HomeMy WebLinkAbout020-1066-30-100 62o - 1666_
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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.
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: L 1 F Fc>P.--n to c: n*t4T
PROPERTY OWNERS ADDRESS: ¢ (, l�I y� V4:5
Legal Description N til _1/4 , Al�,W. .1/4 , Sec.,—_, T -Z-9 N-A tg W,
Town of U O � ,Lot: No. I Subdivision
FIRE NO. B flo LOCK BOX NO.
Color of house .,—Realty sign? --- 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: c w► .vsc H
Telephone No._7-:2
REPORT TO BFI SENT TO•
CLOSING DATE: 14 Lcn.)c IPW 460
Signature:
a� fir } - C)
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��l�� �� � ��
���������� Laboratories
`su1 West County Road ox. St.Paul. Minnesota ao,m Phone(6`mo36-7,m FAX(612)o36-71m
LABORATORY ANALYSIS REPORT NO: 8348 PAGE 1
1O/16/91
Commercial 7esting Laboratory
514 Main St. Box 526 DATE RECEIVED: 10/02/91
[olfax , WI 54730 COLLECTED BY : C=lENT
� DELIVERED BY : CLIENT
SAMPLE TYPE : DRINKING WATER
Attn: Pamela Sane St. Croix zoning
Hudson, WI 54016
SERCO SAMPLE NO: 104671
SAMPLE DESCRIPTION: Benedict
1112
ANALYSIS:
________________________________________ ________
Dromodichl��c��eth�ne, ug/L <0. 2
Brrmoformr ug/L <0. ff
Bromonethanev ug/_ (Methyl nromzde) <1 .0
Carbon tetrachlorida, og/L <0. 2
Chlorcbenzens , ug/L <1. �
Chlorcethsne, ug/L (Ethyl chloride) to. -,
2-Chloroethylvinyl ether, ug/L <0. 4
Cnloroiorm, ug/L <0. 5
Chloromethane, ug/L (Methyl chloride) <0. 6
Dibromocnloromethaoe, ug/L <0. 4
1 ,2-Dichlorobenzene, ug/L <1 .0
(o-Dichlorobenzene)
1 ,3-Dichlorobenzene, ug/L <1.0
(m-Dichlorobenzene)
1 ,4-Dichlorobenzene, ug/L
�
(p-Dichlorobenzene)
1 , 1-Dichloroethane, ug/L <0. l
1 ,2-Dichlcroethane, ug/L 10.2
(Ethylene dichloride)
1 , 1-DichIoroethene, ug/L <0. 2
trans-1 ,2-Dichloroethene, ug/L <0~ 1
1 ,2-Dichloropropane, ug/L <0. 1
cis-1 ,3-Dichlorapropene, ug/L <1.5
trans-1 ,3-Dichloropropene, ug/L <0. 9
Methylene chloride, ug/L <5.0
(Dichloromethane)
< means "not detected at this level ". 1 mg = 1000 ug. ����
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IF
� ���� Laboratories
��m��
�������� �����'����'���
,m,West County Road o2. St.Paul. Minnesota e1^x Phone(o2)o36-7/m FAX(6vmo36-71m
\BJFAT�RY ANALYSIS REP3RT ��O: E34 PASE 2
10/16/91
SERC� SAn�LE ��� I04671
E �ESCR�PTION: Benedzct
A�ALYSI��:
-------------------------------------- -- --------
� , 1 ,2,2-Te�rachloroet�ane, ug/L <0. 2
Trichloroet�ane, ug/L <5.0
�-7r- c�l�roe��ans° u�/L �0. 1
Tric�lo�oetheoe, <0. 4
Tr�chloro uoromethane, u reon 11) <C. 7
c�lorzde,
Tstrachloroet ene, ug/L <1~ 5
�enzene, ug/L < 1 .0
E�hylbenzene,
ug/L < 1 .0
This sampIe's analyt results are beIow the U. S. EFA's SD-WP--. Maximum
Cc�ntaminant level of 1/30/91 for those requested compoun�s whzch are
also on ��e SDWA I L list.
Al l analyses were performed using EPA or other acce.ptec metho�ologzes.
