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HomeMy WebLinkAbout022-1059-80-050 a o a° c o o (D -0 U) O C C N (i N O N @ M V 7 N N o o m q aE 00 ° .aQ c' @ N N C c m @(' cc L 7 C r L2 O N p O N a ca o ° E L ° @ i N r @ O N " O N z O O O X@ C O y In L O L @ C @ (D C O U @ L ._ O N d E= Q n U V N co > N Z O z E 00 w I', a m N N I- Z o z c v co P .- N C E N N n N n N •Ai d � O O m z z NN � A � C C G LO N U) .. (6 7 Ct o a H F _ O O O c a� • LL d d d j *� a a> �v ii >_ -o (A J U LO N 0 N N 7 O Z 00 O M �rl @ N @ N 0 0 0 3 _ N N I L O O ._ °O a �_ N (O O (0 V rn x;53 CU 00 'p Q Av`; @ O N l6 3 w \j o p p 3: 'w e Al •• > O R < ~ > �O C C = O N CO O r O) O O O a0 N U @ N a s C d z 0 0 0 0 M C O z N N N N O (A O C (n C O O B N O (D O W O N N NC I- CO O O 04 y�IIC+ N C O O N E_ E_ @ L CC .a c R A U a O y U o p °603� M ao CKj 0. O C M + N a0 X ZZ p 00 Co N y N= CO L N C O U N N c N O O N 2 w ti I N N .0 CL C O L O Y O LL C C d r O N m 0c G 'Ct � O U 30 C N � m� 3 ma c Q7�0 O C _ N O °O O U O(V O L C Z 'O @ O N f6 (6 O- O_a C(n a O LL CO O N co N > Q C @�N cr> 3 Z v) Z y co Z +% O N w d m c� F- Z 1'. I c C7 O Z d m Z c N H O 'c E N N h� CL _ rJ cu a� N C/) 6 0 O ° CD•� d L L O O c 0 2 ° N Z !- Z d o I N Zo R E L � 0.S N N clio E in 0 0 0 a •rNV ;� ', �; a a a �i 0. ii j O N W 00 N fA J U > CO rn a) R o ° :) ° 0) E N o o co 3 m a N 2 - *i O � tj o o m 3 u�i c o E ° N U' C N C c w o ° 0 W C _C N c N r- _M ° U co m L 7 N ~ N C,4 C .O O N p M U • y' o c� Y o Z w F- ►L m m y a tt O. L: a w • a y .2 d y c E c c KINNICKINNIC PLAT a T28-N R18W See Pages 115-116 For Additional Names. me Publishers,Ltd. { WARREN PAGE 32 i 00 100, 1 .. ./ ?��1Dan lFfir°'*jy�'` ;s'Fhsr;°.,+' :i � � d f eati Lend 1 : Simonson a G Hansen 46 Gloria r Jacque H.. J&M Z Farm Arnold j(f/ F ' Roger Nelson 39 2 NN�e D Inc 193 M-11. Vorwald Lenertz sanay , ©g 79 �;Lueck " 265 I 157 Trust 7anseek ' I 117 sAanD 22 3 O �' �jl ■ 40 4in .77S_S 1 1 ss_.32 z z p 44. 69= 40 12 @ 222211- 40 Y Y¢ 94 3 �Rog- N 4 1 4^ 'L&'[ wvunue lay 0' �1 t1 Heinbuch w�klu 3 Eugene Gerald& � ■ Leneriz ek �ser Dale BH w I Robert& Mark& u 2 Trust ss '' R& &uCarol Thom B�en�sonm ' IS z &cs7 169 TROUT Barbara Larson J 40 100 36 20 39 ' Barbara Laurie M $ Gaibe Benson L) } Delander BROOK 69 69 76 rout , Alvin& Lisa Y ( Ickler a v 15 RD 78 awes Lubich F eded k Holly D 118 112 &A zo .rust,Paul @Laa¢euee I S011om Z ,Lao 2 . 53 4 ■ VanBeek 50 +� chmitz 1�, N .ub ch 120 40� - _ bo _ 40 _ � 34 G°rd°.&a - - tames RGaME sa,i& Susan w suerm ,Fisk c 7 Tn-d— Ld ' Mueaer 56 4 of ertz owctak 20 zo zo CL ,A1VIri P]nski 8' Joanna 35 Arnold& Ka�ees Bemm� >> d, ms D&L 21 &rL 40 } & ary Marcella I Benson 67 57 c&a > Middleton 20 VanBeek z zo 1 3 S Her Edwin Lueck w ahr zo J «�127 E&S B 9 (n n&Mary ,�u m: X160 ' irvst 4 > 20 W O^ , '�. D&NM U) Ross K&B 21 S 74 udkr W N 8 K&D 45 Avise �r o&M 0 � Hill I 14 voGwala 57 SR Marvin 1 CL 80 4 Na 1r�a 1 FamBy Trust L6 - 1 Llddle {3 "dae nw 20 maw (r 9 G ohnson Des Charles r& @ n11 >' 2 M to sK 160 ¢ R&rp �� &Anne s cN °°` w 2 } Prop 'es &L 24 70 Ka0 27 a Mi <wo Ph L$15 65 W PO H son 80 40 p u G Cola 32 m►th 3 ° »¢ )s5 H LLC STEEPLE DR I & Ross Robert& u & G&K 1 3 g N reaedck Phoebe th n& © / 24 Thekla Bp Dd.16 IF "aM — Gregory s@ k Shirley Paulsyfj' Call ryn W {\ ' M1` Madsen 80 elan )&1 &c u @ RpCO"n' &Kathryn T&C i"'tr 38 4U 158 U K By 43 bust 40 i s t z o �10 Smith 53 9 _ _ z - - RaM 4 ' David h Gerald z 3 ~z3 Patti s tr— Michael 2 2 G34 _ - Z Emholt2 Harold a pp ' Susan Be.r s Schmidt aNl a john W Agronomics 142 Q Morrov4 --ff3 - 0 b.0 37 4p R&NT13 mend&c Mickelson� 118 _1 :_ 146 w w j 89��ck 146 Z 4 2 2 2 2 T& M Q/ O p F&e z z ia 113.41 2 2 27 75 2 f 8 AKlen G7 Robert@ 3 C Hertz 1 TOWN HALL z Kv 2" Ds "8 Duromr N„ "r.. O u I 4 Jeffrey » z3. rnuuP. Robert r^v N i RD Dan r Kinnlckinni< ..,5 39 &iaNce W . 