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HomeMy WebLinkAbout020-1029-60-100 I N oeo-:� o 0 � � I I o L I U N N O O co y CO O � V N S � O orn c o m -a w 0 O z° -5 T m E o LL o off � I Q •moo � I M ',..,. N Z E U) = g z IL m 0 o wz�I/ v' c ) y T aoi z c z N H T 01 Z c E -o o co CY C N N •� a` co L °- p m o O Z m z w N _ z N E j a O. w CO U W 0 O co coa �, � w Z T p fn V1 a LL w N Ij 000 Zo •N i � aaa a a j Nw' Orn i -1v °= co o M z O l M M � O T = m N c d M cc LO Q } (n O In to FA Tcl) O O C U N Gi O M N C C U n- O O N E N y C N N N C C N N C,_ T Z Z c N N M O N 7 N O O N E E •O o 2 Y - 0 Z H FO m cn r/� d A € a • ad .EL mad` r A (0) CL o3rn (j r Form S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A/44L TOWNSHIP C. Z4 T g' N-R ADDRESS Y-IAO �Z� , ,s, ST. CROIX COUNTY, WISCONSIN SUBDIVISION --ter LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D . l 1y �� A- (,Igoe t � R-eAl (V AW--a 0 ;B INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference oint: P ��De � Proposed slope at site: SEPTIC TANK: Manufacturer: z��/ewscnyefaziquid Capacity: Number of rings used: l Tank manhole cover elevation: Tank Inlet Elevation:— Tank Outlet Elevation: Number of feet from nearest Road: Front Side Rear O 7 �D feet From nearest property line ., Front,0 Side,O Rear,O feet Number of feet from: well > ZJ , building: /I ` (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) • f • 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. O Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: y Trench: Width:_ `�, Len h: $'S Number of Linea: 2, Area Built:___/_Ze Fill depth to top of pipe: �O Number of feet from nearest property line: Front, O Side, Rear, O Pt ,�D t Number of feet from well: 7 /1"D 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). 5 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: �{ 1- '9 Plumber on job: License Number: 1�°J 3/84:mj J DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABeff&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SWj,SW4-,S 16,T29N-R19W CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o4 Huda GV6 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound O 74220 ESS OF PERMIT HOLDER: INSPECTION DATE: Steve Ketcham 28th Avenue South, MinneaprJ&6, MN 55406 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: Davyd B. FagWy 3289 St. Cttoix 119394 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER � PROVIDED: PROVID 00 .�.. � {d� ri YES ❑NO ❑YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH �I ALARM: FEET FROM LINE: r� AIR INLET: ❑YES NO -1 ❑YES�1 NO NEAREST� t"' U DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: I PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [__1 YES ❑NO Y ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PRO TY LL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST---10- N V—;�& I SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETE : ER L AND MA ING: 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 DIMENSIONS ,p+ �-`—. TRENCHES: �P I MATERIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABO E COVER: ELEV.I ET: ELEV.END: PIPES: LINE: AIR INLET:FEET N FROM I� '� 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 I 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 ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: 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 ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: 4AREST- / MBER OF PROPERTY WELL: BUILDING: COMMENTS: ET FROM LINE: / ❑YES ❑NO ❑YES ❑NO Sketch System on Ret.1iin county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Adm ni/st,, atot SANITARY PERMIT APPLICATION COOT'Y' 7 0ILHR In accord with ILHR 83.05,Wis.Adm.Code v/ r_.n u,.M.� .,.