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004-1005-40-100
Parcel #: 004-1005-40-100 11/29/2006 09:49 AM PAGE 1 OF 1 Alt. Parcel#: 03.28.15.36A 004-TOWN OF CADY Current X; ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner DAVID J ROEMHILD O-ROEMHILD, DAVID J SHEILA R O'BRYAN C-SHEILA R O'BRYAN 560 310TH ST WILSON WI 54027 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *560 310TH ST SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.750 Plat: N/A-NOT AVAILABLE SEC 3 T28N R15W PT SE NE BEING LOT 1 OF Block/Condo Bldg: CSM 9/2640 2.75 ACRES Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 03-28N-15W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/19 1035/475 WD 997 /WJç 1250/138, WD 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 147287 184,800 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.750 33,200 145,200 178,400 NO Totals for 2006: General Property 2.750 33,200 145,200 178,400 Woodland 0.000 0 0 Totals for 2005: General Property 2.750 33,200 145,200 178,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch#: 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 , C 0L X36'6 zw ej- 0011 /00.J 1/a /00 �Q �i 7-A..4/) £/6"l� ilr : //6' tili))1 ea Al' k i% ('S'/7 9/iii 4/e 501676 i 7�' - CERTIFIED SURVEY MAP LOCATED IN THE .SE I/4 OF HE. "'E " SECTION 3, -T 28N R 15 W , TOWN OF CADY, ST. CROIX COUNTY, WI . ,,r PREPARED P AR EO FOR.„ ' r 1 1,.- TED HILLSTEAD ` 560 310th ST. rt3 f1 i:3 r rW.IN LL WILSON W I \ v . ,,0(48 \\,"/'>>.,..),: .,-,,� ,r. .� ” NE CORNER ! "•Y r 1 F, SECTION 3 M '''':;12....U '(!t - W DI" Iron Rod) � U,NPLATTED LANDS (Found I h u w "' P. v , v OS 90°00'00"E o °` 100.00' N u,2 w 0 Q \511(n W 2 w c0 z F I 33' 33' fit- 2 11 i W 4• W I O O O Q 1 o1 w o I co 2"1� I z ° 1 N o co w a C' Z 77.82' S90° 00' 00"E 275.00' 1 'Z. p 242.00' 933.00' Q. N90 00'00'W 1 I F--. J• I I W I I W -a. I lo I C w. LOT I W o mi ° Q- 2 2 .75 ACRES �i 1 Y d; w I Iw �I of Z' 0 1 c _ -o =• o Q ^ 1 01 0 o 1z zi 0 o Io ° =• I LOT AREA Z 1 m i O y I-- 1 2.75 ACRES I 1 0: I II9,715 SO. FT. 291.00' 1 33.00' • 2,52 ACRES N 90°00'00"W 324.00' M' 109,705 SO. FT. I EX. EASEMENT UNPLATTED LANDS 1 w _ ... I - a 001 0 = I" X 24" IRON PIPE WEIGHING 1.13 LB S. i •°o M PER. LIN. FT. SET. 5-(/� 1 `/J 1 o '44\ �0��/1is j 0�� '�� 1 SECTION CORN3ER a� �, (Found AI.Co. Mon.) JAMES M. , WEBER SCALE I" = 100' a S • 1804 SPRING VALLEY WIS. i ct. 0' 100 200' 300' Ile 64 o 0 °too. I�U S. 0% . ,..._. JAMES M. WEBER S-1804 SHEET I OF 2 DATED �"` " N.1,1 DRAFTED BY J. W. �,s� �_z9-gs VOLUME 9 PAGE 2640 95 Form - STC - 104 AS BUILT SANITARY SYSTEM rEPORT OWNER 7 /) /i 1 TOWNSHIP CaSici SEC. TN-R�S N ADDRESS rf L . -- 6. UST. CIZOIX COUNTY, WWISCONSIN /III I, ; \.\ , Sy 02, SUBDIVISION for LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERY I'111tiG WITHIN 100 rIxs OF SYSTEM ioovCiwd I \ , \\\ WASbi J ' \ \\\ / I ii,J,I\ (A.,,,„ .,,, . i. N .._ • . , INDICATE NORTH Off,► 'EENCRMARR3 Describe the vertical reference rr'int used �, ,_ �� """ Elevation of vertical reference p4 tnt t j 00 Proposed elope at site: 2, SEPTIC TANK: Manufacture .tg , �( r: 1, v' LixdY"r�,jd Capacity: / Number of rings used: __._, Tank mnnhu ie cover elevation: Tank Inlet Elevation: Tank Oull:..t. L1cvation: . �• , Fron �lumbec of feet from nearr r r- nd. „t:,', Rear' O j a feet t From ncnreat ptupc . ;Inc : Ilnnt / ` I. 41.75wv ek T-42,1_ 9 PUMP CHAMBER " v-�-� �'s Liquid Capacity: X0006 Manufacturers �rr " _._.....__..-• — f y • Pump Model: Pump/ Manufacturer: cA(.... Pump Size _-3 Elevation of inlet: . iS Bottom of tank elevations RC"). 7f Pump off switch elevation: ei4 9 Cf Gallons per cycle: _al o {— Alarm Manufacturers 'c td. ivi.S Alarm Switch T e: perch f7J line: Front, Side, ORea ,p Ft...._...... Number of feet from nearest property Number of feet from well: 36,. f ,/ Number of feet from building: 33h (Include distances on plot plan). SOIL ABSORPTION SYSTEM /'t OCAA Bed: L� Trench: Width: ea Len6Eh: �� Number of Lines: �� Area Built:____^ Fill depth to top of pipe: d � / Front, ()Side, (atear,OYt . 