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HomeMy WebLinkAbout020-1036-70-200 Q o I m° I 03 ~ I a o o o N L) c y o c~ ° E o y c T ~ rn N I N I 76 GL aci ~ ~ N E 3 E I m c c z c •o LL cvzc .2 -a 3 a E ~o ¢`o I i M ~ I N w z w E z 0 (D m I H Z a 0 O z a c a 2 o N H z c E -21 o 2 M N 5 N N = co y C CL N I 2 a) s ° c I d c p f6 zmD o 0 z M c am Lo 0 c = N O is E O CV ` E Q IL a m c c a) 0 no m y m c as -0 .0 ir. a 65 o z 0 3 3 0 Z a z ~ a a y I IL o 0 4j US 0 -0 M 0, U J U = co rn z > n t O E 'n o Q CC = :3 N w O co c o. Q 'O Q (n !6 N W y Q b m v V H c C) C, 1~i O C o m 3 M v a cc) co ~ m N N V N M MO C (n j i-- Tr' of y ! = N N d N O 0 L C6 0 • ^1' o 2 1 O z c z O y I V1 r a • a m .am ` a c 40 E 'c r A c°~CL m 'o ori)u t Parcel 020-1036-70-200 01/07/2005 AM PAGE E I OF 1 Alt. Parcel 18.29.19.157B-2 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * IVERSON, SCOTT N SCOTT N IVERSON 360 CASPERSON DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 360 CASPERSON DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.430 Plat: N/A-NOT AVAILABLE SEC 18 T29AN R1 9W NW NE 4.43AC LOT 4 Block/Condo Bldg: C.S.M. 7/2053 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 844/366 2004 SUMMARY Bill Fair Market Value: Assessed with: 47879 286,200 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.430 43,700 177,700 221,400 NO Totals for 2004: General Property 4.430 43,700 177,700 221,400 Woodland 0.000 0 0 Totals for 2003: General Property 4.430 43,700 177,700 221,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 001-WATER SPECIAL ASSESSMENT 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 01 J, FILED 2 ~ ~.~l.0s:3 /YLJ L-- J 1 _ DEC 0 91988 3 r_ a 9 C JAME-30 O'CONNELL 0 8 no il-ler of Deuds f St. Croix Co., W1 `mow f' 443732 M rt m cCi 73 / /9 2 W C O Q C- W 7 n C W r.. n r T r• n / 7 ' 0. 10 w n o j v 1 ` fn to m r 00 M r'~• T a' w rt W rt~ 00 =r IV C:0 C . i, p% ' ~.?osj 'r• fD c~ o I"r V ` c c N_ o n w NIP n T fn H Ln r. .1~ C w t- Da of ,n m 3 rn ~ cn f- N f, o rn o r w C1 B o: O o 7 4- i o. w z O T w 1 fD ii w r 7 n _ O Z I O) i~ V~ r• N ? m 10 E rt w •O• f6 O nl 'O V N -.2 I N shall tract I~ v l ' w o T rt r_ 66' i 3.94a,i~n T :2. T N N - Js7•a m rt W C a fD i'!'7 .~1~ o ~ S00°17' 12"E v fc• D yr cn z a N r - 239.37' Sr 3 rr O w mc CD rt o N r= 238.11 m in m o - o w cn Co 0 C: r I r T Im V CO O C w V _y Q In T Certified Survey Nap Vol. 7 P0, 2010 ° •S,Yw• a_ I n 66' m w a 1 c S01040111,114 6 4.2?' ° C, v2 S o Icy 33.50' 620.72' cu o v Cn i • o 240.331 - 0; v - -east line of the N41} _ N0000030 "W 661 s • i o °o CID east line - SW} fD m in u r o _ 66, _ z v -o i JI W O N I ..l- .0 2 I rl- ! " rn C0 I o C-,) I H 1 N CT O I T lCJ C 1 O F O - ~0 33.391 - w N i or I s I rt CD v 585.271 0 N I fn o N0002812011E. 618.66' 4- I 1 3~- M / N 1 O I w A. to / f = p~ 'r 1 I 0. LM/) p • -y .tir. W CJ S nl F~ O tn. U, C~> _ fJ I I D =r /tics c' v Tz 0 r":,. L7~~ s .o m .c,u aD V. { 7"' fem..:- 1 ,-r I ,cf :i,~`.: C~"~='q ~I-• p a ^ FC u T N0002812011E 683.03' - 'a' 2, 0 `s~'~!~`s• s 648.821 io 1fr 4, C-r 34.21' 0 1 D C .r 141 .111, Cv di rn 0 ow o a r ~ ~ ~ G1 O C.) o ~ ~o r o fD "v\ 3 ^w ~a 6 / 675.82 N J1j~:o^f11D;s`:~ oa \ C- 1 Z N00028'20"E 720.41' m r rl~ O • r ► • LrI 41 small tract CID r Co In o C7 w W W r 0 o w _ C o m C, o - r C N m r r c~ c~ F x o _ a _ r• m ' rt - - Z N r N N N ••C r• r• r• O O 40 r 7 7 ] 7 a N O O O O r r f' r F n o o > > v fr' m z O O 7 rt '2• -7 Cr 7 O .O 'O U 0. 'O• r W N 7 N N T 'O T T O y • r r W W ~ m n T O O T C O 'O• O O C C O 7 V w Ln ,y p N Z N C 7 7 C 0. _ co C-) to O CD r N m O 7 0. 