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HomeMy WebLinkAbout022-1048-10-175 4 ~ 0 7 N O 7 [/1 ; A 3 n 3 to 'o 0 I ~ ~ d Co O n 0 0 Yn O CD 7 Cl fD O a 7 b0 N ~ -4 CL N Z (D ` y v 7 co O fD D1 M CD C=p ' p 5* go K' N O O O COj 7 5• CD 7 n 0 v 0 A7 O N C A CL O O 0 N~ W CA C l y y V C Er -4 r Ma V 0 W a D m z o m ca y y it N 3 Q W CD CCDD O N a O O O 3 L CD F~ C` ;o CA Z O 4 -4 CT M o N Z MA ti CO) CO) O D N Ca a v v 00 o 3 e~ = N Cn 3 tt N M N CA I a r. ~ ` ~I I Z O O O D a ~r CD co • y c a y ° CD i Z O CD -.4 O ? Z A a I o Z rp V m CD CD w a Z C Z m ~ w z CD W I CL_ a I ° o °a N I a I O 7 ~ y I ~ ID, I a I I c I tv I a I a I o n CD 60 F» O owe I ° ~ ' o b 00 CL APR 1 9 2004 ST. CROIX COUNTY VOL 18 PAGE 4666 SURVEYOR'S RECORD KATRLBEB H. dA111r REGISTER OF DEEDS CROIX CO.. 111 CERTIFIED SURVEY MAP iE E22 FOR RECORD 02/2003 02s80PN Located in part of the NE 1 /4 of the NE 1 /4 and the SE 1 /4 E -T. I : i ~D SURVEY MAP of the NE 1/4 of Section 17, Township 28 North, Range 18 RE rrr: 13.08 West, Town of KinnicIcinnic, St. Croix County, Wisconsin. Cr.. PA>',ES : 2 rt Owner Don R. and Judy A. Coddington a the NE car. of Sec. 17, rn T. 28 N., R. 18 W., found o St. Croix Co. Alum. Mon't. a 0 o I N w g I U1 W A C.S.M. I Vol. 8, Page 2138 ^;::4a I N 89'17'38' E 1294.97' Wire Fence+/-2- a - N .1:1 0 310.00' 918.93 .i 1\ - - Including Right-of-Way s Z 3 100 Roadway Setback Line 34si 303 stT. it 0 66.D4 ` S.d1sa Acne _N N • 16'13'55' 4P1 73% Lot 1 ~ N I r g I~n3e R - 233.00' co Z M w ~ L = 66.01 03 ,32 Excluding Right-of-Way cl! ► s ~ C C.= 65.79 326 07766 sq. >t Z I O 1 s C.B.= S 9'28'58.5"W 7.86 Acres g~ "0 17- N 1 rn Point of Compound "Curve N 89'17 38 E 984.59 N D 927.84 ( ---1 . Cu re of Reverse A _®2'18" Including 6SRiRight of Woy v ( Q Z R = 233.00' 12.i#06 Acres s r" L = 29.30 v 23'2 C.= 29.28 Exdudino Right-of-Woy a D 54 - I WN+4 R = 167.00 " C.B.= 29.S28 26 V= AqM OShed 0 1 N _.o L = 68.31, Lot 2 I(n I t•! j C.67. garage m ; C.B.= S 13'05'07.57W LJ 33.02' 1261.20' House - V I APPROVEd 8977'38" W 1294.22! '-Wire Fence $31 xr.CRMCOWM UNPLATTED LANDS N ~hZ{ haIj DEC O 2 MO Jr. , 0 N IUD if not aoadsd wNWn a0 dsys of Gj~ the E 1 /4 car. of Sec. 17, Im spp"dsbspprors dWbs T. 28 N., R. 18 W.. found - I~ nulondvold Bemtsen `Survey Mark" Noll 14 Note: This Map is a subdivision of the Certified I;0 Survey Map Volume 7 of Certified Survey Maps, page 1834. 10 0 100 200 300 400 $ ALLAN L.. a EVERSON. Scale 1 inch 200 feet o S-1871 D C IVER FAL LEGEND O Denotes 1 Tech by 24 inch o •,~~~9N ~ Z~~p~~~ Iron R b~~ -+g I44Q 4j Su ppe monument set, (1-1/4 inch OD.), weighing 1.62 lbs. per lineal foot. a e • Denotes 1 inch hm pipe monument v7 T^ found. *Denotes Section Comer Monument a found. as noted. N ~n J31 Denotes soN baring loootion ' per sot evalaotion sport by others. s~ Instrument Drafted By. Allon L. Everson Sheet 1 of 2 sheets Vol 18 Page 4666 1 DA INSTRUCTIONS FOR COMPLETING FORM 115 - SRO - 6395 To be a complete and accurate soil test, your report must ir)clcrde: 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 replacement system; 3. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTE ARE RULED OUT BASEL) ON SOIL CONDITIONS; 63 PLEASE use the nations 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 m,,, be used if desired; 8. Make sure your benchmark and vertical elevatir ; point are cleanly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names s, flood plain data, percolation test exemp- tion, i t appropriate; 1(?. information (such as flood plain, elevation) ; riot apply, place N.A. in the appropriate box; 11. the form and place your current address ai-_. , rr c.