Samples that may be of an environmentally hazardous nature will Le
returned to yoo. Other samples will be stored for 30 Cays from tne
date of this report , then disposed of by SERCO Laboratories. F Iease
contact me if other arrangements are needed. his report may no-- be
r�produced, except in its entirety, without prior wr---ten approval
from SER= L�bora�orzes.
Repert sabmittec by,
Project Manager
< means "not detected at this level ". 1 mg = 1000 ug.
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As-Built Sanitary System Report
OWNER Z To h QArj! �t----------- TOWNSHIP__- 1A—<La i ---------------
---- -T- -------- ,Q
ADDRESSM� 1_�X_r1Lj.-- `-'L- ----- - --- R--� �j---
------------- SEC N' W. of -- T--
5441 ---------
SUBDIVISION__C .5 JV�-__________'_ LOT LOT SIZE
_
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83.
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3B
3 St�'ti6 �
H
31
I
i !
i
t1
16t (2,YhiC)
N
( Indicate North Arrow)
BENCHMARK: Describe the vertical reference point used 1 ► roh��.L-Ld_�Q�-���ro���L���
Elevation of vertical reference point:_1Qp_o o_- Proposed sloped at site:_2 Y ____
SEPTIC TANK: Manufacturer: kAj.1ZLE7L� S _______ Liquid Capacity:_
Number of rings used: Tank manhole cover elevation:
----- --------------
Distance from vent to fresh air inlet:_n��_ feet
--------------------------
Number of feet from nearest road: Front 5_,5_ ft. , side_____ ft. , rear ft.
From nearest property line: Front-5 5_ ft. , side ft. , rear_____ ft.
Number of feet from: well $ , building--La--"/.1.
(Include distances on plot plan and 2 reference dimensions to septic tank cover. )
e
manufacturer:_AI,-_____________________ Liquid Capacity:_____________________
Pump Model: __ Pump/Siphon Manufacturer: Pump size______
Elevation of inlet: ---------------------
Bottom of tank elevation:____________
Pump off switch elevation: Gallons per cycle:___________________
Distance from vent to fresh air inlet:--------------------------------------feet
Alarm Manufacturer: Alarm Switch type:___________________
From nearest property line: Front_______ ft. ► .side___.____ ft. , rear_______ ft.
Number of feet from: well building____________
( Include distances on plot plan. )
AIL ABSORPTION SYSTEK
Bed'----- -------------- Trench'--------------------- Mound:------------------
Width: ft. Length:--A&------ ft- Number of lines:_
Fill depth above cover. •
Type - � --- ft
T e of cover � a.� ___�_
__ ft. Spacing between lines:__ __ ft.
Gravel depth below lines:__,�,__�_ -"
�,5 inlet(s) q�_ 3� outlet(s)
Line elevation(s) : 3,1 --- ----"""-"'"
Hole size: 9/�_ Hole spacing:----------------------------
Distance from vent(s) to nearest fresh air intake:___, B___________________ ft.
From nearest property line: Front_ .q__ ft. ; side_______ ft. , rear________ ft.
Number of feet from: well ' _ , building_____ __________________
(Include distances on plot plan. )
UEFAGE LU nn
Size:2V V A-_____------ Number of Pits:--------------- Diameter:----------------
Liquid depth: Bottom of seepac•e pit elevation:_________________
Area built'---------------------------------------------------------------------
Has either a drop box________ or distribution box________ been used on any of the
above soil absorbtion systems? (Check one. )
UlDiVG TANK
Manufacturer: (Y ____ Capacity:_________________________
Number of rings used:___ Elevation of )ott01 of tanx :---------
_______
Elevation of inlet:--------------------------------------------------------------
From nearest property line: Front_______ ft. , side_______ ft. , rear________ ft.