0. > 4- 4' 0 r) C:D N N N N D ul N N C) O N r O C fn 1] N A N d O -1 7 O C CL DEC 08 1988 T T T E :D rt rt rt fr rn rt - W. CROIX COUIV11f n aj h N " 4'9 3'FjVSIVC PARKS f'V~fvtVIIVG ° >~tfi MPJIfJ CCJNIfvi1T11 1= W C N a ° t0 ~J V Z N _ r W to N O r r- , x w-_ rn- In V C r n w V w Ul Ul 0 Inn ° O Cl r CI r N N N N N N N [.7 w fn ,n A to f~ ~ T T T ~ T rt rt rt O N N rt Vol. 7 Page 2053 t R Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNERci-k,;ji~~!!✓ TOWNSHIP H~t4vUrt SEC. T 29' N-R ADDRESS 43o)f-;"'2.$Z ST. CROIX COUNTY, WISCONSIN '6 ~C Q ~Q Y\ ✓L e~ /L SUBDIVISIONe I^ V,,'r LOT ~ LOT SIZE -Z 7A ~tor r PLAN VIEW Distances and dimensions to meet requirements of II-HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Sv.S~arh E/.= q7 3D J 1 I 1 W ~aL 1 1 ( " yota ✓ u ~ C ' Q V I J 1 1 a 3 ' INDICAT- --NORTH ARROW BENCHMARK: Describe the vertical reference point used /Qf P 4e- 5- E, e6v TB-M. S`t E.I._ 103.0' Elevation of vertical reference point ( 0()-o Proposed slope at site: 4/G °ioGi t s SEPTIC TANK: Manufacturer: S dr." Liquid Capacity: fQ~p Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: d- Number of feet from nearest Road: Front 10 Side 19 Rear, O 6~g0 feet ..From nearest property line ' Front, 0Side 10Rear, G $ S feet >r Number of feet from: well 7 Z , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SF REVERSE SIDE - ~t PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed : Trench: Width:I-V Lenith: Number of Lines 3 Area Built:l?T Fill depth to top of pipe: yL i OFt ~S Number of feet from nearest property line: Front, Side, Rear, Number of feet from well: z Number of feet from building: Ze Z (Include distances on plot plan). SEEPAGE PIT Size: /P Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box0 been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK ' Manufacturer: N A Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, 0 Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number : 3/84:mj Omni DEPARTk!NT 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: NW!4-, NEj, S 18, T29N-R 19W [U CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o j HudJ~ on Q,p I i g Tank ❑ In-Ground Pressure ❑ Mound O R: Ar3DRESS OF PERMIT HOLDER INSPECTION DATE: 1TAM`E4"EF7MTr1H' Sam MitteA Route 1, Hud6on, W1 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: rCounty: Sanitary Permit Number: Doug StAohbeen 5432 St. cto i x 119411 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TLINLET ELEV.: TANK OUTLET ELEV.: WARVINING LALOCKING COVER RDEDPROVDED: ❑ YES ❑ NO El YES ❑ NO BEDDING: VENT DIHIGH WATER NUMBER ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROLINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEARESTDOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKNG COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VER T TOFRESH (DIFFERENCE BETWEEN FEET FROM LINE: AI INLE 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: TNO.OF RENCHES: DISTR. PIPE SPACING: COVER MATERIAL: INSIDE DIA.: # PITS: LIQUID BED/TRENCH PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: . N UMBER 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: 7MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO S E] 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: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES El NO ❑ YES ❑ NO NEAREST _o' Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: SBD-6710 (R. 06/88) Zoning Admivi tAato TOIL SANITARY PERMIT APPLICATION COON/~ LHR In accord with ILHR 83.05, Wis. Adm. Code / • / STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES `9 NO PROPERTY OWNER PROPERTY LOCATION '/4 S Tot , N, R / E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME az CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK VILLAGE : II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a.~ New b. ❑ Replacement c. ❑ Replacement of d- E] Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION '6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ❑ Joint El Public G3 G/S ~8 S-O Feet Private ~aj CAPACITY VI. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ~C l~ ~O l~~.' 3 c r ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW N_o.: Business Phone Number: =to k kqq~m ;Z4 ~7)3 2-33r m Plumb 's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # ST's ADDRESS (Street, City, Stat , =Code Phone Number. SS8 / !v: 1S' 3 914 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sarlitary Permit Fee Groundwater ate I suing Agent Signature (No Stamps) Approved ❑ Owner Given Initial '~/l Surcharge Fee Adverse Determination ~v,) X. CO MENTS/REASONS FOR DISAPPROVA SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. - - - - - - - - - - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco in's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) r APPLICATION FOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property 1/9 1/9, Section TAN-R,&-40 Township 7/qZ~ Mailing address Z8 ~1 ~cTr~ LU t/1~ ~G Address of site 4~ c4 C'e, a4l~m 4ela~~ Subdivision name u~~ Lot number q Previous owner of property \/l' r : l a a J~a U C v Total size of parcel ?+8o ~C cy 5 Date parcel was created ( 2 - Z e - Ijg 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 S'S as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 3 9~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County ~Regi er of Deeds, as Document No. qVJ 9 96, Signature of Owner Signature of Co-Owner (If Applicable) I o Y2 Date of Signature Date of Signature w.. r. ~ fNN alMrit awsar~r .i a A *-VAR or WOOONi11iM '!02%!--11m rl. .t jR in •r and warrs >oo tall..~x.,h r 19130 y W, gal . TURN Q. _ R[ . - . . 00. famine meta real estate to ...St....Cxatx, .........................County, - s: Tax Pared No:........... _ -Part of the NE`} of the MW } and Part of NW } of the NE } of Section 18, Township 4 29 4orth, Range 19 West, St. Croix County, Wisconsin described as follows: Lots E` 2, 3 4 of Certified Survey Map filed December 9, 198:' in Vol. "78, Page 2063, f Doc. Na. 443732. TOGETHER WITH AND SUBJECT TO a 66 foot wide Private Road Easement as described in Warranty Deed in Vol. 46560, Page 544, Doc. No. 381696. -1 T. MNSFA a T:iis homestead property. (is) (is not) Exception to warranties : Easements and restrictions of record, if any. Dated this day of _._-...December _ 19$$ (SEAL) (SEAL) Virgil L. Neubauer .(SEAL) ~PGGGL1sR~ oo ,,eA.JSEAL), f Linda M.. Neubauer AUTUMNTICATION ACKNOWLEDGMENT t (s) STATE OF WISCONSIN ML St ---Croix -------County. this ........day of.......................... 19...... Personally came before me this ~Y.....f{ay et December . 19..".. the above warily) .Virgil L. Neubauer and. _Linda..Ms.-N h-~(sband and..Y(i.fe . T1TI;,iL; USURER STATE BAR OF WISCONSIN (If not aotha ed by 1 906.06. Wis. State.) tp me known to be the person S who ex s eeats* t>w fnrewonng in~srtru and acknowledge the aatne. 4T~►+r~s,t~4taIINJI~ENt•WAO{R.ARTpev (V 1dt' s~ iFa 502.4._St_. _AudsEla,_WL... Nota-" i> dlc .5t... crqu : A maw he sail doted or jowbig*j °tbA "MF Comialw t M anent. (if uat, stab Olpr"0t 1! 3'.1- f# a111101W. 1a:. am should M, typed or grist b ku th,4r eirn.u,c . STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County /IW OWNER/BUYER ROUTE/BOX NUMBER ^A- FIRE NO. CITY/STATELLsloyf /-A1 ZIP PROPERTY LOCATION: jL/U) 1/4 1/4, Section TAN, R /9 Town of A fjoy , St. Croix County, Subdivision A.ub,a~r Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department 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. I 'yam SIGN DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LA`BOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION:M SECTION: TT.