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HomeMy WebLinkAbout030-2067-60-000 § ¥ 2f § 0 & \ ) @ w o > ) � \ � /� . � / g\ ¢ . \\ : &c f -0 2L § 2 4 > (D } 7 = U. o 2 z \ - E ) \ : k & § \ 0 CL m q \ z / f \ k / 7 I ) ) \ ( \ N . •� i \ f § Q z m z j � - § k m N / � ■ - C e \ } \ ) / § .2 > _ § % / = 0 0 0 z m a a a E r- co 2 ] ) § § q z k § \ 6 2 0 ! d £ : � 2 t ; 4 a ■ % ca , c ) E Q 2 + m ¥ SI / o \ § $ / S S ; 2 ? j G ` « k k $ d / . \ © I § ` ° \ m U) m o z f j / \ « y z k k 2 2 E6 \ 0 a ' Loll. k k ) ) 0 k ) . , PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size , Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines:-- Area Built: e Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,O Vt 6-2- 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 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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: (o �� Plumber on job: P ati License Number. 12�2- 2— 3/84:mj L Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER1JC.GLY���.l� t�llN�1 TOWNSHIP 3(� SEC. T, -RIO W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISIO 4 pY OTPA (.arc-j�,, LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �6� �ck ate I � Y i PO(z S INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ,<& �T������4op- Elevation of vertical reference point: Proposed slope at site: / D SEPTIC TANK: Manufacturer: j ) Liquid Capacity: Number of rings used: �_ Tank manhole cover elevation: p 5 Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front Side 0 Rear, O feet From nearest property line : Front 10 Side,0 Rear,O 6'a feet Number of feet from: well � building: J (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT .k . APPLICATION r r r 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 fl6w (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Forn•(SBD 6399) to be- submitted to the county prior to installation; 5. Private sewage systems must be properly maintaine&Th�'septic tank(s) should be'pumped by y-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; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill rn 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 8Y2 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 nwdai and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ---------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE - On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more - commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco h"- e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried tea ur$I is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) D,ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code STAT�ANITA RY PERMIT# yAttach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN IOD.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES X NO PROPERTY OWNER PROPERTY LOCATION N QU Aj 'E. '/4$ '/4, S $ T N, R 9-0 E (or PR ERTY OWNER'S MAILING ADDRESt LOT NU BER BLOCK MBER SUBDIVISION NAME O le-- tO r P ,mac 0-cf-e CITY,STATE ZIP CODIf PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK O ❑ VILLAGE 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. KNew 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.Xconventional 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.A Seepage Bed b. ❑See a e 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): ((�� 91 Q , Feet XPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in allons 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 O Z lAkfAtt ❑ ❑ Lift Pump Tank/Siphon Chamber L1 El 1:1 VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature St mps) MP/I .A@W- o.: Business Phone Number: Plumber's Addr ss(Street,City,State,Zip Code): Name of Designer: poy- III. SOIL TEST INFORMATION Certif' 7-e)4—it Tester(CST)Na e CST# ���4 a CS 's A DRESS(Street,City,State,Zip Code) Phone Number: IN t IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater at Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial S rcharge Fee Adverse Determination 42S. X. COMMENTS/REASONS FOR DISAPPROVA : SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 'C Z' O n 3 � D � Fi j C � � rn f - v X 1 voQ, CIO O 8 v co * m d � i �N. :• � s`•� `i N r _ b mot' � I N ` m � m pis - cs► u _ f - N - 1 o � � We LA U e v y � Ok D c :!SL Parcel #: 030-2067-60-000 F7 02/10/2006 03:56 PM PAGE 1 OF 2 ' Alt. Parcel#: 35.30.20.609L 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 O-BOLLES, JAMES R&MARY B JAMES R&MARY B BOLLES 182 RIVERVIEW ACRES RD HUDSON WI 54016-0000 Districts: SC= School SP=Special Property Address(es): "=Primary Type Dist# Description " 182 RIVERVIEW ACRS RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.850 Plat: N/A-NOT AVAILABLE SEC 35 T30N R20W GL 4 COM SE COR SEC 35, Block/Condo Bldg: N 1112 FT, N 86DEG W 644.2 FT TO POB: N 74DEG W 196.6 FT, S 32DEG W 146.3 FT, S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 53DEG E 218.2 FT TH N 24DEG E 221.69'TO 35-30N-20W POB Notes: Parcel History: Date Doc# Vol/Page Type 10/05/1999 611561 1461/253 WD 03/18/1998 575276 1306/507 TI 07/23/1997 914/479 07/23/1997 776/372 more 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 84672 330,000 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.850 80,000 220,100 300,100 NO Totals for 2005: General Property 0.850 80,000 220,100 300,100 Woodland 0.000 0 0 Totals for 2004: General Property 0.850 80,000 220,100 300,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 501 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS DIVISION P.OsBOX 7969 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON WI 53707 SE-4, SFs;, S35,T30N—R20W CONVENTIONAL ❑ALTERNATIVE Sta11 Plan 10.Number. Town of St. Joseph of 1-gned) P El Tank ❑ In-Ground Pressure ❑Mound Lot 19 Riverview Acres NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Dean Raveling Route 1, Box 1A, Dresser, WI 54009 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: 111T REF,PT,ELEV.. Name of Plumber: MP/MPRSW No. 1C..nty: Sanitary Permit Number: William Pfannes 6222 St. Croix 96059 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV,. TANK OUTLET ELEV.. IWARNING LABEL LOCKING COVER PROVIDED: PROVIDED: rl�1 YES ON OYES VNO BEDDING: VENT CIA.: VENT MATL. HIGH WATER NUMBER(tF ROAD: PROPERTY WELL BUILDING: VENT TO FRESH /� _ ALARM FEET FROM L I NE AIR INLET EYES S�NO l., .L DYES O NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: 11-IIIIJID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. NING L EL LOCKING COVER tl I DEO: PROVIDED: EYES ❑NO YES [:]YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF 'PROPERTY WELL BUI ING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) j L-1 YES ❑NO NEAREST: SOIL ABSORPTION SYSTEM.Check the soil moisture at the de th of lowin LENGTH DIAMETER A M RKING or excavation. (If soil can be rolled into a wire,constructions all cease unit, FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: t� WIDTH. LENGTH- NO.OF DISTR.PIPE SPACING. COVER INSIUE DIA. #PITS. LIQUID BED/TRENCH ^ TRENCHES MA?'E`HIA L! PIT DEPTH: OIMENSIONS 1 GRAVEL DEPTH FILL DEP H DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D STR NUMBER OF - PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES rZ ABOVE COVER. ELEV.INLF i ELEV.END. � S.PIPE 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. El YES NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS El YES 1:1 NO ❑YES 1:1 NO DEPTH OVER TRENCH!BED IDIPT R OVER TRENCH!BED DEPTH OF TOPSOIL SODDED SEEDED: MULCHED. CENTER EDGES. ❑YES ❑NO ❑YES ❑NO : YES ONO PRESSURIZED DISTRIBUTION SYSTEM: EDITRENCH 'WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING '. ENTDN AELE V.: ELE V.. DIA_. ELEV.: PIPES. DIA.: OISTRiB TION II{FC �'�°*'IrION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: PLANSCAL LIFT CORRESPONDS TO APPROVED ❑YES ❑NO DYES 1 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF ERNE ERTV WELL: BUILDING: EYES ENO EYES ❑NO NEAREST 9.0 �. S-0 D Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD 6710 (R.01/82) 'r t RauefiVj + S� 41 S C 5 3s, �`3 0� e2v C, ` Wn d Sf "SSSepx 1 bahCC, ,r �(c^rr� �ji (Y /U6 �Uc ( oy, L o }fie Pr fret' ay o e G- 9- J. � . / . ~.