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HomeMy WebLinkAbout040-1119-40-110 \ y � § 140 j _ / § n ) a � ) c0XLo 2 oc- 0. A %gE\ 21 k /k\k \ % E0 j o ID CD �� �§ 5E / �kk22§fA $ \N (on-aE $ #� jcCO C �} k2\ ) m7E\§¥ Ea§ ) CLCrDC -2 E24= 4/cm \ 8$=f - EN ■ t \E ) E/« §\ Je/ 38a22# co « I % ƒ z \ ( z Q § $ � a ■ � q k B 2 / « « ® § n g $ f E f ) [ j k Q) § Or / o k _ Z j � \ _ ƒ CL am 2 k I, 00 4 4 Q a \t E 9 % o a = 5 0 z > ® k I � 2 2 2 \'00,4 oBl / = = m u u \ / § � � / a a t & LL ) — 2 \ a ; 2 $ © CD ' ° § o o CD / E ° 0 § § 7 § § § $ q . ) z ) 2 / - 6 q [ G E $ £ a 5 -� 0 e Q \ z _ e ■ m « � m k } EL . 2 L 0 % c E e c r , c v m , A k v , Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER v ;i C - TOWNSHIP Ty c - SEC. �_ T 2 N-R ,0 W ADDRESS e.'t 3 Lo,- 4 ST. CROIX COUNTY, WISCONSIN F. 1 � z 0,7- C'�m Z2 rDvt--d alp SUBDIVISION LOT Iy LOT SIZE 5 9C 19Ro PLAN VIEW �`"N C4� Distances and dimensions to meet requirements of I•1, HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 f oa, •f" _ `-..- 1 , } 1 i 4 t INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used S�, k ti jo om,—fi• A Elevation of vertical reference point: IOo.OG Proposed slope at site: 15 SEPTIC TANK: Manufacturer: W Liquid Capacity: ! 000 Number of rings used: 112e Tank manhole cover elevation: ! ol, 9 0 Tank Inlet Elevation: QR,5 Tank Outlet Elevation: 9 E , 4 ' Number of feet from nearest Road: Front Si , 110ar, � • feet From nearest- property line Front 10 Side,©Rear,0 1 feet r`� � building: is Number of feet from: well .1� , (Include this information of the above plot plan)( 2 reference dimensions to septic tank) nrTlrnCr CTTr r PUMP CHAMBER Manufacturer: vy 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: t--- Width: 5 Length: /oo Number of Lines:..._ Area Built:Ak Fill depth to top of pipe: ID Number of feet from nearest property line: Front, O Side, O Rear,0 Pt . IS' Number of feet from well: 9:? Number of feet from building: (Include distances on plot plan). C'k, f 7 BSc `° cj �3 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 11 Manufacturer: t'�f _ F Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, 0 Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: !il Plumb,:-: on job: pt`� License Number: 3/84:mj IDEPARTRENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION I 3707 State Plan I.D.Number: S 4 f Is . 31 ,T28-R19 ❑ CONVENTIONAL ❑ ALTERATIVE (IIaeel0ned) Troy Ct . Rd. F ❑ Holding Tank ❑ in Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS MIT HOLDER: 1 os eh N. Persic R Rd. F , River Falls - WT 4022 BENC MARK(Permanent reference point)DESCRIBE IF DIFFERENT M PL : CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Carl P1 Heise � 3378 Croix 135392 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 00 YE 98.S �� 9 ) PROVIDED: PRO D ONO BEDDING: [VENT DIA.: VENT MATL.: HIGH WAT R NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH 29-YES FEET FROM N AIR INLET: ❑YES [ENO � �-��' lLTYES 0 N NEAREST--► 3 `� `� Sl6 ((o DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF W L : BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ED YES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LEN A 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 IN I DI X: PITS: LIQUID TRENCHES: / MATERIAL: PIT DEPTH: DIMENSIONS ro (OQ V I rj GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: N0,DIS R, NUMBER OF BELOW PIPES: ABOVE COVER: VO.INLET: ELEV.END: PIP S: INS: AIR INLET: (D`� , (�. 