~~ pp TOWNSHIP/ LOT NO.:BLK. NO.: SUBDIVISION NAME: fc~.. W ~ / b~Y H/R~ (or~lO~t/ S./M!. viK~ti Bit tr 1 COUNTY: OW ER'S/BUYER'S NAME: MAILING ADDRESS: SA 'CfVtx_ 04k 5- USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: r~ PROFILE DESCRIPTIONS: PERCOLATION TESTS: ,Residence ANew ❑Replace I f //J- - 5"0 i J N1 A/p .r C L / RATING: S= Site suitable for system U= Site unsuitable for system .S Ls/"k d S bA ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) jg.,KSlI u Crxs ,y-~;6• au as❑u ®sou ❑sou os © If Percolation Tests are NOT re wired DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b), indicate: A Floodplain, indicate Floodplain elevation: P5,0F1 LE DESCRIPTIONS BORING TOTAL' DEPTH TO GROUNDWATER-14641 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH Ot. ELEVATION OBSERVED EST. HIGHEST TO BEDDROC~K IF OBSERVED (SEE ABBRV.ON BACK.) B- Z- 7•s' a /udu~ 7 s' . S s , J s/ i /xl I&, S/, gan y /s B-3 11-5-1 . S0 . Y A S/ AA s/ s n ~s B- O • s/, • ~o ,~n S 3. S 'Aft f!h S/~ gnl- t B- 7, S' N 3. Y' 11drU .0- 7 7-s- ' 1, S_ At w *2 S B- 7.S' 103.5 A/0-ve. 7 7. S' , S_ SIS4 -7, c S/ S 3 S PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INEII+E6 AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER1003 PER INCH P-Z 3. o S" 6 6 6 L 3 P- 3. C r o S 6 6 3 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 ELEVATI 9rP. d' _yv . _ _ Score ~Cr G~J 3 f 7. _ niv~ TAP E P ~r' .-lo ~ E ~ N - i me~n '!f►~A Q C Or}'G C 3 f ~ Sic.,` rke E t.. y S _ ....-._p.... .a..~ q. _ t_ 1 00 YI" 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. ~ oft ~ SM~<I qf- rdcsa.. Mrhi~ .ter ~2~1/+`c~/ e K :-arte~~s. NAME (print): TESTS ERE COMPLETED ON: / ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST S ATURE: G DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR- BD-63 5 R 02 S 9 ( /82) -OVER - L r INSTRUCTIONS FOR COMPLETING, FORM 115 - SBD - 6395 To be a and accurate soil test, your report must.include: 1, Complete i , it description; 2. The use section must clearly indicate whe ' ther this is a residence or commercial project; 3, MAXIMUP , number of bedrooms or commercial use planned; 4. Is this replacement system; 5. Corn! suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL 01 H :1S ARE RULED OUT BASED CAN SOIL CONDITIONS; 6. PLEA; h ibbreviations shown here for writing profile descriptions and completing the plot plan; , MAKE LE diagram accurately ' c sting your test locations. Drawing to scab= is preferred. A sepa V - used if desired; B, Make < ~chmark and veltis _ I on reference point are clearly shown, and are permanent; 0. Comps a; iate boxes as to da' names, addresses, flood plain data, percolation test exemp- tion, iI e; '10)n {such a plain, Lion} does n 1y, place N.A. in the a: b x; 11. yid place your ' ::Trent id your c ! ic, Jon number; ~-pies and dis'ribute I. ALL rr;IL TESTS MUST BE FILET; W'TH THE" 10RITY WITHIN 30 DAYS F COMPLETION. 1 ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separa ,s tither Symbols cols C4 (3 - 10") SS - S ~r gr Gara.+r iunder 3") LS - Li HGW - High ldwater Sand Pt c - P' .Rate --n s l sit L(' ,.;nn BI c1 - L )art; Y sc; - Slay Loam R sicl - r=?ay Loam ntot w1 sic ~iay fff i;, faint a X79: _ J'i 1 m ct S _ ninent HWL Ifigh waster level, Six r' sr-s dace water for liqui' ~`'sposal BM _E• ~h Mark VR# - V it Reference Point t. a y x=. rn 1 h G rtty rrr jy request structio' , ' Nvtlh fet ins _ Sct vin rn~, ~~~r C. S. III. V; 6:1 Meaiebawczr Lod N Y fi w. E1. - 98 o Scales O aw, Q $.M. is Vcrfi y 4{e~ i Z Rc~• ~ai a~ '+'~t~ Al s- E. lc-t Colt Na✓ Ov~A-0 P o~ a LIZ ~o'fi P~ ~ Bo re•,5 L ~~-k ke E- ) o _ P~.r~ s ~`fa•s~i' Boftow+ = 94.0' ND~d - Sft,-`\ eat CLfpu~tn7S Q1 10 ~e~N1u,v~ d2r~• ~d~~~ ~~ilXfw~PmwlQrttll~. N M1 j ! ! I i a31~ s 1 T.Q. NA 3/y "P at ! ~ N i ~n f1F- y o 1 ~ BS 4-r,°~s~,P6 o 3S Bb 9S/ Z3 , So~t0. JOT -°--°a~_-Cei mn O t: • 1 ..S S d e 6 ap Q All S J T I all a ► _3 a ~ s J, i a ' d o d 6 J 0 d , M A d d N c9 d vi 0 _ vl J H CIO r lot -0 v v 1 ~