+....o. STATE SANITARY PERMIT# –Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. rFORIVARIANCE ON �^ 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. ❑YES L31 NO PROPERTY OWNER PROPERTY LOCATION w '/4SW '/4, S 6 T , N, R /9 E (or PROPERTY OWNS MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME D CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE/ L DMARK H ,9b/ © E-1 VILLAGE if 2)191 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. E New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM:.(Check only one in##1 and only one in#2) 1. a. conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tan k V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. E"ee a e Bed b. ❑Seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): i r �, Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in aa ons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank — U l �C ❑ El Pump Tank/Siphon Chamber ❑ 1-1 0 ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) -W/MPRSW No.: Business Phone Number: um er's Address(Street,City,State,Zip ode): Name of Desi ner: VIII. OIL TEST INFORMATION Certified Soil Tester(CST)Name CST# e_t , CSI�s ADDRESS( treet,City,Srate,Zip Code) Phone Number: e� IX. COWNTWIDEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved F-1 Owner Given Initial Su cE,harge Fee Adverse Determination I ,t�1 11>2 X. COMMENTS/REASONS FOR DISAPPROVAL: 00r&Yd 7kovnao C. /tJJ14-'�n SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT ' APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; -- 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. Private sewage systems must be properly maintained. The septic tank(s) should'be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc ). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'•/z 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; dosing or pumping chambers; 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. ---------------------------------------------7------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groundt�Tf included the creation of surcharges (fees) for a number of regulated practices which Wisco*n's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) 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 54-CUC N Location of property `'W 1/4 �� 1/4, Section �, T N-R—L9_W Township �Vasc a Mailing address ®. X93 14%) ` othi Address of site !` Subdivision name No Jy�bkiVIRioM Lot number tJo Previous owner of property A N N A ,l.q EN T�)t2ri Total size of parcel 3. 66.4- NC.Ra S Date parcel was created `112118g Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes _N0 Volume gag and Page Number 11T- 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 cer i ie Z ur ,. if available, would be helpful so as to avoid delays of t e ess. 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 jjarr ntvdeed recorded in the Office of the County Register of Deeds as Document No.* a4-4- ; 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 the County Register of Deeds, as Document Noy-- ) . v-�r..c,�..� Signature of Owner Signature of Co-Owner (If Applicable) — 4 1,7,S pt Date of 'gnatu a Date of Signature if l� i w a�/ ���ffs � i r �'� wvr� �✓�y Goo t?Ce� a % d- i' DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1932 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 443344 Dou ; This Deed, made between ---_Anna L. LaVenture, a single REC)IS T ER'S OFFICE _--woman,__also known as Anna LaVenture - $T, C OIX Co., W, ------------------------------------------------------------------------------------------------------- __________ Rec'd for Record ------------------------------------------------------------------------------------------------, Grantor, .,e— and---S-teye�-T-�--Ket.�ham---------------------------------------•-•---------------------------- at 12:25' P. M ------------------------------- --------------------------------------------------- ----------------------------- 69 of" ------•------------------------------------------ ------------ Grantee, Register of Deeds Witnesseth, That the said Grantor, for a valuable consideration_._-__ --------------------------------------------------------------------------------------------------------- YO conveys to Grantee the following described real estate in _____St____.