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HomeMy WebLinkAbout030-1075-20-100. \ ) 60!) o & o ] E _ 2 i \ � $ � ƒ / � � J � g § � % _} C 2 E 0 $ 3 � � 2 ) I � « 2 ¥ w � B � % / z m § \ \ ■ e \ E 2 7 e $ \ 7 CD -� CO ) q G } ; ] k £k " c § & e D 0 2 c / / \ \E ) k z } § (a § y / \ \ . cc § \ z G \ a a m � § � ■ � I � w � , o : > _ = a . { { / & g E : % 2 c IL . ' M J ƒ / ) © 0 . '2 06 : ) \ ƒ $� 22§ 2moo= o� $§ §§ c = co � � \ ) + _ ® CC) - 2 \ i / 7 2 § { ] 5 k k � gj § 0 2 / 2 6 2 ¥ « � - ad E 4) M B C E ) $k a §CL k J a 0 2 6 . . ! Parcel #: 030-1075-20-100 10/21/2005 09:34 AM PAGE 1 OF 1 Alt. Parcel#: 27.30.19.261B 030-TOWN OF SAINT JOSEPH Current [X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner RICHARD A&MARIE C COLBETH O-COLBETH, RICHARD A&MARIE C 661 VALLEY VIEW TR SOMERSET WI 54025 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *661 VALLEY VIEW TR SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.460 Plat: N/A-NOT AVAILABLE SEC 27 T30N R1 9W NW NE 3.457 ACRES LOT 1 Block/Condo Bldg: CSM 7/1814 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 789/398 07/23/1997 778/225 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.460 54,500 151,600 206,100 NO Totals for 2005: General Property 3.460 54,500 151,600 206,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.460 54,500 151,600 206,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: / � t : y5 Length: ,S Number of Lines: Area Built Fill depth to top of pipe: X241 Number of feet from nearest property line: Front, O Side, Rear,0 Pt ✓oS� Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: / $ Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box 0 been used on any of the above soil a 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: p� Inspector: Dated: ��� D 7 Plumber on job: ` License Number: OOfI'� 5 c3jT 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER (,/1 (�O/fjG f� TOWNSHIP j� 61US��T // SEC.��_ T�� N-RW ADDRESS lyl eh�i ST. CROIX COUNTY, WISCONSIN c SUBDIVISION LOT LOT PLAN VIEW Distances and dimensions to meet requirements of I•IHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J D �/j Ag /B� L sir 5 3�� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 1>e- / Garner Elevation of vertical reference point:14a® Proposed slope at site: SEPTIC TANK: Manufacturer: `��-e-� Jl_`> Liquid Capacity: � d Number of rings used: n-L Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ,'4z i Number of feet from nearest Road: Front,O Side,Rear, O feet From nearest property line Front,OSide,�Rear,0 J _ feet Number of feet from: well , building: a o (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION 0.0.BOX 7969 BUREAU OF PLUMBING MADISON"WI53707 NW ,N ,S , 30N—R19W XMCONVENTIONAL ❑ALTERNATIVE State assignnl.D.Number: (if assigned) Town of E. St. Joseph Pressure ❑Mound ❑Holding Tank ❑ In Ground ress 9 140th Avenue NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTI ATE: Rick Colbeth Route 2, Somerset, WI 54025 1'30 f%-�1'! 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: Byron Bird Jr. I3318 St. Croix 96042 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED W 1 (Do 0 61 I S YES ONO DYES ©NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: IVENT TO FRESH ALARM FEET FROM LIN�. l , ` �� AIR INS: DYES YNO ❑YES C�I! O NEAREST l 7 N DOSING CHAMBER: MANUFACTURER. =�YES, LIQUID CAPACITY. JPUMP MODEL JPUMP/SIPHON MANUFA TURER. IWARNING,LABEL LOCKING COVER PROVIDE : PROVIDED: ❑NO } ❑YES ONO ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: BER.OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN E FROM LINE AIR INLET: PUMP ON AND OFF) OYES ❑NO NE REST- SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LEN TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORGE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH. IN1,11 DISTR.PIPE SPACING. COVER =PIT INSIDE DIA.. #PITS: LIQUID D1 € �H TRENCHES J M ERIAL DEPTH: MENttS S S GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR,PIPE DISTR.PIPE MATERIAL: NO.DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW P�$. ) ) ABOVE COVER ELEV.INLET ELEV.END G PIPES. FEET FROM LINE 7 AIR INLET, YY q17.S3 I �'I "1 3Co L 2 ? �- l NEAREST. 