Loading...
HomeMy WebLinkAbout042-1093-90-000 30 N ~ O vj~ N O O ~ i O O O O C~ C _ C it - O N V C w C C ~ M O X d C In 3 I ~o~ j 0 C Z N U c C N IL N O O rn C C -a x Q W 0) M •l6 O v, 0 w N a30 w O Z Z o rn a m M F- O E O Z d C w CD Z d z U) F- c -o p O M N a N N O C U O 2 Q O Z F- Z p _N Z d Ni O R E N V H N O O o o a y U N N N 4 Z r' p N FL LL Iv Z ~U')aaa CL fA J V U) 'g I ) 00) CY) d' - N Q O O 5 ~ N m y C CL <t •O N Q U) ~ O O ~ N C Q CD C d O C> > O O O Cd 0 G N d C -O N N co tn 0 :R (B ~ ° 0 0 C O N O rn U') :r Or pj N 00 p y N H C N N N : O CO O N E co O M U- 0 Z C O b od d V~ d •R € a ~t a L a E V 'c I c A 3 o d O M 0 A IOU) v ` y. I Parcel 042-1093-90-000 10/05/2005 07:21 AM PAGE 1 OF 1 Alt. Parcel 33.29.18.518B 042 - TOWN OF WARREN Current [J ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BLUM, HERBERT R & MARGARET J HERBERT R & MARGARET J BLUM 1104 60TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1104 60TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.030 Plat: N/A-NOT AVAILABLE SEC 33 T29N R18W 5.03A IN SW SW LOT 1 Block/Condo Bldg: CSM VOL 2/301 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 04/27/2005 793295 2791/224 QC 07/23/1997 907/447 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/23/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.030 48,500 161,400 209,900 NO Totals for 2005: General Property 5.030 48,500 161,400 209,9000 Woodland 0.000 0 Totals for 2004: General Property 5.030 48,500 161,400 209,9000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 305 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges Total 0.00 i _W OMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 4:0P 16 io @ ST. CROIX ZONING REPORT NO.S 04331/01 PAID 1 ST. CROIX COUNTY REPORT DATES 4/26/91 COURTHOUSE DATE RECEIVED-* 4/24/91 HUDSON, WI 54016 ATTNS THOMAS Co NELSON B OWNER. David Fogarty LOCATION, 11 th St., Roberts COLLECTORS M. Jenkins SOURCE OF SAMPLES Kitchen faucet COLIFORMS 13 /100 ml INTERPRETATIONS Bacteriologically UNSAFF. NITRATE-NS 12 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 OF.\NDEVENpFHr v 7 Means "LESS THAN" Detectable Level Approved by. :S A d~~rh PROFESSIONAL LABORATORY SERVICES SINCE 1952 0 s ici;i' i Y rOUO? {:itJ is . TL. 32 !OH T :AUO? s E I ca t~tJH? t r TA J '3 L' F, t .'t ~ i~ _i r I i t s .u._~'~1";►::: 'iC' ~,~'r)1 ~"r.• ~ricViiJ 115 i pr31 C, i -19-r D `3 OI FA 19.'UTAI Cli\n:` ?:`fs i!43 IP. 6' +iF G . ?4 54c+r yt _57~5~ "11N~:T +Y.J.J' "T COMMERCIAL TESTING LABORATORY, INC. _ 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 315-962-3121 80G,902 = 5227 c ST. CROIX ZONING REPORT NO.: 04331/01 PAGE 1 ST. CROIX COUNTY REPORT TATE4 4/26/91 COURTHOUSE DATE RECEIVED! 4/24/91 HUDSONt WI 54016 ATTN2 THOMAS C. NELSON OWNER. David Fogarty LOCATIONS 1104-suff St., Roberts COLLECTORS M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORMS 13 /100 mt INTERPRETATIONS Bacteriologically UNSAFE NITRATE-NS 12 ppm Above 10 ppm exceeds the recommended PubLic Drinking Water Standard. Cotiform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gape j WI Approved Lab No. 19 0 E.%N0EVFN1,) r o t; Means "LESS THAN" Detectable Level Approved by! ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 evil CL j r R1 ST. CROIX COUNTY ZONING OFFICE 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix Co. Zoning office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION 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 CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. LIZ WATER TESTING FEE:$ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME: 0-1 PROPERTY OWNERS ADDRESS : CITY : Legal DesFFription 5 to 1/4, 1/4, Sec., TwoN-R Town of G faJ1.2t,. ,Lot No. Subdivision FIRE NO.U LOCK BOX N Color of house i Realty sign? irm: PLEASE 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. Firm or individual requesting services: Telephone No. REPORT TO BE SENT TO: - CLOSING DATE: Signature: ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion 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. Z WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of r--- inspection) Property owner's name.. Property owner's address / S a3 Legal Description ~_],/4 o t e c. _1/4 of Section, TAN-RL Town of Lot Number - Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house