3 &Nancy Fde on 1 River Lana 40 '4 Y 0 r.. screaton Baran— > Orlande b ¢ David Christensen 7 Trust Inc 88 Bloom 85 U 73 0 Gerald C•Bkam $$ Z Donald 6 g &Sarah 164 u� ;°�N&Diane <L zo P�PPs &Gloria ¢ Lee tuart Jr& etdl r a ort �-i Olson T&E 21 D&C 20 Fly �" r Mueller W Bo /Georgians &B K&K 20 LH& 4p Smith Peter�n Trust 99 a Tr' CD n� / Rider 7 154 biin18 20 _3910 53 _Kee.ear MG U � 4 1 2 - - - J Z� z 208 oak & ET 8 80th AVE Elnil& I Hi e5ns °""i3¢� M O Donna w > 3H.toc�� &Mean 6 1 Mio w,...,Fuller Mary 80 .Sa wF 4 s Badje 80 z 20 Thomas& Nelson n rerranee 1. !-. 40 40 Purfeer 32 rn' > 140 _l1 Dale& Kurt @ aaBmBne Harvey oDR s6 t Glen Johnson Lowey 34. p Trusty' I Grimm s SKUwber� 28 Jacobson WIODB 1 carmen eA 43 102 + Pa SHORT 99 77' 80 40 4 4 4 m40 cs&s etal 120 oa LLP 30 UPartners 19 a12.:. 6S arBss DR' OAKDR -, o &V °,. '' ans timothy O u HOWar 15 aaaa ,,t @ ins °&lan n i� 30 Madsen IV TM pv=°a ` Gordon Robert Jr& DawJu Zoerb �d ugiaa @d 76 40 I Wynona �bbye 2 31 uses 3o a L 6 °W W¢u 88 170 Hey Keatley 80 un& ,vi , Alan „y&.4 s Md..rMm a I°ba& a w°^ a &Laura Maran 160 mPSOn : xbnberir w a u can Thompson Kreu ii r s a �L�pyenns��& °�aa�n w 4 u® at a '�A mmb 4$ 37 I r 3Q _ -80 I _ _ _ fiomwc HiB.34 63_ _ O r�_ _ _ •— - T Allen& P kins R&Y Ta Danid _ o ` ” I Linda o ere°ta asses I Terera Cudd is GA &Sally Re1r 4040 ad�e �� 2•'CY,": RaK Bruce -4 f0 Mtd.k 25 1 Wilson s 7 Debon Andrea u' u Nsfiaam R&i y°oia 30 9 Gil '" RB w 3 1 P 3 40a'� ��°40 Circler s6 C&K K10 = EV RG E N DR 40 &P cc 3 s CDUrt 8 8 M County Of M SN SW a N $4 w ' O N Dadel& ac cum 1 z t a u &G 8 �" tavnne r c )e 112 r I 314 ; , St Croix & Forest 80 R s 10 y ae 3 r C 15 d d Lmeban 2$ &py N zt tl o LS9 27 Bs p Paul& 40 6 3 8 ' L// Jeffrey a` Mae Suzanne M@ &C 3 & 9 way" &Jane � < ,Wolfe Kramer e ,99�c7 'K27' z N o 4 debek Him 1 a&n �� 54 Swe son 40 ¢ c@n CC!. Vernon 38 9 ��@ Trust r w o¢ w 4 Uk"p&Stanley Rose C Adeline °"'B'a ' Kenneth Family s^`d"rna,n + 200 �Dardel Vernon ¢Peskar Yunker F GY�Rp Peskar P 5 M 7 �I�' Him 1ta:t 31 M&S 23 C 'Baueanr� Peskaz 3 308 Trust 10 110 M 8 21 40 40_ 4o HA O DR Kessler _ ___ _ _ sL 101 89 2 - --f- '_ ' 139 _N Gary& _ _ Mklnel &Ta Ds 2 ,JL i&9 Judith I &Bdb Cn RiTaa I t .b C I Judith Eric& W � n &Pegry N NF 3 14 "� 7 O 7 &Carol 3 I 40 . 9,bn, 13 oio 2 2 vA7 soN 72 59 enson tno� ,o ¢ ;achder eB ci3' 135 Michelle ` Williams K@ Paul* Gp 3L veto a A& sore garrison p I Garittl�tety 140 s 160 rB Mary3ret 10 i,g N g ?:a P y raw Ro p ¢ I alke -.. ' n 43 f49'l Da c@ 40'in,'r__ iGao-{w. - 39� - --99 on _ . M iisd e 6 Ga &Agappl,TS144»<' J q:� ]udith David& Kelly &LtncWe Don& a,>cs`zf>;; Kell 110 c L7. < `^ ,. Ralph Grimm I �sak 96 2z Tru t 160 Ch 1;� : 4. = Ti 55 4Q Sch' Q� r. ' 8c Dean n John 80 lane Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER STU (�1 c! -c,r TOWNSHIP lc ��„�„y.'� �C ,r,, SEC. T 2R_N-RLaW ADDRESS 0,j ::2 I� ST. CROIX COUNTY, WISCONSIN & � l I t I1 SUBDIVISION 1,) 4- LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I.IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4 oN INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used I.' E-")` rl1( -/' z � { Elevation of vertical reference point: 100. 