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 [DYES ❑No meets the crlterla for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO [DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ASOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE I MANIFOLD MATERIAL: N0,DISTR, DISTR,PIPE DISTRIBUTION PIPE MATERIAL 6 MARKING: ELEVATION AND ELEV: ELEV.: DIA.: ELEV.: PIPES: DIA,: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED L INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF BUILDING: COMMENTS: PINT FROM LINE' J ❑YES ❑NO ❑YES ❑NO NEAREST�/ 9.73 lvalD Sketch System on Rslsln In oounly}Ils}or sudll, Reverse Side. 81 ATUR TITL �� Zt�ni11(� tn1l+'11S SBD-8710(R.08/88) SANITARY PERMIT APPLICATION ©ILHR COON In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PER # —Attach complete plans(to the county copy only)for the system,on paper not less than ❑ e s ''-�lou 8%x 11 inches in size. c i rev sion to pre s application —See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. PROPERTY OWNER W(ti"/a, S '✓ l Tom? , N, R ) Q (or)W PROPERTY O ER'S MAILING ADDRESS BLOCK# v T % W A IV CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER lz t V w Fe-11s s I 546-2P is 92s are w II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE T& ❑ Public X 1 or 2 Fam.Dwelling—�#of bedrooms 3 PAR EL TAX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply)) r 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. N1 New 2. ❑ Replacement 3. El Replacement of 4. El Reconnection of 5.❑ Repair of an System System Tank Only — - Existing System _ , Exiting 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 ❑ Specity Type 41 ❑ Holding Tank 12 W 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.) (Minn./inch) ELEVATION �Q 4 0, l�D a r , Q Feet ) 00 Feet VII. TANK CAPACITY Site in allona Total #of Prefab. Fiber- Exper. INFORMATION New ist(n Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank 60 O e Y S Co rc Lift Pump Tank/Siphon 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) MP S Business Phone Number: Plumber's Address(Street,City,State,Zip Code): 1047 s ma,t`w 57. Rw& IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater ate Issued ssuing Agent Signature(No Stamps) Approved 17-1 owner Fee)Owner Given Initial pp _ Adverse Det rmin lion ` 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. 1 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. lt. 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. 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.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) y t 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 f r ocation of Property 1, Section T,,,�' k-N-R W ownship ailing Address _ v 7 If ddress of Site ubdivision Name of Number revious Owner of Property .S' v1/k/ �f otal Size of Parcel 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 � and Page Number -i4z 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 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) eeA i6y that a t statements on this 6oAm age tAue to the best o6 my (ouA) nowtedg e; that I (we) am (ane) the owneA(s) o6 the puperr ty dens c i.b ed in this n 6oAmat i.on 6oAm, by viA tue o6 a wahAanty deed Aeeonded in the 0 66.iee o6 the ounty Reg-is.teA o6 Deedsa6 Voeument No. e 1 and that I (We) pAeaentty wn the pAoposed site bon the selvage diapos sys em (oA I (we) have obtained an aaement, to nun with the above dedcA bed pAopenty, bon the cons.thucti.on o6 said ys.tem+, and the dame has been duty Al coAded in the 066.ice o6 the County Reg.i.s.teA o6 eeda, ae Uoeumen.t No. GNA OP OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ATE SIGNED DATE SIGNED w.r w..