3 Number of feet from nearest property line: ���/// Number of feet from well: / • Number of feet from buildings (Include distances on plot plan). • SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box() or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, ()Rear, OFt., Number of feet from well: r- Number of feet from. building: Number of feet from nearest road: Alarm Manufacturer: -1- 4, AL # LO Inspector: 0 ,,,7 '. ‘C mbar on job: Dated! � EO L =nee Number: '�r�l ‘et:SI ci;a' 33/84:0 ON r / S. A DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.0111-11130X 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SE 4 j NE 4, Sec. 3 , T28-R15W CONVENTIONAL ALTERATIVE (If assigned) Town /o�of Cady I Holding Tank I In-Ground Pressure . Mound k. GQ TJ/ 814A 411DF A� HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION Teddy Hillstead Rt. 1 , 3088 80th Ave. Wilson , WI 5403 F BENCH ARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: .PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Bennie Helgeson 3215 St . Croix 135354 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 1+6 4) I y 5-0 ❑YES CI NO ❑YES ❑NO BEDDING: ENT 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—00' DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER L • P�OW_�!J�ED: PROVIDED: I'1� JYES ❑NO � � 0�� 33 140/44.1.-' � ®YES ❑NO YES 0 N GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN 2 ` FEET FROM LINE: Z-3.-5 AIR INLET: PUMP ON AND OFF) V YES ❑NO NEAREST—, 3�O 2' -j�f�` SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAM MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN L)ETER: 4a the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER PIT INSIDE DIA.: #PITS: DEPTH: TRENCHES: MATERIAL: 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 I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ...1./t C kES ❑NO LEES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: �f (fl • rLjj ❑YES E1'NO LKYYES ❑NO EYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS 6 Q Y ,`� TRENCHES: 7 r / S MANIFOLD PUMP 7 MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA..^ ELEV •�� J PIP,E�' DIFy:� . ELEVATION AND C7 1,5/ s' 3l /'/` (O� �f DISTRIBUTION HO E SIZE: HOLE SPACING: DRILLED CORRECTL COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION / APPROVED PLANS �� S )]YES El NO YES 0 N PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: .IYES ❑NO 1 YES ❑NO NEAREST—, Sketch System on Retain i ounty file for audit. Reverse Side. SIGNATURE: TITLE: ,e'SBD-6710(R.06/88) d SANITARY PERMIT APPLICATION _D1LHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY St. Croix STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than ❑ 3 5-35--y 8%X 11 Inches in size. heck if revision to pre us application –See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. S-89-02442 PROPERTY OWNER PROPERTY LOCATION Teddy Hillstead SE % NE %, S 3 T 2$ N, R 15 E(or)W _ PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# Rt. 1, 3088 80th Avenue N/A N/A CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Wilson, WI 54027 ( 715 ) 772-4259 N/A 11. TYPE OF BUILDING: (Check one) ❑ CITY NEAREST ROAD ( ) State Owned VILLAGE Cad 80th Avenue ❑ Public ©1 or 2 Fam. Dwelling–#of bedrooms PAR EL TAX NUMBS ( ) III. BUILDING USE: (If building type is public,check all that apply) 004-1006-70 & 04-1005-40 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranVBar/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. ❑ New 2. © Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ 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 600 REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION 500 500 1.2 43 f 9# 6m „fet!hrI,9t o 3 Feet CAPACITY VII. TANK Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank 1450, 1450 _ 1 Menomonie Block ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber 1000.X IR 1000 1 Midwestern Precast © ❑ ❑ ❑ ❑ p 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 tamps) MP/MPRSW No.: Business Phone Number: Bennie Helgeson � , y 3215 ( 715 ) 778-4425 Plumber's Address(Street,City,State,Zip Code): Rt. 2, Spring Valley, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issui g Agent Signature(No Stamps) ❑Approved El Owner Given Initial As Surcharge Fee) / C-� Adverse Determination `® /k C �� X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly PIb-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: I. 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 8.4 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 S T C - 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 je'W_ <7 (yr ` t'�..: _ 1 c ( 4,c >//,PGt'Lt Location of Property S !s 14 HE 14, Section 3 , T .7 j N-R i 3 W Township e.41--,9, Mailing Address 041 1., _3 • . Address of Site 4i).e -� �C. -;/. i Subdivision Name —,,— Lot Number /.---- Previous Owner of Property / ' / 1l S J,i 1 Total Size of Parcel '7 6fiC1 Date Parcel was Created //1/0 (,..t 0.fr) Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes !✓ No Volume 3 and Page Number J '28 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) ce/cti6y that att statements on thi4 bonm cute true to the best a6 my (sun) Fznowtedge; that I (we) am (cute) the awnen(s) o6 the pnopenty desc.i bed in this £n6onmat on 6oAm, by v,chtue os a wa tAanty deec( ixtepti .d in the O66.ice o6 the County Register o4 Deeds ass Document No. -, ?) L , .nd that I (We) pre s entey own the pro pas ed s.te f on the sewage digs as• ' s ys to (on I (we) have obtained an easement, to nun with the above desenibed pnopenty, bon the eonvstttucti.an of said system, and the .same has been uty neconded in the O(b.ice o6 the County Registen of Deeds, a4 Document No. ) . ,, -4,„,e, ,-72/ 012, r.-_, • -L, , ../ . , ) /--2- ((..177/z/L. '--7-yeA-zpryo. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) Y- P-2 - -t> r/ (7- / ..}__, s / • DATE SIGNED DATE SIGNED . • No.S•L Warrant"Add—Common Form (STATE OF wiscomaD Sea.fb AL W4.Statutes. Fern No. , „ Published by Eau Claire Book&Stationery co. I I This Indenture, Made this day of May ,A. D., 19l^ I1 between Theodore "'.i.11steac3 a/s/a Theodore Hillstead, a sin-,le man anr'. • iillstead a/s/a Walter iii)_1:.',ea�l and Norma IIillstead, husband. and 111.L't ii • part ierof the first part,and • • Theodore .al l.stea,1 and Althea Hatmell, ,s joint tenant+1 and not ., `,U:C... a L 1 C oE,:m ln. l lid part -i_crof the second part Wttne;.Vetb: That the said part 1e , of the first part, for and in consideration of the sum of • . C ne toll, r and other ,o d an(! valuable consideration i t 1 to :crl in hand paid by the said part 71', of the second part, the receipt whereof is hereby confessed and acknowledged, ha v.'.'given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and i i confirm unto the said part .r . of the second part, • their heirs and assigns forever, the following described real estate,situated in the county of and State of Wisconsin, to-wit: I I(); ?il ,r.,, V , „e .'if'.;eer. • ., . t cr"c ACC witlr all and singular the heredit;:itrentr and appurtenances thereunto belonging :r in anywise appertaining; and all the estate, right, title, Interest, claim, or demand whatsoever, of the ..ai: part of the first part,either in law or equity,either in possession or expectancy of,in and to the s'5ove barb:incd Premises and their heredit.an:ents and appurtenances. ., ;?;d premises as above des::-;be.1 with the herer?iL.m •nts ^na a��;• ...., Peso ''I t..: o the said part of the second part, and ra oir Ire;rs and assigns FOREV. R. �i' l;�n,;, l '._,.. ._-L��. .c.��i`l .'�]1'� .th°;'� .111f.' � fG a -[`7;' heirs, executors and administrators, do ccve:..?ut, : t.:: .. :1'7(7 ;ice to and with the said part ie:- of the second part, heir;; and assig :hat at thc. of tLe enseali:g and delivery of these presents well seized of the premises 2.:?ov, dcsc.-ibed, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee sin:p;c, and that the same are free and clear from all encumbrances whatever, - - and that the above bargained premises in the quiet and peaceable possession of the said part of the F u I I • - II r ° . . S'TOnd pdrf, 'heirs and assigns, against all and every person or persons, lawfully claiming the Iyhtile or any part thereof, 4- * will forever WARRANT and DEFEND. , -.111 7'..nitnct5q (C.OrFecf, the said part 1,,, of the first part ha-hereunto set ' ,--i•!. hand:' and seal• this 1 r ' day of 1!;.Q: ,A.D.,19 -Y . , Signed and Sealed in Presence of 1 , , . • . , ' 1 (Seal) ) _ , • .' - - .. i .- , •• ' - .......--- ' - -1 ' ' •- .'"- (Se:,1) ■ 1 •• - — \ • i ' . . (S,,,-.•!) , 1 . .... ; " • . • ". '•,—.' '- :-.`.: ,:Tr.c.:'.1, I :.. L' • . ...... . • Cou,. .1 .•''- (fay of . . . . . _ . • ! , . . . . • ,..-.: ,, .'y .''.',,. 1..;!rscr., ".'.1,0 e,xecoted the lo- .;L:iiy, 1.-/ Irinnunt :Iv!: :::..1.:!?,-wf,?(Igo,.' ::.' , ,'.-..-.!:..-. i . ......: _ . .. . . ......, --.. .. . . . t :.'..: .,. I. . . ' '.1 . : , . , .... . .... i ,i • , _ . ... . . • , , i : „ i :-.., . ,,,, . . •••■•4 . :-....-^......- 1, c., . '•-- i r.4 1„. )• ....I :i. . ■, vl El . ••-• .. t.-. Q.„, i HL.) •."3 -.74 .-- I i. : jj .'6•4 id --, v, 0 ... • w„,:. 0 ,..*f -;' (...) \,- !:1— '..4. '' , i , . o , ■-- liFs: 4 H- • .47.. •.4 • „ . t: g 1• .-.:4 .-... ...i , g 11 N ''Z.3 i •-`1". ':. :-.., j ' . ....,. , ,..., E--, i ._, `,- 14 ;' --., ,- L. ., c .#I I L'l 1..." - ' . •, (-, c....4 ....., 01 ' • :., ,...,J tel -4-• .'-!! — .- - ' • .1 : C - , .1.?, (.1 Iii: C.' •—•I ,. ,. , rg ••-. LA ,:,, rl . ----7773 Hnoe. -1,.),.) Pr.