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HomeMy WebLinkAbout042-1076-70-200 a„ 0 0 ova I m I M 0. 0 M CF- 0) 'O C m N O CA O E N O C of O= - O f9 O N C O C C O --o r N L U O E cn v) O O -6 Z 3EN2 (0 L dY N O O C � @ C N•pl w O) N O •X•�- N N O- N U O M O_ d' N � III W Z i p 00 N Z d m W f� N F Z N V "j O C I m C N N N O@_ N C?N � F•�1 (L U L o C O Z 1- Z Nd z CL CL Mn N O L �, oca E N U) U) U) CI U Z N > � 0� H F: a- Z O O O CL a a °- 2 '', -P-, �i 3 6 U) N w m O N J U o rn rn Z Cis 1111 N O O _ Q CL M N �i p O O N O E (D O) w R N C O N C C GfO„ C N Z Z 'O V cn oi Cl) C N • �, N N >>m a ~o o M o Z° �O co T ik w d dt a L CL N a • R Q 41 N C 3 N COMMERCIAL TESTING LABORATORY, INC. 514 Main&eet, P.O. Box 526 Colfax, Wisconsin 54730 715 . 962 - 3121 800 - 962 - 8378 (WI) 800 - 962 - 5227 ST. CROIX ZONING REPORT N044 32996/01 PAGE 1 ST. CROIX COUNTY REPORT HATES 8/24/89 COURTHOUSE DATE RE ti HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS David Coyer a , Q0- ! 0 , V3 S-A l� LOCATIONS 1133 80th Avenue, Roberts, WI COLLECTORS SOURCE OF SAWLES Bathroom Faucet (Sink) COLIFORM*# 0 /100 mt INTERPRETATIONS BacterioLogicaLLy SAFE NITRATE-NS 9 ppm Under 10 ppm is safe for human consumption. COLIFORM + NITRATE LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 5 c 0LIN tire. y3yy�.\NDEiENOirNj of ,.,. V h t Means "LESS THAN" Detectable Level. Approved by' ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r T I ® 0 JG 5 09 i III I i J ST. CROIX COUNTY ZONING OFFICE 940 St. Croix County Courthouse 911 4th Street erg [ Hudson, WI 54016 �f Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form - ' essential so that the groReerty can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE. $ 5 2 .00 �., J . o o► (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at time of inspection) Property owner's name L' Property owner's address 4e--&-",' J te'441-- Legal Description �� 1/4 of the N Su 1/4 of Section 2.�' , TN-R/S g P . Town of �.� a�_,�. Lot Number Subdivision Name FIRE NUMBER K BOX NUMBER Color of house > Realty sign by house? If so, list firm: c� 4 P', a L,— �:_C J PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services:—("- � �� � ( .f' Telephone Number 71 S_ 3 SrG _ c-)0- REPORT TO BE SENT TO: L�40 ` Closing date e Signature Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / c, �'�s TOWNSHIP L L �C� tl✓�(_ SEC. ,2 2 T ,2°!N-R j W ADDRESS /� S~ �i .t ST. CROIX COUNTY, WISCONSIN SUBDIVISIONS LOT LOT SIZE 10 45LAA- - PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �) -J / r INDICATE NORTH A W BENCHMARK: Describe the ve tical reference point used _�.flh ��`�l — Elevation of verticcal reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: L(',Q� Liquid Capacity: /�D0 Number of rings used: Tank manhole cover elevation: �. ;'-2� s Tank Inlet Elevation: C Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, O feet From nearest property line Front,OSide, L Rear,O feet Number of feet from: well R , bui.l.•.: i ng: J (Include this information of tt.c above plot 1-1. 