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HomeMy WebLinkAbout040-1151-30-000 a ~ 0 h � c rY o a � Ci y O C ry d O � N aw c E c i I cg•y y I � 7 C a i II vi c D)o ai m c z ° o LL O O t:a d Q H O I O M 0 N Z y oc E d N E w O W E € o Z N d d M N o a m N C O c O z p v Z � C � o fA FZ- r O N Z c � � o M N 7 C � N a N c •►y a <n s °o Z m Z O w o z of �l N to V O y � r 1� a M c+`� c7 O c d m z •N a LL IL IL CL 00 co a g j N -1 V -0 COi OOi O ! \l Z N a 00 A� 0 O 0 N O p) 0 c �M0 0 0 M a o 9 � a N E m N c O U w N ° m �O C O c V I- 0) O •O C y'�,i O -� O y y c R 0 M co c~ Z CO a p" E co 0 4O MO O L)O Cl) N rn N f�n i F- O Z c F- � rr l C� 'A i � a �t a :: a • � a m � d iw E c c A U a 2 O N V s a Parcel #: 040-1151-30-000 02/16/2007 09:10 AM PAGE 1 OF 1 Alt. Parcel#: 23.28.20.582C 040-TOWN OF TROY Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O-CARLSON,ALBERT W ALBERT W CARLSON 131 GLENMONT RD RIVER FALLS WI 54022 Districts: SC =School SP=Special Property Address(es): '=Primary Type Dist# Description ' 131 GLENMONT RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.800 Plat: N/A-NOT AVAILABLE SEC 23 T28N R20W PT GL 2 PARCEL AS Block/Condo Bldg: DESCRIBED IN VOL 598 PAGE 450 BEING LOT 4 OF CS MAP IN VOL III PAGE610 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-28N-20W Notes: Parcel History: Date Doc# Vol/Page Type 09/08/2003 739119 2402/387 QC 09/08/2003 739118 2402/384 DJ 07/07/2003 728993 2303/70 LC 987/415 WD more... 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.800 696,800 521,900 1,218,700 NO Totals for 2007: , General Property 2.800 696,800 521,900 1,218,700 Woodland 0.000 0 0 Totals for 2006: General Property 2.800 696,800 521,900 1,218,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 104 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 gain Street, P.O. Box 526 Colfax, Wisconsin 54730 lkt� 715 - 962 - 3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT CEO.' 34010/01, PAGE 1 ST. CROIX COUNTY REPORT DATE: 12/18/92 COURTHOUSE DATE RECEIVED! 12/15/92, HUDSON, WI 54016 ATTN' THOMAS C. NELSON ( G �7 l OWNER' CJo'nJambo ss LOCATION' emo River FalLs COLLECTOR' St. Croix Cty. Zoning DATE COLLECTED: 12-14-92 TIME COLLECTED: 2'15pm SOURCE OF SAMPLE' Outside faucet DATE ANALYZED'12-15-92 TIME ANALYZED'2'00pm COLIFORM*. 0 /100 mi INTERPRETATION' Bacteriologically SAFE NITRATE--N' { 1 ppm ` Above 10 ppm exceeds the recommended Public Drinking Water Standard. i Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L l F LAB TECHNICIAN. Pam Gane S, .OF,NDEOFNOpH� `o WI Approved Lab No. 19 3 E , < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 )t-n „) ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street ,AL Hudson, WI 54016 ` Telephone (715)386-4680 )he St. Croix County -Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion 2f this form ja essential zQ that = Drrooerty can DA located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 35.00 35 , 0 0 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 o2S, V 0 j' (Determines if system is properly functioning at .-time of inspection) PROPERTY OWNER'S NAME:7 C)h n Q/Wl b01 S t° PROP. ADDRESS: 131 c., 1C.-Y1 'mnr � fz j CITY ( Ta ll� Legal Descri t'on 1/4 of the 1/4 of Section Z-3 T'Ld N-R� Town of -�12 Lot Number Subdivision:' FIRE ER LOCK ZM NUHBER T) 10 O 6 $��C Color of house _Realty si n g y house?.