Xra&vH Realty sign by house? ✓If so, li t firm: / PLEASE 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. Firm or individual requesting services: d!,L_ 2- r A;0 Telephone Number - 3 REPORT TO BE SENT TO: 'J °w. G 4244 Closing date 7 D Signature COMMERCIAL TESTING LABORATORY, INC. , 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 a T. CRO S IX ZONING REPORT NO.. 01144/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 2/01/91 COURTHOUSE DATE RECEIVEDS 1/31/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: Dave Fogerty LOCATION: 1104 60th Ave., Roberts COLLECTOR: James K. Thompson SOURCE OF SAMPLE: Kitchen faucet COLIFORMS 0 /100 ml. INTERPRETATIONS Bacteriologically SAFE NITRATE-N: 11 ppe Above 10 ppm exceeds the recommended Public Drinking Water Standard. LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 I' oF.NDEOENpEHr A v s - Z, C Means "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP eW1& Xi1 SECTION- T~N-R 1F W ADDRESS_ ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT--" LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I ,FOCI INDICATE NORTH ARROW BENCHMARK:Elevation and description: V 61 Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings us Manhole cover elev: Final grade v: Tank inlet elev.: ank outlet e No. of feet from nearest road- ont ide , Rear Ft. From nearest prop. 1' :Front , Side , Rear t. No. of fee om: Well , Building: (I clude this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacture Liquid Capacity: Pump Model: Pu iphon Manufact.: Pump Size Elevation of inlet: Bottom elevation Pump on elev.: Pump off ele Gallo cycle: Alarm: Man.: Switch Type: Locat Distance from near prop. line: Front_, Side_, Rear-Ft. Distance fro Well Building SOIL ABSORPTION SYSTEM '-Zo Bed: Trench: _V--/lSeepage Pit: Width: Length ~p Number of Lines: 2 Area Built ,?OD Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: .3 / No. feet from nearest prop. line:Front , Side ✓ , Rear Ft.*71D0 r No. feet from well: >/J-O No. feet from building /,9, 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: 1~-- INSPECTOR: /I / 644 DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj a DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & 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: SW~ , SW 4, S e C. 3 3, T 2 9- Rl 8 (If assigned) Town of Warren CONVENTIONAL El ALTERATIVE R,j ❑ H ding Tank ❑ In-Ground Pressure ❑ Mound Wncrin A E IT H E : ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ed Roberts WT / Al B MA (Perms nt refer ce point) DESCRIBE IF DIFFE FRO LAN: REF. P F. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKNG 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 OVER ❑ 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 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: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH i TRENCHES: i MATERIAL: PIT DEPTH: DIMENSIONS 7-v Pz-` GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: O D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: V"4 rl. P/L PIPES: FEET FROM LINE: AIR INLET: (JY 1 '2 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 [__1 NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS I ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST-411- /-S / in in county file for audit. Sketch System on Reverse Side. SIGNATU TITLE: t SBD-6710 (R. 06/88) TD SANITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05, Wis. Adm. Code C71/. STAZeaci NITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less tha~7 Q~ 8'/z x 11 inches in size. ❑ if revision 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 ERTY OWNER PROPERTY LOCATION g. Ac, '/a '/4, S 3 T 2,9, N, R/ j E (or PROPERTY OWNER'S MAILING ADDR SS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER If7XII-745-4 IL TYPE OF BUILDING: (Check one) ❑ State Owned D VILLLLAGE : NEAREST ROAD ❑ Public L~ 1 or 2 Fam. Dwellings of bedrooms R Ax MB ( ) 111. BUILDING USE: (If building type is public, check all that apply) l ! Q 6 -?6 1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 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 applicable) A) 1. ❑ New 2. ❑ Replacement 3.E] Replacement of 4. ❑ Reconnection of 5. LJ Repair of an System System Tank Only Existing System Existing System B) ZA Sanitary Permit was previously issued. Permit # - Date Issued 147 7 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 f e_ I" 710, IL ACA A 41 /a it 51 a ' c t` 9,14,71f e VI. ABSORPTION SYSTEM INFORMATION: #,Pp E,0 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 L15-6 AAO Feet JP40 ' Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New ist)n Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank ~"-F1 F1 Lift Pump Tank/Si hon Chamber - VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps r/MPRSW No.: Business Phone Number: 349 wr' vi Plupb4K's Addre (Stre , City, S , Zip Code): D 1► Ix. COUNTYADEPARTMENT USE ONLY 4 ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue suing A nt Signat to ps Surcharge Fee) pproved El Owner Given Initial Adverse Determination / g:` 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 r 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':;ounty; E) soil test data on a il5,f(?rm; and F) all sizing information. - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARr.E 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 facAnylInadequacies thulteIowntzn delays of the property rty being developed. the plimit Issuance. Should this development be intended Lot tesale by owner/conttactot,(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. -i Owner of property Location of property _.LL_1/4 ,5--&-t2 /l, section Township Melling address 1104- Address of site , Subdivision name Lot number Previous owner of property Total also of parcel Data parcel was created 1-9 70 Ate all corners and lot lines Identifiable? as is this property being developed for resale (spec house)? as 0 Volume nd Page Number __..as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DRBD which Includes a DOCUMENT NUMBER, VOLUME AND PAGt NtMBZR, and the BRAL OF THE RZGI8TVR Of DEBDB. In addition, a certified survey, lE available, would be helpful so as to avoid delays of the reviewing process. it the deed description references to a Ceitlfled survey map, the Certified Survey Map shall also be requited. PROPERTY OWNER CERTIFICATION t(Ve) certify that all statements on this form are true to the best of my (out) knowledge; that t (we) am (ate) the owner(s) of the property described In this Intotmatlon totm, by virtue of a warranV.17 eed orded In the of llee of the County Register of Deeds as Document No. 77-1 ; and that I (V Presently own the proposed alto for the sewage disposal system (at 1 (we) have obtained an easement, to tun with the above 'described property, lot the construction of said ystem, and the same has been dul recorded in the office of the County,i1*115 of Deeds, as Document No. Signature of caner Signature of Co-Owner (If Applicable) 913,a Aso' Gate o siq acute Date of Signature DOCUMENT NO I STATF. BAR OF WISCONSIN-FORM 3 QUIT CLAIM DEED r 1 VoI 5rq lei S Sv4cf NiSlNVkU itM NECWDiNG DATA 342373 Ify 'nus DEED. David D. Fogerty, one of the Grantees REGi TERS OFFICE - 57. GIY. ~_0., WIS. ctantor VA. i~r Rtacord this 1. ,t-.farms t David B. Fogerty and Varonica Rose Fogerty, Ltrr t■t A.D. 19 husband and wife as joint tenants any of f WU , M. ~ Granter s tot r anaufrral:un One Dollar and other y vrlurtdr c f, valuable consideration j , ~ep,,,.r of o.. .,t, .I M: n.ui, the fullowing described real estate in St. Croix C,nint•,. St MET M'. 70 Part of the 6W! of the S'44 of Section 33, T ~9 It, A to s.,1 Ralp'.: E. Senn, Atty ru-,re fully described as follows: Comutencinf, at the nest 4 corner of said Section 33; thence go due ::o,.th ( asiumea bearing) along the West line of said Sk of ~,cction 33 1~ , ,,r,,.•,,, r,, ,1,,.tiv distance of 2286.59 feet to the point of beeinniac of the parcel to be herein describec; thence continue due .,outh Z. 'istarice of 191..',2 feet to the centerline of a Town Road; thence N 890 ;31 1t,1 i; air)rif; said centerline a distance of 853.59 feet; thence N "0 50 SL1i a distance of 4LU.Cfc,t; thence 5 850 581 50" " a distance of 52'1.62 fQet to Lhe poir,t of tiiu above I described parcel containing 5.03 acres, rdore or less. the :southerly 33 feet thereof presently used for Town itoad 1ur~oses. t.~ PT This transaction is exempt from Transfer Tax Lxeclption ff8 - Transfer frui:: huFL)and to wife for no consideration. .r Executed at --_Biver Fa11'Usconsin 4 tiu~1.~L 77 . SIGNED AND SEALED IN PRESENCE OF - SEAL) 1Javid 13. Fogert y (SEAL) - - sC , UPPALi Signaturesof. 