1 ) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE r 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: 'french: v Width: / Lengith: e,4, - Number of Lines: Area Built: Fill depth to top of pipe: Al i Number of feet from nearest property line: Frond, O Side, O Rear, . f�i 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: Hat 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: �� Plumber on job: Z License Number: 3/84:mj 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: NW-l-,NW 4 f Sec. 28 ,T29-R18 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Warren ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound E Or P MIT HOLDER: ADDRESS F PERMIT HOLDER: Tom Johnston 1105 Tower St. Roberts WI 54023 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: .PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Henry Nechville 3258 ST. Croix 135391 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV,: WARNING LABEL LOCKING COVER ( ` 4 G L L; P O)DED: PRO N YES tNO BEDDING: VENT DI VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T ESH L C ALARM: FEET FROM 1 LIN �7 AIRJNLET ❑YES NO ' ❑YES 0 NEAREST�� I DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES LINO ❑YES ❑NO I ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY ELL: BUILDING: AER INLET pESH (DIFFERENCE BETWEEN FEET FROM LINE: PUMP ON AND OFF ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER E I L A MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTE . WIDTH: GTH: NO.OF DISTR.PIPE PACING: COVER INSIDE DIA,: PIT : LIQUID BED/TRENCH / f^ TRENCHES: � MATERIAL: FIT DEPTH: DIMENSIONS S W �� GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE AERIAL: N0.DISTR, NUMBER OF BELOW PIP EIS: ABO OVER: ELEV 11 ET: ELEV Z PIPES: FEET FROM LINES / '� AIR 17:f C ,, NEAREST-�� ! lJ C MOUND SYSTEM: °I 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 I ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED; MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: N0.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO,DIS ITR, DSTR,PIPE DISTRIBUTION PIPE MATERIAL d MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV,: PIPES; DA,: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRE TLY: COVER MA -VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSE TION WELLS; NUMBER OF LL: BUILDING: COMMENTSr r� / FLIT FROM LINE; v l� DYES ❑NO ❑YES ❑NO NIARIBT� 9� y I:a Fl etaln In o��OUnty file for audit. Sketch System on '+verse Side. SIGNATUR TITL : 0 710(R.06/88) Zortir��. l�d mlln�s �olr r < DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COON STATE SANITARY PERMIT –Attach complete plans(to the county copy only)for the system,on paper not less than ❑ / ' cry 8%x 11 inches in size. chat i revision 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 ne `WY4 /a, S T , N, R tT E(o W PROPERTY OWNER'S MAILING RESS LOT# BLOCK# CITY,STATE ZIP CODE �j PHONE NUMBER ) SUBDIVISION Y/.R CSM NUMBER ^ a , 11. TYPE UILDMior• heck one) CITY NEAR T ROA State Owned ❑ ILLAGE Public 2 Fam. Dwelling--#of bedrooms PARCEL TAX NUMBER(S) � � � _ a /'1��/ O 111. BUILDING USE: (If building type is public,check all that apply) A A 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 Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check on 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 ,❑,eepage Bed 21 El Mound 30 El SpecifyType 41 El HoldingTank 12 02 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 ELF/. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ,D � O 4+ t ' �3 Feet Ft VII. TANK CAPA y Site INFORMATION in allons Total ##of Prefab. Con- Steel Fiber- Exper. New istin Gallons Tanks Manufacturer's Name Concrete glass Plastic App Tanks I Tanks strutted Se tic Tank or Hold!no Tank Lift Pump Tank/Siphon Chamber F-1 I F71 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 Stampsl M MPRSW N Business Phone Number: Mc oy MX_ -3 ':-5 Plumber's Address(Street,City,State,Zip Code): IX. COUNTY/DEPAR ENT USE ONLY ❑ Disapproved Sanitary Permit Fee(Includes Groundwater a e Issued Issuing Agent Signature(No Stamps) Approved ❑ Owner Given initial �� 0 6 Surcharge Fee) Adverse De rmin t' n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Pib-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber ,r 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. i 'To be complete and accurate this sanitary permit application must include: I.,- Property owne'r's name and mailing address. Provide the legal description and parcel tax number(s) of where the-system is to be installed. 11. 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) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is 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 development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Location of property &V114 lL, 114, Section Township �ax Xg--,.L Mailing address Address of site Subdivision name Lot number Previous owner of property Total size of parcel o-.' Date parcel was created Are all corners and lot lines identifiable? v Yes __�J0 Is this property being developed for resale (spec house)? Yes v No Volume and Page Number 'yj :Zan 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, It available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. W S:2 4 1)p ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of he County Register of Deeds, as Document No. ) . signature of ne Signature of Co-Owner (If Applicable) At'k"t' C' 19 Date of signature Date of Signature raw I WrA" CAB OF Y . •.: _ A L d....... DOO ragae between ...Aar i d.R._Gayer.an r as ,his wife and in her. own r.i.ght.. ... . X Cf �•• on and Mac i et tag J. Johnston,.. :. .. ii• .�ohsst- t n �nari tat Property x ,- as survivorsh" s °s '� A1M11i$ and wife. _. ooasidention. Q� TAst t� said Grants, for • raiwble ' ood and valuable consideratiuf►...... „sr�n,,.o tY 1l#r.am,other B St. Croix feElorr+M descrrted real estate in ; the TM 16:..... 6 of Warren. tnrtMK #. ' Part of the NE}NWt of Sec. 28-?29NSurvey HOP filed Septembelc_.!1I ,.. jz r 1 as follows: Lot i of Certified Survey Mae t . t!ia Office of the Register of Deeds for St. Croix Countyr i9 to No. 451648. rv� ;- VOL. $. Pale 2151 as Doc - �- F .F H 2 t o not .. bonmtmd PfO"rtq' . jj�j iia tint! jlh�uata 4tMNgMtRt " tar the aereditamento am apparw"ate '! W�eM au sad ate' t he i r he 1 r s v ..C4t1! pnd Carol.J...Coyer.• clear of oaearabrsom esra r� a ,X p indefeasible in fee simple and free and w i n t,N JS of record 4; existing highways.. easements and rights of way +n14es am defend the same. it.. ".• t (� day of 3 '.�+Nis .. .. .... .. i i S E A L 1 - ��+% fJ,t6 ........ [)avid D. Coyer ' (SEAL) C :..' • Carol j. over T .. .i 13 .a ACSNOWLSDUysN "•,. .jv ...•� ' AUT$ENTICATION STATE OF WISCONSIN County.its) ...... ....... ss. & �.1.... .v Ln., _• .. tM thb ...� ' daY O1j 1 Persgnally came before the above earned . 19 _. tr, Neat"this ......day of...... lil y - Oa Y.i.r1. U,.(:uy.{ r and .C�r,o1; J,,.( oyec, r hush Ind and { TITLE. yEliBER STATE BAR(F «'j`{r)ti�IK S a ho lxe�utad th! i (if not, . person . . r t c 10r,.pFi. wig. St:ct .) t me kn{,err. to Ice the ( aelenuwriedRe th! same. (. gnttlorized by , wng Ihslrument and , e N NT 'N AS Cf.gc F'. f" r . � list f{.