Number of feet from: well___________________, building------------------------
Number of feet from nearest road:-------------------------------------------------
Alarm Manufacturer:------------------------------------------------------------
(Include distances on plot plan. )
Inspector:__ --'-"`- ----------------
/r job:_��f1_�1 ' ----------
Dated:--1_21421/11----------
Plumber on
License Numbel :--- .,1`__ -.-------------
•, DEPAR-�MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
;P.O.BO X 7969&HUMAN RELATIONS
.O.BO PRIVATE SEWAGE SYSTEMS DIVISION
MADISON,WI 53707 BUREAU OF PLUMBING
NW4f SE 4, Sec. 24,T29-R19 El CONVENTIONAL ED ALTERNATIVE State Plan l.D.Number
Town of H dson Lot 1 (If assigned)
#� El Tank ❑ In-Ground Pressure ❑Mound
McDiarmid Rd.
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION
Clifton Benedict McDiarmind Rd, Hudson, WI 54016 io2 `'�l� � {�
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV
Name of Plumber: 1 P... v� 3't.t-'(y�' C1 V,
MP/MPRSW No Cnunly Sanitary Permit Number
Carl P. Heise 3378 St. Croix 135404
SEPTIC TANK/HOLDING TANK:
MANUFA TURER////^�+� LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
�+ Cf PROVIDED: PROVIDED:
_ 5d
J ! 1� C ° �� YES NO DYES ONO
BEDDING: IVENTDIA,.: VENT MAT! HIGH WATER NUPR . : BUILDING:j VENT TO FRESH ALARM �,/ FE1r,,.,I,FRCIM ,// LIN ) / �� / AIR INLET.
❑YES NO �� ❑YES aNO NEAREST / N
DOSING CHAMBER:
MANUFACTURER BEDDING- LIQUID CAPACI IV PUMP MODEL PUMP:SIPHON MANUf ACTUHEH I WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑YES ONO O Y ES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS P RATIO NUMBER OF PHOPEHTV WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET,FROM LINE AIR INLET
PUMP ON AND OFF) YES ❑ O NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at h depth of to ing F RGE 7F NO,TH IDIA1,11 T1 IMATIHIA1 AND MARKING
or excavation. (If soil can be rolled into a,wire,constru io shall c se til
the soil is dry enough to continue.) MA
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH n E .T TH OF U H IPE SP (YPa(; M H ji7S I DE OIA SPITS LIQUID
I/(x/J THENC FS MA E PIT / DEPTH.
DIMENSIONS, .� �
GRAVEL DEPTH -- FILL D TH D151 II PIPE UISTH PIPE DISTR PIPE MATERIAL NO ry T PRO ERTV WEL BUILDING: VENT TO FRESH
BELOW PIP $ ABU V C EoI El EV INIL I ELEV.END ,/� f' pipF/`��. FUM1BE#OF,
1 ^f FEET FROM LI AIR INLET
I t NEAR EST'--�--�r
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
❑YES NO
meets the criteria for medium sand. TIONS MEASURED.
❑
SOIL COVER ITEXTURF PFHMANf NT MANKF RS OliSEI/VATION WELLS
❑YES ❑NO DYES ONO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH HE 1) UFPTH OF TOPSOIL JSODDFD SFF UrU MULCHED
CENTER EDGES
YES. ONO ❑YES ONO ❑YES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES ATE HAL SPACING GRAVEL DEPTH HELUW PIP[ FILL DEPTH ABOVE COVER
DIMENSIONS,
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATEHIAE NO UISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEVATION AND
'ELEV.. ELEV. DIA. ELEV. PIPES DIA.:
DISTRIBUTION'
INFORMATION "i HOLE SIZE HOLE SPACING CHILLED CORRECT L Y COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO OYES ONO
COMMENTS: PERMANENT MARKERS: ` OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING:
FEET FREM LINE:
❑YES N [:]YES ❑NO NEAREST"
� � 9
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Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATUR TITLE'
DILHRSBD6710 (R.01/82)
SANITARY PERMIT APPLICATION
•` (�ODILHR In accord with ILHR 83.05,Wis.Adm.Code couN
STATE SANITARY PERMIT#
—Attach complete plans(to the county copy only)for the system,on paper not less than ❑ 1 than -';/o
8%x 11 inches in size. chat if revision to pr sous application
-See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PROPS TY O NER PROPERTY LOCATION
1. TO,K) ene�r cf u1'/4 S F- '/a, S �'� T aQ, N, R l Q E(or W
PROPERTY OWNERS MAILINc�ADDRESS LOT# BLOCK#
rv1 a.r m��/ _T
CITY ST TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
se,, us u�'4GIL C5m vo OfzZ 9 953
CITY u.d AREST ROAD
II. TYPE OF BUILDING: (Check one) ❑State Owned VILLAGE; S+rJ y4 OIQ r MI` nn n
❑ Public 0 1 or 2 Fam.Dwelling-#of bedrooms PA EL TAX UM 5 E K( )
111. BUILDING USE: (If building type is public,check all that apply) "
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. New 2. El Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.El
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 U Seepage Bed 21 El Mound 30 1:1 SpecifyType 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 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) �y ELEVATION
(/, 0 1) ,2 0 ,7 a L Ci '7 j.4 0 Feet 10C)A 10C). Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION - New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdina Tank I o�?b�
Lift Pump Tank/Siphon Chamber
Vlll. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown maim hed plans.