--rtification number; 12. M,: e legible copies and distribute as required. L SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10") BR -+k cab - Cobble (3 - 10") SS - ; ie gi - Gravel (under 3") LS L _..tone s 7d HGW - roundwater cs Sand Perc Jon Rate med s - :tiur 'Ind t`. ss Is - i -_Than sl C -are 'I Bn - sil Silt L BI Silt: Gv - Clay Loan-? Y Sandy C"-- R - F Silty C` I mot I Sandy Clay yFV/ - t s;c ley Clay fff y cc pt t rnn7 - M.; ck d lz rrt "n rtace w liquid ~ BM BE.,~;:h Mark VRP - Vertical Reference Point TO THE OWNEI : Th rst st r, in a sari- y permit, runty or the _ grit may request is the -mhlete set the private ter~ and a t, I to ro priate i I r in order to I ~rrnit. The s~ unit mi ~ old poste , the start construction. I~ L i ' w DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON W1 3707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: C TOWNSHIP UNICIPALITY: LOT NO BLK. NO.: SUBDIVISION N NE 'lN£~1 17 /L2B N R/6 E(Or n K/NN/CK/NN/C COUNTY: OWNER'S BUYER' NAME: MAILING ADDRESS: ST. CRO/X DON CODDINGTON 1340 SHORT ST. RIVER FALLS, W/ 34022 USE DATES OBSERVATIONS MADE 3 CRIPTIONS: PERCOLATION TESTS: NO.BEDRMS.: ICOMMERCIAL SCRIPTION: PROFILED- Residence 3 New ❑ Replace l - 31 - 67 j - / - 87 RATING: S= Site suitable for system U= Site unsuitable for system r Of~VENTlONAL: MOUND: ND-PRESSURE: rEIS YTEM-IN-,FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) EIS ❑UU ❑S S U E111 ❑ S ElU CONVEN T1DNA L If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the C under s.H63.09(5)(b), indicate: LASS 2 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / 8.9•' 99.3' NONE T 8.9` Bn1 (0.6') BnrilI/.9'1 Bdsl (6.2'1 B_2 8.2' 99,6' 8.2 anIf0.8')On ri/(/. 2'1 B'nt/(6.2') 7. g3, d' /I j 7.1 Bn1 (0;9') Bnsi/(./.9'1 Bn r/ (4-3 B_ 3 4 7. 4 ' 93.1', 7. 4' Bn I 1O. 91 Bn r/l (2.0') Bn r1 and yr ( 4.5'1 B- r1- 8. 4' Bn / (0. 7') On ri / 1 2.2'1 an s/ ( 5.59 B- 5 8,4 9T.P SOIL MAP SHEET 83 PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHr//o,, RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P_ 1 3.6' NONE 30 3//8 " 3" l/ ;P- P_ 2 5.0' i 30 5 " 5 114 " 6 P-_ P_ 3 2.9' 30 2 15116 ° 3 //8 " 27/B /0 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. IN I T 1A L 92.2' SYSTEM ELEVATION REPLACEMENT 94.4' 0 Pi T I IN S C. / O 'PER;C H LSU/TABLE RE (7 `X 2'1 3418 PIP S T _ _ -j i i 12 X 9 4EDS i i 84 It' IP21 ~ O - 77 1 I 142 i 1-g Fe y V. P.± TO P PE i I ' 162 AS LIMED 00 SE C. 17 DG B OF 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: LAURENCE W. MURPHY 4- 2 - 87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): Rr BOX 36A RIVER FALLS W/ 54022 35 - 2443 425- 9032 LCSTSIGNE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester DILHR-SBD-6395 (R. 02/82) - OVER - 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: E ) Ft. Number of feet from nearest property line: Front, O Side, O Rear, ^ Number of feet from well: Number of feet from building: (Include distances on plot plan)." SOIL ABSORPTION SYSTEM ww ~ Bed: ~(J 9 Trench: Width: ~a Length: Number of Lines:. Area Built Fill depth to top of pipe: 17 Number of feet fiom nearest property line: Front, O Side, ® Rear,O Pt. Number of feet from well: /1 D ~LC 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: Plumber on job: l License Number: j~ 3/84:mj { Form - STC - 1 4 t AS BUILT SANITARY SYSTEM REPORT OWNER a-m TOWNSHIP ~I 6J r~ 141k1e I SEC. T 6~N-R W ADDRESS J3 Z2 5X ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IMR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N6~,P ~a ►~ODO E71 B 3 ~ Y/ INDICATE NO TH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: (!q3 (Liquid Capacity: l_ Number:- of rings used: a? Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O feet From nearest property line Front 10 Side QRear, 0 feet Number of feet from: well l~ lj~~building: 3 (Include tiis information of the above plot plan)( 2 reference dimensions to s?ptic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS L#BOR &'OUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 NEB, NEk, S17,T28N-R18W XRCONVENTIONAL ❑ALTERNATIVE !isssPlan P.D. Number: Town of KinniCkinniC ❑ Holding Tank El In-Ground Pressure ❑ Mound IS I NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: 7• Don Coddin ton 1340 Short Street River Falls WI 54022 BENCH MARK (Permanent reference pmnU DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. PRSW No: Sanitary Permit Number: Name of Plumber: rF323 M a A SEPTIC TANK/HOLDING TANK: MANUFACT FIER. ~ LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. AR NG LABEL LOCKING COVER IDED. PROVIDED. OG 7C- /IN YES ❑NO ❑YES NO f BEDDI G: VENT DI VENT MATL HIGH WA E NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT T FRESH I I FEET FROM LINE/ /C N ) AIR INLET ❑YES ❑NO NEAREST 5 /V 3 3 ❑YES NO - I I DOSING CAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODE L. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED'. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑No NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING 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: WIDTH: LENGT NO. OF DISTR. PIPE SPACING COVER =NSID1 DIA tt PliS LIQUIBED/TRENCH TRENCA ERIALDEPTH DIMENSIONS GRAVEL DEPTH FILL bEIrT H IDISTFWPIP DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPE PITY WELL BUILDING VENT TOF HE SH BELOW PIPES ABOVE CO R EL~EyV INL T EELLEV. END. PIPES LIN AIR INLET V1 ~ l3D l3. Oct j FEET FROM NEAREST /2O -i 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. ❑YES ❑NO SOIL COVER TEXTURE [PERMANENT MARKERS OBSEHVATION WE LLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED JDEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING JGRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IND DISTR DISTR PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.. DIA. ELEV.. PIPES DIA.. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑YES ❑NO COMMENTS: PERMANENT MARKERS: O E NATION WEL t NUMBER OF PROPERTY WELL: BUILDING. n FEET FROM LINE ❑ YES ❑ NO ❑ ES ❑ NO NEAREST Sketch System on '•a y file for audit. Reverse Side. 1 n fi SIGNA TU . ITITLE. i yr , ' DILHR SBD 6710 IR. 01/82) ZOni 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: 1. 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'/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 l' result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater included the creation of surcharges (tees) for a number cf regulated practices which WiScorissin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ~reasure is used in your building is returned try the groundwater- through your soil absorption system or the disposal site used by your holding tank: pumper. ~oon~es coll~: ;teo thr-)ug' these surcharges are cred ted C,.) t1he groundwater fund adminis- ere by he 7)ek,_rtn!! nt )t N3tur~a Resources. These fur ~e used tc monitoring ground- ~fl Fi ;I ,er C ontL_mir•ation iriv:stigation8 a:tt> nt c! stc':da-ds roJndwatrr 1 s wort! protecting. 