`,:F ,-, 1, . . H z H 9 STC - 105 r' a SEPTIC TANK MAINTENANCE AGREEMENT �y-+ St . Croix County z // p / J o OWNER/BUYER C;, �; e /1 1 _`f� 't 4/Y11 / t . '/_5 € J✓ rsi ROUTE/BOX NUMBER /_) `k` _ Fire Number 7 CITY/STATE t(ii /S-C' L�' ,( .3-4---7/(.;:A. °7 ZIP PROPERTY LOCATION : 1, , ' , Section , 'T , N , RIS W , Town of G,{ { , 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 waste 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. 0 • 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- u 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 / 2- - • 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 . • ULNAHIMLNI-OF REPORT ON SOIL BORINGS AND : AI-t_I Y « twiLuilvuo INDUSTRY, DIVISION LABOR HUM N REDLATIONS PERCOLATION TESTS (115) MADISON W 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIIPIM 'LOT NO.:4BLK.NO.: SUB,DJVISION NAME: .5 14 14 /T)2 N/R 1sE (o )W� Nft N�/l1 COUNTY: M+ILIN ADDRESS: 5 . PO , T e.k. 4 1 1 1 5 f1aci e1Li .9033.go o WI(st,.. : zlo 7 USE DATES OBSERVATIONS MADE ,,��,--,,// NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: PERCO ATION TESTS: LiGResidence 4/ n /4 , ENew ePlace �A y g ? _ 7 3 Q7 RATING:S=Site suitable for system U=Site unsuitable for system CODENTIOD : MOUND:❑U IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLsG-TANK:RECOMM! NIDED SYSTEM:loptional) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: /�/�� Floodplain, indicate Floodplain elevation: NA. PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCI ICC CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E T. • HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Mil o 7' 8 1- TS 11 ' /.... w Fil 4:: ,1. 4 r .• B- . ` $.S� 1I .�,' )3.�,�(,rs 3'67 S,•1 . '1 tAS.•j .(D 'Q, SCL,i 4 B- g `�+ !to I I 0 J r 7'g/ J;l 1� (r.'�_ a 0 k• di i ' Si/ ' c' 0 f 67 t, U J Q ( IMEII,Val (y O 1�� O �K� I �/ �S s 4 r St' " '84 S z --Fr 0 J ✓�d i w' A, n a_ • r( INIENS 5-.11 I a MOE'.8"B1 5=I TS ,6'G47 Si ,7''& S. .../rrr o . Na IMIW" ` .O i' 11.11M1.11 ..S'8I5;I T 7'14n 5i ,N.'iP lialkilINENIMEININIMIIIIIIIIIIIIIIEMINIIIIIENSIONIENIUMVIRti It'd .. PERCOLATION TESTS TEST. DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RI•D 1 P 111•0 -. RIOD3 LL-_ • PER INCH - P- .2— L( IIIEMENIII I ‘,/...3 • P- P- *' re•s+s 11Pu v- '/ h oc.i p S 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 $9, 6 a c ,,�� 13.2 - _ ._ , {? S ._ _.._..+ __ � _ L L ---____I -L- 3 ?. = � - 1. I i i 1 , 1 F— -1--- .. � I L_4 1 I 1 ! 1 I _ I I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print —TESTS WERE COMPLETED ON: IADDRESS: ,CERTIFICATION NUMBER: PHONE NUMBER(optional): CST S$Lf'TURE: . 4..-s-,---------------- DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 IR. 10/83) –OVER – ■ ' I =INN - Num 1 ! - imia IN iggi 1111 Emu . _ mum '_ IU I '.- 1111MERIMINIMI 16of 1111 11111111W NM III. I I I I I r l l_r l l I l -- L. • MIMI — ' -1- NM I II ' • MINN ,___._ _ 1111111111111 i • MI= , MIMI" • ---- II 111•111 , r MEM • IIIIIIIIII um ,1_04 , mum • L - - 2 - mom -1 ' i s 1 1----, 1,111111 , . ' . ,i IL : . - MIME 1 1 1 H 11111111111111111111111— : :...! v‘-'' 4 ARMS ' 1 I .1 111111111011111 1 ' II mom mill z- 111111111111E11111 f--- - -__ ,,I , 1-. - - -.-‘ t. , IMMO 811111 111111111111111111111 i , MEW '5 IIIIIIIIIII 7_ IIIIIIIIIIIIIIII Ell EMI _ 111111111 11111 '111 MEMO 1 MINI _ MIMI= _ MIMI= 1111 MEM MUNI - c- 11111111111. . 11111111111111N IMAM 1111 MIME llllIlllU1 = IIIIIIIII MIME 111111111111117, . IIIIIMINIIIIIIIN IMMII N111111111111 , MEE= 11111111 — _ ME= IIIIIIIII mum 11111111 _7L: _ EMEMINEMEI „i 11111111111 7' 1111111111 IIIIIII 1111111111.11111111111111111 i MEM ',_ MUM MEI –_ • , N11111111111 11MM ' ,4111111111111111111 ' MINIM Mill IIIIIIIII MIME gpmanq - I 1 Num NEN ___ ___ ___ Imo . mommi,allinaria. ._, 11111111 pm N ammo immummo Immo al 11111 " al - 11111111111110 • 11111111111111 MM. MM P _.__..: : 111111g01111611. MUM 111 . 1111.111W Wermilism. MIK . -----1 - , , _ Ell if_ j_ Ns. - EMI III= 01 '' - .4 O• I 's IIIIIIIIIII ; , t':io.