____C______lX__ ___-- RETURN TO County, State of Wisconsin: A parcel of land located in the SWl/4 of the SW1/4 of Section 16, T29N, R19W, Town of Hudson described as: Lot 1 of the Certified Survey Map filed in the Office Tax Parcel No: ----------------------------------- of the Register of Deeds for St. Croix County on November 17, 1988 in Volume 7, Page 2046 as Document 443210. Subject to easements of record referred to on the face of such Certified Survey Map. a. �r_VA-OP - .� This ........is-_nit-------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And______________________Anna L. LaVenture -------------------------•----------------------- ------- ------------------------------ ---------------------•------._... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements of record, if any, and will warrant and defend the same. Dated this .tl-&-'L-------------------------------- day of .......... .November------------------------------ --------, 1988 ----------------------------------------------(SEAL) --� ��_ (SEAL) 't -----------•------- * . ANNA-L.__LaVENTURE----------------•------------ ---------------------------•-----_-----•----------------------••-----(SEAL) --..-----•-•----------------•----•---------•-------- ------(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(es) . _�f_Anna__L.__LaVenture__________________ STATE OF WISCONSIN ss. -------------------------------yd-y----------------------------------------- --------------------------------------County. authenticat this �'� _ a of_NovemUe_ Y____-__ 19.88_ Personally came before me this ________________day of ---------------------------------------- 19-------- the above named * J HN D. HEYWOOD TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not- ----------------------- ---------------------------- authorized by § 706.05, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood, Cari & Murray, By: John D. Heywood ----------------------------------------•--------------------------------------- --•-----------------------------------•----------------------------------------- * P.O. Box 229, Hudson, Wisconsin 54016 ---------------•-------------•----------•--------------- ---_-------------- --------------- ------------ - Notary Public ------------------------------------------County, Wis. (Signatures may be authenticated or acknowledged. Bcth My Commission is permanent. (If not, state expiration are not necessary.) date: --------------------------------------------------------- 19--------- 'Names of persons signing in any capacity should be typed or printed below their signatures. j WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lecal Blank Co. Inc. FORM No. I—1982 Milwaukee, Wis. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S He ve N ROUTE/BOX NUMBER ( 01< FIRE NO. CITY/STATE 'A VSarJ �J'3'z ZIP S40( (O PROPERTY LOCATION: S W 1/4 S W 1/4, Section Ib , T aq N, R_!iP__W, Town of �AvASah) , St. Croix County, Subdivision kkJC , Lot No. AJD.i' 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 A N. SAFETY& BUILDINGS INnUSTPY, BORINGS /''"1 DIVISION LABOR RE PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON,WI 53707 (1-163.090)&Chapter 145.045) LOCATION: / SECTION: OWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: /T� H/R E(o — �s COUNTY: QWNE 'S/BUYER'S NAME: I NiXIDIJORESSit USE ar e °—,^iof 6ATtS O SERVATIONSMADE NO.BE ma.: COMM RCIAL DESCRIPTIO R F $: Residence � ��1Vew ❑Replace � � XD RATING:S=Site suitable for system U=Site unsuitable for system ONVENT ONAL: MOUND: IN-GROUN URE:S STE -IN-FILLHOLDING TANK:RECOMMEND D SYSTEM:(optional) CAS ❑U O S DU IDS ❑U ©-S FA ©S EA If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: L-V� PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER O SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERV D E TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- / fc' 6- 7- /o i, F tr-1 -Ile / B- !1 / i• J /f 1 E ' El- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PER INCH P. jr 47 Nlye I > /.In P- t P- a P. P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 4 :4P i i� I 4 i 1,the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print PLUMBING TESTS WERE COMPLETED ON: Licensed Perk Tester & Plumber 41 r ADDRESS: Fogerty Heights Road CERTIF CAT N NUMBER: PHONE NUMBER(optional): Phone 74"654 CST SIGNATURE: _ r;,( DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. L DILHR-SBD-6395(R.02182) - __ __ —OVER — v w h _ P IN a \ O •$ lg2 �C I .y .. _ I "Y,� _ � ��. _�� �--v��. _ _ ,� Ky 'ir 1 . ,. 0 a �� �� � a � � , � M ,� � °° �, � � , . ___.__ .__ � _ _---j�--;- � � _i ;, • • > � I �;. �I t , � � � �'+ �•i i• !:� j ,, � � i i, .i i L~ ~ ~ 3 o I o ti p va N O C~ b ~ U O O I _ , N v _ b ti .gyp c ~ II 71 S O N ~ Z C C 7 6 E LL O O M ~ Z N I O ~ p O (D (D a m cD F U O C U O Z ~t c d z a c Z N O O 7 d rr c d s O O O O w Q w Z m z o N Z N ` N a d m f~ N y ~ N T O c ~ 'coa .ter 'm o ',CDNNV> > o Z~>': ~LL Z d c I N J U 00 a Z ^I ° ~ Y O E > m v d o ti ¢ r in co ~v o ~i O O O O y C y O > O V `C O N V 7 M C2 N C_ c d O ~ n O U O v O N aj C ~ c y O c = M_ Lri O~ O N L O N N'0 Z C N a _ r FBI O :3 (D o (n o O S Y O Z Z 1- g (n w fat a a • ea a m u m tt`I~v ~ o m 3 'o A U a O v~ U . r► Parcel 020-1029-60-100 02/16/2006 09:16 AM PAGE 1 OF 1 Alt. Parcel 16.29.19.133D 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current LX' Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JAMES R & LINDA M STOLZENBURG O - STOLZENBURG, JAMES R & LINDA M 905 DAILY RD HUDSON WI 54016 I Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 905 DAILY RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.624 Plat: N/A-NOT AVAILABLE SEC 16 T29N R19W SW1/4 SW1/4 LOT 1 OF Block/Condo Bldg: C.S.M. 7/2046 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-29N-19W Notes. Parcel History: Date Doc # Vol/Page Type 07/23/1997 866/533 07/23/1997 828/115 2005 SUMMARY Bill Fair Market Value: Assessed with: 91590 197,600 Last Changed: 10/25/2005 Valuations: Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.624 75,100 126,400 201,500 NO 05 Totals for 2005: General Property 3.624 75,100 126,400 201,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.624 44,700 121,200 165,900 Woodland 0.000 0 0 I Lottery Credit: Claim Count: 1 Certification Date: Batch 122 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 44321® CERTIFIED SURVEY MAP LOCATED IN THE SW1/4 OF THE SW1/4 OF SECTION 16, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. 8Y W1/4 CORNER FILE SECTION 16 SCALE IN FEET T29N, R19W I~~ L NOV 171988 u- I of 100' 200' J` (700P','_L 9 X33 I 1 S~ 3313 3 1 ly~o 2 , 9Q, I G ~ I i ~ ~~~Sti ~ ~ ~O~ ~'S•'0~ N w 1 C; u I o z O z H I w O~~0 w rn z O ~ I H iZti o 1a~17.5 W ' 00 (cHi)W _ mz~ I U' N I U N zA I pq AI I W a LOT 1 o al ~ ~D0 1 3 157,861 S.F.+ _ ~o as o i i IM °a N 3.624 ACRES± +I wl A co oo cn .o 0 3 H I x .t C3 f~'~"') = E-i H A i I N k H V" %-0 O O 3 14 H z 0 P41 z co I I I N N cn POND I 40 -4 M O >41 o 0 0 ~ NOTE : N. HI z - z THIS CORNER APPROW I ' ch q IS OCCUPIED BY I 1 z W H VAR I o z A TELE. PED. Nov 17 N8 z + I l h zTi: lQt I H WISCONSIN TELEPHONE Cer: N • W r' ' G I I 33' a° EASE. VOL. 295, PG. 37:3 ~ A ~ 1 33, 23.89' 1 661 _ 128.94' S84_ 3 06~~W N86°47' 29"W I o,oN89 39 14 W SOUTH LINE OF THE 0~ IL S82°39'14"E > 2623.42' > SW1/4 33.00' COUNTY o TRUNK M HIGHWAY M "A" M M O _ - M ~ - - - - W p 3 SW CORNER -4 SECTION 16 UNPLATTED LANDS ° zo x T29N, R19W LEGEND -4 W N (N78°W) PREVIOUSLY RECORDED W cn H BEARING OWNER AND SUBDIVIDER 0 1"x24" IRON PIPE, ANNA LAVENTURE WEIGHING 1.68#/LINEAL RT. 5, BOX 5269 FOOT, SET. HUDSON, WISCONSIN 54016. COUNTY SECTION CORNER MONUMENT J} THIS INSTRUMENT DRAFTED BY JAMES T. SWANSON VOLUME 7 PAGE 2046