1)4V I-0 B- _.Fogerty ] { day of J~urust authenticated this Title: Mun:bor State Bar of llis• resin ar-~t~e~3TT~ -Aulleer+ard undua_&-- 7(k.A•+Tr- STATE OF WISCONSIN 1 County. Pe, na11V came befe.re me, the, day of lv the above named to me known to be the 1 --on wh, ov,. ut. I it), lon•ti u., tn- :mcnt and a, knew 1. Iged the .me This instrumoril was d•afted by iialph c. :Jelin, nttorney lul N. Main vt 13J NolarV Publi,~ Count,. WIS. iuver Falls, The use of wtlnv::se. My Commissi„n lFxpires) Q.) N.,mes pens ms signing in am' caps, ov should he tvpt-A or printra lwl.iw• their signature.. N c wwrwri.® QUIT CLAIM UEED-STATF BAR OF WISCONSIN. FORM NO 3 - 1471 ki- H z STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT St. o Croix County z d a OWNER/It ROUTE/BOX NUMBER Fire Number CITY/STATE GrIZ ZIP- j-t'(Oj'3 PROPERTY LOCATION:,aa Section, Tz? N, R/,R W, Town of !i✓"z , St. Croix County, Subdivision Lot number - Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the was-te disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- i ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. 4 0F-PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION AND P.O. BOX 7969 LABOR HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1► & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: .5-W '14V14 N111,1y T E (oto 4~~1017_N COUNTY: OWNER'S MAILING ADDRESS: cg?.Zy-. 1411E E 1467x-. RQ. o as USE DATE OBSERVATIONS MADE rte/ NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: LJResidence QNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CON__VENTIO~NAL: IMOUNP: IN-GR Pa URE: SYSTEM-IN-FILLHOGT❑ANK: RECCO~M~u~TEM:(optional) b~b a If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.1463.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: API PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- H'J S . XJ J2.. Is 411hpir B- B- 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 PER D PER INCH P- P- P- L GKG s 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. SYSTEM ELEVATION 9 E E E E E Q S.V f E `rl area, 1, the un ersigne hereby certi y that t e tests reported on this form were ma e y me in actor wit the procedures and methods specified in the Wisconsin I QO lCojl ,aryl tha~thy~data or ed and the location of the tests are correct to the best of my knowledge and belief. TESTS WERE COMPLET6,15 ON: NAVE (print): DAVE FOGMY PW Of UCeMd Perk Tester & Plumber G ADDRESS: F y Heights R08d CERTI ICA ION NUMBER: PHONE NUMBER optional): ROSE WISCONSIN 54023 Phone CST SI NAT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Y t. °.i INSTRUCTIONS FOR COMPLETING FORM 115 - SRS} - 6395 To be a c( f accurate soil test, your report must include: 1. Corn r.' ascription; 2. The use r-iust clearly indicate whether this is a residence or commercial project; 3, MAXIML! I ber of bedrooms or commercial use planned; 4. Is this a n lacement system; 5. Complete ` :ability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYS, 1 IS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A sheet may be used if desired; your benchmark and vertical elevation reference point are clearly s' own, and are permanent; 9. i appropriate boxes as to dates, names, addresses, flood ply n < percolation test exemp- pri te; -sch as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11 F~ 1 _irm I lkice your current address and your certification number; 12 f_.! e legible c( )res and distribute as reczuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 36 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS S= rtes and T - Other Symbols st - S'_r,r--l {over 10BR - Bedrock cob Cobble (3 - 10") SS Sandstone gr - Gravel (under 3") LS - Limestone *s ",r s HGW I. -t,n Groundwater C's C Perc P -olation Rate coed s - IVl n.? W fs Fir) Bldq Building Is Loa ny Sand ~ Greater Than - Sandy Loam < - Less Than Loam Bit - Brovvn Silt Loan,) Bl - Black Gy - r,3 ra% Loam y yellow Clay Loam R - Red S,i ; Clay Loarn mot - 1Vlot les - dy Clay w - with sic u:I. y Clay fff fe v, ; C - cc - ctnl arse r~1 P ,r rrrm - Mar,- ins p pron.: HWL - Mi Tavel, Six general soil textures water for liquid VIaste disposal BM - B -ark VIV V~ ti( Reference Point « S T C ER: t' . D R, s ~y w kvN w ~ O p' o ~ n 7 O L~ O ©o i ~ o ~o A w C V ~ ti jai, W 0