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Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER d/ = TOWNSHIP i SEC. N-RJW
ADDRESS CROIX COUNTY, WISCONSIN
s moo/7
SUBDIVISION ,/1,4, LOT "/Z", LOT SIZE A 1/0-
Ir
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1 9 5�
a �Q,
/z INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: / Proposed slope at site:
f
SEPTIC TANK: Manufacturer: '�� Liquid Capacity:
Number of rings used:
g Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,0 Side
/17\ Rear, O /�7 feet
From nearest property line Front,0 Side, Rear,O _jvi/ feet
Number of feet from: well J D�'J
building: _
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
fik SFF R_F.VERSF. STnR
I
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,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench: lot
Width: �a � Length: � Number of Lines:_ �. Area Built:�
ii
Fill depth to top of pipe:
O
Number of feet from nearest property line: Front, ®Side, O Rear,O Ft .
Number of feet from well:
Number of feet from building:
(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 O 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, O Rear, O Ft.
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
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HAJMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
State Plan I.D.Number:
NA,-, :S12,T30N-R18W 129KCONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Richwnd ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
O T ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
David Naser Route 1 New Richnond VTI 54017
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 119453
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES [j NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
ED YES El NO ❑YES ❑NO NEAREST- 10
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO I I ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: I BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF [--]YES ❑NO NEAREST---00-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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:
BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: MATERIAL: PIT DEPTH:
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 TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
[--]YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED PTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES: DE
❑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 I 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 I ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM
❑YES ❑NO [--]YES ❑NO NEAREST
Sketch System on
Retain in county file for audit.
Reverse Side. SIGNATURE: TITLE:
SBD-6710(R.06/88) Zoning Administrator
—�°°-� SANITARY PERMIT APPLICATION
HR In accord with ILHR 83.05,Wis.Adm.Code couNTV `
l�.e.,�..� S
STATE SANITAR PER IT
-Attach complete plans(to the county copy only)for the system,on paper not less than �A�
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 PR PERTY LOCATION
IZ din '/a %,S T Q, N, R
PROP TY OWNER'S MAILING ADDRESS LOT# BLOCK#
Cl ,STATE ZIP COD PHONE NUMBER SUBDIVISIO N E OR CSM NUMBER
11. TYPE OF BUILDING: (Check one) CITY NE ES T
❑State Owned ❑VILLAGE
❑ Public X 1 or 2 Fam.Dwelling-#of bedrooms 3 PARCEL TAX N NUMBER(S) _ a3-1 _ 'U-QO
III. BUILDING USE: (If building type is public,check all that apply) /,;l, 3o / a
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 Wa h
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 JZ Other: Specify A If
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 El Specify Type 41 [:1 Holding Tank
12 In 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
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION
Feet 97,Ope Feet
VII. TANK CAPACITY Site
in as llons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdina Tank
Lift Pump Tank/Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the site jewage.system shown on the attached plans.
Plu er's ame(Pri Plum s Signature: o S m MP/MPRSW No.: Business Phone Number:
��
Plum is Address(Stree City,State, ip Code):1X_Jt) �I)
I COUNTY/DE RTMEN SE ONLY
Disapproved Sanitary Permit Fee(includes Groundwater Date sued Issuing Agent Signature(No Sta ps)
Surcharge Fee)
,Approved ❑ Owner Given initial
Adverse dl fy S,a6 -g
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber
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'f 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 caNeffect 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
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
esuence. 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.
er of Property
Location of Property _410 k /lj f,(��k, Section l Z , T 5'o N-R W
Township __ M o n .
Hailing Address
Address of Site S�
Subdivision Name
Lot Number
Previous Owner of Property
Total Slue of Parcel $ j.
Date Parcel was Created ,,,
Are all corners and lot lines identifiable? \ Yes No
Is this property being developed for resale (spec house) 7 _ Yes _x No
Volume and -L_
� � Page� 8 Number r' 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 (too) Cokt16y that a.CC Ata.teme.ntz on tl ohm ane tAue to .the beAt o6 my (ouh)
hncwtedge; that 1 (we) am (cute) .the owneAk i 06 the phopehty deAcAi.bed in th,i,.e
i"AaAmation 6o4m, by viAtue o6 a waAAantWiry ee ded in the 06 ice 06 the
Coi►nt RegiAtett 06 Deeds ass Document No. and that i (We) phebentty
c,vn tie prtopoa ed a i,te bon .tile �s ewage d its e em (o,% i (we) have obtained an
eaAemen.t, to nun with the above deAcAibed ptopehty, Gott the COn6thuction o6 aaid
system, and the ewne ha.e been duty Aeeohded in the 066.iee o6 the County Reg•i,ateh o6
flee ab Ooc vnent No. ) ,
IGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
_Y 2-
a,_4
S
DATE SIGNED DATE SIGNED
ou_u+iL,�, iiu.
1 �
31.4434
BY THIS DEED, Gerhard M. Keilen and Mary Alice Keilen,
hushand and wife, and Gary Naser and Nancy Naser, husband Read fa
and wife Jar,
day�-------
T Pr and Ard l l da_ Naser at 8 :30 A.
Grantor conveys and warrants to �aU].Ci Z �aS e , -- ---
busband and wife,
Register of De.
Grantee S_
for a valuable consideration of One Dollar (81.00) and other IT""
T
valuable consideration • P. OReinstra
St. Croix 127 •W. 2nd St.
the following described real estate in County,State of Wisconsin: New Richmond, Wis. 54017
Tax Key #
This is homestead property.
A parcel of land in the Northwest Quarter of the Northwest Quarter of Section 12,
Township 30 North, Range 18 West, St. Croix County, Wisconsin,- described as follows:
Beginning in the center of a Town Road at the Southwest corner of the Northwest
Quarter of the Northwest Quarter; thence East• 208.8 feet; thence North 1,044 feet;
thence West 208.8 feet; thence South 1,044 feet along the center of the Town Road
except an easement over the present driveway from the Town Road East for ingress
and egress to the outbuildings located in the Northwest Quarter of the' Northwest
Quarter of said Section 12.
This deed is made pursuant to a land contract between Gerhard M. Keilen and Mary Alice
Keilen whereby they were the grantors of the above described property and other
property to Gary Naser and Nancy Naser. Said contract was dated March 25, 1970, and
recorded in Volume 460, Pages 124 and 125, and Gary Naser and Nancy Naser join in
this deed to release their�eq�uiity in the above property which was acquired by the land
Con &;Jib. to warranties: Tj'�'�J ij'•SFER
S�
FEE
Executed at New Richmond, Wisconsin this day of January 1913_.
SIGNED AND SEALED IN PRESENCE OF �y �!�u"�'"�� (SEAL)
Gerhard M Keilen
.Gf SOP,! c.�pirf_ (SEAL)
Alice Keilen
(SEAL)
Gary ser
I
n (SEAL)
Nancy Na r
Signatures of Gerhard M. Keilen, Mary Alice Keilen, Gary Naser and Nancy Naser
authenticated this day of 9
Wm. W. Ward
Title: Member State Bar of Wisconsin
2tvt�nmt�sexl 3ml�C,�.p�f,���'�7�L7Sx
STATE OF WISCONSIN l
j
County. JJ as.
Personally came before me, this day of 19_,
the above named
to me known to be the person_ who executed the foregoing instrument and acknowledged the same.
This instrument was drafted by
Notary Public County, Wis.
The use of witnesses is optional. My Commission(Expires)(Is)
ow 494 rV';E105
es of persons signing in any capacity should be typed or printed below their signatures.
N.GM+IISrCampenr�
,RRANTY DEED—STATE BAR OF WISCONSIN, FORM NO. T — 1971
PF
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STC - 105 a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
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OWNER/BUYER I �►�p�1 I�gSe r M
ROUTE/BOX NUMBER fl Fire Number
CITY/STATE /y,.1� i\ �G �i c� �-�r ` zip _S y Q/ 7
PROPERTY LOCATION: , Z, Section, T 30 N , R /d W,
Town of /I " St . Croix County ,
Subdivision /V , 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 , I
if needed , by a licensed septic tank pumrer . 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 . Ho
E
I/WE, the undersigned , have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with H
the standards set forth , herein , as set by the Wisconsin Depart- 'v
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 q- -2� `— f7
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 .
MDUS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
PNDUST•RY, _ R It DIVISION
LABOR AND O PERCOLATION TESTS (115 P.O. BOX 7969
)
HUMAN RELATIONS 1 / MADISON,WI 53707
(H63.09(1)&Chapter 145.045)
LOCATI '/ SECTION: u/e� �(o TOWNSHI UNICIPALITY: LOT N .:BLK. SUBDIVI ON NAME:
CO NTY• 0 WNE 'S BUYER'S N ME: IL G ADDRESS:
Al
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMER I L DESCRIPTION: PROF E DESCRIPTIONS:IPERCO�ATION TESTS:
Residence ❑New Replace
1
RATING:S=Site suitable for system U=Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRESS URE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM*(o tional)
ZS ❑U ®S ❑U EIS 3U 1 DS ZU DS ®U
If Percolation Tests are NOT require DESIGN RATE:
y portion of the tested area is in the
under s.H63.09(5)(b),indicate: F indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTA ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WI H THICKNESS,CO R,TEXTURE,AND DEPTH
NUMBER.DEPTH 9j. OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- p
B-
B- ? / /
B- f
B-
B- s -
r- PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERI t PERIO 2 P PER INCH
P-
P
P-
P"-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
E
--
E
E
i
Z E
a l ;
E
E 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 rint): TESTS WERE COMPLETED ON:
1
AD DR CERTIF CA ON _"01
PHONE NJUM ER(optional):
101L&AJA jy_ IA:J� �" f
CST SI A URE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. i
D I LH R-SB D-6395 (R.02/82) —OVER-
INSTRUCTIONS FOR COMPLETING FORM 115- SB - 5395
To be a complete and accurate soil test,your report. must include:
1. Complete legal description,.,."
2. The us "Sect€ori must clearly indicate whether this is a residence or commercial project;
1 MAXIMUM number of bedrooms or commercial use planned;
4. Is tPais a new or replacernent 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 to scale is preferrec9. A
separate sheet may be used if desired;
�I S. Make sure your benchmark and vePtical elevation reference point are clearly shown,and are per-mane I
9. Complete all appropriate boxes as to dates,names,addresses, Hood plain data, percolation test:exemp-
tion,if appropriate;
10. If the inforrnati<on (such as flood plain,elevation)dots not apply, place N.A. in the appropriate box;
11. Sigfj the form aut] place your current address and your certifiCatior} number;
12. Make IegiNe copies and distribute as required. ALL. SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10") FfF — Bedrock
cob - Coh1)!c {3- 10"} SS __ Sandstone
Caravel (under 3") LS — Lianestone
's Sami HCjW - C-licfh GrL>undvvatcr
('s c oause sand perc P:recolation Rat-
= r i s — kAledium Sand 01 - "A" I
L=osPny Sand > f� 'cater
sI Sandy Loam D,ss Than
L_f ,ii ,;t F,
°ii __ `iii{ Loam B! _. Billc;k
si - :'silt t1y
C;loiv Lnarso
l - xfy Clay Loarn R - Red
sie_I _ r;,,ty Clay Loam mcO Mv4tL?u5
— &;;a:.ly (-'!ay vv ._ v,-t}t
p7$. - tat P inn Mjny, e ;i `..-urns
(f Stnnct
-- t)ro(Y1WI(?sl%
Six gc cor=ral soil textwes surfacz vvater
fr„ IS€q€uA ,v ,t<:disposal BIVI f I;
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PAGE OF
Cr� SS `L � 1 O T 4JC1� SYSIC'n �
,/► / Fresh Air Inlets And Observation Pipe
5�1 r J
r/ ( Approved Vent Cap
Minimum 12"Above
,Ili ��77 Final Grade
20-42"Above Pipe _4"Cost Iron
To Final Grade Vent Pipe
Marsh Hay Or SyqAggregol g
Mite
O
Distribution
Pipe —' 0 —Teo
Bo Perforated Pipe Below
B
o _Coupling Term inating At
Bottom Of System
I
G
Prp�U5e1Dr[(��tns_� Cfre,clt
SOIL FILL
DISTRI13U'TI0" PIPE
APPROVED SI►IITHETIC COVER �
OR 9" OF STRAW
rof 1\66RE6AlE -�� OR MARSH HAy
(a OF%2 -2t/2 AGGREGATE
ESE V. OF��EET—...
DIS'rRIP_tJTIDIJ PIPE TU BE AT LEAST INCHES BELOW ORIGIIJAL GRADE
AtJU AT LEAST ZO INCHES BUT KIO MORE THAtJ L12 IIJCHES BELOW FWAL GP.AOE
MAXIMUM DEPTH OF F-XCAVAT100 FKOM 0KI&INAL f tla WILL BE INCHES
PUNIMUM gr-Mi OF MAVATION fPOMr! 01t14,114qL GRAPE WILL BE INCHES
SIGHED:
LICEUSE DUMBER:
DATE : �' r / �.
110
Parcel #: 026-1037-80-000 01/24/2007 08:28 AM
r
PAGE 1 OF 1
Alt.Parcel#: 12.30.18.173A 026-TOWN OF RICHMOND
Current X ST.CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
O-NASER, DAVID L&ARDELL F
DAVID L&ARDELL F NASER
1659 140TH ST
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description ` 1659 140TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 13.270 Plat: 3772-CSM 14/3772
SEC 12 T30N R18W PT SW NW BEING CSM Block/Condo Bldg: LOT 1
14/3772 LOT 1 13.270AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
12-30N-18W NW SW
Notes: Parcel History:
Date Doc# Vol/Page Type
04/16/2001 642893 1618/581 QC
12/11/2000 635053 1566/181 QC
06/03/1999 604258 1431/171 WD
06/03/1999 604257 1431/169 WD
M0re...
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
176863 228,200
Valuations: Last Changed: 04/22/2003
Description Class Acres Land Improve Total State Reason
OTHER G7 13.270 59,900 118,000 177,900 NO
Totals for 2006:
General Property 13.270 59,900 118,000 177,900
Woodland 0.000 0 0
Totals for 2005:
General Property 13.270 59,900 118,000 177,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch M 516
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
. ,�•.....✓ D � C°J � Qom"`''*-- �,
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sr.�
CERTIFIED SURVE� R P
Located in part of the Northwest Quarter of the Northwest Quarter and part of the Southwes Quarter
of the Northwest Quarter of Section 12, Township 30 North, Range 18 West, Town of Richmond,
St. Croix County, Wisconsin.
Prepared for and at the request of:
OWNER:
David Naser
1659 140th Street
New Richmond, WI 54017 F'L�D $ APPROVED
Drafted by. Ty R. Dodge ST.CROIX COUNTY
F DEC 2 2 1999 b y Planning Zoning and Parks Committed
NORTHWEST CORNER
—SECTION 12-30-18 Regis ErofDeeds H DEC W-1 1999
(ALUM. CO. MON.) Z, Sc Croix Co.,WI
ao� If not recorded within days of
/ I o,I �' i approval date approval shall be
�( F� _, null and void
I I IL
aI
' I ' UNPLATTED LANDS OF OWNER
— —— — — — —— WI
U.1 �l
Lal
i °I
0
o ° 5' 1
n N8943'17" .
v_I
0i i 896.35' O�I
01 I D; I I-=>33.00' 1 �� QI
JI SHED 000 Q
09 r _
wi I I I BARN o LLJI
C! z QI
I ao J
ai ,, W �. 8 L O T sHED ° W z
ZI N Z I j 0 O :t �I
�l I I 1 io TOTAL AREA: o
I y Ia6 1�a, 578,030 SQ. FT./13.27 ACRES 1
N 1 N AREA EXC. R-O-W: 0 I Ir
.
.,
553989 SQ. FT/12.72 ACRES
J I rn �
�168TH-AVENUE!d SDU7H LINE OF ME NW 114 OF NE NW 1/4_x_ u —� _
- 1- _1! ^ -NOR1N LINE OF 7N£ S 1 4 O 1H£N 1/4
—— —W--l�� 0 _ MEADER u�_�gp6.5'2 -
_ S 6'5 K RE
.r 0'3 C
P 1IZ poi. ' __T�-N ORE R PAPERJg400o4 g"W
I vl' GE S82'14'2
°o i I I I EEK APP 138.78
o� �I I CR` 5�3
�i �I i �i �-/ PApER__
CLI QI 0 I
' S83'41'58"W 375.74! I _ UNPLATTED LANDS
�I I -N89'31 44 W
33.01 I o`°
�
j �I I I of UNPLATTED LANDS N
Ui; J I 4:4 #'
r'I WEST QUARTER CORNER *► R/N LD F. '
SECTION 12-30-18 JOHNSON NO TH
(ALUM. CO. MON.) r:-11e(3
�\ AM-my
LEGEND
WIS.
0 County Section Corner Monument �y 40
• of Record 1" x 24" Iron P g g
i a wei hin e*� NO•SU R`��,,��R�
a minimum of 1.13 Pipe
sper
linear foot.
O Found 1" Iron Pipe NOTE: The parcel shown on this map is subject to State, County and
• •••• ' Building Setback Line Township lows, rules and regulations (i.e. wetlands, minimum lot size, access
�100' from R-O-W) to parcel, etc.). Before purchasing or developing any parcel, contact the St.
75' from shore) Croix County Zoning Office and the appropriate Town Board for advice.
JOB #99120 (Sta. 2) 200 1 200 O
Prepared by. L;-. '
A & E GRAPHIC SCALE
SCALE IN FEET: 1 inch = 200 feet
LAND SURVEYING & CIVIL ENGINEERING '
Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE WEST LINE OF THE
109 East Third Street, P.O. Box 325 NW 1/4 OF SECTION 12, TOWNSHIP 30 N., RANGE 18 W. ass
New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S00'47'04"E.
Sheet 1 of 2
Vol.14 Page 3772