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HomeMy WebLinkAbout022-1030-20-000 § o C-) § j $ I G K 0 I ) � � 2 m 2. ) ) 2 . cu .§ £ ■ 0 � 'D 3 E J 2 m n I » 2 \ i \ E B � / § \ � :t ) 2 7 § \ 7 \ [ } a. k } ) k j $ 7 � PIZ CL. . F ■ E A Q ) 2 IL 04 § / \ t co 2 2 k k k k C) . •� ) / a a a CL 0 co Go to 3 \ § CO C : 2 } LO I . \ § \ a 0 8 / E � 22 & - 0 a J » m u c \ o / k 0 = E / � ® 2 @ M.p e a » ; o Q . § # / a'R o R k f ƒ _ s f I f ) § $ � e . ■ _ u § s % 2 c o - § § / j / o z k } k \ � ■ � ■ , § - � \ L (L CL w C9 E 2 a § & v a 3 & J . ! Parcel #: 022-1030-20-000 04/04/2006 05:11 PM PAGE 1 OF 1 Alt. Parcel#: 11.28.18.162 022-TOWN OF KINNICKINNIC 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 ARNOLD A&MARCELLA A LUECK O-LUECK,ARNOLD A&MARCELLA A 1357 CTY RD N ROBERTS WI 54023 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1357 CTY RD N SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A NOT AVAILABLE SEC 11 T28N RI 8W NW NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-28N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 941/362 07/23/1997 450/547 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 143269 Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 4,900 0 4,900 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 3.000 24,000 107,000 131,000 NO Totals for 2005: General Property 40.000 29,000 107,000 136,000 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 20,000 92,000 112,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 204 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � � /J �[°� TOWNSHIP SEC. T oe/ N-R/f W ADDRESS Il ` ST. CROIX COUNTY, WISCONSIN tee SUBDIVISION -- LOT �— LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Xx V raj lu (o id Od S �C FA it m U' Hoke INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used qrJ E e ojr h PJr 1'10Lse Ij Elevation of vertical reference point: IL'�©. 6 Proposed slope at site: SEPTIC TANK: Manufacturer: fr('C44iquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: r'7 Number of feet from nearest Road: Front,@ Side,Q Rear, O /a feet -�A I From nearest property line Front 10 Side,O Rear,O �.' feet Number of feet from: well -3 1,&,' , building: /a i (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, OSide, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: r Width:_ Length: �� � Number of Lines: 3 Area Built: Fill depth to top of pipe; Number of feet from nearest property line: Front, Side, O Rear,O Ft . _ Number of feet from well: Number of feet from building: (Include distances on plot plan). . SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of' feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: . / Inspector. Dated: /'9 6 Plumber on job: 1111hA License Number: 3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 MADISON, 537T28N-R18W ENCONVENTIONAL El ALTERNATIVE State Plan I.D.Number: (II assigned) Town of Kinnickinnic Holding Tank El In-Ground Pressure ❑Mound QTY N NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Arnold AL Lueck Route 1, Roberts, WI 54023 --Fly 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, Thomas A. Wang i3231 St. Croix 106089 SEPTIC TANK/HOLDING TANK: MANUFACTURER. ILIOUID CAPACITY-. TANK INLET ELEV.: TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER ' 1 1 PROVIDED. PR OVIDED lq(o F`'l� YES ❑NO ❑YES�NO BEDDING. VENT DIA.'. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING.(VENT TO FRESH FEET FR/ ALARM ' LINE O AIR INLET ❑YES1�N0 G� OYES L�JNO NEARESTM 1� �V DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODE L. JPUMP/SIPHON MANUFACTURER WARN I NG LABEL LOCKING COVER PROVIDED PROVIDED. ❑YES ❑NO PYES ❑NO OYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PR OPERTV ILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET UMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER N MARKING Or excavation. (If soil can be rolled into a wire,construction shall ease until , FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH- LENGTH NO.OF D ISTR.PIPE SPACING COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES t MATERIAL: PIT DEPTH DIMENSIONS 4— GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR.PIPE DISTR.PIPE MATERIAL'. NO.D R NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET EoLEV.END. PIP{ FEET FROM LINE}� AIR INLET \t_1_T_ 3 t,23 � �.