{••I AttgrneY ,UaY. d.. �, i1 , c rut x Count 1 „r,;I,ualnn u perm;ulcnt.tit notr state,exnY ik* .1. �I , 49 V 1 ,fft�tures may be guthenGcs ed or - art not neeessary•) tar 011eem et Veens skew,t on .'. }..r:•r: r. .. . �,, bTA0. BAR STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ YER ROUTE/BOX NUMBER f/1 "� .�CmZ�t �� FIRE NO. CITY/STATE 4L,'�-,4 ZIP PROPERTY LOCATION: &W_114 lVC._1/4, Section :;;k , T_2�4N, R W Town of toCKU ,-'t— , St. Croix County, Subdivision a , 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 DATE 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&BUIL `NGS I NDUST.RY, DIVE ON LABOR RELATIONS.,; PERCOLATION TESTS (115) MADISON,BOX 0 HUMAN RELATIONS (ILHR 83.09(1) &Chapter 145) �'+� �� ��Cr- LO A, ION: E N: TOWNSHIP/Mt iCLP. UTY: L T NO.:BLK.NO.: SUBDIVISION NAME: NE 1/ PWV /T L N/R I P E(or)W &1j"k-A) R o� o A c4[s COUNTY: S BU ER' NAME: MAILIN ADDRESS: � SV-601 07 ITO#Wsllw /08 -row,--R Sf. IWZtRT'S wi S . J USE -1 DATES OBSERVATIONS MADE i NO.BEOR : COMM A ES RIPTION: TESTS: 1 Residence [1 /1� ❑New ,Replace s'E r/ _ [,C S'&PT, r i c ,1 / /I�J< RATING:S=Site suitable for system U=Site unsuitable for system Sc's kti R i ONVENTI NAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional)DS ❑U �S ❑U QS E]U ❑S NU ❑S 2U covae4)ftda-r4-- 71 a,4s '. If Percolation Tests are NOT re wired DESIGN RATE: 4 I If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: LGf}SS �— Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS 1Aj _UeV-4,t(_ FT' BORING TOTAL PTH TQ GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIG7E_S TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- l 0,- /.s' Ilk. Sa ►.s ' 74w SJ'/ . Q4. Coo R F s z > .9D" 1�{ , s ' B-2 9,0 9�iz - >?1 0 <s B_3 y� y� � ?�, � s E� � �. . S. s w B- B- B- PERCOLATION TESTS Iiij &4 WV Cs TEST DEPTH WATER IN NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P I D 1 DROP IN WATER L V L- N H S RAPER IINCH ES P_ < Z P. L / 1- 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, i i SYSTEM ELEVATION 'Flo lbw, T� V1va-- yZ'° I � � ill �_..--_i _.�__. !_ '• 1- � _._ { t I f r 1 f { � ( 1 P t oT _ = TN I _ hi tot ite A P OVED � I col on T sep�t)c jute i- 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: HOMESITE SEPTIC PLUMBING CO. S�4;/• 14 1 ADDRESS: 655O'NEIL RD.,HUDSON,WIS.5Q16 CERTIFICATION NUMBER: PHONE NUMBER(optional): ROBERT ULBRIGHT 3CP6 _(P MS.MASTER PLUMBER • M.P.H.S. CST SIGNATUREA i MINN.INSTALLER&DESIGNER LIC.NO.00663 i DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHRSBD-6395(R.10/83) —OVER— i K -n i a f s i 2. °b cq V. - � rn Q p Ct � O 1 � � y m � I 4 Q u i parcel #: 042-1076-70-200 02/13/2007 08:49 AM PAGE 1 OF 1 Alt. Parcel M 28.29.18.435A-10 042-TOWN OF WARREN 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-PETERSON, RAYMOND J&TERI K RAYMOND J &TERI K PETERSON 1133 80TH ST ROBERTS WI 54023 Districts: SC = School SP= Special Property Address(es): '=Primary Type Dist# Description " 1133 80TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: 4231-CSM 15/4231 042/02 SEC 28 T29N R18W PT NE NW LOT 1 CSM Block/Condo Bldg: LOT 02 8/2151 NKA CSM 15/4231 LOT 2 5.00AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-18W NW NW Notes: .