p/
WIS. MASTER f i# 1 i3>:St4t 3307MP.R.S. SS ^D2 Llt ' N0.OW
Ut ,ii,t1 , I CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILFIR-SBD-6395 (R. 02182) - OVER - '
;t~_
REPORT ON SOIL SORIN&S PERCOLATION TEST5 115
PLO r P t~ AM r• D. TM ~~-sp~-,e.ro,~
PROTECT S'0"V4 7L IV_ .
NOMESITE TESTING CO,
RT. 3, O'NEiL ROAD BOB ULl,lr'd
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PROQOSED HOJSE MVST LIE 2 .GL TE~T f~rP A E 5
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CERTIFIED SURVEY MAP
LOCATED IN PART OF THE SE 1/4 OF THE SE 1/4 OF SECTION 28, T301, R19W,
TOWN OF ST. JOSEPH, ST.•CROIX,COUNTY, WISCONSIN.!.,
OWNERS AREA OF LOT I
~RICHARD E`STEWART RIVARD
217,866 sq. ft. (5.00 ac.) INCLUDING ROAD R`W-
RT. 4 104,624 sq. ft. (4.70 ac.) EXCLUDTNG ROAD R/W
NEW RICHMOND, WI. 54017 '
'LEGEND `IL`•,,..,: /
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Parcel 030-1079-50-100 02/13/2007 12:00
PAGE 1 OF 1
F 1
Alt. Parcel 28.30.19.287B 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): O = Current Owner, C = Current Co-Owner
O - GELDON, CHARLES A & CATHERINE F
CHARLES A & CATHERINE F GELDON
588 PERCH LAKE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 588 PERCH LAKE RD
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 28 T30N R19W PT SE1/4 SE1/4 LOT 1 Block/Condo Bldg:
CSM 6/1643
Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4)
28-30N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 871/460
07/23/1997 845/519
07/23/1997 814/368
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 79,400 175,200 254,600 NO
Totals for 2007:
General Property 5.000 79,400 175,200 254,6000
Woodland 0.000 0
Totals for 2006:
General Property 5.000 79,400 175,200 254,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 520
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00