�+ NEAREST—=� V 'DO JT 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- meets the criteria for medium sand. TIONS MEASURED. DYES ONO SOIL COVER ITEXTURE PERMANENT MARKERS OBSEH NATION WELLS OYES ❑NO ❑YES –]NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED J.EPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. JEDGES ' ❑YES El NO 1:1 YES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKIN(, ELEV.. ELEV, CIA. ELEV, PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED DYES ❑NO ❑YES 1:1 NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS'. NUMBER OF PROPERTY WELL: BUILDING' FEET FROM LINE J\ 1 S El YES El NO OYES ONO INEAREST 1----------- L4, Y_ L) for Sketch System on Retain in county file for audit. Reverse Side. (� //►► �./� TITLE DILHR SBD 6710 IR.01/82) -nQI�O l.. ► �JL,�,O Zoning Administrator (� SANITARY PERMIT APPLICATION COUNTY LY.DILHF� In accord with ILHR 83.05,Wis.Adm. Codev� X STATE SANITARY PERMIT## 106 d?q —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. PETITION fvi 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES Ll NO PROP TY OWN PROPERTY LOCATION r 166 n L°� '/a , S f Tod , N, R ? E (or W PROPS OWNER' AIyING AD S LOT NUMBER BLOCK NUMBER SUBDIVISION NAME r-> C/�Y,gTAT ZIP CODE PHONE NUMBER CITY t ' RES AKE OR LANDMARK Il D IT J� �� rfO41 El VILLAGE LX TOWN OFF II. 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. ❑ 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. NConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) /p 1. a. N Seepage Bed b. ❑Seepage Trench c. ❑ See pa e Pit ` a X�� ife 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): j Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons 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 /,&a p S s El Lift Pump Tank/Siphon Chamber ❑ ❑ I Li I ❑ I ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Business Phone Number: Plumber's Name(Print): Plu Signature: N",,tamps) MP/MPRSW No.: P um er's Addre (Street,Ci ,SYa te, Co � ? r Name oj Designer- VIII. S IL TEST INFORMATiON Cer i oil Tester(CST r ame CST# CST's AD RES Street,City, Zi o ) Phone Number: IX. COUNTYIDEPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Iss g Agent Signature(No Stamps) 19 Approved ❑ Owner Given Initial ( Surcharge Fee Ra Adverse Determination `�� X. C MMENTS/REASONS FOR DISAPPROVAL: 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 permrtt 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: Property owners name and mailing address. Provide the legal description where the system is to be installed; 11. 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 81/2 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. ---------------------------------------------------------------------------------------------------------------------------•--------------------------------- 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 cve. 2 years of steady negotiation and public debate. The groundwater bill Groundwater — included the creation of surcharges (tees) for a number of regulated practices which Wisco WS can effect groundwater. The surchar�° took effect on July 1, 1984. All of the water that buriedreBatlre is used ir. your building is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. a The monies collected through these s:;rc urges are �ediied t-> the groundwater fund adminis- tered by the department of Natural R-,sourcer These func<s aye used for .monitoring ground- f V..ate:, grc;undwater contamination in,•estigat ons and establishment of standards. Oroundwaf-r:1; :'s worth pro tecting. ".3D-6398 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 (.�( �'I2 te, k Location of Property , Section _ 1�2 �, T �4 N-R 0 W �,/e Township /C f l4 f1 l C 1,2 A !C Mailing Address Address of Site te 1A?Ie Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel ��(� Date Parcel was Created � � 6 Are all corners and lot lines identifiable? Yes ! _ No Is this property being developed for resale (spec house) ? Yes �_ No Volume 3,? and Page Number -24P as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTy OWNER CERTIFICATION I (We) eenajy that aft .6tatement6 on this 6onm ane tAue to the best o6 my (ou,%) knowledge; that 1 (we) am (a&e) the owneA(,$) o6 the pnopen ty dens eh ibed in thiA inbonmation bonm, by viAtue o6 a wav%anty deed neconded in the 066iee o6 the County Register o4 Deed6 as Document No. 09415'14 ; and that I (We) ptuentty own the pnopos ed z to bon the 6 ewage disFo-zat s yss em (on I (we) have obtained an easement, to nun with the above dan bed pnopenty, bon the con6tnucti.on o6 .saki .ayetem, and the same has bee dut recorded in the 046ice o6 the County RegiAten o6 Deeds, a3 Document No. a SIGNATURE OF OWNER SIGNATURE OF CO—OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. WARRANTY REED•-fir Copra" STATZ OF Vi00DN3n4-F0RM a 294516 105 STACK UMVID FOR ISOONOM DATA THIS INDZNTURE,Made this--_.....