1:3D--,,398 (1.03/36) DILHF~ SANITARY PERMIT APPLICATION COUP Y In accord with ILHR 83.05, Wis. Adm. Code STATE PERMIT # ATE /©9'7 7 / -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 V` 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES Lnj NO PROPER n WNER PROPERTY LOCATION L d il i a a d /aS TC,,J,N,R/'P E( W PROPERTY OWJLER' MAILING A RES LOT NUMBER BLOCK NUMBER SUBDIVISION Q eliTy, STAT ZIP DE PHONE NUMBER 77 CITY NEAREST ROAD, LAKE OR LANDMARK l );;I E] VILLAGE : 11. TYPE OF BUILDING OR USE SERVED: 12a4,4--XV, J~;;? d Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X 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.F] 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) 4 r-~ 1. a. 9 Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit /Vx / g 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): a Y. 147 `7 7 9a. Feet LaPrivate ❑ Joint ❑ Public CAPACITY VI. TANK in gallons Total Site Fiber- Exper. p INFORMATION # of Prefab. New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks strutted Septic Tank or Holdin Tank UU t°S t°Ca ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): PI Signature: (No 5~? MP/MPRSW No.: Business Phone Number: a a U60L4 2 y ~ ahtlj~ ~ PI er's Ad re4yreet, City, State, Zi ode): Na~n Designer: VIII. SOIL TEST INFORMATI Certified So' Tester (CST) Name CST CST's DDR SS (Street, City, Sta , Zip Cod) Phone Number: oft") r Fl? IX. COUNTY/DEPARTMENT U ONLY ❑ Disapproved Sanitary Permit Fee Groundwater rate Issuing gent Signature (No Stamps) Approved ❑ Owner Given Initial ! Ua a~r^ge Fee /Q D Adverse Determination U~~ J ~ X. COMMENTS/REASONS FOR DISAPPROVAL: L SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 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 dd A Id Location of Property lyf t6, Section , T PW N-RIq W Township T\ropfokilo nailing Address Address of Site ~c Ll l ~G Subdivision Name .Lot Number l Previous Amer of Property 1° Total Size of Parcel Date Parcel was Created P7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume *17=rt p 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 I (We) cen,ti.6y that a,tt St temen t6 on thi6 okm ahe tAue to the but o6 my (our) knowledge; that I (we) am (are) the owner(~s~ o6 the phopehty de~scAi.bed in .thiA .in6okmattl.on 6onm, by v.ihtue o6 a waAAanty deed h c %ded in the 066ice 06 the Countyy Regihten o6 Deeds ass Document No. ; and that I (We) phebenttey own .the pnopoa ed hi to bon the sewage diApos b yas em (o,% I (we) have obtained an ea ement, to nun with the above dea embed p)topen ty, bon the cons tAuc Lion o6 da.id dyd.tem, and the eame hae been dut kecoAded in the 066ice o6 the County Reg.ia.teh o6 aeedd, d6 Poement No. . SIGNATURE Oh OWNER/ SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNi&D DATE SIGNED - QOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 784P 'E IrtA 42A#G7G A5 AEGISTERS OFFICE This Deed, made between ---Glen---- Wiese ST. CROIX CO., WIS. Rec'd. for Record this 2nd - - - - - - - - Grantor, y Of- July- A.D. J987 and---_-Don R. Codd_ng-ton_ -and Judy A, Codd ington, t 11:35 AIIIAL husband and wife as survivorship marital r property p~l~ 111111 gawk Grantee, Witnesseth, That the said Grantor, for a valuable consideration----__ conveys to Grantee the following described real estate in St_.___CTOix-- RETURN To County, State of Wisconsin: _7 7 Part of Ek of NEk of Section 17-28-18 Tax Parcel No____________________________________ described as follows: Lot 1 of Certified Survey Map filed June 15, 1987, in Volume "7", page 1834. JiNSFAft FEE This is not - - homestead property. (is) (is not) Together with all and sin"~ular the hereditaments and appurtenances thereunto belonging; And Wiese warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of record. and will warrant and defend' the same. r_N 87 June 19 Dated this - - day of - -------(SEAL) ----=S~--C'- ------(SEAL) Glen M. Wiese ------------------------------------------------(SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN SS. - ------------County. TH authenticated this ......-.day of 19----.