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HomeMy WebLinkAbout040-1030-10-100 2 ¥ / \ / & _ / : , , \ � \ \ � � I , ( � \ } o \ 3 LL .0 7 0 n f 2 ƒ § � E z / a . § ). IL m % § 2 � j = t $ k 2 0 m _ _ / z E r : N & C CY j § ( ) -� § 3 / / Q zmz \ § j t = : § m ~ / ck % k f G § k ƒ ® 0 ) \ \ # \ \ k 2 K ° -� ' a 2 a z IL B « B 2 m u \ / / / � / \ g { � § c E , & 6 . \ £ e 9 a � © � » m Cl)\ j U) 2 . E . O \ ® ° � � @ ° . @ � E 6 \ \ 7 c / a ] ) / � £ � � * $ de . . / § ) \ / \ J 3 e 3 o z z ■ $ « � f2 L 4)" a IL \ § r k a § Q 3 a 2 j o w v , Parcel #: 040-1030-10-100 04/07/2005 03:22 PM PAGE 1 OF 1 Alt. Parcel#: 07.28.19.95A 040-TOWN OF TROY Current X ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): =Current Owner " BETTY J ENGLISH ENGLISH, BETTY J 393 RED BRICK RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description *393 RED BRICK RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 20.640 Plat: N/A-NOT AVAILABLE SEC 7 T28N R1 9W 20.640 AC PT NE NE LT 1 Block/Condo Bldg: CSM 8/2102 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1117/070 TI 07/23/1997 841/549 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 26320 477,700 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.640 75,500 376,900 452,400 NO UNDEVELOPED G5 15.000 26,300 0 26,300 NO Totals for 2004: General Property 20.640 101,800 376,900 478,700 Woodland 0.000 0 0 Totals for 2003: General Property 20.640 96,500 349,400 445,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 106 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • I Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C 4^,Pi 12 �1 )C� ^y TOWNSHIP (�',' ��, SEC. T aN-RW ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION N LOT �� LOT SIZE i PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i i i * J P �9- G 0 INyA w � V r INDICATE NORTH ARROW 1 BENCHMARK: Describe the vertical reference point used la" rP �-- Elevation of vertical reference point: IUV , Proposed slope at site: �T SEPTIC TANK: Manufacturer: �f P Liquid Capacity: 1010 CiAl l 1 Number of rings used: -D' - 1 Tank manhole cover elevation: Tank Inlet Elevation: 103, (01 Tank Outlet Elevation: 103 , j� Number of feet from nearest Road: Front 10 Side 0 Rear, O 5 S V feet From nearest property line ' Front,OSide,�Rear,O `off feet Number of feet from: well I IQ building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE ti 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 Ft. Number of feet from well: Number of feet from building: y (Include distances n plot plan). 144 /01.S3 5A I. t�,7 SOIL ABSORPTION SYSTEM �0�,y�j (bl. 0 4�c j / iol� Bed: V T en Width: ( � Lengt h: Number of Lines: �` Area Built: Fill depth to top of pipe: 3�DI 4a� Number of feet from nearest property line: Front, Side, O Rear,/V' Number of feet from well: � �V 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, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: I Alarm Manufacturer: Inspector: Dated: V t 3 1 t� / Plumber on job: License Number: 3 3/84:mj D�PARTMEMYT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABbR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 N NE 7 28 19W CONVENTIONAL E]ALTERNATIVE State Plan LD.Number: Town of Tr ❑Holding Tank ❑ In-Ground Pressure ❑Mound (,f assigned) Red Brick Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT, N DATE: Richard J. English Route 1, Box 61 C Taylor, TX 76574 ©„ ® 3 FN,C�MARK(Permanent reference point)DESCRIBE IF DIFFERENT FFROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEVrJ� r,-e� �i o Name of Plumber. MP/ No.. Coun Sanitary Permit Number: Richard Hopkins 1059 St. Croix. 