Loading...
HomeMy WebLinkAbout028-1022-70-100 4 li cY �v m .. ayi C I y z° = > z° E o co o m E U LL C 07 � LL C 7 — _ yy _ O C. 0 3 0 cLi� 3 03 00 N M zt a�i y Z W E E g g € � € � z a m a m C*4 g I c C7 v v w � N N U O I d Z C C O rn Z E '2 v m co N N C�•/d� y a y a N y y C •� am r am t z m z z m z N Z co l m m c �t E 0) E N I d C. 1 L. ` C. y d 0) C N 0 rr 0) � O ororcra z y NorvIL m Q p I' FL Z � > _ I I •N a d a 3 a a a y � 4j j O O ti CN tAJC) imrnrn Z mrnrn Z I N N O 0 N Lo ^I � = O = E L O O '_ 'O L O O M � m O z to m ¢ } (A m O 0) C U) 0 0 N C N O 2 O '0 O E Gi f� O D L U 0) O 0) N 0 1 N 07 0) cc iz: v 0 • O a N C m y C 04 iz c M v Z Y � r0* C q � C E E ,' L A l O T O z N Z N 'a Z =ca I—O I ed m L I � �, da ` a a 0 ` a rte• a m d d c d m c r A ti a2 0U) u 0viv DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 3969 BUREAU OF PLUMBING MADISON,WI 53707 SW,,SE!4,S14,T28N-R17W 000NVENTIONAL ❑ALTERNATIVE state Plan l.D.Number: hf assigned) Town of Rush River ❑Holding Tank El In-Ground Pressure F-1 Mound 0th Avenue NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Richard Walton Route 2, Baldwin, WI 54002 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: Dale E. Hudson 6629 St. Croix 92553 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: []YES ONO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: NIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET. DYES ❑NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ]YES ❑NO ❑YES ❑NO OYES ❑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 ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER 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: BED/TRENCH WIDTH: LENGTH: TRENCHES DISTR.PIPE SPACING MATERIAL: PIT JINSIDE DIA YPiTS DPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET.ELEV.END: PIPES. FEET FROM LINE: AIR INLET. NEAREST--► 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 ITEXTURE PERMANENT MARKERS OBSERVATION WELLS 1:1 YES F-1 NO 1:1 YES El NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED. CENTER: EDGES. 1:1 YES 1-1 NO ❑YES 1:1 NO ❑YES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR. fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV: DIA.. ELEV.: PIPES A.. E LEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED LANS ❑YES ❑NO ❑YES 1-1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES 1:1 NO ❑YES 1-1 NO INEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710(R.01/82) Zoning Administrator 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 revisipns to this permit must be approved by the ipermit 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 tahk(s) should be pumped by a licenged 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 f f Plumbing, State o Wisconsin, Bureau o To be complete and accurate this sanitary permit application must include: I. Prcperty owner's name and mailing address. Provide the legal description where the system is to be installed; 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'/z x 11 inches must be submitted to the county. The plans must include the following:.A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system-if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- 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 atBr— included the creation of surcharges (fees) for a number of regulated practices which Wisco in S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea` 0o: is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) SANITARY PERMIT APPLICATION COUNTY DILHR In accord with ILHR 83.05,Wis.Adm. Code _5011I.- ` d i .��....,�.,— STATE SSANITARY 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,4F1111 NO PROPERTY OWNS PROPERTY LOCATION ` Ll) '/4�� '/4, S T,Z , IV, R /7 H (or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION IJAME t. z N� CITY,STAT ,_ ) ZIP CODE PHONE NUMBER CITY Q NEAREST ROAD,LAKE OR LANDMARK u>i111 GC/i; ���� �/�' 0 el—Z6 C I ❑ VILLAGE;7S�S7P'✓L'r' D �l/� 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family, '� OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. Reconnection of e.❑ Repair of an System System Septic TankOnly an Existing System Existing System 2.,11 A Sanitary Permit was previously issued. Permit# �,1 yU7a—y� 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.j9 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.X 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): /� 9�J 5 7C'� Feet Private ❑Joint ❑ Public CAPACITY VI. TANK Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank fe ❑ Lift Pump Tank/Siphon Chamber ❑ I L Li ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb 's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: /?a, .I VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name � CST# . Ales CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved I Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial ff 11 rcharge Fee Adverse Determination /v�'U� aS,Uc? s "Q 7 ( L'A X. COMMENTS/REASONS FOR DISAPPROVAL: Plat) b y 1"cry 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 14, ic./.:��� Location of Property W S E , Section J S� , T d' N-R J 7 W Township y'u.s hr -e l vE� Mailing Address !C'7=rZ ,B�[ f1 t4J�r,1, �✓I �`�dc>a, Address of Site Subdivision name . Lot Number Previous Owner of Property /hAPL L!4.J cz Total Size of Parcel Y3 /�e.Ca---s Date Parcel was Created 4AJ;<,vz?,,Jj Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes A,,b No Volume 4<7rl� and Page Number --5-2e-7 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) ceAti.6y that aU statements on thin 6onm ah.e tltue to the best o6 my (om) know.tedge; that 1 (we) am (ace) the ownen(.a) o6 the pnopenty duchi.bed in th.i.6 .in6o4mation 6o4m, by viAtue o6 a waAAanty deed heconded in the 066.ice o6 the County Regi4ten o6 Veed�sas Document No. 2,j V6 ; and that I (We) pnesentty own the pnopo.sed Gate bon the aewage diod6at a yss em (on I (we) have obtained an easement, to &un with the above descAibed to p pehty, an the cons-t�cuction o acu.d dydtem, and the same has been duty tecokded in the 046.ice o6 the County Regizten o6 Ueed6, ab Document No. SIGNATURE OIL OWNER SI ATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED [ DOCUMENT NO. STATE BAR OF WISCONS,IN-FORM 5 PERSONAL REPRESENTATIVE'S DEED THIS SPACE RESERVED FOR RECORDING DATA REG. 121WS OFFICE Norwest Bank Minneapolis, N.A. , fornerly known as ST. CROIX CO-, WIS, banking association —, as Personal Representative of the estate of Nov. A.D. 19-83 Marcel K. Lynum day al 2:00 P for a valuable consideration conveys without warranty to Richard D. Walton and Joan M. Walton, husband and wife as tenants in ccnmn, Richard D. Walton an undivided two- thirds interest and Joan M. Walton an undivided one-thii7d- RETURN TO -intexest, Grantee, the following described real estate in St. Croix Cc-.!nty, HAROLD D. OLSON State of Wisconsin- (hereinafter called the "Property") ATTORNEY AT LAW BALDWIN, WI 54602 Tax Key No. The Southeast Quarter of the Northeast Quarter (SE 1/4 of NE 1/4) and the East Half of the Southeast Quarter (E 1/2 of SE 1/4) of Section Fourteen (14) , Township Twenty-eight (28) North, of Range Seventeen (17) West, St. Croix County, Wisconsin. West Half of Southeast Quarter (W 1/2 of SE 1/4) of Section Fourteen (14) , Township Twenty-eight (28) North, of Range Seventeen J17) West, St. Croix County, Wisconsin. i? ;ven in fulfilln-kent of a certain Land Oontract between Marcel K. LYnum and _ui�"Jausband and wife, and said Edith H. Lynum in her own right, to Richard T .-Wit6n, am m. Walton, husband and wife, as joint tenants, dated February 18, A69 ,' ch 13, 1969 in Volum 449, page 615, Document No. 295565, in the ite er of Deeds for St. Croix County, Wisconsin. Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Propertv which the Personal Representative has since acquired. NOINEST BANK MM04EAPO IS, NATIONAL ASSOCTATIa 1, Pe ,gron the Estate of Dated September 2, 1983. AM yn, f Its Vice y�6s i2e_n� 14i'lliam J. Cullen By HiRZ' T?.- A- 14pl1irkson Personal Representative Its Assistant Vice President AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WHMMINEXMinnesota ' 19 SS. Hennepin County. Personally-came before-me, this- 2 n ri day of '19R3 med Cullen, a Vice President and E. A. Hellickson TITLE: MEMBER STATE BAR OF WISCONSIN Assistant Vice President of Norwest Bank (if not, Minn:apolis, National Association also known s authorized by §706.06, Wis. Stats.) known as Northweste�n Naiional Bank of I This instrument was drafted by Nancy S. Bender-Kelner Faegre- & Benson to me pown to be the person_S Wh�oAxecuted the fore- 2300 Multifoods Tower 33 South 6th Street Minneapolis, MN 55402-3694 Genevieve 14. Young (Signatures may be authenticated or acknowledged. Both Notary Public Hennepin County,VWM are not necessary.) Sion-is-VmwAwAnt. (if not, state expiration date *Names of persons signing in any capacity should be typed or printed below their signatierf. ) ENEVIEVE .:YOUNrl 114� 7] NOTARY PLXLIC—MINNESOTA HENNEPIN COUNTY PERSONAL REPRESENTATIVE'S DEED—STATE EIAR OF WISCONSIN, 1... 11.- b — 11 I ...... :G Ln H a r STC - 105 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a I H OWNER/ bA-AJ LJ4 ROUTE/BOX NUMBER o6-, &C"4 is Fire Number �a CITY/STATE ZIP PROPERTY LOCATION : St') 14, -SO- �4, Section /V , Tod' N , R W, Town of ,{�'i.!-f�! iC�JG�, , St . Croix County , r Subdivision Jr✓/`> , Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into 11 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 . Ho F 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- ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE ! /y7 St . Croix County Zoning Office P .O. Box 98 Hammond , WI 54015 715-796-2231 or 715-425-8363 Sign , date and return to above address . Ilw � o � 0 o 0 o � o b � IIIw rri °F REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS PERCOLATION TESTS (115) DIVISION TIONS `. P.O. BOX 7969 MADISON,WI 53707 +:TIONt SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: .s'l� ';4sE�4 /-Y IT29N/R 71(or W ti� COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDR S �' •C'r' i USE f r / �!//' 'J/�D Z I�qq•• O.$EDRMS.: COMMERCIAL DES RI TION: DATES OBSERVATIONS i 1�v Residence ZNew ❑Replace TS: �r _f­ 7— RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-G GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SY �GV CAS ❑U ®S ❑U G S DU DS ❑U ❑S &U t ':(ors If Percolation Tests are NOT required DESIGN RATE:S y under s.H63.09(5)(b),indicate: If any portion of the lot is in the q`,; /� Floodplain,indicate Floodplain elevation: ` t _5..0 29e ROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST- HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 7 7Z s 20" Z B- Z " r 9 2I 13- y xe Ile e7 r- 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. RATE MINUTES RIOD 1 P PER INCH _ P IOD A�a P- P_ P- P- P- AN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Desch what are the hori- ntal and vertical elevation reference points and show their locat n on the plot plan. Show the surface elevation at all borings and the direction and percent land slop. 1 YSTEM ELEVATION 92.5 v / _ 63 $(i/ n ._.I* r1` ; _ rj Ot r I . F 3 t {{ I 2, { leg Q•a2,l�?� o 91-r ncY tN , yj jt i C le Flo l ©� rover i , S5 i. ' E 3 :'24 Pole t I ! € t e undersigned, ereby certify the(the soil tests reported on this form were made by me in accord with the procedures m� ethods specified in the Wisconsin imistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. E(print : TESTS WERE UUMPLETTED ON: R ESS: 19 L 4 61V/n0 6(—J" S CERTIFICATION NUMBER: PHONE NUMBER optional): ST SI RE: RIBUTION:Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. R-SBD-6395(N.03/81) Parcel #: 028-1022-70-100 01/23/2007 09:10 AM PAGE 1 OF 1 Alt.Parcel#: 14.28.17.127A-10 028-TOWN OF RUSH RIVER 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-NIEMANN, BRADLEY A&DOLLIE R BRADLEY A&DOLLIE R NIEMANN 1964 30TH AVE BALDWIN WI 54002 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description ' 1964 30TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: es: 5.000 Plat: 4118-CSM 15/4118 OEC 14 T28N R17 PT SW SE BEING CSM Block/Condo Bldg: LOT 01 15/4118 LOT 1 5.00 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-28N-17W SW SE Notes: Parcel History: Date Doc# Vol/Page Type 05/23/2003 722706 2252/01 WD 05/23/2003 722705 2251/649 TI 09/18/1987 430304 791/332 QC 2006 SUMMARY Bill#: Fair Market Value: Assessed with: 166048 255,400 Valuations: —Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 42,000 196,200 238,200 NO it Totals for 2006: General Property 5.000 42,000 196,200 238,200 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 42,000 196,200 238,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/0312006 Batch#: 06-15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 a a o � I o FF I N yty N O. � N W C I N E2 cc c aNi y I 0 o Z a r ii c 3 0) Q cv M 3 v (D I Z `- C co € •o I Z d m 0 O z c d Z O Z lA F- c E v d � M c m y y C U) •N aN C (DI O O o0) Q q N zmz o z Ili a E N d O a - O }� I '� y EE v N G G d � Z 30 o ' a � d d z •N A n u, CL c ov�i vcoc Z V1 J V m O O) N r r N _ ! M V m N D) O (n O Li O T 7 +" O O 0 c � va °to w _ N N L 0 o Y ; 2 E C 1f) N • r 7 O l9 O O � > N c a • a y rr`1wV ++ E c c :: AS BUILT SANITARY SYSTEM REPORT OWNER /ci,C l? G1 -G/ TOWNSHIP Ald,, SEC ./y T&N-R/7 W ADDRESS )'FX ST. CROIX COUNTY; WISCONSIN. SUBDIVISION — LOT A�4 LOT SIZE AM PLAN VIEW Distances and dimensions to meet re uirements of H63 W- EVERYTHING WITHIN_100 Fl?I:T OF SYS'1'I?I9 �o 1 - - - - -- IRF I � I di ate or,t.h� A r0 BENCHMARK: (Permanent reference Point) Describe : Mad on , -lec • Pole, o-F A!r','ve eday Elevation of vertical reference point : /00,0 Slope at site : .G % SEPTIC TANK: Manufacturer: s Liquid Capacity : /000 Number of rings on cover : oNE` Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer : Number of gallons Number of gal. pump set for a cycle gallons ; total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits feet diameter feet liquid depth seepage pit in et pipe-elevation bottom of seepage pit elevation ee- feet . SEEPAGE BED SIZE: number of lines width' ler�gth�� file depth0 Sh.EPAGE: TRENCH: width length, PERCOLATION RA'Z'E: /,; AREA REQUIRED �_AREA AS BUILT_ 9, �f°�_______._ INSPECTOR ;)A'l'ED PLUMBER ON JOB LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR d SAFETY&BUILDINGS LA'dOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.6.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 ,CONVENTIONAL 1:1 ALTERNATIVE State Planl.D.Number: (lt assigned) ❑Holding Tank ❑ In-Ground Pressure ❑Mound NAM F PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELE V.. Name of Plumber: MP/MPRSW No.: Co nty: Sanitary Permit Number: zg�� i SEPTIC TANK/HOLDING TANK: S-3 S 5 MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: Y ES ❑NO DY ES ❑NO BEDDING: VENT DIA.: VENT MATL; HIGH WATER ROAD: PROPERTY WELL: BUILDING:IVAER TN OT RESH ALARM. LINE: OYES ONO DYES. ONO DOSING CHAMBER: MANUFACTURER BE7YE LIOUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑NO ❑YES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: T s PROPERTY WELL. BUILDING: VENT TO FRESH �.LINE. AIR INLET: (DIFFERENCE BETWEEN PUMP ON AND OFF) DYES ONO SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until 10 the soil is dry enough to continue.) �K CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER °'INSIDE DIA.- #PITS: IL IQUID / � _ TR ENCHES. MATERIAL: DEPTH: � ..� R VFL DEPTH FILL DEPTH IDISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.IF ELEV.END. PIPES. LINE: AIR INLET: MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES ❑NO SOIL COVER. TEXTURE. PERMANENT MARKERS. OBSERVATION WELLS. OYES ❑NO ❑YES ❑NO DEPTH OVER TRENCH;BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER EDGES. ❑YES NO DY ES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: ?` = WIDTH- LENGTH- NO.OF LATERAL SPACING- GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. TRENCHES: MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERI7��DISTRIBUTION PIPE MATERIAL&MARKING: ?,. ELEV.. ELEV. DIA, ELEV. 8 HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES El NO ❑YES ❑NO Mo COMMENTS PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: DYES ❑NO ❑YES ON( I 7, 18 5� 7_t__ _ (1P L � �o Sketch System on Retain in county file for audit. Reverse Side. 7RL TITLE. DILHR SBD 6710 (R.01/82) DEPARTMENT OF APPLICATION SAFETY&BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON,WI 53707 Attach plans for the system on paper not less than 8%x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale.Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property ner: Mailing Address: Q .e G�JRL f-0 N `r2— /oiR�caw i w LcJ� r Property Location: City,Village or Too-wnsh' County: 1515 NaS /� iT A?NiR /116(or) usf/ /Sl I/e, ot7��oi x Lot Number: Blk No.: Subdivision Name: Nearest Road,Lake or Landmark: State Plan I.D.Number: (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY Q >< x HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: G S . EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED(Square feet): CK New ED Replacement ❑ Experimental Seepage Bed 1:1 Seepage Pit / 3 9145 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for inst tion of the private sewage system shown on the attached plans. Name of Plumber: igna MP/MPRSW No.: Phone Number: Z�v -e e- /--/- ea m p 6 7 P Plum ' Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signaturprof Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: � DISAPPROVED " ry eas n' Disapproval: Alternate course(s)of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County,Canary-Bureau of Plumbing, Pink-Owner,Goldenrod-Plumber D I LH R-SB D-6398(R.07/81) lik. i no''ooi DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 HUMAN RELATIONS LOCATION: t SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.'BLK.NO.: SUBDIVISION NAME: SLc7 '/4-5`1/4 17 IT29NIR -7 1(or(9 r /1�14' A COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: Q�fo USE I rjjfJ F C71 DATES OBSERVA IONS NO.BEDRMS.: DESCRIPTION: tx TS: Residence d �LINew ❑Replace r_ 7— p Q� dl RATING:S=Site suitable for system U=Site unsuitable for system i CONVENTIONAL: IN-GROUND•PRESSURE: SYSTEM-IN-FILLHOLDI�N`G TANK: RECOMMENDEDSY RS ❑U IMOUNE ®S ❑U dS EA DS ❑U DS ,�lU If Percolation Tests are NOT required DESIGN RATE: STEM ELEV. If any portion of the lot is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: y `4 Jecve So�� (/`a ,:?5 ROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED E T. HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- 7Z 7 72 s-• 20" cfZ'' s 20 B- 3 �Z QJ'rZZ/ ii 9'' 21 �. y r /f S -`� 3� B z5, B-5 72!:� 9�-yz 20 3 s r B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PE IOD 2 PERT PER INCH P- P- 2 3.Z P- Z Alo/ 6 3 P-_ P_ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descri a what are the hori- zontal and vertical elevation reference points and show their I on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 92- �°� (3��,�C wel/ 'd. n AI *a> i tae bu.. �� e ��.._.� _ .. �. -_for ��. 1_.. _... �_.._ P. , ` \ t tN 3 / 9 y� F �. ._. .., .,. __`... ..�. _ . ..... / . �.. w P.1 e I 1, the undersigned,�ereby certify tha the soil tests reported on this form were made by mein accord with the procedures methods specified in the Wisconsin Admimistrative 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 optional►: Z—), S AS`- 7 ST SI RE: DISTRIBUTION:Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester, DILHR-SBD-6395(N.03/81) L_ __ h ' 0� • Ot •. J ; v we EP F3 4 a 4 `o OL, � %001 mD r -° � h � wa �M cv T N �..,. 0ae lz f r3 a Tzo Z. -<p a �, w 9651 1� 8 Kh`i rILEEN H. WALSH POP REGISTER OF DEEDS 2441 'W �� ST. CROIX CO. , WI �� " � 2001 ���' ` 'j�N 7 RECEIVED FOR RECORD / 06-27-2001 11:00 AM I ST.CROIX COLINTY —...S0R,,'EYOR'S RECORD > CERTIFIED SURVEY MAR 4► EXEMPT N CERT COPY FEE- CODY 99910 o CERTIFIED SURVEY MA R FEE: 12.00 Richard D. and Joan M. Walton RAGES: 2 Located in part of the Southwest 1/4 of the Southeast 1/4 of Section 14, Township 28 North, Range 17 West, Town of Rush River, St. Croix County, Wisconsin. APPROVED ST.CROIX COUNTY Planning Zoning and Parks Committee OWNER'S ADDRESS JUN 2 7 2001 1964 30TH AVENUE LEGEND BALDWIN. W15"2 If not recorded within 30 days of approval date approval shall be null and void a INDICATES 1"x 24"IRON PIKE SET . (MIN. WT. - 1.13 LBALIN. 17.) N 0 SECTION CORNER MONUMENT(AS NOTED) BEARINGS ARE REFERENCED TO THE SOUTH LINE OF 7WE SOUTHEAST 114 OF SECTION 14, NOTE T 28 N,R 17 W,ASSUMm As THIS PARCEL IS BEING CREATED S 89V637*E FOR PURPOSES OF FARMLAND CONSOLIDATION. SCALE IN FEET 1"=1'.IQ' 5Q 50 160 160 20 UNPLA TED LANDS. LOT I C'0I ; 218,000 SQ.FT.OR 5.000 AC. 1202,420 SQ,FT.OR 4,847 AC. �� EXCLUDING.ROAD IRIGHT OF WAY} Q mu D G 01 w p`� LLI; &; p; - SHED LU; i N �I Z{ Z ARE� O-; 100'COUNTY BUILDING SETBACK LINE O \ p O Q NORTH RNV LINE 30TH.AVE N 000557"VIN 465.75' _T T S V,,r E 453 7 s'33:00' 89 O 2 33.00'-1 S 89005,57'E 1714.92' £h SOUTH LINE SOUTHEAST 114 0 " M r, Cn N 89 05 57 W 466.37 AM MI f T --r SOU H RM!LINE 30TH AVE, SOUTH 1/4 CORNER --S 89°05'57"E 2634 99'— SOUTHEAST CORNER SECTION 14,T 28 N,R 17 VV; SECTION 14,T 2&N,R tM,, (FOUND RAILROAD SPIKE) (FOUND R91LROAD SPIKE) �INPLATTED LANDS. `�poo�CO1Vg��91Cr° S •`°LAUR ° FEBRUARY 13,2001 nA w. Y ••o r REVISED THIS 147H DAY OF MARCH,20 0 17 3 04 e>� ° RIVER g REVISED THIS 23RD DAY OF APR/L 2001 4,�°°° FALLS.' °,°�O� Gp°p Fo LA N� �ODOp�C�'1D� THIS INSTRUMENT DRAFTED BYJERALD L.LARSON SHEET I OF 2 aft VOL. 15 PAGE 4118 1111111111111111113