`Y)o If so, list firm. PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF .THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. // -- Firm or individual requesting services: "Zu'fnif �Qa 'rU Telephone Number - O REPORT TO BE SENT TO o 2 a a CLOSING DATE: Signature Stillwater Office 2020 Washington Avenue Stillwater,MN 55082 612/430-2100 Fax 612/430-0212 of t't(, n rn grut w fwv M 0-)t rk- OVN rwtf vu LL 2-V c k ct 'iu I--) a a b-_ Lk f E � ck ® Q ' k �. ST. CROIX COUNTY WISCONSIN +1�(-•S, > ,r` ;. ` ZONING OFFICE - ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 (715)386-4680 December 15, 1992 Bob Farrar Burnet Realty 2020 Washington Ave. Stillwater, MN 55082 Dear Mr. Farrar: An inspection of the septic system on the property of John Jambois, located at 131 Glenmont Rd. , River Falls, WI was conducted on Dec. 14, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Sincerely, �.w Ifi Mary J. Jenkins Assistant Zoning Administrator cj Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �Ls LL7f, TOWNSHIP SEC. .9,3 T pR�� N-RU W ADDRESS ST. CROIX COUNTY, WISCONSIN CSW -3/ (-) (o( SUBDIVISION .0 LOT LOT SIZE 040- a7- 5-01c,rid( - 3�`PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 f SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �,�SrOf{1vCE r 9sI *� "ofoP"p-ery 114, INDICATE NORTH ARROW A)o ScAtE BENCHMARK: Describe the vertical reference point used �,(�, �,V OA-r 6X- 111V", Elevation of vertical reference point: /00� Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: /000 aAd' Number of rings used: / Tank manhole cover elevation: 92, 07 " Tank Inlet Elevation: yG / Tank Outlet Elevation: 9'�,?0 f Number of feet from nearest Road: Front,O Side,�ear, O ico' feet From nearest property line Front 10 Side,(?rRear,0 /3g feet Number of feet from: well qlc building: a?-S' (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, O Side, O Rear,Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: j611,611. Q,?./O Trench: Width: Ar Length: Sy Number of Lines: 3 Area Built: Fill depth to top of pipe: �, s Number of feet from nearest property line: Front, Side, O Rear, Pt .�y Number of feet from well: ll 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: c Plumber on job: License Number: �✓/'1f 3/84:mj L ©EP,PRTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON WI 53707 Gov't foot 2, S23,T28N—R20W CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number Town of Troy f assigned) y ❑Holding Tank ❑In-Ground Pressure El Lot 4 Glenmont Road NAME OF PERMIT HOLDER i ADDRESS OF PERMIT HOLDER: INSPECTION DA John & Elizabeth Jambois 404 Orange Street, Prescott, WI 5402 -j - - .3C) 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: Gary Zappa 3300 St. Croix 106044 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. ITANK OUTLET ELEV.. WARNING LAB L LOCKING COVER UL✓( �Q.�" l(/C1(�! ( I k1 PROVIDED XYES LINO PROVIDED XNO BEDDING VENT DIA.. VENT MATL: HIGH WATER NUMBER OF ROAD: [ROPERTY WELL. BUILDING. VENT TO FRESH �/// ALARM FEET FROM V� I NE G^ 1AlRiNLET OYES I�NO ""1 �V ❑YES10 NEAREST If Ir DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY JPUMI MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL ILOCK:NGCOVER PROVIDED: PROVDED'. ❑YES ONO ❑ ES 0, OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPER TV ELL aUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth ofplowing LENGTH DIAMETER IM TER LA RKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WE LENGTH NO OF JDISTR.PIPE SPACING COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES M ERIAL PIT DEPTH DIMENSIONS 1j GRAVEL DEPTH ILL DEPTH IS PIPF DISTR.PIPE DISTR PIPE MATERIAL. No TR. NUMBER OF PROPERTY WELL BUILDING VENT TO HE SH BELOW PIPES ABOVE COVER LEV.INLET EL.EE VV.END^ pip E LINE AIR INLET t,[t�ec NEARESTO—i eaf MOUND SYSTEM: 1 