119,512 SEPTIC TANK/HOLDING TANK: MANUF TURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER Q ] ROO�VIIDDED: PROVIDED v (�aha I b� I 103 AYES ONO DYES ONO BEDDING: VENT IA.. VENT MATL- HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH !1 ALARM. FEET FROM ,/]O LINE: I (0 LAIR INLET: ❑YES NO � L DYES NO NEAREST-----) �(pJ1 JI- DOSING CHAMBER: MANUFACTURER: [71 G. LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ES 0 N � I ❑YES ONO I OYES ONO GALLONS PER CYCLE: PU PA ONTROLS OPERATIONAL NIUMBER''OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) r OYES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the s&I moisture at the depth of lowin LENGTH D AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE E the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH,/`C� LENGTH. JNO�OF DISTR.P,PE.SPACING. COVER JINSIDE DIA.: #PITS: LIQUID BEP/TRENCH J/ TRNC� TERIAL: PIT DEPTH'i ]DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. I R NUMBER OF PROPER Y WELL: BUILDING: VENT TO FRESH BELOW PI S ABOVE COVERT ELEV.INLET ELEV.END PIP FEET FROM LINE/:- n AIR INLET �o'� ` 1. I� . 4 o2 7 �.� NEAREST /�P � 1 D Z5 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM 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 TEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER: EDGES. 1:1 YES 1:1 NO 1:1 YES ONO 1-1 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: Pt-01.*S[NC114 "'WIDTH LENGTH: TRENCHES: LATERAL SPACING:JGRAVft DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. DIM EPSIONS. MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. JNO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV: ELEV.. DIA,. ELEV. PIPES: DIA.: IsLEVATtON AND IRIS#I HOLE SIZE HOLE SPACING. DRILLED CORRECT LY. COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED NFC�ft1ATION PLANS: El YES ONO I ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF" PROPERTY WELL: BUILDING: F ET"F9 LINE: ❑YES 1:1 NO ❑YES ❑NO NEAREST . Le ko� r' 1 � I Sketch System on Retain in county file for audit. Reverse Side. S TITLE: DILHR SBD 6710(R.01/82) CMYV�� OIVL"G ADML:`ZIST�tATIO:`I L — ` SANITARY PERMIT APPLICATION w In accord with ILHR 83.05,Wis.Adm.Code COUNTYL � DILHR STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than ❑ � — 8%x 11 inches in size. ch if'rev�ision to previous application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PRO ERTY WNER PROPERTY LOCATION �-7 1G�la %M Y., S / T3& N, R 17 E(Or) PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# „ R. Q C N CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER + LIA CITY NE EST ROAD II. TYPE OF BUILDING: (Check one) 1:1 State Owned ❑ VILLAGE ❑ Public �1 or 2 Fam.Dwelling—#of bedrooms a- PAR TAX. UM R( to 46/ /jg�� _/j lQ/� 111. BUILDING USE: (if building type is public,check all that apply) ! ' �f `C/p�Cr"'� v 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. N 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 El Mound 30 El SpecifyType 41 El HoldingTank 12 M 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 30 < '0O-'s Feet O Feet VII. TANK CAPACITY -- —- Site in allons Total #of Prefab. Fiber- Expp. INFORMATION New istin Gallons Tanks Manufacturer's Name Con re Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 0 6 o--p Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plu is Si nature:(No tamps) MP/MPRSW No.: Business Phone Number: R�I �hFRd Ns 9 1 ( 7/s -ga�o Plumber's Address( treat,CIV,State,Zip Co dg): l,. e W i S — d) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuiinn/g/1 Ageent,Signatur/e//No Stamps) pP "'f 7✓'SO�rge Fee) - � `o`rK"L Approved ❑ Owner Given Initial Adverse Determin ti n 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 s 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. Ill. 