- Personally came before me this ...day of ---------------------June----__---- 19--_8.7 the above named G 1 en M. Wiese 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 LlG~L'Z - ----Gay-lord-----Attorney------------------- LEl7z N tvoi , so &TA t Cyr ;'ti ;;;~fv31N River Falls WI ___-54022_______________ Notary Public 15E Wis. (Signatures may be authenticated or acknowledged. Both My Commission is pe manent. (If not, state expiration are not necessary.) date: - 19- •Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN H.GMuIlerCompany M - FORM No. 1-1982 - - Stock NO. 13001 - H z r 1 ST C- 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d fi H OWNER/BUYER ROUTE/BOX NUMBER ~~~~IJ ~L~(3y c Fire Number r__ CITY/STATE ZIP PROPERTY LOCATION: 14, 14, Section , T_ L-210 N, R W, Town of Alin to /J/1?Yj St. Croix County, Subdivision t ----~'Lot number I 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 H three year expiration. H E z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'U ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office withifi 30 days of the three year expiration date. SIGNED DATE f~? /G 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. pEPqRTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INTRY., DIVISION LA11 A AND PERCOLATION TESTS (115 P.O. BOX 7969 F.UMANr;RELATIONS l MADISON, W153707 (1-161.090) & Chapter 145.045) LOCATION, 44~ SECTION: c y TOWNS IP UNICIPALITY: OT NO •BLK. NO,: SUBDIVISION ~AMT M4_r ~flq 17 /T N .R/I E(O n K/NN(CN(NN(C CO. MAILING ADDRESS: ST. CROIX DON CODDINB'TON 1340 SNORT ST. RIVER FALLS, WI $4022 S DATES OBSERVATIONS MADE IND. BEDAMS.: rOMME77irESCRIPTION ~!li8idence 3 ~ New ❑ Replace I 3 - 31 - 17 q/tl'04Q-. Sm Ske sillift le for system U; Site unsuitable for system ` I -IN-JILL iOLDING TANK: RECOMMENDED SYSTEM: (optional) Q J A LJ~! V S ~ OS LJI~ El S ~U CON V E N T/ONA L If Itorwatiatr T~et re NOT required DESIGN RATE: If any portion of the tested area is in the CLAS! 2 under s.1-163.09(6)tW, indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BO I G TOTAL; ATER- NCH A A ER OF SOIL WITH THICKNESS. COLOR, TEXTURE, AND DEPTH a ELEVATION OBSERVED ---EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 93.3 NONE ? g•9' On/ 10.8V 8nril1 /.99 Bnsl l6.2% g.2 an I ! O. 6 'l On ri I ( 2'l On s / ( 6. 2'/ El- 7 / ' 9 3. 6' 7. / ' On / ( 0, 9') Bn s i l ! r .9'J B n r/ ( 4. 3 B- ` < 7. 4 93 . / ' 11 7. 4 B n I ( 0 . 9 ) On r i I ! 2 .0 ' l B n s l and pf (4. 3 B- iY B, 4 ' 9 T. Y ' ,l B, 4' On l (0. 7') On ri I ( 2.2'1 On 3'1 SOIL MAP SHEET 83 PERCOLATION TESTS TEST DEPTH!- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE M04 ES NUMBER INCH 4' AFTERSWELUN INTERVAL-MIN. P 1 H P .4t0 NONE 30 3 //B 11 311 2314- .P- P-"2 30 510 3 114 31101, y P_' 4 2.9' 30 2 /3//6 p~1g # P- PLO1'PLAN: Show: locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe #AM am the hori- contd and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the dirictiert end paro"t of IsridJlopa. /NI T IA L 92.2' SYSTEM ELEVATION REPLACEMENT 94.4' - j ! jrE M,6 E ON. ~,s 1 - _L.Et ' SUIiTA LE RE 171' 42,) 3318 60. FT. 1 INC 5$G. B3' fP S T 7 , 40'1 1 I 12 X 79 iEDS , i I Bs N t I i 111 , V. R. P. TOP PAPS (o s % ASSUMED 100 ' S ! ` ! EOG BiUFI 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 Admitdstrative Code and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NA print : TESTS WERE COMPLETED ON: LAUR~ENCE W. MURPHY 4- 2 - 87 D . CERTIFICATION NUMBER: PHONE NUMBER foptional): *f SOX 36 A RIVER FALLS W! $4022 33 - 244 3 423 - 9032 CST SIGN TUBE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester % DII,0 i-SSD41398 (R. 02/82) OVER r a t S A OkAl h~ e~~~hgton ?Afg-S ID31 /0119JI5 I30 ~~►or~ 5'~r 9 Pk tb 0 r 3, Q 3' ~MPerf. 0 rk. 1~+►vt No, ~a•~ r a' >y , h ~Eb loo a