Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
022-1036-50-000
\ o \ CD � § \ 2 _ a k o \ a 0 0 k D m 7 a m (/ � k �5$ $ 77 \� � 2e � 2S/ � ) ) k / §\ � \ k\ � co <1 7 � § co � z / \ § z � Cl) / § % z 2 \ % $ § c \ e » / k = I e $ ® I o 2 } 9 a)* } § k D k t � t c § q % E / ' o e � k 0 $ § S \ \ o o _ o § \ < 0 m m k \ e \ K Z > ] § § \ } 3 3 •� � � § EL /ca k \ G k_ k p LL ® D 0 a @ % o [cl t o o 2 \ a 2 a 2 a A $ ] J » m A $ i LO ; ■ i 04 % CD / 4 § ) ®u & g 0 ° § § e & § c ; n :z (D / j k \ < ® \ ) k k ] Q . - 4@ E E co « E E $ 0 C14 2 2 ' 2 ° o z $ / / ■ m �« � I \ a� � k Q v a 2 0 ca 00 , - 1 Parcel #: 022-1036-50-000 07/31/2006 11:13 AM ! PAGE 1 OF 1 Alt.Parcel#: 13.28.18.P203A 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 THOMAS E&MARYJO BLOOM O-BLOOM, THOMAS E&MARYJO 325 SHERWOOD FOREST RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *325 SHERWOOD FORES SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 13 T28N R18W 20.58A N 1/2 SW SW LOT Block/Condo Bldg: 1 OF CSM IN VOL 3/804 ALSO KNOWN AS LOT 1 CSM 6/1713 A REPLAT OF LOT 1 CSM 3/804 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 13-28N-18W Notes: Parcel History: Date Doc# Vol/Page Type 09/19/2002 690977 1982/425 QC 07/23/1997 813/02 07/23/1997 811/76 07/23/1997 736/290 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 234,000 314,000 NO PRODUCTIVE FORST LANDS G6 15.000 90,000 0 90,000 NO Totals for 2006: General Property 20.000 170,000 234,000 404,000 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 170,000 234,000 404,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 143 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 INDUS TR Y,TA OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IND4IS G DIVISION LA'BOR AND PERCOLATION TESTS (115) MADISON WBOX I 3907 ` HUMAN RELATIONS dV y2 Op S� �� ( 6 0 h pter 145.045) LOCATION: SECTION: �QWNJS UNICI LITY: OT NO.:BLK.NO.: SUBDIVISION NAME: �/ �3 Tz$H/R ��E ( c1 iJ1J L C -. - — COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS: ���� Z gpX 119 S�' C�01x - � Sw�E►JSo�CG �21vC2 FP, LLS w1 SYOZZ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: I PROFILE DESCRIPTIONS: PERCOLATION TESTS: 10FIesidence 3 t--)._ A ONew ❑Replace Il _ Z/J_p/ MA RATING:S=Site suitable for system U=Site unsuitable for system O > CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: YSTEM IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) NS ❑U NS ❑U IS ❑U IS❑S ®U I ❑S Rll If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the t� 1 under s.H63.09(5)(b),indicate: C° L]�S S Z Floodplain,indicate Floodplain elevation: N` A• PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-`"'_ E_±- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTHI:W ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) L6_' _`30 � 1voti1E 0*'&vnoT @3 Z' o.�'8r 1�S TS � �-5' $n_�`�S' 1-Z-\( �'S W S_ LA't@QS R o 3.9o.9'b Y%Sl 11; • 1.1' Bh L '0•8' `fBh -fS -o•S'8n FS- _ _ __ -------- ---------�'b-'-`�-�S_w-jL>1zBh__Co►,�o�4�T��._S1_�3�w�s 4p 04 Gy o-8'1Z)1L8h I TS;2.S '8h�`�S ' ) `1'If FS w/bFr $h hnoT% 3-Z Cc. kl SOLItATetA _S �_._.$FINDS B- w.u`r La j.z' o.S'D $h Ids TS ' o an L ,z.) ' -�.s u-)j Dtz Qh __ ___ B- S 6•o' "1 S ' rno� o•S'Dec 31 n -F s I Ts• l.S' Sn L - k.o' Y bn i� •o•3'8 n B-- ----- - ._ _ ? 3.9 O�'r+S�SI l0•3'`tar` St,►�I1Ttr_7I1e1JS�_fS�o- _'iD�-cB_h-.. G�N.SCLl 11�1�0 S I �.S' �wh►r w ttb'h PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P E R r6= PER INCH P P 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. vrACSE `ay SYSTEM ELEVATION sQ-= Pr\c ? °F 2' \-Ojk"'Y SAk)tD v �._.,.���..