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. Abs rption system information. Provide all information requested in ##1-7. VII. Tan( information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tans 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. Vlll. Res 3onsibility 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 plar s must include the following: A) plot plan, drawn to scale or with complete dimensions, location of hoic ing 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) c mplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump pert rmance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these,surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) AI1111ACATION I (W SANITARY PERMIT a as S 11' C - 100 This application form an 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 duvelppoent' 'be int•;:nded for,resale by owner/contractor, ("sped' house") , then a second rorm sho"Id bu rutn l.iiad and completed when the property is sold and submitted cu L:hin afficcs with Lho appropriate deed recording. Owner of Proper Pro P �r Z°_/�/9�2i i✓ �iS 'y i �p' Location of Property _ ii;,. Sec:tion `, T �_ N - R W + Will Township r Ufa Mailing Address �`� QX lo/ G +4tM 't'" Subdivision Name _ Lot Number Previous Owner of Property MX—S bG j Est f Total She of Parcel tas}i+ . Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes �_ No Volume 1 l and Page Number -y�� as recorded with the Register of Deeds R',k °t,^'f; INCLUDE WITH THIS APPI..ICA'I'IUN ONE OF THE FOLLOWING: 2. Land Contract 3. Other recordingd filed with the Register of Deeds Office 4-e.�11 In addition, a certIf ,ad a"rvmy, IF = l I blu, would be helpful so as to avoid delays 'i`- +, ;!' of the reviewing procuHn. If thn f ued dvorripUJon references to a Certified Survey , ,`�V �14; Map, thus the Curti f l od 110runy Nnp nb i l l n I n" h" ruquir.ed. ,;rt + '+,`.;r•' OAK 1.. 'i:+ ` ►'I't11'( I�� 1' t4�111( i; Cl hfIFTCATION oil NNY a s` Eli I (We) cakti.6y that of etct.temc'It.aA on llt.c.�: 6v�trtl-ane Me to the best 06 my (out ) . ,�R111A; �.' knowledge; that I (use ) run ((utt�,) .the. OW"VA (s ) 06 the p�topeh/y des chi.bed in this ; '",l; in6onmMon l6ohm, by u.Mue. 06 d t0a)(Aali- / (Iced accoaded in the 066.tce o6 We County Regiztea o6 Veal~ al gnclamenf: No, and that I (we) w0 7 paesentty ours the p!topoS d h't.f.e. 6o; lhv si_ri�t�c je rlcsposa jbtem (on l (wel ; 4� obta.,i.ned an easement, f.n hen wi.tlt •thd above des c hlbed pnonen ty; 6ol the n x consttaucti.ox o6 Wit ,,ptem, and the some llcaa been Wt Moaded in the 066ice :`. .tie COUP t . t 06 'Dee1115 as Lh . anent No. ) . f , ' k,. SIGNA'I' iF OLJNE( SIGNA'T'URE Or C07OWNER (IF APPLICABLE) DATE SIGNED DA'T'E SIGNED $Vc: 01 L Vh t;_t) .. DOCUMENT NO. I p �.y WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA U�� ! i�STATE BAR OF WISCONSIN FORM 2-1882 ;I --- REGISTER'S OFFICE SL CROIX CO.,Wl I' Recd for Record .............James.-I--..Wa druf.f___and._Mar_garet;_.Sr...WQQ�rt f, . . . ..._. Husband_and..Wife,.__holding__as__aurvivarahig..marital............. at MAY 2 6 1989 pro.p.e.rty............... ••-•....:••••---••--••••••••-•-•••-••.._......._..... `M conveys and warrants to _..Richard J. English and Betty. ............ :,1• �� Engli .,w_ survivorship_____ - ReglslerofDeeds" I' ._max.it.a7.__p r.o_pe.xt.Y__...---•------..._-••--•--..._....__. � ;� I , •-•-•__-_ RETURN TO .... .... ..........._.___._________._ . ...................................................................... — ..-_.. the following described real estate in ..........S.t....jCxojx . ...................County State of Wisconsin: • Tax Parcel No: ................. ------------ A parcel of land located in part of the Northeast Quarter of the Northeast Quarter (NE 1/4 of the NE 1/4) of Section Seven (7) , Township Twenty-Eight (28) North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin, described as Lot One (1) of Certified Survey Map as recorded in the St. Croix County Register of Deeds Office as Volume 8, page 2102, as document number 448086. l i` NS i; F� , tea• I, PEE II This i� not -•-•• homestead property. I� (is) (is not) Exception to warranties: easements, restrictions, and rights-of-way of record, if any ; 1 7 ;. Dated this 5.......................................... day of ._ x......._..................._, 19......... -----------•-----•-•---•--------•__________________________(SEAL) ._ _.._. . ...... (SEAL) ................. Jame.. T. f •-Wu �! .............