0n Proposed slope at site: / SEPTIC TANK: Manufacturer: Liquid Capacity: 1a0 a Number of rings used: �_ Tank manhole cover elevation: 1 0L_ 610 Tank Inlet Elevation: 103,7 Tank Outlet Elevation: 103,42 Number of feet from nearest Road: Front,O Side,Q Rear, O (:'?00 feet From nearest property line Front,0 Side G Rear,O lQ 5 feet Number of feet from: well 7r) building: -?0 f (Include this information of the above plot plan)( 2 reference dimensions to septic tank) '� SEE REVERSE SIDE 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• &7, 7 r 4 9"2,0 Width: 5' Len$th: 3 3 Number of Lines�9 8�_ Area Built: Fill depth to top of pipe: a O � Number of feet from nearest property line: Front, O Side, © Rear,0 Ft . Number of feet from well: 13 a Number of feet from building: s i (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 0 or distribution box Q been used on an y of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: n/ Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: '7/ q Plumber on job: License Number: Yk PR.S 33 3/84:mj r DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SF,,W,-, ?16,T28 7—R18 T (If assigned) CONVENTIONAL ALTERATIVE Town of Kinnickinnic ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound c{ IRAWCW PA OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Stuart Rider Route 2, Highway 65, River Falls, TiJI 54022 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name 4f Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Carl P. Heise 3378 St. Croix 119480 SEPTIC TANK/HOLDING TANK: MA UFA TUBER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER _ PROVIDED, PROVDED: 0 YES ❑NO i ❑YES 0 BEDDING: V4 DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY// WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: ,/ -f AIR INLET: ❑YES ZNO C ❑YES ZI NO NEAREST—� f� `? ! DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS ER TIO L: NUMBER OF PROPERTY 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 the dept f pl I g O E LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall se nt I MA the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENPTV¢ NO.OF DIST .PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID BED/TRENCH �' `/L7'o+" TRENCHES: TERIAL: PIT DEPTH: 15 DIMENSIONS 4 6 / y ' r/ - GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELO PIPES: ABOVE COVER: ELEV.IuNL T: ELEV.END: PIP . LINE: ('—'' AIR�LjET,FEET C 1 I NEAREST----- �J /� 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 S OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: DEPTH ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: N0.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: 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: j� ❑YES ❑NO ❑YES ❑NO NEAREST----1110' Sketch System on Retain in county file for audit. Reverse Side. A YRE,' TITLE: I. SBD-6710(R.06/88) (�' t Zoning Administrator SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY �o � � g STATE SANITARY PERMIT# // -Attach complete plans(to the county copy only)for the system,on paper not less than 10/i/M 8%X 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S,fiu $C %S %,S / T aQ, N, R (or)W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# Kta lbw GS )y/ CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 9%.e, r=a11S 1540112 IVA II. TYPE OF BUILDING: (Check one) ❑State Owned ❑ 172 ZQWWRF:VILLAGE 1� NEAREST ROAD�C C 84WX 7r ❑ Public 6!%l or 2 Fam.Dwelling-#of bedrooms PA EL NUMBE ( ) ` 05- 1111 ;25W/9. BUILDING USE: (If building type is public,check all that apply) ;25W/9 Oaa 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.KNew 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 X 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 13.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7.,FINAL GRADE REQUIRED(sq.ft.) PROPOSE�sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION )3Q jev jr 1 S Q 9 7 Feet t7 q Feet VIi. TANK CAPACITY Site in allons Total # Manufacturer's of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manu Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 3. Lift Pump Tank/Sf hon Chamber Vlll. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) M; 07 o.:=Business Phone Number: 1 lse Plumber's Address(Street,City,State,Zip Code): to 4.2 S Ma ty, 5 t �e •- ll s "s IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date issued Issuing Agent Signature(No S mps) Surcharge Fee) .Approved ❑ ownerGivenInitial & /�f�l�� L 4-10 Adverse Determination / ")' 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of where the system is to be installed. II. Type of building being served. Check only one and complete ##of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers;wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the 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 effectgroundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations-and establishment of standards. SBD-6398(R.11/88) I 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. Wner of Property \Xl. 1Z1cke�(Z �'[Z. f1�C (�r,� G•�f�l-�fid��- P 1 ocation of Property fV� JVk/!14, Section 24 N-R j W ownship N h(( El C-L ni<i ailing Address 'ft-t�lE[Z rl�c-c-5 . 1.7j S40-Ll- ddres s of Site _ SA via / l-1 W V 2 W y CIA4 ubdivision Name of Number MA revious Owner of Property ARNE -CAF-LE-lbtiL pip- A. Wk otal Size of Parcel l.I pry { ate Parcel was Created re all corners and lot lines identifiable? Yes No s this property being developed for resale (spec house) ? Yes ►✓ No olume �j--S$.... and Page Number 3401-107.as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: 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 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) eenti6y that att Statement6 on thi,6 6oim ane tkue to the but o6 my (ouA) now.te dge; that 1 (we) am (cute) the ownen(.a) 06 the pxopent de,seh,c.bed in th.i,a n oAm at.ion o�un N 6 6 by vchtue os a wama.nt deed neeond d y e in the 066 ice e o 6 the ounty RegiAten o6 Veed�s a3 Voeument No. and W ,�,n , n that I ( e) pheb en,tCy the pnoposed bite Son the sewage di.61p d a y.5 em (on I (we) have obtained e an azement, to nun with the above ducki.bed pnopehty, bon the eonstAuction o6 said ya te►n, and the came has been duty neconded .in .the 066.ice o6 the County Reg•i.aten o6 eeda, ae Document No. NA ) I IGNATURE OP OWNER SIGNATURE OF 0-OWNER (IF APPLICABLE) PATE SIGNED ' DATE SIGNED vurt e.iaim lueea. Dot. 5�1 ASS6 kornl l`Jo. 29-Nl .,...... ...... .. ..... ..�..-.... Individual to Joint Tenants Muvuuxa Uniform Gonvcy inch g Blank. (Revised 1974) jib 1r�ber�gure, grade this..................... ............day of..........D.ec.em er...................... 19.3.6...., between..�e...Carleton....Procter.....(before....her...marriage...Anne...Whittler...Q.ar!!Pton) and A. Wyman Procter Jr. , her husband, -of the County of.........F.4%j:field.................................and State of......................Connecticut................., parties. of the first part, and-Stuart...W_....Rider...Jr......and...Geoxgian,a....G.x....R.ider...... usband...and. ... . ..................................................................., of the Count of ....................Hennepin.......................and State of...................Minnaw ta................................1 parties of the second part, Wltneactli, That the said partie8. of the first part, in consideration of the sum of........................... ...F'orty...Thousand....and...no./..100......(.x.4 0..r.QD.Q...0.0)......-....-....-.....n....-....-....-....-.....-....-....-.....:DOLL.IRS, to.........