-2 6 t 1?_..day of-..... Y REGISTERS OFFICE A. D., 19...1, ST. CRO1X CO.. WIS. --�q�-,�,Corporation Reed for Record this-23112- duly organized and existing under and by virtue of the laws of the State of W"igrAt"e,located day of Nq_v_ember__q,D.19_ at. _.._Rs'�II� L �r.S2t,lS�rry d. 1� �94isseeeein, party of the at part and 8i__ 13 ----P►M. fiat Lueck nd Ar Jt b-11 r J_ Luek -.-ter 1L_.. - Reg tt of eeds part-19.S.of the second part, _ �- NETRNN TI W i t n e•e t t h, That the said party of the first part, for and in consideration of the s -----_._........._.......__ ._. _. _ .... ._--_--.to it paid by the said par"Z_of the second part,the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised,released,aliened,conveyed and confirmed,and by these presents does give, grant, bargain, sell. remise, release, alien,convey and confirm unto the said partiaS.of the second part thj-JIlElrs and assigns forever, the following described real estate situated in the County of_.__ State of Wisconsin,to-wit: The West One-half (A) of Northwest Quarter (NWk) of Section Twelve (12) and the Northeast Quarter (NEk) of Section Eleven (11) , all in Township 28, Range 18, subject to a real estate mortgage to Prudential Insurance Company of America, a corporation, dated February 15, 1960 and recorded in Volume 365, page 256, instrument No. 260887 in the Register of Deeds office for St. Croix County, Wisconsin and. a real estate mortgage to Paul E. Garbe dated April 1, 1962- and recorded in Volume 385, page 18, document No. 268579 in the Register of Deeds office for St . Croix County, also subject to easements dated June 11, 1938 and November 25, 1938 to St. Croix County Electric Cooperative and subject to lease and contract for public fishing grounds to the Wisconsin Conservation Commission dated February 21, 1951. (IF NECESSARY. CONTINUE DESCRIPTION ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining;and all the estate right,title,interest,claim or demand whatsoever, of the said party of the first part,either in law or equity,either in possession or expectancy of,in and to the above bargained premises,and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances,unto the said part-J. .of the second part,and to_t he j.1~.heir9 and assigns FOREVER. And the party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said parties--of the second part,_tJleir__..__._..---heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described,as of a good,sure, perfect, absolute and indefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever..&ae_-_de.ar-r-ip.ti:ori_3ho-_ZT-P. _.__.....-_-_............_.. _................___...........--......-......._..... _. and that the above bargained premises in the quiet and peaceable possession of the said parts e-Z -of the second part(;hP1btirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. In witness whereof,the said_....-..___----_---- Corr.a 11._.Re a�t 3z,•-Znc.. ______ _ ___._.._._._. _-_� party of the fast part, has caused these presents to be signed by.__...__.___... phrl_Z.-.__L:yiP l,]. _....._w .__,its President,and countersigned by. Ri Ylx'yI1 -�....C-U rrna la.._...._.._____..__._._._.its Secretary,at_.31-. E&U.1--r. Wlswnft, its corpo a seal to be her nto affixed, this-_.2-fth......day of..._.....NDWeMhL'r__---__, A. D., 19_..�. �""""'��i�``• N ANDS .• .,, .. CURRELL REALTY INC.` :�- : �,- ;y�� r tc • to c o _ a�tr nee P Jlher - = '•' .� •� . y -- -- J hn L Currell �� • C ERSIGNED: � ��. .n ---_-------•_----------------- _ _.�_____._.___._ _._.__.._w Eathr n M Currell STATE OF ,g a } _ W n ss. ashing-t.n .............County.JJJ Personally came before me,t his.--26._.....day of-__XouembLer_...._.,A. D., 19_6.8.-, ....................John---L.___Ciax.re•].1._------------_---, President,and...._....- Xat1=.yn..-M-..-._Mirre11.. . ...,Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument,and to me known to be such_--_-....----_---.•-.President and...---.....____._-..__......