„ maim 1 . i 1- - so -b . I • MEM ' r1::, • i ___1441111 i MOM I • 1 I-7'P IT _1 . I al= - • 1 ' • i I 1 Ill 11 11111 , 1 • H---. - --Irt ' II • i 1 I 1 11111 ' -1 1 ; I : PETITION FOR VARIANCE APPLICATION F Wisconsin Department of Industry, Labor and Human Relations FFI E �N Y Amo'Ft 'a, Safety and Buildings Division Petition No. 201 East Washington Avenue, P.O. Box 7969 Receipt No. Madison, Wisconsin 53707 E—Number 608/266-3151 Name of Owner/Petitioner Building or Project Agent, Architect or Engineering Firm Teddy Hillstead Teddy Hillstead Mound System Bennie Helgeson Company Tenant Name, if any Street & Number Rt. 2 Street & Number Location, Street & Number City State Zip Code Rt. 1, 3088 80th Avenue 3088 80th Avenue Spring Valley, WI 54767 City State Zip Code City County Telephone Number Wilson WI 54027 Town of Cady St. Croix 715/778-4425 Telephone Number Plan Number, if known Name of Contact Person 715/772-4259 Bennie Helgeson 1. The rule being petitioned reads as follows: (cite specific rule number and language) 82.23 (1) (d) There shall he at least 24 inches of unsaturated natural soil over high groundwater as indicated by soil mottling or direct observation of water in accord with ILHR 83.09 (4) (d) and (e). 2. The rule being petitioned cannot be entirely satisfied because: 9 - 0 2 4 4 2 The greatest depth of unsaturated natural soil as indicated by sni mottles in 1.3 feet. 3. The following alternative(s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: 1.7 feet of sand fill would be placed under the proposed mound bed to meet the intent of the code. Note: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER — PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Note: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. Teddy Hillstead , being duly sworn, I state as petitioner that I have read the foregoin (NAME OF PETITIONER, Please type/print) petition, that I believe it to .e true and I have significant ownership rights in the subject building or project. A.r ■ i ' Subscribed and sworn to before me this date: 3 I Signature of Petitioner /,� pof wisconsin � /. My commission expires: My Commission Expires Jan. 12,1992 otary Public SB-8(R.09/88) ' State of Wisconsin \ Department of Industry, Labor and Human Relations ^r_ SAFETY&BUILDINGS DIVISION October 12, 1989 201 E.Washington Avenue P.O.Box 7969 Madison,Wisconsin 53707 Teddy Hillstead Route 1 , 3088 80th Avenue Wilson, WI 54027 Petition No S89-02442-P Dear Mr: Hillstead: Re: Teddy Hillstead - Residence Onsite Sewage System SE,NE,3,28,15E Town of Cody, St: Croix County, WI Section 145.24 (1 ), Wisconsin Statutes, and s. ILHR 83.09 (2) (b), Wisconsin Administrative Code, allow the owner to petition the department for a variance to the installation for an onsite sewage system to replace an existing onsite sewage system at a site which is not in full compliance with the siting standards in the administrative rule. The system design proposed should protect the waters of the state from contamination. If this system becomes a failing system or contaminates the waters of the state, this variance shall be rescinded. The petition for a variance requested to s. ILHR 83.23 (1 ) (d) of the Wis. Adm. Code was considered on October 5, 1989. The petition has been approved. The rule requires a mound system site to have a minimum of 2 feet of suitable natural soil. The variance requested was to install a replacement mound system on a site with 1.3 feet of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sinc- ely, 'R'c a d eyer, Archi ect Director, Office of Division / Codes and Application (608) 266-3080 RM:JQ:4366e cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County Bennie Helgeson SBD-6928(R.10/87) l , P 10+ pi ` 0. LL'' � weer' 1P(Jr17 Hil1s+t-c el PICLw,lctr'. ;I:Se&In,e H LgcSOvx J, /J \if,,-4 V r. 8 6.4 1 //// / / rIeu. g-7,134., ( ( . ( (S4 4g l I I 1 / 101000 b4.I• I 1 t e Pww.p c1,,%.,, yet- t et-18 a e I { I+ IL 4„ PVC.... �i�5ot 1 Grain,1 i c cq , gol, A 1 l i )-,au-7n I� c Gar. Drw¢, i 70 reS o. 403.61 ONSITE SEWAGE SYSTEM •-;,-, dpS-e- ..,,,,,, ,,,,,,,,it:t___ • i %. E'411 1 .. ...50-ii-tats ,4 ;1' pFloyti it, '.:ri,PARTNIENT OF INDUSTRY, LAisOR AND HUMAN RE AWNS V.R.P, �Oo.00 Sept-ti., DIVISION OF SAFETY AND BUILDINGS of HOctS'L - 'd-i a n a' SEE CORRESPONDENCfi S ca r r " r g01 RECEIVED OCT. 1 1 1989 OFFICE OF DIVISION li CODES AND APP' •\TION •z` . r Ie__01 , L� 1.4 illeac `P Page of Y � j Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand .0000. ` CI Topsoil �� • MAW , `II/11I1,411 )' II/J/k/IKlIGMANI % Slope Bed Of Zr— 2 %2 Force Main Plowed /` '' Aggregate From Pump Layer D /,7 Ft. as fELA11 NS . E Ft. o .`,-.9 , , ;C r�dss ion Of A Mound System Using d fvi�ly ,. .�.,.,r..: F Ft.• 77 �. Bed For The Absorption Area '"' G / Ft. H / F �-. ,, A 6 Ft. •5 Ft. Sign C j� ' ' 7-- fi. 1€',4 ________ B 83,' ;2 Ft. License Number: =>a i `_=; K / ?,. (o Ft. /�j� Date: L %fit• /°6' '� j 7,65 Ft. Alternate Position T /34 Ft. of Force Main W ,/313.15.Ft. I r T...________—.