�em............in hand paid by the said parties of the second part, the receipt whereof is hereby acknowl- edged, do............ hereby Grant, Bargain, Quitclaim, and Convey unto the said parties of the second part as joint tenants and not as tenants in common, their assigns,y the survivor of said parties, and the heirs and assigns of the survivor, Forever, all the tract.. comes of land lying and being in the County of .............Sts.....CrQi X................................a7sd State o cribed as follows, to-wit: All that part of the Northeast Quarter of the Northwest Quarter (NE1/4 NW1/4) of Section Twenty-one (21) , Township Twenty-eight (28) North, Range Eighteen (18) West, described as follows: Beginning at an iron pipe monument set on the northerly line of said tract at a point 442 feet east of the northwest corner thereof, and running thence south on a line parallel to and 442 feet east of the west line thereof 324.6 feet to an iron pipe monument; thence southwesterly by a deflection angle of 47 039 ' to the right 68.5 feet; thence southeasterly by a deflection angle of 63 039' to the left 184 feet to an iron pipe monument set on the northerly right-of-way line of the River Falls- Pleasant Valley Road; thence south on a line parallel to and 442 feet east of said west line, 36. 3 feet to the center line of said road; thence by a de- flection angle of 116 035' to the left along the center line of said road 93. 8 feet; thence southeasterly by a deflection angle of 98 042' 178 feet; thence northeasterly by a deflection angle of 81 07' 351.9 feet; thence northerly by a deflection angle of 750 to the left 180.6 feet, more or less, to the center line of said road; thence northeasterly along said center line of said (toad 77 feet; thence northerly along a straight line to an iron pipe monument set on the north line of said tract at a point 890 feet east of the northwest corner thereof; thence West along said north line 448 feet to the point of beginning. Containing 7.1 acres, more or less. Together with the right of ingress and egress to that certain cesspool and connecting line located south of the said River Falls-Pleasant Valley Road, for the purpose of repair and maintenance of said cesspool and its connecting line. All that part of the Northeast Quarter of the Northwest Quarter (NE1/4 NW1/4) of Section Twenty-one (21) , Township Twenty-eight (28) North, Range Eighteen (18) West, described as follows, to-wit: Beginning at a point on the north line of said Northeast Quarter of the Northwest Quarter (NE1/4 NW1/4) , 442 feet east of the northwest corner thereof and marked by an iron pipe monu- ment; thence south on a line parallel to and 442 feet east of the west line thereof, 324. 6 feet to an iron pipe monument, thence southwesterly by a de- flection angle of 47 039' to the right 68.5 feet to an iron pipe monument, thence northeasterly in a straight line to point of beginning, according to the United States Government Survey thereof. To Jabe anb to 3bolb tbC 16arne, Together with all the hereditaments and appurtenances there- unto belonging or in anywise appertaining to the said parties of the second part, their assigns, the sur- vivor of said parties, and the heirs and assigns of the survivor, Forever, the said parties of the second part taking as joint tenants and not as tenants in common. 2t Zeg;tirnoltp (jereof, The said part... E= of the first part ha. ... hereunto set......their hand....9 the day and year first above written. C.:4/... ........ .......���rQ.. .... ...... . ........ ...... U ...... . ! ........................................................................................................................ ��L � � ........................................................................................................................ COD C* eo Z VO, tZ M C4 4 0 0 o Ho 0 Vo, R El Cwt rl* too, c CS C) 14, IZ QrA ti T* ii (SSqjppv) 9"L...t-,ET .V a,.i i.d.x a....u.o.T.9.s T.w.ui.o.o.... (OLUeN) .....................................(XNV--a No H,11u) 031JVda SVM 1N3wndlSN1 SIHI ofit-4-om.................... (-LN3wqGalmoN)v)v 9NIXv.V.NOS)rg'd I HU IVN S) .................................. qo ...... ... ...... .... (uaf)aa-im ENixov do 3 N) 9 .................................. ............ .............. . ...... fiq v 9L 61 ..... ... ...... J49 fi'Dp ..................Sly?.za d'Ul diq.1,)q Pdgpdj(klO?jaj,')V RV.,n .....PTOTTITV'a... filu'nOO TS InDMOHNNOD cn a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x q OWNE /BUYER :5TU/A'IZ,'�_ 1.o &fV_L"1 "A C• ROUTE/BOX NUMBER t2!C77, TC QV *�540 Fire Number CI T Y/STATE CL���'� �/� LL-5 C�t.> Z I P SOZZ PROPERTY LOCATION : AW Section , T 2.16 _N , R-L&-W, Town , St . Croix County , Subdivision NA Lot number /VA Improper use and maintenance of your septic system could result in I its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , I if needed , by a licensed septic tank pumper. What you put into the system can affe—cn the function of the septic tank as a treat- ment stage in the waste disposal system. St . Crolx . 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 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x M the standards set forth , herein, as set by the Wisconsin Depart- ►a ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offkpe within 30 days of the three year expiration date . SIGN Z' D A'r E Aez -qtz� 7 /TSt . Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-22351 or 715-425-8363 Sign, date and return to above address . APARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS JDUSTRY, G DIVISION OMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (1463.09(1)& Chapter 145.045) OCATION: SECTION: TOWNSHIP MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: S F_ 1/4%0/4 I /T 28 N/R (or)W , N N A- N A OUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: ST, MIX SI a.rTd co n r RT 2 Nw GS IR(VE2 F, 4LS W I S 54o2Z 3E DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILEDESCRIPTIONS: RCOLATION TESTS: Residence NA I ®,New ❑Replace ATING:S=Site suitable for system U=Site unsuitable for system DNVENTIONAL: MOUND: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ZS ❑U EIS ®U ®S ❑U EIS ®U EIS ZUI 1 -7) FFA)Cd +x 33 Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the nder s.H63.09(5)(b),indicate: 1'Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS ORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH UMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) // " 0-3" Gy$1 mo.(s 2-48"LTBn m,&S 4$-36"RO..5L 70 q.7 NON� C10 0 56-?O f-S w�',7c rn00)4�'-L kr:f :.. o.TGO+' 0_4 y ) %,2 S 4-so"t'rBn n.. S SO- o R6„5 3 2 78 QJr, j N0h G 2 Go- 98 w1;;tt�S me1rlV 4s,-t ,- ,+ -- a-t42� +, r 0-9 c'"rQ ». s -482- n ",1S 48- /o0 2Dn5( r7 n J -75' w1; i4s v+no'd.,3%1 oil- fa +, 0 3" Gy a1 „„.d s 3- 4 Lra„ Yh s +B s 2a�5 9 '7 to q9.�6, oni - 51 W4,1-e -FS r // +� 0..t'' Gy (3/ rnd5 4"-50 "/-ra., yr.,al s 50-riq 26..51 3- fj l q .;�� N0Nr. C� Z S9-�$ w1ti�'Fr �s r�o171•�ia3►-�.r:�.a-atG2 3- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES IUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERT D 2 P R D PER INCH Z H OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ital 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 land slope. YSTEM ELEVATION , xE� ER�REE �15l _.' jai 3`— 1 I f k•�'IJ _ _� .. _�. _.. . -E. .�-._- 9_JT r2 .Jvt I I' � ea, 21 I .J.......... _.,. �_._ .. .... . . 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 iministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. >ME(print): TESTS WERE COMPLETED ON: r) ► Q 5- t5-89 )DRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): j 04 S ' aC,,) ST- �cr �s 5q0 2 3 / 115-4ZS -L)�S CST SIGNATURE: STRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. I'I LHR-SBD-6395 (R.02/82) —OVER— Plo7 VL4N Fo`� i STKART RkPrR 2 W wy 45 C-0 Rive, FALi 5 WAS Aver:��t� SVW4cTkC FABENc 54ozz --_ k�Nn��CkI(vN1e TCLVNS9,P 2. A sG RFGAr F 4'' PeRFaRAtF.D P�1'I' ' DtSIGHr� �� 1 (10-.( o ND2TV f76o Pa?, a( �L i oL gels ,f j oil A LTF iZ N AT E A �G �M SPIke (r� Ig�� �,ox �`LD6R tR�l- A s ma Cl. 100,00' P