-.._mow a ESP► or 2 __� ' [._._ .b. > Ft _ r � ► __ 1 . [ 3 E " ►t_ S@C''TIO►a �3 SCp�LE, 1 -Zoo' I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: Z'n-1vR L. w� R Z- zy- 8(. ADDRESS: CERTIFICATION NUMBER: 1PH110SNE NUMBER(optional): 'ZT H $wk ZZ ~ Ww S40ZZ S-)b 4Z S-Ot6L/ CST SIGNA URE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — r i INSTRUCTIONS FOR COMPLETING; FORM 115 - SRD - 6395 1-o be a complete and accurate soil test,yoatr report must include: 1. Cornplrete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or cornmercial use planned; 4. Is this a new or replacement system; S- 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; Vii. PLEASE use the abbreviations shown Here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet gray be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9 Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropi late; 10, if +he in€ornaation (such as flood plain, elevation)does not apply, place N.A.in the appropriate box; 11. Sign the forrn arid place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED VVITH THE LOCAL. AUTHORITY WITHIN 30 GAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St - Stone (over 10") BR - Bedrock cob Cohl)le (3- 10") SS sandstone gr Gravel (under 3") LS - Limestone "s - Sand H(3W - Nigh Giouncawater cs - Coarse Sand Pear; Percolation (late med s - Mr',diuni `sand VV - WeII Is _- Fine Sand Bldg -.- Building Is - Loarny Satan! Greater Than "sl -- Sandy Loarn - Less Than `I - Loarn B Biokvn ` i BI Black = t l si --- S It Gy -- Gray �cl - Clay Loam Y - yellm'v sc! _. San=dy Clay Loarn R Red sicl - Silty Clay Loam meat - Mottle=s s - Sanely Clay "ficitlt s{c - Silty Clay f:f f:w,fine, fa;rlt - Clay CC -- Wnlrnort,coarse pi Peat mm Many, medwll m --- Muck tl rl stinct P - pl orninent 1-I�VL - High wator ievel, k SIX general soil 1extta;es Surface watr;; T01 lit#aid waste disposal BrV1 - Berle€1 Mark V RP ; li tic:;al F1el'- -lmco Pn'nt TO THE OWNER: hi"s"-'ii test t"k3poTr is tho first stop in..r.ccrritl„ F s',aflitt.liv ilea?nit, The county of the Der)artrnew-may rnquest u_. ficano!€ t')t this sod test ,.l f w "i I < pr''cll =o pk7 rant to f;ornvlI oi. ',Iol of p!aits frlr t:he piivato ar~;d a 13e3-alit. .t( plic,{'•:lon rr,i�I:e. „e Slit ,�1C$"i a�l tct t:, i �{lrC)pti<1I¢' loc"aI <€Lt T:I?CJ#;'t',' Ill 01-d€'r t.o . 'xt r,i t<€ r , ::; ii 9. wsr he� t 'aw""d 3t a, i).`3CI !-PiOl, tQ 0i. . t 0f qtr=y _ �J A Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �,�, c-rJl Ccy may, TOWNSHIP ei JwJ, C /<,�d,,J1 G SEC. 1._3 To2�N-R/,!�g W ADDRESS gl /J? ST. CROIX COUNTY, WISCONSIN � r SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INJ oe v $ � L �3 I ` A INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used A/4-.-L 1A/ -7 ` .JsaO � Elevation of vertical reference point: /Q,10� Proposed slope at site: 10 SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: / 2 Tank Inlet Elevation: S Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side, Rear, O O� feet From nearest property line Front,0 Side, Rear,O i feet Number of feet from: well building: (Include this information of the above plot plan)( 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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: I Lenith:7.L,_. Number of Lines: 7Gt1 d Area Built: CAS Fill depth to top of pipe: 7 Number of feet from nearest property line: Front, O Side, Rear,0 Ft6W9 Number of feet from well: Number of feet from building: IZ6 (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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: �O Plumber on job: License Number: i i 3/84:mj DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LA60R AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS MADISON,WI 53707 (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSH UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: Sw-sl��/ �/ 13 /TZs M/R �aE co t�)�r.��c MIA3 N I C — - - COUNTY: OWNER' UYER'S NAME: MAILING ADDRESS: QVU T� Z 8dX ti9 Zr' cIX0 Ix 76" M- F:0,,u.S, w, suoZz USE DATES OBSERVATIONS MADE NO.BEDRMS : COMMERCIAL DESCR PTION: 177Z FILE DESCRIPTIONS: PERCOLATION TESTS: IgResidence - l r") - Pt, ONew ❑Replace. _-Zy_S6 /\J- 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 MS ❑U ER S ❑U S 01 ❑S ?U required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C L,�SS Z Floodplain,indicate Floodplain elevation: If Percolation Tests are NOT re ' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-Lim CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH kRZ ELEVATION OBSERVED EST.Hl TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 6 7. '_ 9 . � = nb@ y•o' . " -Sn-�STS ;1_•3' C � IS .4'In o _ IS _77 -1. S' q_). 