--------....,) Observation Pipe--- r - -g- ------ - -----jK I. A i .1` 1.----- J -S, w , 0 l- Distribution Bed Of 2 u u — 2 i . Pipe Aggregate I Observation Pipe Permanent Marker tCJIVED OCT 1 1 1989 Plan View Of Mound Using A Bed For The Absorption a� ICEOFDIVISION AND APPf r^Air,oN r .._ . 1 f.--elci L., N1 I( ,, --,'.--,1--(..! ,el .) Perforated Pipe Detail 0 ,./ End C . 00001Perforoled op., . •o\t';1' PVC Pipe al c'6 Permanent End Markers Holes Located on Bottom ••••••/.0•000"."#"":.> 0 . are Equally Spaced 9 Hole 5 4-;.Ai er Force Main lkoso From Pump • ..— Li'.S i- ilc>/e /17 L/14 ezi,D ENL) ,•••• ..------- . PVC ell)" Manifold Pipe /" Pt./c. 4. Dislribullon Pipe Lost Hole Should De Next To End Cap ONSITE SEWACE: SYSTEM RECEIVED Pipe Layout r OCT 11 1989 L):1'.PARTMENT OF INDUS my, 1_03011 I-•',ND Hnlikil RELATIONS P ziO) (5 il OFFICE OF DIVISION DIVISION OF SAFETY'AND Bilii.DS , CODES AND APPi mATION ,- '4:'4..7.1*IC,. ',' ' ...:.' ‘:'':. 4k•V't'P'■12k.,1,10, .' R t SEE CORRESPONDENCE S 3 X 51 Y 3Z " Signed: c LI' z -- Hole Diameter 1/41 Inch License Number: Lateral "/ AV **, Inch (es) Date: it, • '2 Manifold " Inches Force Main " Inches ? /exeerz..4 /4.401 ?9-0 . '-`0 L ore-x- I e-cicki N I 1 15 f"FILcl P A ro. ,.:,F °NEAP CHAME:.:R CROSS SEC'!CU.; AND SPECIFICArrOI;c_ ` ), —VEUT CAP „ 'i"C.I. VEVT PIPE —" WEATHERPROOF APPROVED LOCKIMG 25' =RO.^1 DOOR, JUNCTIOJJ BOX MANHOLE COVER 44/ ` `•/WCOW OR FRESH / 1rMIN. �� AIR INTAKE I / GRADE I 4, , ' `1! � 7(eMI1J. �Y I `__ le'MN. COJJDUIT 18"MIN. V ---___--- t _S� \ .11 - --� IAILET ..... PROVIDE I "• 11 1----_ = / m AIRTIGHT SEAL I III APPROVED JOIIJT A '""' �.�..� III APPROVED .ICI W/C.I. PIPE III W/C.I. PIPE EXTENDING 3' I I ALARM EXTENDING 3' ONTO SOLID SOIL 8 F' 'I I ONTO SOLID Sc � F T. . ;A' - If— r „. • OFF ./110,� ,w.ati. MN aGr::.w-ikY: SEE V�fi^�0 LC. �.i'd\.Jdi�,6�K AIF CONCRETE BLOCK--I RISER EXIT PERMITTED OIJLY IF TANK MANUFACTURER HAS SUCH APPROVAL a15 i1.1c1 1L150 3-a.l ` SEPTIC E SPECIFIGATIOKJS •C DOSE [} TAIJKS MANUFACTURER: MI�"iu''��x�i r`r1 Pn-e'n y+ NUMBER OF DOSES: 3 PER DA.y TAAIK SIZE: 1 0,e)o GALLOIJS DOSE VOLUME ALARM MANUFACTURER: X7.1. E Ir_(_4ti-C, 04-ev)1 S IAJCLUDIAJG 6ACKFLOW: O GALLON MODEL ►DUMBER: /31 1-I.W. CAPACITIES: A= I 1` INCHES OR GAO GALLON SWITCH TYPE:_fl rci-t.%"11 FI OC&+ 8= IAICHES OR 50 GALLC J PUMP MANUFACTURER: A Ltd r_) lck.-1-1 C. C= $,4 INCHES OR (10 GALLOA: MODEL NUMBER: (J`--) �3 D- 13'40 INCHES OR .34o GALLOk' SWITCH TYPE: 61F?Y C«r iJ \Ic-1- NOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE RATE 9.5 GPM INSTALLED ON SEPARATE CI C I VERTICAL DIFFERENCE BETWEEN EN PUMP OFF MUD DISTRIBUTIO.J PIPE.. ?'U FEET RECE1v 4- MINIMUM NETWORK SUPPLY PRESSURE � 2.5 FEET + 'O FEET OF FORCE MAIN X 3.i7 FX,0 FLFRICTIOAI FACTOR.. I.3 FEET OCT 1 1 1989 TOTAL CD IJAMIC HEAD = fir' FEET OFFICE OF D% CODES AND AP IIJTERIJAL DIMEIJS101JL OF TAIJK: LENGTH 11� { (- ;WIDTH �g o1 ;LIQUID DEPTH �� / SIGMED: C: ,_ 4. ) -------- C LICENSE AIUMBER: A 15 DATE:/6` !c Q State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY&BUILDINGS DIVISION October 12, l t5,2' 201 E.Washington Avenue P.O.Box 7969 Madison,Wisconsin 53707 Teddy h,l ) 1.,teaa Route 1 , J088 60th Avenue 141i son, WI 4027 Petition No. S89-U24424 Dear i 11 stead. Re: Team/ Iii l istead - Residence Onsite Sewage System SE,hE,3,23, ibE Town of Cooly. St. Croix Cuunty, WI Section 145.24 ( 1 ) , i sconsi n Statues and s. ILhR 83.09 (2) (0) , Wisconsin Adrr+inistrative Code, allo the owner to t,eTltion the department for a variance to the installation for are onsite sewage sys em to reolace an existing onsite sewage system at -1 site which is not in tJl 1 compliance 4,i tr1 the siting staroarr;s 'ii"[ the administrative rule. The system design DroDOSea shouln orotect the : aters of the state trom cone :minaTion, It this system becomes a tailing system or contaminates the waters of the state, this variance shall be rest i ndeO. The petition tor a variance reouestea to s. iLhr< b:5.2J ( 1 ) (r.) of the Wis. Adm. Cole was considereo on October 5, 1 39. The oetiti,ir has been approved. The rule requires a mound system site to have a i-clnimon) of 2 feet of suitable natural soil . 1 The variance reciaaesteci Was to i nstal i a re lacement mound system on 3 site with 1 .3 feet of suitable natural soil , :All of the rata and staterents submi tte r l f of the petitioner were conSilerer. This var"'iance is specific to the subiec'c petition and cannot be used for any additional modifications. 9 /1 j Sii9 rely, /y. / / RtCEI vED 44, Tichard Meyer, Architect i OCT3 1989 ,t.z Director, Office of Division 8Tcpoix Codes aria Application (6c)8) 2c5-3080 o v /- (t :JQ:436Ce cc. Leroy Jausky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator ST , Croix County Bennie H1elueSon SBD-6928(R.10/87) / lairL44‘ !. thi- 41 11 .1°. ) i 't 24-:At, State of Wisconsin \ Department of Industry, Labor and Human Relations :„:,;:••,:i,----,,., PRIVATE SEWAGE PLAN yyRoylki. SAFETY&BUILDINGS DIVISION Ultil:e of Division Codes and Application 20I Last Washington A..iebne r O. box 79b9 Madi ,on, Wisconsin S3707 BENNIE HELULSON Owner : 111DY HICTSTIAD ROUlE 2 k0011 1 , $o88 . 80TH AVENUE SPRING VAL1EY , WI 54/hi WILON, WI '.141027 RE:, Pl4n Number: S89-02442 Date Approved: October 13, 1989 Gallons Per DSy: 6b0 ' . ltate:-Rer:Mved: ...:eptember b, 1489 Project Name. HILLT,JEAD, ILI1OY - RtSIDLNij location: '..)L,NE ,3,28,151 Town of CADY CountY : :.,1 CROIX. ' - ---- the plumbing plans and specitications fur this proiecf have been reviewed for compliance with applicable cede requirements . Ihis aporoval is based on Chapter 145, Wisconsin statutes and the Wisconsin AdministratI ,Je tode. The plans are stamped 'conditionally approved' . ihi'., ,ippli.,val is , ontiogent upon compliance with any stipulations !, 0WO on the Haw, . All 10.-w that are cited must be corrected. All permits required by the City, villdv , townAlp ,Jr cuhty ...hall be obtained prior to construction. ihe licensed plumbT re,,ponsible tor this Installation shall keep one set of War , w th the Apartmf-nt "., AOptov.II stamp at the construction site The installer shal l nAit.-:,' the Apptoutiate iw,p0( tur when inspections can be made. Ibis approval will expire two years timid the date approved or it a sanitary permit is obtained , it wilt expire the dav tw., initial ..anitary permit expires . The Section of Private Sewage has rev lowed these plans fur ut )vate sewage system code requirements only , These plans have hot nePn rev ieri ti the code requirements set forth in Section ILHR :','i2 for general plumbing or lo chapters 50-b4 of the Wisconsin Administrative COOP. Ihislapproval is for the folloWing component , only i - REPLACEMENI PT:11110N - REPLACEMENT MOUND Inquiries k.oncerninq this approval may hf-' made by f ,:litiOY (608) 266-3937 . Si9cerely, ././ . . / TAMES QUINIAN Section of Private Sewage Division of Safety and buildings PPP012/0009ni 6 cc : TEDDY HItY.)1EAD __Private '.*,.ewago Consultant .y . ut,..i. '.tMlifili _Plumbing Consultant Owner Plinqhor THL, Ihittentil Health 85D-6423 (R.08/88) - - - ' ST. CROIX COUNTY `t :.. WISCONSIN 10: ZONING OFFICE r t %F' ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (71 5)386-4680 August 30, 1989 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Teddy Hillstead property located in the SE 1/4 of the. NE 1/4 of Section 3 , T28N-R15W, Town of Cady, St. Croix County, revealed soils to a depth of 1.3 feet, after which high ground water was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN:sma r 77? - 4as9 INDUS DEPARTMENT OF ;. REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION • INDUSTRY; 1 c LABOR AND_ PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (ILHR 83.0911)& Chapter 145) LOCATION: SECTION: TOWNSHIP LOT NO.: NO.: SUED VISION NAME: 331/ � 1/ /T.2g H/RISE(o )W CQ� 1 ' NA- /"n COUNTY: 1� 6� (4111 sfe.a-N 61--/UN3U ES �1Nt/O1 t SO V\ ' USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: _ / PROFIT E DESCRIPTIONS: PERCO ATION TESTS: C(esidence / A//1 ❑New I—!•lF�eplace �/ a / /g .7 7/3//g7 �u[^r l a / RATING:S=Site suitable for system U=Site unsuitable for system CONDVENTIOR : MOUN :aU IN-GREOUND-PR�E: SYSTEM-IN�HOLDIN TANK:REC'OMM0ENDE4 SYSTEM:(optional) : / ,{ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the </'_/Ifi- under s. ILHR 83.09(5)(b),indicate: /VA Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCI ICC CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) r ©`7 I 8 L is `7 '.6... SL F!"1 O-• A1el. B- ( 3,p —71.90 rl ovl - 6' `� ", 33..51, J 8' 8., „V rs , 3'G7 S;1 • Y`ty,,S:/ .6 'E., gCL ° 't.) B- .2 9.0' 11 1. ----' 1. 9- 6,, CC `'%ri cf idf _ '•( O , 1"8/ S,/ rs `SFiO0kJ - o1 ,S '� S:Jt '(OD tG7 frld' B- 3 �,.�� g1.94 s pG pis 4 � O pc, )4.4 I.O Al y C J900 A ' O '9 (31 7.1%}S e 4,6 S[ ,V 14 SI: 1.*Fr 0/3 iiol B- 5-a! �.il i I / 0 B<61 S-I TS .5'67 Si ,,'1 .► Si( .%i�F)+co-).. Mot 5 a _$ 1 . 3 . 1,1 5'C�- "y���„)t de.i. tit t _9e 2 ',v.�p c_ `XI y (o i.5' 76.c ii . ' •s'e,i5il /1 7'An Si 'i .nP Otr-7, Mo - 14' y •`I J. . ?' . . q' 6( Stt IS t:t, • ii.. Sll ';iiiII.