«www N f N•�.•�.ii ♦♦i.»i♦iipjt♦wi♦♦i♦xN i • N�x1»W»«N ... Y.W.n �NI-.Kalf. .+NN.�-»q w-iy.�.,yt..•e«.�MN.i�+r.i..i...fs... err is N In 4 } : 4 S i 4 of a lid AmL Y TAis �M •w- fir►• `cumom r • • !t +.s ..r• of MA wa won"*ftd. 0 OVA& a0ew tide , . ... ...... . ...: .. ..`10.. ,., .. .... . ...(ii;Ai•1 ,.... • . ............. + ... a. t Eli .... ...... ... . ........ ............(sLAL► -.� ` �' � A�lStDi!lIQAltON ,"�. ACKNOWLND419SX'! .. 1TATi Of AIWONf1N �� .. l.!': �► .: ► lyt .cx.1............. .: 8t. Croix IL fi �, Oi10 r war Mfo1r su • ..........♦♦. Go F ....... .. ...... tU rM TITLZ: YiC�EiC>t is'I'ATa t NaIR. ....... .8( �MH .. . .... 41 (if .................. .•.. �athorissi 07 1 76iR+N.w'ii,Kati,) ....................... .......... ........ ..•......,... ...................................x,..w.� M Ow known a be tiw psres� ...... . Obe spwabi mat nub "knnryfte*0 sew. TM s rNftlltlM[N/ WAb ORA"=nr ....-N P. O. Hoot;.... !. ................... * ... ........................ !il•Li.... 5402? tears Pantie . .us (g�+�ata •M-�sr I[r Cssn�dea .. •iIw•[1���h.LS M f fr A�Mr MMIi M 4r�r Nir1�t bi► �f ,•`� tirx COt 1V1r NeYw.r- STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER--'E j J� FIRE NO. 7 0 CITY/STATE I\ tV C / P—ci �IS �J ) ZIP PROPERTY LOCATION: 1/' ��I 1 1/4, Section ,jf , T N, R W, Town of , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED s,l -7 AL2 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.°. BOX 7969 HUMAN RELATIONS \ / MADISON,WI 53707 (H63.090)&Chapter 145.045) C SECTION; nWNnS UNICIPALITY: OT NO,.BLK.NO,: SUBDIVISION NAME: S , W1 31 /T.28 N/R.14(or)W Ir CO NTY: OWNER'S B YER'S NAME: MAI LING ADDR SS: ST.CR01X 1D RT 7 R10e F404 0 22 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DE RIPTION: PR D 10 S: NTESTS: IgResidence 3 1V P1 ®New ❑Replace )0-2G_ 8q 10.30–QQ RATING:S=Site suitable for system U=Site unsuitable for system a ONVENTIONAL: MOUND: IN-GROUND.PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) 1 IS ❑U OS ®U ®'S ❑U DS ®U DS ®U I _5x106' rreY•aI. 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: C a1 SS Floodplain,indicate Floodplain elevation: NA I PROFILE DESCRIPTIONS BORING TOTAL P H Tn GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / 0-B" G S L I?-4o'[r 6h r.el S w 9 .tk r 4o-48 B- " 96 101. 2 rJoINt > 98 ox,00 Z"Piy S;L 49-46LYa„ "45 o-G" 4y 0.SL /0-38 LtIR n►J S w:+ 9r 38-44 B- 2 92 100. 9 move, > 42 o k7k49- S.-4,S0 4t-a2 LrCi• t+,.�/s 0-0" ya-. S) V-#I 1r13" rw S w -0 Jr 41- �o B- �O �0. 9 ,V Dn1 G. } g 0 P'ka" .S^*a, Si 46-40 L" Q- V.-1S 04 " 0 k 43,% S 6-?s " ox sh f 25-40 L7 4 h s B- q 86 10 1 . 1 N 0,4 i ' 86 40 -6&" Lr On S y- 0-S" r7ke. SL w/sr 5-11" an't'e/ Si B- 14- 86 c~, • 5 r l Q 0'.f" a., .51 w:t&J` 4-14 R.j ar S1 w/J. 14- 37 S,r�• B- (� Qo 1Q,0 NOr��' �0 37- 42 Vfsl 42-90 "COays.. 5-43V PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 R PER INCH P_ 1 48 luaw c- 1 �., 5 5 �8 1.1 P- 2 46 1' Wow' I n+�N 3 S ' S 4 4 P- .3 48 rj 0.v 10 YM I'w Q . 0 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 97.0 ' �0-r / - C' nM tSV �g5' _ r . I ) f ,r i �NOrlltQr • .. i r 3 i 1 fi r E �y M .i .5��`-i \.� 17 j 1 0 i Q Co ' � J .� .. .�_....._ �.. �.... _... _ . .-...._-i r i ;io _ t j RA I i STN vR ±H` 1 9S Q 45tI4— v i ass+. �• i rcp. .•+• I s. IC } 1 i 4-.-.-4 —, a I 1,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(print): TESTS WERE COMPLETED ON: C&Y n' t 10- 0 - 81 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 104Q 5, a►'w 5T, Q%U ev FLI1 S W s ,54OZ7- '33)4 CST SIGNATURE: cod f DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBO-6395(R.02/82) —OVER — __ joSEPN PERSIC6 ._ _ 3 C-TYF 421'roUEJO, R V E R FALL S till 5 —51-0 2.2 _13Y CO.