Plumber's Name(Print): Plumber's Signature:jNo Stamps) MP W Business Phone Number:
V
3� � 7J 49,S-v21 A3
C a.rl ►� ��-�sc S`
Plumber's Address(Street,City,State,Zip Code):
04;t Cvw F-A(s L4) s a
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee(includes Groundwater a e Issued lssuln pjgenialynat ure(N Stamps)
Surcharge Fee)
Approved ❑ Owner Given Initial
Adverse Determination 7
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: '
SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety 8 Buildings Division,Owner,Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete##of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all 3
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 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-6396(R.11/88)
a
APPLICATION FOR SANITARY PERMIT
STC - 100
his application form is to be completed in full and signed by the owner(s) of the
roperty being developed. Any inadequacies will only result in delays of the permit
ssuance. Should this development be intended for resale by owner/contractor, ("spec
ouse"), then a second form should be retained and completed when the property is
old and submitted to this office with the appropriate deed recording.
weer of Property C/iffoh G . 0--CL (3 Bene- 1* C4
ocation of Property -L�1ClL_ ,3�� Section a , T_a2_N-R- W
ownship UCLSO V\
ailing Address ���,/ ����^ -AdOa-
ddrese of Site
rr
f r
ubdivision Name Su-ri r)-
of Number N. . � f
revious Owner of Property `1GL/YLQ,S Y-� /} ,Q
otal Size of Parcel
e2 . O O 8'
ate Parcel was Created 7—/S 4'?
re all corners and lot lines identifiable? X Yes No
s this property being developed for resale (spec house) ? Yes X No
olume and Page Number _L/a as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
Warranty Deed whoh includes a Document number, volume and
, page number, and the
eal of the Register of Deeds. In addition, a certified survey, if available, would be
elpful so as to avoid delays of the reviewing process. If the deed description refer-
nces to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
(we) ceAtri.6y that att Atatement6 on th,i,a 60,%m aAe tAue to the best o6 my (our)
now.tedg e; that I (we) am (ahe) the owner f� ) o6 the pnope�rty dens c�ci b ed in th i a
n 6o"a tri,on 6o&m, by viA tue o6 a wahAanty deed neconded to the O K Kice o6 the
ounty Reg.i6 teh 06 Veed6 ass Vocument No. �79� ; and that I (we) ptuentty
can the proposed site bon the sewage dispo.� aye (on I (we) have obtained an
"emenZ, to nun with the above des' ch i.bed pnopen ty, bon the cori tAuc ion o6 aaid
ys,tem, and the came has been duty neconded in the 066ice o6 the County Regizten o6
eedb, ae Document No. ) ,
IGNA OI? OWNER
SIGNATURE OF CO-OWNER (IF APPLICABLE)
ATE SIGNED DATE SIGNED
�i |'
. | oocuw�m�
!|
WARRANTY DEED
i
�
This Deed' made hotwo°o
---------------- ----------- -------------------------------------------------------------- -_------- ST. x
----_-------_------_-_---.-_.-_-----_---.----_-- |
.!