( P Off(.J ..44 PERCOLATION TESTS ia II TEST. DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES ' RATE MINUTES F NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- / . I in OVI 0e ' C'' 3-¢' "ii Div 3 10 P. ? .2 Lt (I y . P- .3 '/ It H - ."- a- 9 _2 5I4, 4 /'3 P- P- -re 5' ate.w '4 hours 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 B9, 6 '-t-\0 04 R'at_tc., 13``� t k:4 i t-_ a_ - � , t -1-7—t--- .—t-- ' 1 . �` ` Plot a -, a E� 1 � � _ r I , - r Pa i ' 3 r 1 ( € i 1 � t t'il F 1 _ ..< .. - _.� .. E t t 1 : 3� 3 � € o t re ( E P . I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print . (TESTS WERE COMPLETED ON: �, t42..- ► I 2-s0,A 1 7(5 l/ t2 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): R 4-� �rl` i If Lei- ,s-4-71�7 ® CS I / 77 RE: O f�°� DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD.6395 (R. 10/83) -OVER - INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 - To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes.A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS 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 scale is prefered.A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all apropriate boxes as to dates, names,addresses,flood plain data,percolation test exemption,if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as requited. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soll Separates and Textures Other Symbols st — Stone (over 10") BR — Bedrock cob — Cobble (3 - 10") SS — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sI — Loamy Sand < — Less Than 'I — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot - Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water • Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance.A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit.The sanitary permit must be obtained and posted prior to the start of any construction. III- • ill 1 NE • • 1 --r --r - .s Km= ELARELt -1t_. 0.- 1-r) -r_ :- war Arians i lormormil ii. .fi; 4 _ _ __ "lir 1 I 111.11. 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I I i 1- -1 , I I- 1 --- - ---- - - -- -1 - - - T TT t ! , I I- 1- I : i i ' ■ '1- + 1-i LI i- F- __ _--f --- ---- f- 1 L t 4 1 1 1 __I__ _---i--- -- - ---4,--- -t --" 1- 1 i I ± 4 , ■ ■ 1_ -± --t _-,--H --i- --I-- 1- t I I , 1 f_ --- , I i i I i 1 i T1- - --1 1 I I 1 I • , I .4 T--- t- i t , -J. - .._-+.--1- - --- - , - / [ I 1- —/- 1- , !, 1 i 1 i i i I H I i -I- I , ! , L 1111 4- + I- __ __I__ 1_ _____I _r_ __ _i i t t TII , I T trt I I 1 1 ! 1 _ i I 1 ' i , , VOL 1.4 V 7PAGE 126 16.31.. "91 .91‘ KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Theodore Hillstead aka Theodore R. Hillstead, a single 11-01-1999 9:30 AM person, conveys and warrants to Steven L. Froeschle, Gay WARRANTY DEED A. Froeschle, Shawn S. Froeschle, Chad S. Froeschle, EXEMPT II CERT COPY FEE: Nathanaet S. Froeschle, 1/5 each as tenants-in-common COPY FEE: and not as joint tenants the following described real estate TRANSFER FEE: 110.70 RECORDING FEE: 10.00 in St. Croix County, State of Wisconsin: PAGES: 1 Recording Area Name and Return Address Thomas A.McCormack 740 Main Street Baldwin,WI 54002 004-1006-70-000 004-1005-40-000 (Parcel Identification Number) SE %4 of NE 'A and All that part of NE 1/4 of SE 1/4 lying Northerly of Interstate Highway "94", All in Section 3-28-15 EXCEPT Certified Survey Map in Vol. 4, Page 1192, Doc. No. 379045 and EXCEPT Certified Survey Map in Vol. 9, Page 2640. Exception to warranties:all easements and restrictions of record. This is not homestead property. Dated this may of a��i , 1999. / AC.)/1/ "ffleodore R. Hilistead AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST.CROIX COUNTY Personally came before me this /YIN day of , 1999 the above named Theodore Hillstead authenticated this day of aka Theodore R. Hillstead to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. signature lr�� type or print name signature -ltZv--y type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not Notary Public St. Croix County,Wisconsin. authorized by§706,06,Wis.Stats.) 2-) My commission is permanent. (If not, state expiration date: .) THIS INSTRUMENT WAS DRAFTEBY : • Thomas A. McCormack► ,_ • -Names of persons signing in any capacity should be typed or Baldwin,WI 54002 ,.': printed below their signatures. Notary Qublio-State of W In2 ,rQaen Exalres Maroc+ • • Information Proreaalonals Company Fond du Lac,Wisconsin 800855-2021 / 6to A.) / 7 _3 3 37 ?,_37 -3 - 5- 0 / / 44 4'1 ,60,0P( 7-6A7 / / //72._