6 '! _ >_ 1 S'. )-o'bNT_�3r l g T-s;1.5'1 �n Is a S.o\-T-18n_l s B- �•o' 95.3 ' �, -�, o' o.q� �� -z.V 11 L4.0' 11 q- -$.O' QS.3 ' '! _ . .>._ 'c�' ._. _. �I i 1-$' 11 'i S-Z ' u 1I `3.© ' 96-8 ' tt > S.0' O.9' -Z o' I' ;, S•! !I B- B- c - 11 S \ L'A'BS R IJ GS U 1 C )V 01 1 L S B PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER1oD1 _PER IOD2 PERIOD PERINCH P- 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. 11vNY1%-�%L — 93.4e' SYSTEM ELEVATION kePLacC+-fEN7- 9Z.o ' ___ �� �'uat J"Q -7 ( — i o l I � U O i / 3fi F t _�. .. N ..i __. .... ;. I , W Lam$ �CL - `� _ �.__ -- _ 5 C�c.c.EPT +�S -5►tow N- _ I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: RtzTl-FvR L. wE6�2�Tst Z- ZV- 86 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): IzTy Lox zZ(, T=LLSvwoZ'T)j ,wl shut) S-A6 I-)I S-Liz S-oj&y CST SIGNATTUR,E- L�`vGYfM/ti DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. PAGE 2 of 2 DILHR-SBD-6395 (R.02/82) —OVER— `L _ INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report nactst ir)clucle; 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 a new or, reoacernent 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; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locatim your test locations. Drawing to scale is [.)referred. A separate sheen may he used if desired; 8. Make sure your benchmark and vertical elevation wference point are clearly shown,and are permanent; 9. Cotnplele all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information) (suCh as flood plait),elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12, Make legible copies and distrihote as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIES} SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") 13R - Bedrock coh Cobble (3- 10") SS Sandstone gr - Gravel (under 3") LS - Limestone �s - Sand HGW - Hi<fh Grocrnriwater c Coarse Sand Perc Percolation Rat€ need s - Medium Sand W - Well f3 - Fine Sand Bldg Building Is Loamy Sand > --- Greater Than `sl Sandy Loam < -- Less Than "I __ Loam Bn Brown 1sii Sift Loana BI - Black si - Silt Gy - Gray 'cl Clay Loam Y Yellow sc.l - Satidy Clay Loarn R - Red Siel - Silty Clay Loam mrat - Mottles sc .. Sandy Clay vv -- with sic - Silty C kly f ff __ f€ vv, fine, fa r)t C -- cI a')! c€; - comrr)on,coarse pt pl at ;nrn -- Many, wedi€aril IVluck d - distinc, p — pro titi(t e!lt HVVl.- - High vvatr ,r, level, Six getteral soil Textures surface walef, for liquid vvaste disposal BM Rench Mark VRP __ Vt rtical Radar,mc.(? Po n,� TO THE OWNER: ( ra s,I),t test report i,,the fir t step in sMlrir)cf a sani�rary K:)(MI-it< The carroty c>t cot;l rrg�art(rent may r e(puest v `„cat'.nn o this sod �Eest in the field prtcit io rennin ss t. t {r. A €;ample*€ s€ai of l ian", fm the pnvato ,v uv&'i�: uSt:"am and sa permit rr)at,=13€;zatt')r"S 7T7[tM 'he Su'Ormlteill `t) trw opja)iop,tlal.: i£}cal autho v Ir. order to d_,�;,vn, a f�€'i nnii, The r`til:trs`C"� pa' r lit rn9 lit be hta n�i and pod ,; ,'d p> lm too th , . c,..: Dt 2Wv c 1i5tt'u 't.a�::+rl. DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION •P.O.•$OX 7969 BUREAU OF PLUMBING MADISON,WI 53707 �yy SWV.,SWk;613,T28N—R18W MCONVENTIONAL ❑ALTERNATIVE State Plan I D.Number: Town of Kinnickinnic E:1 Holding Tank El In-Ground Pressure 1:1 Mound Ilf assigned) Sherwood Forest Road 15. NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DAT Dr. Thomas E. Bloom 1085 S. Robert Street, West St. Paul, l _ '� —'3? r� BENCH MARK(Permanent reference point)DESCRIBE IF DENT FROM PLAN. REF.PT.ELEV.: CST REF.P .ELE V.. Name of Plumber: MP/MPRSW No.. Cn�nty Sanitary Permit Number: Lyle J. Myers 6219 St. Croix 106072 SEPTIC TANK/HOLDING TANK: MANUFACTURER. N LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROV IOED. PROVIDED: Put Q�" �'a YES ❑NO ❑YES O BEDDING: jVFNfDIA.: VENT MATL HIGH WATER NUMBER OF ROAD: { PROPERTY WELL BUILDING. VEN O FRESH _ ,/� ALARM FEI•,I,FROM /1 LINFJ,/l �1 / LAIR INLET. DYES O `._ ❑YES O NEAREST �C/ -�Qy /[7�� �G� DOSING CF/AMBER: MANUFACTURER BEDDING jLIQUIDCAPACIlY PUMP MODE PU MP;SIPHON MANUI ACTIIRER WARNING LABEL LOCKING COVER P VIDED. PROVIDED. DYES ❑NO YES �[:]NO YES ❑NO GALLONS PER CYCLE: PUMP AND C ONTROLS OPERATIONAL