0 �a 0 7 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 1:1 NO SOIL COVER TEXTURE PERMANENT MARKERS JOB WELLS ❑Y E S ONO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH/BEO DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER- EDGES. : YES ❑NO OYES ENO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: TRENCHES: O EMIONS !MANIFOLD PUMP MANIFOLD DISTR.PIPE IM ANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.. DIA.. ELEV.: PIPES. DIA- 1:L VATION AND t?#STRIszWTl01�1 "HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED � � PLANS. ❑YES ONO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM OYES 1:1 NO OYES AIEA-REST L, o Le �q 0 Sketch System on Repain in county file for audit. Reverse Side. SIGNATURE. A TITLE: DILHR SBD 6710(R.01/82) Z i rator INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new- criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399)to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained:The septic tank(s) should be pumped by a licensed pumper whenever necessary; usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks, building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate.The groundwater bill Ground ateC4,� included the creation of surcha ges (fees)for a number of regulated practices which WISCO 111`8 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 to the groundwater through your soil absorption o system or the disposal site used by your holding tank purnper. 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 COUNT r 70ILHR In accord with ILHR 83.05,Wis.Adm.Code Gr'o STATFSANI ARY PERMIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE((P//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 PROPERT WNER PROPERTY L CATION S T 0, N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK N MBER SUBDIVISION NAME CITY,STATE t ZIP CODE PHONE NUMBER CITY :�� EAREST ROAD KE OR LANDMARK TOWN OF. X VILLAGE: II. TYPE OF BUILDING OR USE SERVED: 036— `0 7s—cam l 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. 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. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy: IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. .Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 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): Feet p� Private ❑Joint ❑ Public 4 .30 / VI. TANK CAPACITY Site in cia llons Total of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank G ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ 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 is Signature:(No St ) MP/MPRSW No.: Business Phone Number: n c r Plumb 's Address(Street,City,S ate,Zip Cod- of Designer: /' C_ I`' •� VIII. SOIL TEST INFORMATION Certified Soil ester(CST)Name / CST# sr l/ �1^ 0 Z CST's A SS(Street,Ci ,State,Zip Code) Phone Number: Zaf ! oo - 6C IX. COUNT /D PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) rg Approved ❑ Owner Given Initial M� ''\\ Surcharge Fee / Adverse Determination I W •C)6 1 9- X. CO MENTS/REASONS FOR DIS PROVAL: ,� Pico, F\�����j " �. S-etik.cs 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 Location of Property } P Y _ IV.fit/ �t I�l � 14, Section , T 30 N-Rj ? W Township & � fp Hailing Address Address of Site _ 4� Subdivision Name . Lot Number Previous Amer of Property S�.4t}IER, Total Size of Parcel _ Date Parcel was Created 13 I M Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _�_ No Volume -_2 9 and Page Number act 5 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 (Wel centi6y that a.tt Atatements on this artm aAe tAue to the but 06 my (ouh) hnowtedge; that I (we) am (cute) the owneh(af 06 the pnopehty deacnibed in .th,ia .i"404mation 6oftm, by vixtue o6 a waAAanty deed teco&ded in the 066.ice 06 the Count RegiAteh o6 Vee6ass Vocument No. tf35Co c� ; and that I (We) pneaen.tfy awn •the pnoposed site bon the aewage duspoa ayes em (on I (we) have obtained an eaa efien t, to hun with the above deg ch,1bed pnopeh ty, bon the cons tAuc t i.on 06 aa,i.d aya.te+n, and the name has been duty kecokded in the 0661ce 06 the County Regeten o6 Veed6, eA Document No. �a (,p a i J . SIGNATURE Op OWNERy SIGNATURE OF CO-OWNER (IF APPLICABLE) U _ DATE SIGNED DATE SIGNED b'OCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA ��5��� STATE BAR � WISCONSIN FORM 2 1982 r Fh _ :�-�tu' 1. �11; RECaISTERS OFFi CS ST. CROIX CO,, Wig,,N T. SCHOTTLER and GEORGINE M. SCHOTTLER, Rec'd. for Recp--- -- - -- -----• --•- ------...-- ---- --•- ----------- -- --- ... ----•------ ---- -•-• - band__and__wfe_,-::and_•each--in_• their_ own _ri ht 13th . .g.. y of Ma ----•--- -------- ------- _A.D. 1987 ---- --------- ------- ----------- ......-••-••-------- ................... ••--••... --- --- . 1:30P. conveys and warrants to .-RI •_CQL�ETIi..ar141. M RAH t COL . ..._.husband__all _ w fe,••holding-_as suryiyor— 4 ship..martal...PrS?P�rtY.---... ••-- ---• ................................................... __ _ _ /f1 r. //11ns. rQlCA a6»( in--.consideration•-Of- 4-,.200. OO RETURN To Co�6mt ----------• -•--• So �.�set CrJ�' ,Trro2,s the following described real estate in ------ .......S - _t,___ Qih State of Wisconsin: -------------County, _ "-- Tax Parcel No_ Part of the NW4 of NE4 of Section 27, T30N, R19W, described as follows : Lot 1 of Certified Survey Map filed May 13 , 1987 , in Vol. 7 of CSM' s, Page 1807, i)oc. Y10. `� ; ; ;, i.1 the office of St. Croix County Register of Deeds. Subject to town road right-of-way over the northerly part thereof as shown on said Certified Survey Map. F2B This .._...is__not homestead property. 4t)g (is not) Exception to warranties: Dated this .............._1,3_tj,....................... day of ---•------•- iIa .................................... 19.-8 7-.. f -- .--......_(SEAL) ---••---------------------------•---------•------------- -----------(SEAL) 7 -----•------•---------•-•-------•----------------------------•---- ` ---•-- John T,....Schottler ---------------------------------------------------------------------(SEAL) 4' � 4 Lr�.c!.... :. ' -----------------------(SEAL) --------•-------------- ------------••------•--•-•------• -••-••-- * ...... Georgine...M.---S-chottler........ AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ �2 ._s70Y)dl _�', C} STATE OF WISCONSIN ,---.ScJaatt1 az.................. SS. au nt ca d his 13 t1d of_-- --------------------------------------County. A-1— 19$_7._ Personally came before me this . -_ . � - - ----------daY of 19-------- the above named -------------------------------------------------------------------------------- ---..w1.117'aln_.sl-'------],a b�St----------------•------- TITLE: MEMBER STATE BAR OF WISCONSIN --------------------------------------'°-•-----------------------------•------- -----------------•--------------------------------------- -----•- f not -________ „ authorized by § 706.06, Wis. Stats.) -------------------------------------------------------- --- - I to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY I� William J. Gilbert ILBERT, MUDGE, PORTER & LUNDEEN ' II W-1 5441.6--------------------------------------- (Signatures may be authenticated or acknowledged. Both M•v Notary Public is permanent.(If not, -----County, Wis. are not necessary.) � date: ----•------------- --------------------•- I 'Names of persona signing in any capacity should be typed or printed below their signatures. .... �) HGMdI�r Comprry ryI STATE BAR OF WISCONSIN ru....«.w�,c...�. FORM No. 2— 1982 Stock No. 13002 H z cn H . a ST C - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d OWNER/BUYER fi / �� H ROUTE/BOX NUMBER 0. 'CrX ads Fire Number CITY/STATE ZIP PROPERTY LOCATION : l�-1 �, � 14, Section �7 T 30 N , R _W, Town of s�- � ��� St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into 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 . 0 E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- It 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 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 . I INSTRUCTIONS FOR COMPLETING FORM 115 - S 3D - 6335 To be a corriplete and accurate soil test:,your report must include. 1. Complete legal cjescript.ion; 2. The use section must clearly indicate whether this is a residence or cornmercial project= 1 MAXIMUN'I number of bedrooms or commercial use planned; 4, Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbe eviat ions 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 may be used if desired; B. Make sure your benchinar€<and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses,flood plain data,percolation test exemp- tion,if appropriate; 10 If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the loan and place your current address and your ceitification number; 12. Make legible copies and distribute as required, ALL 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 - bedrock cob Cobble (3- 10") SS Sandstone g€- - Gravel (under 3") LS - Limestone *s ...._ Sand HGW ..__ High Groundwater cs -- Coarse Sand Perc - Percolation Rate rued s - Medium Sand W Well fs Fine Sand bldg - Building Is - Loamy Sand > - Greater Than 1'sI -- Sandy Loam < Less Thar? 'I --- Loam Bn -.._ Brown Xsrl - Silt Loarn BI - Black s€ - Silt G Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R Red sicl - Silty Clay Loam n-iot Mottles sc Sandy Clay w' with sic Silty Clay fff - few, fine,faint *c Clay cc common,coars e pt Peat min - Many, medium ni - MUCk d - distinct p prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mar k VRP Vertical Reference Point 1 TO THE OWNER: This soil test report is the first step in securing a sanitary permit.The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O.MADISON WI 53707 HUMAN RELATIONS ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: WNSHIP UNICIPALITY: LOT NO.:BLK.NO.:I SUBDIVISION NAME: 41W AANIIVf E COUNTY' OW ER'S BUYER'S NAME- MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: Residence 3 — New ❑Replace RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MO ND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(. tional) DOS ❑u s ❑u s ou EIS u a s u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b),indicate: G Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DOTH 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- � 6 9�S D.: � y _ B-o� Q �� B- 2� f B- 4C 7 f® B- /u f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- P-P-P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION `- �c a 5 s fc �l• �( 16 E E E t i E 3 t 'q 1 e I D2� k E E E i I,the undswogned, 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��$7� ADDRESS' NUMBER: PHONE NUMBER(optional): CST SIGNATURE: c DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R. 10/83) —OVER — L DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS DIVISION INDUSTRY, LABOR AND PERCOLATION TESTS (115) MADISON W 53 07 HUMAN RELATIONS ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: WNSHIP UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: _ 37 ose COUNTY: OW 14E BU ER'S NAME- MAILING ADDRESS: .G $ L ro — / ;' O vJ 2 '. USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: R I • Residence 3 New ❑Replace Z RATING:S=Site suitable for system U-Site unsuitable for system ONVENTIONAL: MO ND: IN-GROUND-PRESSURE: SYSTEM-IN FILL HOLDING TANK:RECOMMENDED SYSTEM (o tional) VU s au s au sou o s u o s u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0915)(b),indicate: G Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL H T ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVAIN OBSERVED : HES TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) 4 J•z r 3. -/,a-.7jo 017 3r d/� r r7 r3� �:t 3 n 3r/�f�/�, a1► B- B- fut PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL-MIN. P RI D t P RI D _Ps PER INCH P- r P- 02 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. i SY M ELEVATION <. � - o� S s�'`````_�' 9G c j L - I r O 3 i • �� kosr Ail• �• _ . . - ----%----�--#--- BkI+ — /� PI) ! loo / UPS _ . i i 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: ADDRESS- NUMBER: PHONE NUMBER(optional): p !iv/SC BO — CST SIGNATURE: { DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.10/83) -OVER - L�. �Y i �+ ' �. �., '� t ' + V � ,?..... �� �� PLOT PLAN 4 ° PROJECT_ A ' DRESS �oaz� ,tle1 l4,#;5 . 1/4/S a7/Tn N/R!y W co Cra MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC CONVENTIONAI,�IN-GR PRESSURE CONVENTIONAL LIFT MOUND HO ING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE C 3o BED SIZE — b, Benchmark V.R.P. Assume Elevation 100' Location of Benchmark _ � c,. ����, ��'a�� , * H.R.P. 0 Borehole Q Well Scale Feet O Perc Hole System Elevation TYPAR COVERING 26 12' 3' 0 6' 0 3' 3' 0 3' 6' Sewer Rock 12' 18' to n op 40 ,56$ � o2Gb r Qr° i ,ale 5l�p f/ y Iq 17 NiV RILED ` (� 2� MR a3 CERTIFIED SURVEY MAP W Located in the NW 1/4 of the NE1/4 of ..Section 27,T3ON; �a R 19W , Town of St. Joseph, St. Croix County Wisconsin pZN LW� Owned by: John Schottler Surveyed for: Rick and Marie Colbeth WX_ Rt. 2 Box 306B Rt. 2 Box 306A MWW 3Z Somerset, Wi. Somerset Wi. _� N 1/4 CORNER m SEC. 27 NORTH LINE OF THE NW 1/4 OF THE NE 1/4 4.00' NE CORNER T30N,R19W � �EC N 890 58' 10"E 568.18 315.06 ' S 890 37'38°E 568.19 TH g 140 _ AVE � — _ S 89°37738 —568191 — — — — O \POINT OF BEGINNING N VC co i OI 3 0 Jl ° o LOT 1 b ° w �I ( o M 150, 568 SQ. FT. (3.457 ACRES) o N 01 t- ° N Including Right-Of �) zz 130,681 SQ. FT . (3.000 ACRES) a o W� S� Excluding Right-Of-Way 0 �I ZI o Z) D 568.19' LEGEND N 89 037'38"W 4� SCALE IN FEET (1" = 100 SECTION CORNER MONUMENT p 1°X 24" ROUND IRON PIPE WEIGHING p 100 200 300 1.68 LBS/ LIN FT. SET UNPLATTED LANDS O 2" X 30° ROUND IRON PIPE WEIGHING — — — — ———" 3.65 LBS/ LIN. FT. SET A parcel 'of land located in the NW1 /4 of the NE1/4 of Section 27, T30N, R19W , Town of St. Joseph, St. Croix County, Wisconsin, described as .follows: Commencing at the N1 /4 corner of said Section 27; thence N89°58' 10"E (bearings referenced to the North line of the NE1/4 of Section 27, assumed N89 058' 10"E) 315.06' along the North line of the NE1 /4 of Section 27 to the point of beginning; thence continuing along said North line N89°58' 10"E 568. 18'; thence SO°01'50"E 267.00'; thence N89 037'38"W 568. 191; thence N0 001 '50"W 263.00' to the point of beginning, containing 150, 568 square feet (3 .457 acres) more or less, and being subject„to Town Road right- of-way as shown and also all other easements, restrictions and covenants of record. I, Harvey G. Johnson, Registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such map is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the subdivision regulations of the Town of St. Joseph, St. Croix County, and Section 236. 34 of the Wisconsin Statutes,ofittth4est of my knowledge, understanding and belief. ��*1�(`,0/Vs,�j� �.��► APPROVED HARVEY 6. A, op -I s I « S-'18;99 } arvey C . o s HUDSON Professio 1 an Surveyor S-1899 WiS Busch Surveying, Inc . rr ��f �'Q-`o�► COMPa !Ei f.'119VE 1W.R S PLAHM Iii 407 Second Street i0yi<'9N 400..004... MMR �"� At,1U zOivlhlG COl,1.!4tiTEG SU Hudson, Wisconsin 54016 ejo,�IQ0l foists y87-//7<0 Volume 7 Page 1814