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OIiSERVATI(lN WE LES ❑YES ❑NO OYES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. OYES ONO ❑YES 1:1 NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKIN(, ELEV.' ELEV.. DIA.. ELEV.. PIPES A: EL EVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY CTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO 1 1-1 YES NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE ❑YES El NO DYES ❑ a NEAREST C1 _ �2 U 9 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator -- SANITARY PERMIT APPLICATION COUNTY 7 UILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY /RMIT# - � Id 60 -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 NO PROPERTY OWNER PROPERTY LOCATION v. '�elvr '/a, S .23 T e, N, R V_O E (or) PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CITY,STATE V ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LAN MARK ❑ VILLAGE: 70 O n /V II. TYPE OF BUILDING OR USE SERVED: , 0q0- 115-/-go-400 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 Agreementto 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. 19 Seepage Bed b. ❑Seepage Trench c. ❑seeoacie 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): 0 D i Feet ®Private ❑Joint ❑ Public VI. TANK CAPACITY #of Prefab. Plastic Site Fiber- Exper. in gallons Total Manufacturer's Name Con- Steel INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holding Tank—,&00 zoo O ® ❑ Lift Pump Tank/Siphon Chamber I ❑ ❑ ❑ 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: A '1-7,00 / J - f s-o Plumb s Ad res ( reet,City,State,Zip Code). Name of Designer: v /V. 0~ Z/0 Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CS 's ADD flfSS;(Street,City,State,Zip Code) Phone Number: D o" I o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) 4QApproved ❑ Owner Given Initial S c/ha/rge Fee Adverse Determination /�U• yU . '/� r7 C I��� J�' `�'^"�v X. C MMENTS/REASONS FOR DISAPPROVAL: 1 C4* L� /Y 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 whenevar 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; 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'h 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 included the creation of surcharges (fees) for a number of regulated practices which Wlsco jS a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried tr+Basklt°@ 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. 0 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) N(DUSaT"7i�"'--�OF REPORT ON SOIL BORINGS AND AFETY & BUILDINGS LABOR AND PERCOLATION TESTS DIVISION 115 HUMAN RELATIONS ( � P.O. BOX 7969 r . Lo Z (H63.0911 J& Chapter 145.045) , MADISON,WI 53707 LOCATION: SE TI N: OWNSHIP MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME:p '/� 1/ Z TzBN11 4(.r) 'T,- q - CSM- OL 1L COUNTY: NER' UYER'S NAME: MAILIN ADDR SS: �= .�c,(x �ouN EEnv �Ar4 Rn. l% 1" tscorr , USE _ _ DATES OBSERVATIONS MADE V.s.dence N�O.B�EDRNLS : f , $S Si MCOMM R AL DESCRIPTION: �{New ❑Replace M R SFS� A 9 "- 1 L�5 .��'' C+► �J� -. < �Yt,c- C Wt rt1�'1QT RATING:S-Site suitable for system U-Site unsuitable for system - CoCZ- NVENTIONAL.: MOUND:QU IN-GS iU E S S E -IN�FILL O�LpING TANK:RECOMMENDED SYSTEM:(optional) Jc ((L�����JJ UU (I!'S�I S S S U S U A l.. [If Percolation Tests are NOT required DESIGN RATE: If an under s.H63.09(5)(b),indicate: y portion of the tested area is in the L,LA S� Floodplain,indicate Floodplain elevation: NA —� PROFILE DESCRIPTIONS BORING TOTAL P H T R UNDWATER-INCHES CHARACTER 65 SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS ELEVATION OBSERVED E HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B ±_7 z g6:73 >�:4Z 9"9LSLTS „BaNSL B. 97. 15 t�(fliJt �Q StC �oBe�Ss64- 37 LT 190V#1S B- • > .ZS 7., �L i y Z�Qe St�Get 2 a ' 8 BRNFS�'�,1� �B- 4 7.50 /U/ 73 i N > 7•SV 6.,�c�tr ?o fi� Str 26�trr? r�-tC�b 2�` �A ��Co� B �' x.83 97.9 > ?.83 N C� B- co L IL PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DR IN WATER LEVEL-INCHES NUMBER S AFTER SWELLING INTERVAL-MIN. RATE MINUTES 'f�•7 ,O —�.�.�D.� PERI D ' PER INCH P �� �_�� a P- 2 5.9c. oW b i/4 �, s P- 3 S•tb E ( Z - I / d P- P- rP '.'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of su' le soil areas. Indicate state or distances. Describe what are the hori- -ontal and vertical elevation reference points and show their Iota ion on the plot pla the surface elevation at all borings and the direction and A land slope. 29, a-I — S, &ir4CIJMAIZK- SP)KL j.4 14" &4V, ent SYS EM ELEVATION 87,10 R"CFTt o7 /-,w i.L it/0(1.00 4 I,MOIVEA -T*,Ee ANA LATHE . 1 1 E !P Z4- AL T TN ■ g-4 j 'ScAif 3 I" S _SatJ'rN L I N T qF Lo i L)�G1 Q 3 tom--- EJA I ! � I 3B .— --- 36 — _ 9q / _ 'l,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: r ) r11 , .;ft t.� i`L} 4� �a,4`` AP ADDRESS: - CERTIFICATION NUMBER: 1PHONE NUMBER(optional): t-- !— n•�' - yr l :`�� r,( — ,y0.ti �. c) CSI of ATURE: • C, Qy C1U-z- DISTRIBUTION: (h nlmal It'd one r,npy to Lnr-al Authoi ity,Propel ty Owner and Soil II:Stel, ir) 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 Propertyljok(1 e. uvO EbzMETH L-,,TAM 80r5 p y pU,'T LaT h; Location of Property , Section _:5 , T c26N-R 20 W k Township T P-6 Hailing Address IT 0 l Si, 410 Address of Site Subdivision Base cm`j V. 3+ p; (!0 (0 Lot dumber Previous Amer of Property f z r-k Er 1 c SQ n Total Size of Parcel c a a re: Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ \� No Volume _ and Page Number 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. PROPERTY OWNER CERTIFICATION 1 Wo I cot,U6y that a.CC statementA on ti ohm ah.e true to the but o6 my (out.) hncwtedge; that i (we) an (ahel the owneh(hf 06 the phopelrty d"cAibed in tha .in6olmation 6oAm, by vivue 06 a waAAanty deed neeoAded in the 066ice o6 the coun.tyy RegiAteA o6 Deedsah Document No. _4W_1074/10 ; and that i (We) pnesentty avn tl�e puposed Bite bon the sewage diApo syh em (ore I (we) have obtained an eaAemen.t, to Run with the above deAck,4bed phopeAty, bore the eon tAue_Li.on o6 eaid aya•tcm, and .the dame has been duty keevaded .tn the 066tce od the County Reg•ca•ten od Veede, as Voc m►ent No. ) . SL ATURB Op ER SIGNA RE OF CO-OWNE (IF APPLICABLE) 2L-2 _ Za ' DATE S GNED DATE SIGNED DOCUMENT NO. WARRANTY DEED THIS SPAI.E RESERVED FOR RECORDING DATA • STATE BAR 2F WISCONSIN FORM 2-1982:�; 417074 8MOK -1.54PAGE '83 OFFICE ,Mark M. Erickson ST. CROIX Wq WIS- 18th -.1.11......... .......--•............................................... Recd. jor Rmrd this- . .. ........ ............................... .......•.•.•.•.....••.•........................................ . 4 S:'pt._A.D. 19_§6 y Q.- ............................................................... 8:30 A.I M. ------ ------------------------------ J6_TiFC`.____J L......... cony ,�nf -ar 0 rant u S, SAd. Wff&-_6�s-_s� --------- ---------......... . ............................................................................................. of s PO"W property, W d .. . .................................................. ................................................... ------ ---------------------------------------- ................................. ................... . . ......................................................................................I.................... - ----- ­­­........................................ ............................................... RETURN TO ----------- ................................ ---------­---_------------- ..................... - -- ----- ----- -------------------------------- -------------------------------------------------- - Z the following described real estate in ...... ....St-....Croix...................County, ....• .......... State of Wisconsin: A Darce 1 of land located in Government Lot 2, Section 23 Tax Parcel No: --_-------_---------------- T28N, R20W, Town of Ttroy, St. Croix County, Wisconsin, described as follows: Commencing at the SE comer of said Section 23; thence N1*3512811W (true bearing) 1334-15t along the East line of the SEk of said Section 23; thence N89*58'13"W 1895.79, along the North line of the SE% of the SS-i and the South line of said Government Lot 2; thence N13*38'5011W 448.06, to the point of beginning; thence N89*58'13"W 317-93' to a point which is 251 , more or less, from water's edge of Lake St. Croix; thence along the meander line along the Lake N14*27'37"E 402.45' to a point which is 45' , more or less, from water's edge of Lake St. Croix and the end of the meander line; thence S89*58'13"E 204.001 ; thence S1*58128"E 390-00' to the point of beginning, including all the land lying between the meander line and water's edge of Lake St. Croix. Also an unrestricted roadway easement along the 501 wide private roadway easement as shown on the Certified Survey Map filed June 13, 1978, in Vol. '13", page 610, Document No. 349303• The above parcel is also described as follows: Part of Government Lot "21' of Section 23-28-20, described as follows: Lot 4 of Certified Survey Map filed June 13, 1978, in Vol. "T'., page 610, together with 50 feet private roadway easement as shown on Certified Survey Map. f hi-114 S Pic 0) A This -----is..not........... homestead property. FEE .... ...... (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. -------------- ------- Dated this ... -----------­-............................ day of ------.' e - ----- ...........04k. - . ............................................ .......(SEAL) ''" (SEAL) Mark M.Erickson -------------------------------------------------------- -------------------------- ......... _­ ­1----------- ------ ------ - --------------------------------- -----------------­-----(SEAL) -----I-------------------------------- ------------------ ......(SEAL) ---------- ........................ .............................. _--------------__............ ­-.1-------- --------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) ....... STATE OF WISCONSIN SS. ------------------------------------------------------------------------------- - V - ---------------------------*--------- County. authenticated this 4 14day of. . . - - - -------_-- 19�� Personally came before me this _-------_------day of 4,-e,&�13 11,4W, " L�- ..........................................1 19----"-.. the above named ......................I........................................ ................................................................................ rllv,,q c7ee-,1,4-1vj9 z-i1,wF,%o1 -----------•---------•--•--------•--••- ....................... TITLE: MEMBER STATE BAR OF WISCONSIN ................................................................................ (If not- ............................................................ --------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY J�rjati 0gland Lundeen -------------------------------------------------------------------------------- ..ya............................................................ Attorneyat law a----------------------------------------------------------------------------- ................................................................................ Notary Public _------•------_------ ------------_--County, Wis. (Signatures may be authenticated or acknowledged. Both 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. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin L(val Iflarik Co. Inc. FORM No. 2— 1982 Nhjw mlkec. Wis. r' day j$ ,0 N88°01'32"E a' ,349303 W 50.00 , '°q► co i co ° \� POINT OF BEGINNING . l • ,UNPLATTED LANDS J. W: SHORELINE S °5 'I � Q 04 00., d .J 451 I %66.62 137.38' S O., 9 Y M W TRUE x : � p : BEARING -O. v : 4-MEANDER LINE m 3 a a F- 0 v1 O N i 4 o a- 2.8 ACRES M w `= NORTH LINE SE 1/4 w 2 _ a 2 OF SE I/4 AND t g N g,0 GOV'T. LOT 3 W . +LUG 15.69' O Y ti �O a) w J : M ,` M 1,895.79' z ►�� N 89°5813"W V6 _ N �! m O �� YQ W ° O SOUTH LINE (cPa OQ 5`* 1g 122.39 195.54 CD s' GOVT. LOT .2 `Od a M '317.93 N 89 58'13"W �N �j0� �..' to to 01 ° POINT OF BEGINNING 3 tn z CERTIFIED SURVEY MAP. ' PARCEL 3 GOVT. LOT 2 l o � N APPROWD o SE CORNET!, 2 SECTION 2c ST. CROIX COUNTY ® ® T28N7RM COMPREHENSIVE PARKS PLANNING i AND ZONING COMMITTEE : SE P 1 5 1976 APPROVAL OF THIS MINOR SUBWAS1010 - ;,?.),OVAL FOR, SEPTIC DOES N01 IN" � � � Q , s' .�t t0 SYSTEM. REFER 'i Coo �ry M F- SCALE I N FEET ,Q• Q : .J: i a. : Q z: 100 O 100 2 00 �' i' i Volume 3 page 610 0-Ok �} / T6,.lIC i.i�ICT"t t&A['nlY Rn.nrt•r-n -,1-_o .-a fq r� Alt . 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Croix County z d ' OWNER/BUYER®k(\ C, C41d ELl ZLtbe ) L , javhb©r5 M ROUTE/BOX NUMBER J40q Off"e, ��, Fire Number CITY/STATE - re-scott } YJZ 'I.IP '54C01:I ( t �T �. PROPERTY LOCATION : 14, 14, Section, T ,�8 N , RD W, Town of T01-0 St . Croix County , Subdivisions V,,3)P (Die Lot number "7 S e e. Q-5 Ag40 1 N VOL- = P9 , to 1 Q 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 I` 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 . H 0 E I/WE, the undersigned , have read the above requirements and agree Ccn to maintain the private sewage disposal system in accordance with x H the standards set forth , herein , as set by the Wisconsin Depart- 10 ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office hin 30 days of the three year expiration date . 0_94 �t'�///� GD' SIGNED C DATE 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 . ,/ * �L x=.t 72i✓G l3 LNr F LZivE (�A niK) �1,CCTZD..� ��Lro N.f' 4 1`C.l_B).,o& f4-PltmoblEO WELL .J'E wr:2 i 1 /2ELi�fNG4. 1 GAa,a6L� X600 GAL 1G/hYG�Su o 1 6,1/�ju,PosEl� //LnPAtEQ A�5^, v kr7FI)l . LDECK __ 1 O/ul/EwnY T wN OJ` T.2DY T�7' .1'r_' Cnosx Cou,,TX I Alt =s so4zia, r/v A a s // OVC L-LF/. _/00.0 0 b6 i S 3 9 VE,.r STALK—,, J1opE ALTS �SSTE Q �y ilioTE=�GL7 J`ZT� SS iwr�osFa Tv 4Z A /roaAZ J'&7EM .!'Z71 / I / .EAST r/�Pf27 y L2Nt Q3o 9y A/oTE= h/,EST /?i.,o 2TY Z-T vt IS Uvvz do/ f 2orr L LuFF (� Q_ /vo PC.vL r .SouT/J ALOPE2TY Z:Z,,,E FRESH AIR INLET AND OBSERVATION PIPE APPROVED YENT CAP MAXIM-IM 12" ABOVE FINAL GRADE MAXIN-11A OF 42" ABOYE 4" ::AST IRON "."ENT PIPE PIPE TO FINAL MADE DE SIGNED: yX I-MRS31-1 HAY OR SYNTHETIC COVERING LICENSE- MINIMA 2" AGGREGATE �. DATE: OVER PIPE � T DISTRIBUTION PIPE TEE s • . :t>IL TESTING BY: AQ,1/0 n,y o.,/ ELEVATION BED AGGREGATE • BOTTOM PER SOIL, BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING FT. AT BOTTOM OF SYSTEM