NUMBER OF PHOPEHTV WELL. BOIL ING VENTLE FRESH (DIFFERENCE BETWEEN FEET FROM "E AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST=--)r► SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing 1 I N(,TH MAMF TEH MATE IA AND RKIN or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH NO.OF DISTR PIPE SPACIN(I COVER ,INSIDE DIA -PITS LIQUID BED/TRENCH /� ice, TRENCHES I NIATE131AL PIT DEPTH. DIMENSIONS GRAVE LDEPTH - FILL DEPTH UIPE DISTH PIPE DISTR PIPE MATERIAL O D iH NUMBER( F PROPERTY WELL. BUILDING: VENT TO Fq ESH BELOW PIPES ABOVE COVER E ELf f ELEV.END PIPES LINE. AIR INLET. /i FEET FROM 1 NEAREST' --i 1 8 11/v 1ro MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER IT EXTURE PEHMANf NT MARKERS OBSERVATION WELLS ❑YES 1:1 NO _❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL BUDDED [511 DED MULCHED CENTER EDGES DYES, ❑NO ❑YES El 11 ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO OF LATE HA SPACING GRAVEL DEPTH HE LOW PIP! FILL DEPTH ABOVE COVER 'BED{TRENCH TRENCHES. DIMENSIONS, MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND 'I ELEV.'. ELEV. DIA. ELEV, PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHFCT LV COVEN MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES 0 N DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBE OF '+ 'PROPERTY WELL: BUILDING: FEET FOM LINE: DYES El NO ❑YES LINO i INEAREF T f - Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE Zoning Administrator DILHR SBD 6710(R.01/82) SANITARY PERMIT APPLICATION 'COUNTY In accord with ILHR 83.05,Wis.Adm. Code 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. PETITION 1. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 5�NO PROPERTY OWNER PROPERTY LOCATION '/4 '/4, S /3 Tom$,N, R $� E rdW PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME .5 iZo,�9 CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR NDMARK / ❑ VILLAGE: s � II. TYPE OF BUILDING OR USE SERVED: . /W• 001;—103 & _S0'-00d Number of Bedrooms if 1 or 2 Family 3.d6 o xtoz,^ OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. XNew 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 Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Dd Seepage 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): 8 '� 3, Feet %Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ciallons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed it Septic Tank or Holding Tank 1©d d OA)e Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system hW on the attached plans. Plum er's Name(Print): Plumbe 's Sig ture:(No Stamps) P PRSW No.: Business Phone Number: 452 1,9 ZS Zo Plum is�A[ddress(Street,City, tate,Zip C ,Q s� Name of Desig er. F� sl�O °L'�C C,�j VIII. SOIL TEST INFORMATION Certified oil Tester(CST)Name CST## 'T a Z, CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY �q F-1 Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) R Approved ❑ Owner Given Initial It C j Surcharge Fee C Adverse Determination 0(' �» X. COMMENTS/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 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. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. 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; 111. 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; Vill. 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% 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 over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater . included the creation of surcharges (fees) for a number of regulated practices which Wisco *n::$ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that ! ° buried reasurB is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. c The monies collected through these surcharges are creditEA to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) ti APPLICATION FOR SANITARY PERMIT S T C - 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 n- � '(-ti.�-Y,,a S F_ Location of propertyN�a�cyl/4 5Ly 1/4, Section 13 , T N-R W Township /C/"ICk;-'%tile. Mailing address to `� �GlJ, �T,�r9cc,`, lkb Address of site Mti�� S©u Subdivision name Lot number 1 Previous owner of property �Vw -V^A-5 S4-0edt? u�oe�j. Total size of parcel ao , a� Pce kV4 Date parcel was created 1,R-,+ 06nJtA-C[�-j 6u&Jf &( �ov�k Are all corners and lot lines identifiable? '� Yes No Is this property being developed for resale (spec house)? Yes No Volume ((and Page Number a90 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 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. Li ll 3 ; 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 Co ty Register of Deeds, as Document No. ) . Signature of Owner Signature of Co-Owner (If Applicable) Da a of Signature Date of Signature y. i '6FASC29 T.RM 11-1982 DOCUMENT NO. STATE SPA(;t RESERVED FOR RECORDING BAR OF WISCONSIN FO DATA LAND CONTRAC I' � �� Individual and Corporate �d v ' � '(TO BE USED FOR ALL TRANSACTIONS WHERE OVERI; $25.000 1S FINANCED AND IN OTHER NON-CONSUMER ACT TRANSACTIONS) _. I, •' �GIST0-3 OFFICE ..gam -and Yassa=..... -• ' �. 'S. y�,t OIX Contract, by and between 71-�alas.P.. • •� Co.,., {$,r ..--....._.... 3aad q.-b► �d arynfp----------------------------------------------------- ..._.. ....... ... ..... ....._._. �, 'y.• 1 r ^ppr! this 7th ("Vendor , ..................... r f ,.&April A.D. 1986 whether one or more) and-_M:mT s-E,-•B1GCm------- - ("Purchaser", whether one or more Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- 4,I `� N Dom, formance of this contract by Purchaser, the following property, together with the "`'� ::� " I: ... . rents, profits, fixtures and other appurtenant interests (all called the Property" II -- in...St.-�'O1X------------------------------------------ County, State of Wisconsin: RETURN TO Tax Parcel No. .................................. 'Ihe N 1/2 of the Si 1/4 cf the Sri 1/4 of Sect'M 13-28-18. 9b3eCt to easaTents of re=d. This .....iS..nat........... homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to .Vendor at S=11.pl acp-.r1S_.reasonably.-directed the sum of $..2Q,.000.-0L0L..................................... in the following manner: (a) $.-2r-Q0L0L.-0L0L............................. at the execution of this Contract; and (b) the balance of $.18,000_00.................... together with interest from date hereof on the balance outstanding from time to time at the rate of...ten...(10)....................... per cent per annum until paid in full, as follows: purchaser shall pay monthly installments of not less than $580.85 camiencing May 1, 1986, and on or before the first day of each month thereafter until October 1, 1986. Purchaser shall pay the sum of $2,000.00 on or before October. 1, 1986, after which the monthly installmen t shall be the sum of not less than $506.00. The $506.00 monthly payment shell commence on November 1, 1986, and monthly thereafter on or befoe the first day of each month . Payments are to be applied first to interest. then to principal. Provided, however, the entire outstanding balance shall be paid in full on or before the..3.1.St............... day of March------------------------------- 19..$9._ ( the maturity date). Following any default in payment, interest shall accrue at the rate of 1.0.......% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest -unless otherwise required by law, ,a •auo ;no 49013. • .---•emu .. -•---••-•----•--------5WES©T9-•g©--e412'P-•-uo Slaadoad aqj ;o uotssassod 91ju3 of a1 pua aq Ilugs ias-cLpm j *plod st aotad asegoand lln; aq; It;un aopuaA Sq paute;aa aq Begs It 'pua;sge tie ;o tuao; aqj ut si aauaptea atll; JI •aouaptna all!l aanin; ;o Isoo aql Sed of saaaals aasagaan j • •�tm�ma M -4LO turd Lprss p ;s= .m qix� alb d aP ST u a�R JP ;26 C4 '41� a.R WZ4 TTY ,xpzuzLR u:)T4TpL= A e S-P r m U mPa-CF4 sTTJ m a•P LZ-�l ;--e J L�rs X'3PLn -4m�r Am ned o4 size; 2TL2A q2LD ;Ls^a a.R uI '@qm'aA MSS2= se 'UD9240f aWI GssaL'=9 TLE 'TE JaqurGQ 9PPSO I=XCO �I 2 MPM �A S2 t�.T a)-fd aP aM-;eLp�Y.� SL R �' H :3daaxa not}eutuexa ao; aamgaan,j o; pa;ltugns aauaptea al;t'3 aql Sq umogs se al3tl aq; glla pagsj3t.s st aasupand Ieg3 saluls aasegaand •tuo.t;aaaq papnl0sa aal;eatagj gutaq sastutaad pauuapuoa aq; 'uotquuuapu0a ao aausansut ;o spaaaoad Sue ;0 3tpaaa ;o Juana aq; ut panupuoa aq Ilsgs s;uatuSed Slg3uou jeg3 papteoad :aeoge pagtoads Isag sa apeut uaaq sjuacuSud tlgluou aql peq uaag anetl pinom ssaupalgaput pass 3eq; ;unoua aqj uegj ssal st (ledtautad ptedun se palsaal aq Ilegs q;uou o; gluon uoa; Isaaalut Sutnaoae asua Bons ut pus) Isaaalut pus 'ledtautad ;o aoueleq ptedun aqj se Zuol 0s juauSud of ;aadsaa q;t•.0 lIns;ap ut ss pa;roa3 aq jou llegs 3asaauoa stgl 'juautSsdaad Aug ;o }uaea aqj uI aa;;e aut, Sus ;e ledtautad uodn aa; ao untuaad znogjpA ptedaad aq Seu ;unouc . :........ n,lr_la,rr,aris a,ea au1 110 aaulama ptedun aql uo }saaa;ut oq }sag patldde aq llsgs s;uautdea Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in iL and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of .fU7, •_j,051))~ �,�__V �110._., but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: ...Easenient.-91......................... .....restrictions-.and.x ights=o£-way-.o£-.reco>rd.,...i f..any--------------------------------------------------------------------- ............................................................•-------...----....--•--•-•--•-.................•......• .... -•-------------•-••----....................------.. ..................................................................................................................... -•---.•--•........................•---.....•--......-•--•••••----•-----•---•......--............................................................................•----••-- Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of .6.Q.....days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of...��,,{{}} ... days following written notice thereof by Vendor (delivered personally or mailed by certified mail),then the entire ou anding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder(in which event all amounts previously paid by Purchaser shall be 4orfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and.other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforceany remedy. hereunder (whether abated or not) to ti:e extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendors written consent, the entire outstanding balance payable under this Contract shall become immediatelydue and payable in full, at Yendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or.prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) 4Datediis da y of ... ..-•Ap mi.1.......................... 19...tea.............. u! -r ..........(SEAL) wY.. .. ._.... ^?�l .............. ......(SEAL) Thomas-P. Swedenborgt...,, rt o ......... • .Thcmas..E_..Bloom,•-Pur-chaser............. Yasuko.Swedenl?Qrgr..Vendor..............(SEAL) ...................(SEAL) , ' ...............•-•-..._........................................... AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) ..........................•-•----- 1 ,,, .• � ..., paiui�d so pad63 a4 Plnoys ,ppedco 6ua ui eutuxtc�suossad�jo�wultpj ,---------••---� ( .�aessaaou ;ou aaa �- ON ( i u;oQ •pa2palmouxas .10 pa;ea!;uay;na aq ,tutu saan;eu, ) uoi;eaidxa a;e;s ou• 11'"luaueujY sc uolssctuujo0 .Syq .......................................................... sim 'B;unoO•---- G�.,.... ....._ •,. atlgnd Aju;o11 ZZObS IM 'sTTp3 �ant� '4aaz4S ut2i�1 'N 6TZ . ......... / .� ...........0'S 'S370S 8 Z`d)ISSS 'I'IQO,L 'S�ZOH 'Q Hd`3501, ' •• •• '•••-••-"••• /1Y 's p31d a0 SdM 1N3W(1a15N1 SIHl ' 'a11I65'�2L[�,��•-a�0u�j�B �j��.Z�awni;svt �v[o3aio; • ...,�i�����.��,�� ,.�.� q o1 umoux aut o; t ; ;g ?AA 9090L § S4 Pazioy zn e aq; pa;noaxa oqm iaya ' ............................................................ 'IOU J I) .............................. •---xioo�g--�-g•-s��uor��-•pu�-...a�tM.-�•-puPgsrlt•I._ NISMOOSIM .d0 KVfi �> �bzoq�apaMg ©s;t1s� ptie'-b-7oquap M �S.._a.. uy --------------------- paumu aeoge ag; -"99.61 ' Z id ------ o de st areal ua na t� ;0 ,tep-------- stq; atu aio;aq aujeo -,3UOsaad 6i ,t�uno0 t•........Xt 0 a $ STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYE _ ��,-s , I QQA- _ ROUTE/BOX NUMBER {,gam —6a FIRE NO. CITY/STATE W.&I SLOO4d M U . ZIP STII� PROPERTY LOCATION:/ '41,4k2/4 :;;�W 1/4, Section T_IL_N, R C W, Town of ftii�n�ic K ;%vn,tC , St. Croix County, Subdivision , Lot No. 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. S I GNTI ,c DATE / a /100 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Date, and Return to above address REPORT ON SOIL BORINGS AND SAFETY & BUILLSI «;. o)vlslon �U' P,0, BOY, 7969 PERCOLATION TESTS (115) nnAOlsorv, vvl 53-707 ?�`tiT IONS (H63.090) & Chapter 145.045) Cie ION. SECTION - TOIrJNS UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: t ICOU,NTY: ftuWNER' UYER'S NAME: MAILING ADDRESS: wI sYOZZ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PERCOLATION TESTS: 1 OResidence 3 I ®New ❑Replace Z_ ({ =961 A I RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ,®S E]U I ®'S EIU I IBS DU I DS ®U EIS NU 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: C 1_h S S Z Floodplain,indicate Floodplain elevation: I v` �• PROFILE DESCRIPTIONS BORING A DEPT H TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH ti ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) I 4,L�' SO ' lvo►JE 0tS,tn6T-,,)3•Z' o. 7 )1 TS ; z.S' -S n Z. Y'FS w SS Lh� S B z 5•S' 76 ' tt RrnoT�3.9 o,q'Dr�$nSl YS �•1' B►t L 'o•$'`>'Bn �S;o•5'8n �s- _ _ �•b` 5 w�Dlt Bt, CD>JSo��t�r�Tr� S� ��DS __ B- 3 y.-�' moo' 11 Tp oa GY o-8'�tt�Qn 1`�STs;2.S '$hJ`rs ' I y't'�s w/D� 3n -rQ> 2 ' ctsQ:i_SD LloA� S 1 8_R,.��s B- 14 B- 5 �,p' S ;- ----,`---- ;.C t r.�!- o•S'-7-)lrc 1�?% <S I '"s• l.S' �en L ; •0' Y Bn �S ;o•3'8 n 3.9 s� �0hlJSG 5.10.3_'�rcBn_ B--_ ,_,,,�`ol..l D?,`� S 1 �.<3' �w�,•-re � w o1z�n B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING I INTERVAL-MIN. PERIOD 1 1 PERIOD2 PER100.3 PER INCH P- 1 I P- P P- P- I 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. ca SYSTEM ELEVATION S� � Z 0;= Z. RgtlJFt�LD �0+ `t vF`.1J� _ i Sw fly - S — --– --- I ----- , �� •-OR)-,���to -_ ' ' r2: Lvi _ - 1 --- --=. ----- ----- --—= — ---- I 1 — 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 V6sconsin 4dminist-ative CDde,and that the data recorded and the location of the tests are correct to the best of my kno.vledge and belief. —4'v1E (printl: ----- —— — TESTS 1"ERE COMPLETED ON: i SS: --- ERTIFIC A TION NUPa1BER: PHONE NUMBER ,) ',io-..1): S�b CST SIG-NATURE: / .. ., _ '.� � ., . ..,`,.,��'.1', - _. d col; Trs;er. •�.��" 1 �=- .5 n DEBAR-eMENT OF REPORT ON SOIL BORINGS AND SAFETY L4 BUILDINGS ' DIVISION L tOf3'RY,• PERCOLATION TESTS 115 P.O. BOX 7969 L F30t� A.IVD H'1MAN,RFLATIONS ` MADISON,1h'! 53707 (H63.090) & Chapter 145.045) iLOCAT -[ION:T p TQkld SHI AUNICIPALiTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 3 /1 ZQ N/it 1` Iorj c1fJiJ lCt�!l�1/J r C — I COUNTY: 1Ot"✓NER'SBUYER'S NAME: MAILING ADDRESS:p�w� Z SOX J J o 5\ • C'-J iX �l SIiJ��Cl�.?���� l< 1V CR F=Ku-S, w1; SVO1-% USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: IgResidence ONew ❑Replace I Z_-2-V- S6 N. A RATING:S°Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: L HOLDING TANK:RECOMMENDED SYSTEM:(optional) �S ❑U ®S ❑U JIN-GROUND-PRESSURE:ISYSTEM-IN-FIL �S ❑U OS L�U DS WU �2'x�� 'Ga�u=>J�D�, DESIGN RATE: It Percolation Tests are NOT required DES 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-tA*eMCS CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH W. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) _? --�• S' q� 6 ` it — > 5 ' ).o�bfiz�3r 'is_Ts-)I-S,le n Is S_o �3►._1 s --- � B- °� '1.p' q5.3 ' ,I > "i• �' 0-4� '� 'Z.l' ,t y.p' II B- B= L(-7 ` PERCOLATION TESTS FTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAE PER IINCH NUTES BER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERIOD 3 P-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. 1N��1 A L - 93•�' SYSTEM ELEVATION I _. "Z�1 +-'1. 1P f F-: 0 " C, - lapv V$j Ztt CzV�Z r ' �I 1 1�3�iicLZ 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optiond): ;may , ��� _�L_s:�L `---, :/jI Y�►� s�� ;��-uZS_ c,sy 1--=-- ---- - - CST SIGNATURE• .d , pISThiSU i IJ7J. 1 c Lo:a' A u i h o ;ty,P,oper1y Crane•_- SoiI Tester. - y DILHR-SFD-6795 (R 02 62) - OVER- ' .I\. C`.j PC,F" V •.. ._�'{i�.-u r �i1{Yr 1 Iv . ._ .. _ • , .' • ' 2- The use section must clearly indicate rdhe"+er?i'i i ':'>:Ci=ncF- or comme?Cia: rirojeC.; °. I,,gAXWOM number of bedrooms or corrtn-lercia 4. 1s this anew or replacement system; 5. Complete the suitability rating boxes. �. SITr !�, S'UiT-A LE FOR A HOLDIPJG Tr�NK ONLY IF ALL OTHER SYSTENIS ARE RULED OUT BASED ON S:)IL CONDITIONIS; 6. PLEASE use the abbreviations_shown het "c•r �.'>. ++ ; profile-desci iations and wrin!nnq the pint plan; .. - -_._ _ g y t t_ scale is preferred. A 7. MAKE A LEGIBLE diagram accurate) loca.iag your test.locations,Drawing to sca separate sheet may be used if desired; 8_ Make sure your benchmark and vertical ele�atior, ieierencepoin, are clearly shov✓n,.and are permanent; _ • 9. Complete all appropriate boxes as to dates, names, Gddresses,flood plain data,percolation test exemp- �_ 'tio_n,if appropriated 10. If the information (such as flood plain,-elevation)doe5-not:apply, place N.A.in the appropriate box; - - - -11. Sign the form_and pl ace,,your-current address;and your-certification number;- 12. A9ake_)egrhlp-'c�nies_'and�isti it�ute_ac required:"ALL SOIL_TESTS MUST BE -FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.--.- - • - _ — --' - ----- i s COMMERCIAL TESTING LAB, INC. COLFAX, WI 54730 (715) 962-3121 2-20-86 WI Approved Lab No. 19 Date ' OWNER LOCATION Route 2, Sherwood Forst Road COLLECTOR Cashmanis River Falls Realty, Inc. a I { SOURCE OF SAMPLE I COLIFORN► 0 /100 ml INTERPRETATION__Bacteriolobically SAFE NITRATE-N 4 ppm - under 10 ppm is safe for human consumption. LAB TECHNICIAN Pam Gane cc Form No. 227 Pv aa 4 CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW}, OF THE SW}, OF SECTION 13, T28N, R18W, A P P<l..} E� BEING PART OF LOT 1 OF CERTIFIED SURVEY MAP VOLUME 3, PAGE 804, TOWN OF KINNICKINNICK, ST. CROIX COUNTY, WISCONSIN. JUN 1 z 1�3a0 N OWNER rn = rn Thomas E. Bloom ° ° ° ca lu Box 16083 o ,a St. Paul, Mn. 55116 O 7 N ON CD O N F+ Of Cf 7 W} CORNER SECTION 13 X COUNTY MONUMENT a CD SCALE IN FEET N n. N c rr o ° 200 100 0 200 a er s et m 0 unplatted lands owned by others 33 33 north line of the SWi of the SW} S88 05311511E 1326.50' 33.01' PRIVATE 1293.49' ROAD EASEMENT rn c �y S88°53'15"E 1293.39' N C i 1'r Im Imo' m I y 10 1 O p y Of -h O I O 1 0 O F rl N ,.� r ,' ►• I Ci w I v - °_' m �< LOT z °'`3 o iId C. O C71 0 882,428 sq. ft. (20.26 ac.)INCLUDING ROAD R/W s ° I� cn 775,141 sq. ft. (17.79 ac.)EXCLUDING ROAD R/W Iw 1 N CT I. I co 1 t0 C+ 100 Cb S O fD 14- 9c 1� I 33.01' I 1292.49' N8804610211W 1325.50' 33 33 Lot-2-of-Certified- - - Survey Map v. 3, p. 804 --- -- -------- ----------------------- ::this strip of land was o deeded to an adjoining 0 o owner. .-r o LEGEND 0 CT ° ,°, • 1" IRON PIPE FOUND. 0 -n s O 111 x 2411 IRON PIPE WEIGHING 1.68 LBS/LINEAR FOOT, SET. m rn rn N •F E a`F•• N W SW CORNER SECTION 13 this instrument was drafted by Douglas Zahler job no. 79-01-186 .. COUNTY MONUMENT SURVEYOR' S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Tom Swedenborg and Thomas E. Bloom, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows : A parcel of land located in part of the SW 1/4 of the SW 1/4 of Section 13, T28N, R18W, Town of Kinnickinnick, St. Croix County, Wisconsin, also being part of Lot 1 of Certified Survey Map Volume 3, page 804 as recorded in the office of the St. Croix County Register of Deeds, described as the N 1/2 of the SW 1/4 of the SW 1/4 of Section 13, further described as follows : Commencing at the SW corner of said Section 13 ; thence NOOo-O1 ' -16"E, along the west line of said SW 1/4, 664 . 23 feet to the SW corner of said Lot 1 and the point of beginning of this description; thence continuing N000-01' -16"E along the West line of said Lot 1, 664 . 23 feet to the north line of said SW 1/4 of the SW 1/4 ; thence S880-53 ' -15"E, along said line, 1326. 50 feet to the east line of the SW 1/4 of the SW 1/4 ; thence SOOo-06 ' -41"W, along said line, 666. 99 feet to the South line of said Lot 1; thence N88 -46 ' -02"W, along said line, 1325. 50 feet to the point of beginning. Above described parcel is subject to Town Road R/W and a Private Road Easement of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236. 34 Wisconsin Revised Statutes and the Land Subdivision Ordinance of the County of St. Croix insurveying and mapping same. 41 CS Q/1 Vol WE ALLEN C. NYFiAGEN = L 5-1407 l C' HUDSON, f T 1i;;S. .•'P�O�y`a~ Allen C. Nyhagen date .. NNo sup, S,,�°`� r}.