--- ------- Grantor, NOV 2 9 1989
' uoD=-]���e�i��' ---------------------------------- at 10:10 AA
---__—_---_---.------_---_--'-_-_------_.------' /
--------------------.---_ U
' .—.—__------_------- /| �
Witnesseth, That the said Grantor, for a valuable consideratioll......
RETURN TO
conveys to Grantee the following described real estate in ----St-.---Croix............
County, State of Wisconsin:
Lot 1 of the C.S.M. filed in the Office of the Register of Deeds for St. Croix County,
Wisconsin in Volume 7, Page 2092, as Document Number 447453.
FM
is not
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And----- Greenwood Enterprises, Inc.
warrants that e title is good, indefeasible in fee simple and free and clear of encumbrances except
easements and protective covenants or restrictions of record, if any
and will warrant and defend the same.
...................................... JAME�SF. RUSCH, President�
See additional Notary on back
AUTHENTICATION ACKNOWLEDdMENT
of
TITLE: MEMBER STATE BAR OF WISCONSIN Z 01—
authorized by § 706.06, Wis. Stats.)
to me known to be the person ------- �i4o Qecutebthe
foregoing instrument and acknowledgi�'tit'K"
THIS INSTRUMENT WAS DRAFTED BY
yppA.& Cari, by Donald J. Gillen
Notary Pu ix
It
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date:
*Names of persons signing in any capacity should be typed or printed below their signature�.
WARRANTY DEED STATF TIAR OF WISCONSIN Wi%consin Leval Blank Co. II.
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ACKNOWLEDGMENT
STATE OF WISCONSIN )
)ss.
ST. CROIX COUNTY )
Persc�#� 1y came before me this 9aydday of
\► j� , 1989, the above named
JamesjF Pasch, to me known to bQL,� Vt ....... ,
pexso who`executed the foregojTly.. ,,, .,..�5� ''•,
�!atrument and acknowledge
Il
Notary Public, St. Croix County, 444S������ ,,� ,
My Commission /�/
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
0
St . Croix County x
� d
OWNER/BUYER G�)L/FTO� �T- ��lE� C7'
ROUTE/BOX NUMBER 4)e.()1,gym tin iQO'q-o Fire Number
CITY/STATE a0-so h/ a)Z ZIP
PROPERTY LOCATION : /V W 14, SEj 14, Section, T Ac? N , R-2—W,
Town of 14 u-D,50A , St . Croix County ,
m
Subdivision Lot number��.
I
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
M
the standards set forth, herein, as set by the Wisconsin Depart- to
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Offtepe 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 .
T OF REPORT ON SOIL BORINGS AND SAFETY d BUILDINGS
INDUS
INDUSTRY Y,. DIVISION
LABOR RE LATIONS. PERCOLATION TESTS (115) MADISON W 5307
HUMAN RE
(H63.09(1)d Chapter 146.1146)
rE'CTiaNi TOWNSH /MUNICIPALITY: OT N0. LK NO.: SUBD VI •
ILOCATION:NvJ /s�/ Tai N/R Ig 1 uD So�.1 — Pl:.o�sra C.S.
.COUNTY: I� MAILING ADDFIESS:
Sl o I G 2t✓cNw000 nrrari� R-t ses 4-Z� . 4 v O o,l 1. cz /G
USE DATES OBSEF VAT10NS MADE
I" C ERCIAL DE'SCFi1PTT�N: N TEST
I Resldenee M. it. Now Replace I L�- Z.7- �dj ¢ z .7'A
RATING:S-She suitable for system U-Site unsuliable for system NCrF: -r1?S r DC-1m F-Ow- MAre'>
CONVENTIONAL:• M �•a� li�f•�� �� M O SGM1 .RECOMMENDED SYSTEM:(optional)
'II Percolation Tens are NOT required DESIGN RATE: (It any portion of the totted area Is in the
under s.H63.09(6)(h),indicate: N �, Floodploin,indicate Floodplaln elevation: ,
peielr.n/�t.