� . ^ ^ ` INSTRUCTIONS FOR COMPLETING FORM 115 SBD - 6395 To beanomploueond nonum/esoi| test, you, ,oport must include: 1 Complete |ego| description; 3, The use section must clearly indicate whether this is residence or commercial project; 3, KUA0K8WM number of bedrooms oruommorrin| use p|mnncd; 4` Is this p new or replacement system; — Complete the suitability rating boxes. ASITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6, PLEASE LISmtha abbreviations shown here for writing profile descriptions and completing the,plot plan; 7� MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 0, K8akosur*yourb*nchmark and vertical elevation reference pointare clearly shown,and aro permanent; 9, Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation lost exemp- tion, ifoppmv'ialn; 10, If the inkxmo/kzn (Such as Mood plain,elevation)doe not app|y. Place N,A, in the appropriate box; 11. Sign the form and place your current address and Your certification number; 12. Mbke |*0ib|u copies and distribute as eqvind. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 20 DAYS OF COMPLETION. ' ` ABBREVIATIONS FOR CERTIFIED SOIL TESTERS $mU Separates an(] Textures Other Symbols � — Stone (over 10^) BR — Bedrock cob — Cobble 10^) SS — Sandstone B, — Gravel (uodu, 3^> LS — Limostnnn Sand HGN/ — HighGmundwater cu — Oonmm Sand Pe/c — Percolation Rate mcd n — K8edium Sand fs — Fine Sand Bldg — 8ui|diny |n — Loamy Sand — Grnaze,Than ^ Sandy L � s| — mn y oam � — Less Than °| — Loam 8n — 8vovvn °oii — Silt Loam B| — Black si — Si|/ Gy — Grny -d — Clay Loam Y — YcUuw sm| — 3andvC|ay bzam R — Red oid — Silly Clay mot — Mottle", uo — SandyC|ay w/� — vvith sic — Silty Clay fff — few, fine. faint: ~u — Clay nc — (1m,mon. conoe W — peat mm — Many' medium m — Nluck d — distinct p — prominent HVVL — High water |pvd. ° Six general woi1 textures oudacevvmor for |i(Juid mmstediopooa| BM — 8enoh Mark VRP — Veniom| Reference Point TO THE ()VV0ER: � This soi| tws', repo/t is the first step io securing a saniNiry permil, The County orthe Department rDaY re(jUeSt ve/|/icmdon of this soil lest in the field Prior to permit issuance, A complete set of plan, for the private ��aQu syuom and u pormil app!iuodon mum be yuhmhtmd to the epproprime local autho,hy in ordbrto uL�min a Thoaan)tury Wmrmh must maobtai"od and postod priorto tile start ofany construction, . � DEPOT QUST�iI"MENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IN , . DIVISION LABOR AND PERCOLATION TESTS (115) HUMAN.RELATI"S P.O. BOX 7969 MADISON,WI 53707 c (H63.090)&Chapter 145.045) Gou'f. LO f LOCATION. SECTION: TOWNSHIP/MU:a;OW—'-';F-: LOT NO.:BLK.NO.: SUBDIVISION NAME: sr 1 ' 35 T30N R2°E (o sr. TosE/°hy f�l �iv��l�Ew J �4 COUNTY: . OWNER'S 00TER�A�: MAILING ADDRESS: r if x �'1�Ry ti R0-7 Rdlkeow ct Y1111 449PAe 5'ropx USE DATES OBSERVATIONS MADE NO.BE MS.: COMMERCIAL DESCRIPTION: PROFILE D TI C IP NS: E OLA ION TESTS: Residence 3 ? /�/ A New ❑Replace I ��1/ /,� ���� RATING:S=Site suitable for system U=Site unsuitable for system ��� /� ���� Q /��✓� CONVENTIONAL: MOUND: IN-GROUND-PRESSURES STEM-IN-FILLHOLDINGTANK: RECOMMENDEDSYST€M:(optional) 0 S ❑U WS ❑U ©S ❑U ❑S ZU I ❑S KI U I elo oveir",r Ae,41e A;cdd P If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C64 SS ,.L T Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Fr. 33' 3//- S;/ IF . 6 7 ' Su-y'/. Si , 133 L�!Q,v Si B- z- /0-o 76 10- '/o.o 76 " 5,,1. flc,V cs G.e B- 3 %S 7 �o/ S 5 �i , s;�, -�, / - �s yam. , �.�' 30 - Q ? vF.E' C S ' P� G"Q � �N.�. � BS i� B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER PER INCH P- P_ r mi 5c l' <?rt! %W " /AP41 El P- o —S-4A4 L P_ > N 0 Am 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. �r � N ��e£� ,-B-2- a = 9yo " SYSTEM ELEVATION =� .47e�� f3 a T 13 So � F v _ _ _ _ �_ _. _ I o i s 1 - - - __-_ i` Off,- _ � • � Ctvro O f--f---- I T aQ 103 i S Y t 0 I 3 L a- 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 HOMESITE SEPTIC PLUMBING CO. WERE COMPLETED N:O�� ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER': PHONES NUMBER(optional): W.MASTER PLUMBER LIC.NO. 3307 M.P.R.S. -2 /�Z-- J tP�a le f,.-.INN INSIALLLR&DESIGNER LIC.NO.00%3 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — i I. DEPARTMENT OF REPORT ON SOIL BORINGS AND ��{ SAFETY& UILDINGS INDUSTRY; DIVISION LABOR AND PERCOLATION TESTS (115) P.O.BOX 77 MADISON, HUMAN RELATIONS SON,WI 537007 7 (H63.090)&Chapter 145.045) G0V�f to 70- LOCATION. *OWNSHIP/Mt1Nle1P^k4;R,- OT NO.:BLK.NO.: SUBDIVISION NN/MoT 1/ 1/ o35R�/T30N/RAME to sT� ADDRESS: sr CAW)( B4)eRy S.4 i),A P0'7 ;P*4~ USE DATES OBSERVATIONS MADE NO.BE MS: COMM DESCR PTION: ❑ F I S: TES Replace Residence RATING:S=Site suitable for system U-Site unsuitable for system " "� Av 4 Q r ONVENTONAL: MOUND: IN-GROUN : SYSTEM-1 N-FILL O.LDING TANK:R COMMENDED SYST M:loptional) ®$ ❑U $ ❑U ®$ ❑U ❑$ QU ❑$ rU C�ouv�vrav ��A°4;.vA;E�1� If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: CLl�S.S Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO ROUND ER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.H EST. TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) '3/A" 7 s au-yy. s i 33 -I s� B Z M.0 99 76 7te- 1,/0-0 23A,1- vc. VIE elr C 5" a P dw . B- /O. 99 3y r .- >/a S`� �;' s ,� s,�, a 8AI s; , • s N ; S B:� o ' `I�. oyr' > 70 Fr S' 644- �s, s ,' r3�► /s /o ' f3N �S Jo B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RI D t -PERIOD 2 PERIOD 3 PER INCH P- P_ O S 4.4to 1 L P- N 9 P- P- Uj �2 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indi le o�I e ib at are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface eleva ry t all borings the 1� at and percent of land slope. 3N g,�£,�- ��'�2^ Q = 9y0 SYSTEM ELEVATION Aec f>-' - =,,- -- _ �i�,p soy#& /w WO 4 Vier : - �*-r— ,W - 1 • - } ,:• Olt- --j f oc; 7Ao OF X� IUbIT _ s3 _ fIriv. lotto ;.. r o 3 "Pep 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in / accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: �iE SEPTIC PLUMBING co. P� ADDRESS: ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER(optional): MAS.MASTER PLUMKR LIC.N0.3307 MAR.S r� CST SIGNATURE:. DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I Owner of Property .�,e .r� �- _ K��1�� �� n �L �' �•L� 1<C� i%c ���h Location of Property 1% c�E hr, Section , T C_) N-R 2 L) W Township Nailing Address W f tL�e r(f t Q L Rc.r s Address of Site Subdivision Name . Lot Number Previous Owner of Property _&(Irw Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? x Yes No Is this prarr�y being developed for resale (spec house) ? Yes X No r� a 7k Volume and Page Number 149-Z 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 cVLU6y that aft Statement6 on this for ane tlCue to the best 06 my (OU4) knowledge; that i (we) am (aAe) the owneA(,5 the pnopehty deAcAi•bed in this Cn6o" t ion 604m, by viAtue 06 a w �g►�,�d4 ed neconded in the 066.ice 06 the Count Re iAteh o D des 9 6 ee cu Vacumenta 'NS�?" and that I w y at own •the pnopoded .bite bon the -sewage di�spob ey-,s em (on I (we) have lob.tai.ned an ea.aement, to nun with the above deacAibed pnopenty, bon the condtnuctLion o6 6a,id byb.tem, and the name hae been duty n in n the 066tee o6 the County Regiaten. o6 Ueede, ab Vocwne►Lt No. - 1 . 6 SIGNATURE OI► OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) z DATE SIGNED DATE SIGNED ST C - 105 r s a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNE BUYER C / r,✓� lc�� ROUTE/BOX NUMBER1', 12 �1'UC.i� (✓(,:t/ �14C e '14-Fire Number CITY/STATE Wylc n -l,� ! '_ ZIP PROPERTY LOCATION : ­SE 14, S�. �4, Section_, T ?,Q N , R_Q�d_W, Town of S r, �TOSe Ply St . Croix County , SubdivisionE.,cr v'e-1 Lot number. /91 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 pdt 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 . yo I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with ac the standards set forth , herein , as set , by the Wisconsin Depart- v 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 . SICNED 2 DATE 1 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 . ... '"��r �`�.5 � x t'z •'k a .',�- - .rr��.°�w-e �:y$t�r �' { QMM vjQ�~• I; .March, 19:3 t �° w °az, t �•�� =,ft rE�+r4 ' .}: r 1t a P �+ tlr r py�k rr�r.�r�rt'•./�� r A 4. -.-,, t t- �� t� rit� � t+Y. �i -.� �''� 1 �-a �`7 " t++ .+1Ct -.: - M�G.-., l ..✓ I PART i - Property Transferred I County St. Croix In®fM of St. Joseph Township Name Municipality Street Address s A DESCRIPTION: All that part of Gov't Lot 4, Sec. 35, T30N, R20W d Joe 1,L Township, St. Croix County, Wis. described as follows: Commence at corner of Sec. 35, T30N, R20W, St. Croix County, Wis. ; thence 11 alol the E line of said Sec. 35 for 1112 ft; thence Wl,y by 6 deflect- " ion angle to the left of 860 551 bearing of N 860 551 W for 644.2 ft. ` 4 point of beginning of this description; thence N 740 501 W for 196.6 thence S 320 53' W for 146.3 feet; thence S 530 341 56" E for 218.2 f` . • { thence N 240 581 E for 221 .69 ft. to the point of beginning. seip,y .. ♦..} .: :4' fit... '�.rds-a r T�er-v+� tr � .1. , mtaiA _ - r - y ,` t i •w: 1 '� ._,m{���sc-�yY� ,.E'.'4-1'� �.-. ��.a L :N mfr ,v r ) �1►+7y T�, * ''.l ;• cs:-* ��„ °•4#, t'�,','-�'- kr'r � •���'��c '�_ -/ ,:.6 t ,F, -• ' mot' .a� _ -viy .' �k; a �. 3 ¢„�' X" arQN -.•�.t �'• f..�`c - 9� v �t4 •j - yy�j;;! ki'. �*.- .f1't' ,M1r "r` h' :!"r '� E y'"•`'f • �,j •��.}3c?+�3'�.'IM� � +'_ k t s`}Zy,}�y�,.T�b._ `�<, r _ .L� , 't-r _.�r_-' _ _ .-. � i�sde+�>�"� L'A 'i'/'."W w�..'l6' �� .iY.-- A ♦)F+w1G'w .. r r, ,. x S - r } ,m. ' :.�• ) r -o `r BARRY S. SMITH rf. F Y b' S 4 } =_ * 807 PAMBOW COURT - ; ` STILLWATM MN. 55082 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1—1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED o Barry S. th and Cheryl K. Smi�th, husband and Dean L. Ravelin d Witnesseth, That the said Grantor, for a valuable consideration------ Girantors conveys to Grantee the following described real estate in ...... .......... RET.URN TO County, State of Wisconsin: L 30 North, Range 20 West, St. Joseph Township, St. Croix County, Wisconsin, described as follows: Commence at the Southeast corner of Section 35, Township 30 North, Range 20 'Kbst, St. Croix County, Wisconsin; thence North along the East line of said Section 35 for 1112 feet; thence Westerly by a deflection angle to the left 86*551 bearing of--,North 86'55� West for 644..2 feet to the point -of begitnin� ofthis description; thence North 74'501 West for 196.6 feet; thence South 32*531 Wast for 146.3 feet; thence South 53*34156" East for 218.2 feet; thence North 24'58' East for 221.69 feet to the point of beginning. Subject to a roadway easement being Southwesterly 33 feet of the above description. Containing 0.85 acres mre or less. Together with right of access to the St. Croix River beach and the right of use of said beach. Together with easemht over a 66 foot roadway over all that land described in Exl-dbit "A" attached to the warranty deed to Howard J. Conn recorded January 11, 1968 in Vol. 439, Page 461, Document No. 291105. This deed is given in fulfillmnt of that certain land contract dated Decenber 29, 1986, recorded January 13, 1987 in the office of the Register of Deeds, Together with all and singular the hereditaments and appurtenances thereunto belonging; warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easemnts, restrictions and rights-of-way of record, if any. and will warrant and defend the same. S. Smith Cheryl. K. Smith AUTHENTICATION ACKNOWLEDGMENT � ~= ~ ~^i^^^ �� �1 K. STATE OF °IowvNo/m ��� � Smith authe;ntle ted this ........day of........................... 19E_ Personally came before me this ................day of � ' ���------�--'----',---------------------' � �c�ot�za� O�lazx� I�oo�ae� ---------------------------------------' TITLE: MEMBER STATE BAR OF WISCONSIN. 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 � ----'----------------------------------' Notary poWi ------'_� ! (Signatures may be authenticated vr acknowledged. Both ou/ Commission is permanent. (If are date: ---.--.---------------- U - - ' U *Names of persons signing in any "ap~"uv should be typed or ,n"vo below their signatures. i