•-,J� ,(�,A �, Parcel History: rw, cJ Date Doc# Vol/Page Type 02/03/2004 753359 2503/171 WD / 01/08/2002 667581 15/4231 CSM 2007 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 42,500 111,200 153,700 NO AGRICULTURAL G4 2.000 300 0 300 NO Totals for 2007: General Property 5.000 42,800 111,200 154,000 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 42,800 111,200 154,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 N mm r� O C! LS Ea67581 C:H L_.. 15 F-"j'a IC`;E.- 4231 15 KATREEEN" H. WALSH' _..._. REGISTER OF DEEDS ST. CROIX CO. WI st Caw t,�„llyrl•• RECEIVED FOR RECdRD C3= O v' — w,.d 01-08-2002 1:30 PM °7'�' D COPY FEE: 3.00 z�- r RECORDING FEE: 13.00 m� 4- O • 0 PAGES: 2 �3 Z t m ., fTi Z n cyD � oa m o tQ r �`Id -p ZCDn-1 -i 0 ° �m rte. z z� rn�� D "13 �p m �t� ° ry Ho =o �7 -���pZO �° II � o� Nx : yz z '""<v �ap70xN � < tri N N ^ d to 3y �N a� �z 1n� = F�J C 14 O ° I/ t' r'r' a ClM, ;� °z a rom yDmpC -gym i—1 Iv,. O ��, r 2D r.." 3m w ❑ �� z txi C) ll., z -'c� z o v m� I'1 C -I 3c.z ' °iml * W90cc C z r °' r ° m0�-0 f < o A o z� -p� �m t�M ZZDy m -I �p� -i �0zL -� � �DN -m mt7' H❑! OCAS "�I ;p Z � �m�� m-N'IOZp n � i 1 rrr jN ,czi �t�p � O 1 j o0o I-I pml- > '1 CO D ( w N R) i Cn n x P-r� m (D 0- 0 j 1 it x r1I--4 m r 1-� Z r Z a m i rn 1 �P� ❑ 1 v m � 3 i D CD It BEARINGS ARE REFERENCED TO THE N Z N to 1 n ro D NORTH LINE OF THE NW1/4 OF SECTION m� CD CD m i o N v � 28, ASSUMED TO BEAR N89'41'47-W. 90 °It o 0 � j (n 1 �AV NZ (RD r. [11 Z7fl t I D I t11wy 0° m I �� ZZ cQ0 i m1 �y 1coco 1 °om I,coo `° 3 i m 1 n -t N -'.'o (D j Z I ��wo ° �°o� s' 1 I n -----------------------dLaGI 00 QC9MG [Ely pUULEa ;y ;� I m 1 >y ------------------------ I< 1 1 I A (S00°1 5'20"E) Iz t� N VV 800°02'53" 1059.87' I ( IC I 1028.87' 33.00' ;m 0 •z . 6' 529.93' C to :m 2 O 1r I � V0]0 Z cf) O A O p V O Z Vp 04 '5 m m ] 1O 4b 0 -n.A �v 0 ., ml i ... :cn .+ � p / p z I g / g b � o Z I� , _�cODO I� 529.93 �: 3 3 A a �' I t 498.93' to -• 00 529.94 0 7f Q I N 4- I� 1026.87 ? v 33.00 - N00 002'53"E 1059.87' i0 N00°1 5'20"W) 1,4 I I I zz ' @MMI-MD o U G°�dLQ 4C�G� � Ao ;� --------------- vvp Z J m A go O ZZ 00m SHEET 1 OF 2 SHEETS Vol.15 Page 4231 45 .698 CERTIFIED SURVEY MAP Located in part of the NQ of the NW4 of Section 28, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. North line of the NW4 of Section 28 N90 000100 11W N90 000'00"W 411.00' N9000010011W 1492.09' Both-Aynue— 746.191 NW Corner N9 °00'00"W 411.001 N4 Corner Section 28-29-18 w w Section 28 o house o 0 0 N shed Cr 0 W ❑ barn W ° (D N "7 CO rt r S Z �• Q o ° �, o tbuildings o o z O M N O O ❑ O _ rt rc N `" O ICI N E R O I C Z ° LOT r 1 = I o' David Coyer f n 1 w �. L O 1� o o IN 1069 70th Avenue U rt N N rt CL ;a ° ;; Roberts, Wi. 54023 N ft I •co ° ;w Area Including R/W " Ln I � a s i n o f 435,600 sq. ft. cD I N Ln co 1 a 10.00 acres " "^ m Area Excluding R/W FILED I 422,037 sq. ft. 9 1� 9.69 acres SEP2 Y 1989m,. SCALE IN FEET JAMES O'CONNELL j2 Register Of Deeds 200 100 0 200 SL Croix Co.,W1 y :rI C:WIX G'CUi;+`. S900001 0011E 411.001 4JK �y,r.vvrr��vv. (`l r;,1.i•.11:,,• 00� PAINS� c.Lrsvl LC..�S+I:1 i'�'c �'� ��,��,�r unplatted -lands `4 �'' � " &e LEGEND 1 ' ALLEN C �ro� St. Croix County Section Corner Monument Found a r�YIi��G ICJ a 407 w; r O 111 x 2411 Iron Pipe weighing 1.68 pounds per linear foot, Set. FiL`CSOi�I, v© y----%- existing fenceline ��0— +��°�'••• u u Np SU RJ this instrument drafted by Douglas Zahler job no. 89-33 VOLUME 8 PACE 2151 V (VIN VU