ICE T PROFILE DESCRIPTIONS
BORING TUTAL ELEVATION AT INCH A R O SO WITH THICKNESS.COLOR,T XTURE. AND DEPTH
NL"ER DEPTH M, Q TO DERfJOCK IF OBSERVED ISEE ABBRV.ON BACK.)
p /,08 L ,L T5; Z.o3' (3M 1L) +.17 /Vie -ro
88.77 /e�NC } `7.1o(v' CoARjF_ 15 16 C-8 ' 2.33' 3•+ MILD ro -C
5
I , /OL.ZI 0.9z' 6L SQL Ts; 1.00' 1Z r> %,,)lr j/,67'Lr 8r.1 f'ruAiw..
B- Z 9' 7 n�on1G 7 °�, /7 /.00' Dk840- Sw/GR ; /.0,5'1 nBN,CrrMtinS;3.33'D�13•�C{
W/6 • o.i7' DK 9- ro 114C1`0 5 w G 9_ — r
B- 3 11.7.50 /00_.84.' LJONG > ll. 7s' o.S8' Olc G.f e, t_rs� oc 7' kC 8"1 L S /6r,�� I.00• Lr. 8..1 l
D14 lei 45 AB.ar-t-f• ,d ' Lr.8n/ r0 re•�• S
B-¢ 9. zS /oz,3S Nor1 y 9•LS' /.00' et_ 5:1_ ; 3• o 54 Ls w a.;o, z• �, n,acv
e B.s oj,00 7,00' LT 9,1 Me) Yo C S W/A� Aa�t
7 � 708' '
5, 5 0B L- S:L 15; 1,00' 1 b ..1 L-~a. W/Gs R.• 0.7r'BN
A µ,�&j*. v, 7 t:' l_r Lit► .c ry M�0 5 4-.oo' Y B rJ
CA S ' 1.70' Dv- ppi Nara To tc S.
FEES PERCOLATION TESTS- NOTE, N UM H1r2 COrz.ItES PanIOS tnI n
D.J AG6" r- 801"-ft N
TEST or
DEPTH W TER IN HOLE TEST TIME DROP IN WATEA [EVEL-INCHES
NUMBER taMtyl6 AFTERSWELLIN INTERVAL-MIN. RATE PER INCH
P_
P. E L es VA'(I o.l
P.
LOT PLAN: Show locations of percolation tests, toll borings and the dimensions of suitable toil treat. Indicate scale or distances.Describe what are the hors
)ntal and vertical elevation reference points and show their location on the plot plan. Show the surAce elevation at all borings and the direction and percen
I land slope. SC-+4t—% : 1"-- ¢0'
;YSTEM ELEVATION 9-.¢o
St*-NC.H &4A P fL r-, A I " 1 fs_c.:e..l Pope
19 i
Lot I
�.�
01"
/ \
a /
v
O PHi„C.ni..AT17� V fi
rest N•ot.fi ,$•'L �, �o� �.� v�
the undersigned, hereby certify that the soil tsstt fspor on this form were mode by the in accord with the procedures and methods specified In the Wisconsin
dministrstive Code,and that the data recorded and ocatlon of rite tests are correct to the least of my knowledge and belief.
IAM print : TEST5YVERE COMPLETED ON:
DRA . S fr. iZuscN.--- ---- ----- __.... 4'/Ldl89
CER1 �'IfICAT1ON NUMUER: PHUN NIIMIIEIirinpt.unrll
4 Lt> d ` ST. n sOn11 l.�I• '' sag �,s 3e6-3�o74
CS SIGN TUIIE:
1ISTRIBUTION:Urglmal arel one coley In I ocal Authratty,Prnla•rty Owort nntl Sml 1'osun.
.0 urn 4-en e+ns in n•tro•s n%tFn
1
Fresh Air Inlets And Observation Pipe -- " - "
„ `^r Approved Vent Cap fo r
Minimum 12"Above -
Final Grade -�1-1F_T-O N UNEPICT -
.it,D aA,R141 a kD_
20-42"Above Pips 4" Cost Iron D S�fsN1�� 9 I
To Final Grade Vent Pipe
Synthetic Covering
Min. 2" Aggregate
Over Plpe
Distribution
Pipe —to 0 0 0 0 —Tee
6" Aggregate o
Beneath Pips
C _C-L. 9/..40
LOT 1
s
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AITERNATr 07 t P
v Qa034lor �/GNt
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