(SEAL) Q: (SEAL) I; * * ........Margaret__S__.Woodruff._._... ii .....•..............•-•-----•------•-••-----•----••-•---•- ..._.. i r. AUTHENTICATION ACKNOWLEDGMENT ! o Signature(s) f James T. Woodruff and I -•--•-•-•--_........•-------- STATE OF WISCONSIN I r aret_ S_,Wr ood uff ss. L ......................................County. au he t' a ed this $...day of_ MaY___ __________ 19.a9._ Personally came before me this ................day of i •--• -- •- •• ------. ---•............ .....•••--_..... __------•------ •--------••- 19-------- the above named •..............................•-----------•----.._..------••----•---••---•••... *........Jec__A..__Jes ax-------------------------- ------ TITLE: MEMBER STATE BAR OF WISCONSIN ..............•----•--.-----....---...-••--•..._.__....._______________.._..._.. (If not, ------------------------------•--------•-----•------------.......•-••...•••••-•. I I I� authorized by § 706.06, Wis. Stats.) •--•-----------•----------------•----......._.....----.._..._..............._.. to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. �! THIS INSTRUMENT WAS DRAFTED BY LeoA. Beskar, Attorney ------•-----•---•---------------------•---..___....---••-•._...•••-•••-••-•••••• i! KodTi Beskar--VBoIes;-•S-:C.:•---"•••-••__-_-• ----------River..Ealls,...WL..S4022............................. •.........................•--------•---•....---.._.._......_...._.._....__.._ Notary Public ----•---•------•--•----••-• ----•-County, Wis. II (Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration I' are not necessary.) , date: ......................................................... 19......... ) it j •Names of Persons signing,in any capacity should be typed or printed-below their signatures. I! F4 C rrlra► STATrORM No. 2 WISCONSIN FORM Stock No. 13002 L t' Ln H -S T C - 105 a> , ' r Y SE1'1'IC TANK . TL AGItl?I MLN'1',: rH, St ._ Croix, County ' v 'OWNER/BU Y S[t � 9�2.✓� iv ,�/' H p: rrn ROUTE/BOX NUMBER h _5 d. Fire Nu CITY/STAT'E_�/9 �LU'� . LIf YROP.L'RTY LOCATION : . '� � k e, a > Sectiun l 4 'Town of St . Croix County -7 Subdivision Lot -number Improper use °and, nfaintenance• of your suptic `systein could re8Li in its premature failure . to handle wastes . proper maintenance c'un �' silts of pumping ;o:ut the septic. tank every , three years or soot}e'r ' if needed by a li`ce'nsed si jtic tank. �uul,er:: 'What yvu put ln'co; � the sy;;tem can affect the .function of Gllu SO-htic tcnk a5,s.i treat ule-lit stage in tl'Ie,waste dlsh.-)sal system . • S 7t H` .f,. tr 4 J . St Croix; County ri,sidents4 ;!!igY e eligible to Tec.clVe a ,bran or' yf f a maximum`V,of '60/ of theitcos°tw of replaceuiEntol£� a!: fal'lin�; y5teln;' ** i . which' was `inz.operat`ion rpr�ic%r to> Julys 1 , .Lc)7>3 �fi� ySt . l'ro1x ;Goun,t °} , opted this grog"ramiY` Au°Lust`; of�1 380,,, wltlli the rc,z iw : , ` ' ; julre�nc nttha owners of all 'newt systemsa �ree to keep 'thuii� sys`tems } pro'perly 4 La 1 11 e 1'Ii,e pr.opc rty, owner ; agrees t:ci submit to St .. .Crolx County :lonln'b a .. certification ' form signed;y�y the owner "ancib,y a' master : plumber , journeyman plumber , re`stric.t4d :plumber oI a ,aicen5ed ^'punlNer ;veri fyirig;! that -, (1) the., on site wu"stewater disposal ".systeui 1$ inY prupe�r t operating ;cbnd1tion�and' (2)' after ins ec'tion ` aild' P _ pulnp.lnb {lf .nec essary) , the septic Can`k ls- less than 1/3 fu11: of sludge.`and scum Certification furm;`will be scnt, approxiliiately � 30� d a y s- prior'toy ` three year expiration . 5 �"r t > I/WE , the undersigned ,- -have ': read the above requirements a.nd -agree ,czn to maintain the pri vate sewage disposal system in accordance with`' _: x t'he• standards set forth, herein, as `set . b 1 Wisconsln 'Depart z ;.