-I Alec . rqPRs3398 p 4" PrRFO RAT F Yuc AG,G. W nr+� f—I►5' -4$' m f ► ►90� /I ►oo' 8z I p0�g.�14efgI' -pz. PO D CIO s 1�4 f) ►a REPIACCrnC►vr- Q' 1Cb.Ito,Go 3 V i 2 jl r�j F2 wet L S. FILM JUN 2 019900- 9 JAMES O'CONNELL O Register of Deeds SL Croix Co.,WI 459723 � CERTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE NW 1/4 OF SECTION 31 , T28N , R19W, TOWN OF TROY , ST. CR01 X CO. , W I . OWNED BY: JOE PERSICO R T.3 RIVER FALLS,WI 54022. • = I"IRON PIPE FOUND. 0 s SET 1"X 24"IRON PIPE WEIGHING 1.13 �1 LIPS. PER LINEAL FOOT. NOTE:BEARINGS ARE REFERENCED TO TH.E N-S QUARTER LINE( RECORDED NI 14 CORNER SEC.31, BEARING.I T28N,.R 19 W. (COUNTY MONUMENT FOUND). • I I $ I UNPLATTED LANDS right-of-woyllne Mf W —, . . . . . . . . . . . . . z S88 023 12 E 462. 61 I ,� a I/ a ; vt 1 J�,• _O`� . . r-�' �O J�S�/ t�f \/'a L.„9�0�I 0�-'(n' v e m UY DRAINAGE S87•32 22 ID Z. : N_8 8•23'12"W es " W 20.30' 32.45' ti n q field VE drive.ADRIVEW W. LOT 0,- 0- I I I I, �• 4J $ SEPTIC co I �• go 9 S0.FT.I - M a• et + ENT v 4 C.EXC.EASEMENT apo N J• N �j l (204,854SQ:FT.) a W Z• Z HOUSE r*a M:N OD ELEC T Box w I N dD O S� "t- Z 8 5- -88.32'32"E_ - 264_43: 1 C J Npq— — — — — —fie14 occess 0 N I 1 =d, l � � S88-32'32' eosement � 1915.78 V 1-7 292.93' 1 26'4.4 N88°32 32 W ' 557.36 C 1/4 CORNER ap EAST- WEST QUARTER LINE (COUNTY MON. F FOUND.) Qe; M= UN PLATTED LANDS I W Z n� •, fi„' ,'3 a r':�.i, J70 SCALE 1 „ _ 100., m CA u z z o o cy�.�" .iii[:c?u r9. S~`f` i 0 50 100 2 00 I I — 4 EJ : ;,.t z S-PI$If:Ci VALLEY � APPROVED S I/4 CORNER OF SEC. WIS. �.µ. W 31,T28N, R19 W.(NAIL o i� yy C-, ++ q FOUND). �� 19gOp•••, S•`;� ow t-x-•.J�J�7�::'�:y°:.�':..,:1�''r'�' �;�0!Nw12Et(Fi�SIYc PARKS E'LANNINC. _ AND 2cxvir G,—,,cnm,\,ti�rr;f Lo JAMES M. WEBER 5-1804 SHEET I OF 2 WEBER LAND SURVEYING VOLUME 8 PAGE 2223 DATED oc� z�..�•t�9 89- 124 Rte' %\77-t tg%%q THIS INSTRUMENT DRAFTED BY -� ' w-n- r Parcel #: 040-1119-40-110 11/05/2004 10:37 AM PAGE 1 OF 1 Alt.Parcel#: 31.28.19.487A10 040-TOWN OF TROY Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): =Current Owner JOHNS M ERICKSON ERICKSON, JOHN S&VIRGINIA M 64 CTY RD F RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): `=Primary Type Dist# Description SC 4893 SCH D OF RIVER FALLS I ` SP 0100 CHIP VALLEY VOTECH `''� Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 31 T28N R1 9W PT SE1A NW1A LOT 1 Block/Condo Bldg: CSM 8/2223 5 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 874/249 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 225,800 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 71,500 182,800 254,300 NO Totals for 2004: General Property 5.000 71,500 182,800 254,300 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 48,400 168,900 217,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 110 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Y N PART T ROY T• 28 N:- R.20-19 W 13 SEE PAGE PS Lt• r e�' f to/.N • eAbl a �✓ LA KE StPou/• n°e[ ead Nxker YMCA an �u�.r E IYi//iam J ST CRO/X /u/z C/woe,V`• T"&wn . ea 67 S ue7 duK FFF •`� n St Pau/ i(Tarncs 75 IJLMC.R. 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Serving: St. Croix, Pierce, Polk, and Burnett Counties Title Insurance, Escrows, Closings, Letters of Title, Abstracts HUDSON ST. CROIX FALLS 212 Walnut Street, P.O. Box 266 State Highway 35 & U.S. Highway 8, P.O. Box 838 (715)'386-2633 (715) 483-1606 �S'1