-.Secretary of said Corporation,and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation,by its authority. �'���� ��• T , 6UR:. .LL uMlnn. -1•q �� stiwt# ��,0(tyery�u fission Expires June Z 1971 This instrument drafted by :�' G+ •y Notary Publfi::-� .&--County,Wien Lawrence P Gherty ✓.,� l �.= My --------------------•------ - -----— ----i•=. �T : � � Commission(Expires) (Is) (Section $9.51 (1) of the Wisconsin Statues provides tiiil 5i1i'loitrumonto to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees, witnesses and notary). .._ WARRANTY DEED--STATE OF WISCONSIN, FORM NO. Bom 447 PA u E425 a.G uusa CO..ruWAVUE ' H N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St . Croix County z ty H OWNER/BUYER 0 or no M pp 1 ROUTE/BOX NUMBER Fire Number ^ .CITY/STATE ZIP� e��er��S Levi I PROPERTY LOCATION: k, 36, Section /� , T 0 R W, Town of butt_, St . Croix County, Subdivision , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained . The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration . 0 . E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►d ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offkce within 30 days of the three year expiration date . SIGNED /p p✓ DATE St . Croix County Zoning Office P.O. Box 98= Hammond, WI 54015 715-796-2239 or 715-425-8363 i Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION IN13US,TRY, , PLABEWAND PERCOLATION TESTS {115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON,WI 53707 (H63.0911)&Chapter 145..045) LOCATION: SEC N: TOWNS UNIC PALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: l�'/40/ If/T awl ( ► 0 --- COUNTY BUY S NAME: AILI A R//ESS:p Dmx d l P_Dber,*s l�g. USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E S R h,� NS: ER %�I STS: [1iResidence ❑New tRReplace b(l U O(a RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑ ®S U ®S ❑� (�S ❑U ❑S IRU ❑$ 6P U. 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: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.//ON BACK.))/ B- `I.B� q��a /X��� > 7 00 Z 6a tZ r ` B- B- 2 `7�� ���� �� ��.� e sir oL4 S�ac� re fihil B- U fi) S"'X Vr 6 5 e° s 1101 le AY h B- 3 7� B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH P_ y.ao p P_ a vD 9 6 ? 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 ' - Ir - a ��a tN i _ .... _ �......._.,. L f _ t i 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(, ' t : TESTS WERE COM(P�L TEfDiON: ADD ' CERTI IC4 ON N MBER: PHONE NU ER(o tional): CST S RE: ♦� DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — V INSTRUCTIONS FOR COMPETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this as new, or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; S. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; I. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred, A separate sheen may be used if desired; 8, klake sure your benchmark and vertical elevation reference point are clearly shown,and area permanent; 9, Complete all appropriate boxes as to elates, narnes,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10 If t1Fe information (such as flood plain,elevation) does not apply, plate N_A. in the appropi iate box; i i. Sign the form and place your current address and your certification number; 12. Make, legible copies and distribute as re(tuired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN ;SCI DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS i S'€.°sit Separates and Textures Other Symbols 't St;)'is (ovt� r 10") 8 R Bedrock col, - Cobhic 1,3_ 10") SS __ Sandstone C, av rtr _ O (under 3 t.f°i __ Llrvaeston= "'41 nS.F 8-'r:f;; -- C yr coIU 4iY„trI rY1E':t �; -- I�,Tt't3tt n. `any➢�i klv, VV'i;11 B1(R, B'Jldinq s L<<rasasy ,aE�,cl � ._ Greater T 4 r« r Sl — 4L ndy . ern � ..- l E ss 7"IFan an= Br, R ti i i - €It Cry _. :gray ca y : R Red 5-t t! fir-, f r a a t t°J" H r°r t� High L3.<att;? Six genet .; coil C x'ur'.es S r fad,. ,c =t lama °a,t €?k'nosEal BM Rench Rfla:L TO THE OWNER: This s od test report is the first stet, In securing a sanitary permit, The county or the Depactmc nt rrMy request v r ificat;on of this soil test in the field prior to permit issuance. A complete sw of pram', for the private 5eVrVaOR, system and a pe=; it application must i)E; submitted to the appropriate Decal are horny in order to bt"Im F7 t:Crrnit. True Sanitary permit must be obiair ed and”, �3{3sted pii€1r to the. stain, oaf any conoructlon. fell, 0 � 331 t Pa u� ©U�e r s �fi/t�►� r X y4 /a"r a p JS" rl b k Ba A .� 3I Q l0® h oIlse,ia' t,00v �a� Sewt;e `� o�� NE 6riiekr 14olae