•d went of Natural Resources Certificati fo must be mpleGed 'r and returlied ,.to the St Croix -Count L 1 Off: `e wi 1 3 days ` ar y of the three year expiratjon date ✓ � � 'SIGN- - D AIT St : Ctloix C.aunty Zoning Office P.. O. Uox 98 Hammond , .WI' 54015 715-7S:6-2239 or 715-425-8363 Sign , date and return to above:, address.r ... - yutn^,e}tC i-1 • _*_. + :yL — 'i'�J z.<d.� tfk. F �`Y$f'"+�:3.. .� r 6 7 P L_ OT A N 1 c ' 1 \' O S S (= C:; _l: l0 1\I _ _. _ NAME 'i c. � r° J ry n ME (A L O c AT ( o N! 1z _KOA r L I c E N s E =ff. !os.2_._..- _..__.. .... .. ... n,T E P L 0 I- k.d AT gn1 FL e-Iva,U' 3 v=BM 'la" S flee 1 Pow 'IN JR.) N-M 4.0 steel rvi q Rk ITN, t'l'iJGp QoRDFR)N� �6D-S (ppW ® N£ dot C.o!ti-AQ sj'ee i Pr I (n0�' iN Gad WS 0- &Z,� k10 S► IQ s x= pricc W., _51te s 65 By d► 56' 18k353c B� So' 2 S _ r S 1' ► aoa' cr IV�Q: 1-�c��F7�crP- F Ions w GJe Il s AQ � No�'-t: IN�II '� s ��nTic►z TLrq, 79 FRESH All! INITA:.CS�AND OBSERVA'TIOU PIVE CI:QSS SECTION Approved Vent Cap Minimum 12" Above INA I PCRO�_ "Final Grride-r--` -- 104 K 4" Cast Iron Above Pipe Vent Pipe To final Grade:----- Marsh [lay Or Synthetic Covering Min. 2" Aggrcyl t( o _ Over Pipe DistribuL-i Tee Pipe Aggregate Perforated Pipe Below 3eneath Pipe Coupling Terminating At IOU S ►3o��y� (}� Bottom of System t CERTIFIED SURVEY MAP Located in part of the NE} of the NE} of Section 7, T28N, R19W, LEGEND 9 St. Croix County Section Corner Monument- Aluminum Cap O 1" x 24" iron pipc weighing 1.66 pound3 per linear foot, sct. NT existing fenceline I I i Ni corner 1282 NE corner ------ ----- ' Section 7-28-19 CSM v. :-p_ Section 7-28-19 i 1 north line of the NET— - WEST 2653.741 750.00' 350.27' N89 653122"W 750.00' N p F - C ' s F A .o N LOT 1 I� I N t d to C M_ _ I fi Ito 2 1�, 7 Q_ O I N 9 r,o o- 7 899,175 sq. ft. ) ,0 0 o t' to INCLUDING ROAD R/W o o 1 '^ 20.64 acres ) I O I to to rt N is �ic 871,637 sq. ft. )EXCLUDING ROAD R/W i z '0 20.01 acres ) m m 1 Cr NJ I ' A co I N N O in Ito w t9 7 q, ti SCALE IN FEET w - 200 100 0 200 EAST 916.06' unplatted lands owned by platter � y ^`�,'�� OWNERS -------------------------------- w AI C. K, James E Margaret Woodruff hY14A r, 477 C.T.H. F A . Hudson, Wi. 54016 ; Imso SL This instrument was drafted by Douglas Zahler job no. 89-06 te�Qi'S`hc3+ D EJVT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN.Dj1ST DVSTR Rl4, •- DIVISION LABO'R AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (H63.09(1)&Chapter 145.045) LOCATION: SECTION: OWNSHIP/ Y: LOT O.:BLK. SUBDIVI N NAME: !� '/a �'/a /T��N/R�'[1(or COULNT/Y: O NER'S(BUYER''S�NA MAIILLIING ADDRESS: 7— aox Q USE DATES OBSER TIONS MADE 11cc �� NO�EDRMS.:1COMMERCIAL DESCRIPTION: PR TONS: ATI TESTS: &INesidence ✓1� 'New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL:� ❑� M��.a� IN-GROUND-PR�ESSUR : SY5❑TEM-I -FILLHO�LDING TANK:RECOMMENDED SYSTEM:Joptional) Ib�,(J7 S U S S 4 � If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: ` Floodplain,indicate Floodplain elevation: /(' PROFILE DESCRIPTIONS rB TOTAL/ DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,AND DEPTH DEPTH W. ELEVATION OBSERVED IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / , . � B✓,,•7S�s;� , /'>�y s �r�-, 3:sY" .,s, 3� yes �' S.. �, �s �i�l T � B 9,171 , i \.'7C� J ����° 9r7�'95'r ,r �,���i,�J�.—, 3�s8 fJ,n3 B 5 ,�� / / B- PERCOLATION TESTS TEST DEPT ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING -INTERVAL-MIN. PERIOD t PERIOD 2 PER INCH P_ ; 16..1/ C e 3 P- l � G <3 P- r Z L! 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 ELEVATION J CD 8 IN ai i y Li sr k ! .. t i e I i I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded ana the location of the tests are correct to the best of my knowledge and belief. NAME(pr t): TESTS WERE O PLETED ON: ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optional): CST SIGN U DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER —