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HomeMy WebLinkAbout040-1012-60-000 \ \ 0 � I = � � 2 � . i f � m o @ D § c / ] � £ f £ z 0 ƒ � m k §Z etb < m CL ± % � � I W z K z 0 § # § \ a m § E z k \ j 0 U) 2 c § { a _ § � � 3 & D Q { q 0 \ ( \ k z k .. � 3 S 4 ) £ ; Clil a.& ® C g 3 CL c Lo An e 0 I2 a k a ) ƒ / § k_ k k k CL � k � $ � R a a a IL c ) \ k \ \ 2 I 04 � \ = o; _ 04 \\ /\ - $ co m ƒ � § k J \ f R © � 2 ■ ■ CL C14 o\ § 6m � -00m -0 04 C14 C\l \ § / . § § a e @ c e ; LL $o z / z ) 2 � 22 � � a — , _ _ ; " a E2 � ' � a § / J a ! o U) S ^ PaYcel #: 040-1012-60-000 11/03/2004 09:13 AM PAGE 1OF1 Alt.Parcel#: 04.28.19.51A 040-TOWN OF TROY Current FX ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): '=Current Owner " FREESE, CHARLES H&NANCY E CHARLES H&NANCY E FREESE 562 TOWER RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): =Primary Type Dist# Description "562 TOWER RD SC 2611 SCH D OF HUDSON S� SP 1700 W ITC 09 f Legal Description: Acres: 2.720 Plat: N/A-NOT AVAILABLE SEC 4 T28N R1 9W SW NE 2.72 AC LOT 1 OF Block/Condo Bldg: CSM 5/1450 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 790/332 07/23/1997 777/381 2004 SUMMARY Bill#: Fair Market Value: Assessed with: 310,300 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.750 60,500 262,200 322,700 NO Totals for 2004: General Property 2.750 60,500 262,200 322,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.750 55,000 243,600 298,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: y Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 1 Z Length: •S" Number of Lines: Area Built Fill depth to top of pipe: !Z"-- /$ & Number of feet from nearest property line: Front,/ O Side, ('Rear,O Ft . 7S'D Number of feet from well: 7 !00 Ayor =W Number of feet from building: s- (Include distances on plot plan). f/E�DE�z SEEPAGE PIT f77 ; Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• Dated: Plumber on job: License Number: 3/84:mj i SON Form - S T C - 104 " SYSTEM REPORT AS BUILT SANITARY Y OWNER �!? �P /-releS+C TOWNSHIP p SEC. �_ T,;?-,? N-RI47 W ADDRESS .3 3 cm.. l/1' ST. CROIX COUNTY, WISCONSIN IV A 4AIC SUBDIVISION LOT LOT SIZE PLAN VIEW Distances End dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ��iT ` JVtU -` Nov g A 1 1' i n I INDICATE NORTH ARROW BENCHMb.RK: Describe the vertical reference point used 1,W i Elevation of vertical reference point: /Ca ,e) Proposed slope at .site: .3 SEPTIC TANK: Manufacturer: �JG,��cs Liquid Capacity: Lem C) Nuaber of rings used: p Tank manhole cover elevation: f 2- Ta,.ik Inlet Elevation: Z fp. VS Tank Outlet Elevation: NLmber of feet from nearest Road: Front 10 Side,gRear, O !00 feet From nearest property line Front 10 Side 10 Rear,a > $'d /feet /101- N amber of feet from: well 7 /GD A , building: 6y (Inc73de this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE S 'DE DEPARTMENt OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON SVl 53707 t �t NE%, NE�,S4',T29N—R19W )MN ONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number: (if assigned) Town of Troy ❑Holding Tank ❑ In-Ground Pressure ❑Mound Lot 1 High Ridge NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER INSPECTION DATE: harlie Freese 933 Falcon Drive, River Falls, WI 54022 //—�8? �Y -IU 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: Dave Fogerty 3289 St. Croix 99085 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. ITANKOUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. DYES ONO OYES ONO BEDDING: VENT DIA.: VENT MATLL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING JVENT TO FRESH ALARM. FEET FROM LINE: AIR INLET. ❑YES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYES ONO I DYES ONO 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 1:1 NO 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 FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: JILENGTH NO.OF DISTR.PIPE SPACING COVER INSIDE DIA.. #PITS. LIQUID BED/TRENCH : TRENCHES MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PI PF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR N(JMBER,OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END: PIPES. FEET FROM LINE: AIR INLET. NEAREST--- -r- 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. 1:1 YES ONO SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO DYES NO DEPTH OVER TRENCRBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED: MULCHED: CENTER. EDGES. OYES 1:1 NO 1:1 YES 1:1 NO 1:1 YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BEDJTRENCH WIDTH LENGTH TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.. DIA.. ELEV.: PIPES. DIA.: ELEVATION AND I?ISTf€I tIT10N HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS ❑YES ONO ❑YES 0 N COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER©F ROPERTY WELL: BUILDING: FEET FROM INE: ❑YES ❑NO ❑YES ❑NO N Ske tch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION , TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; J 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 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: l Property owners name and mailing address. Provide the legal description where the system is to be installed; li. 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; Ili. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Groun iter -- -. included the creation of surcharges (fees) for a number of regulated practices which Wisco iCY`S e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried -easure is used in your building is returned tc the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 through these surcharges are credited to the groundwater fund adminis- t�rei by the _:iepertrnent of Natural R?scurces. These funds are used for r-nomtoring ground- Atka'. t gF�ur;dwalier contarnination in,estigatinns and establishment of standards. ;roundwato:; 1 . is s worth protecting. i D-f;i9R 1R,03/'36) I�JLHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05,Wis.Adm.Code teo STAT�SANITARY ERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ❑ NO PROPERTY OWNER PROPERTY LOCATION '/4 '/a, S y T 9, N, R 9 E (o W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME o `v CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, �Z �r �y ❑ VILLAGE TOWN OF! II. TYPE OF BUILDING OR USE SERVED: f Bedrooms if 1 or 2 Family OR Public(Specify): Numbe r o y III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. LJ SE 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. 1�i See a e Bed b. ❑seepage Trench c. ❑ See a e 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): �/ r 1� Feet ER/Private ❑Joint ❑ Public VI. TANK CAPACITY Site in ga ons 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 0 Lj - El I Lift Pump Tank/Siphon Chamber 0 1 Li ❑ 1 ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: :;L-j 3G5� Plumber's Ad ess( reet,City,State,Zip Code): Name of Designer: D VIII. SOIL TEST INVORMATION Certif d Soil Tester(CST)Nam CST# �3 CST's ADDRESS tr t, ty,Stat Zip Code) Phone Number: -,4 A/0,144 IX. C NT / EP ART USE ON Y ❑ Disapproved lanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) Approved charge Fee 1 pp ❑ Owner Given —1%� j1�7 Adverse Determination CJ ! X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber T 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 ahR 6_5 H , PRee_se. OR . and Mom cy P . Location of Property _SW ;4 NE k, Section , T aN-R L� W Township TRo Mailing Address �rn m o nc i_S' con ( r-L 540 15 Address of Site -5'6n Q T,,-) a_R __ Po Subdivision Name l QCQUR-� Lot Number - Previous Owner of Property /`t E R .-L 1 nC Total Size of parcel .9 , r7 oC Date Parcel was Created �sas5 Are all corners and lot lines identifiable? i/ Yes No Is this property being developed for resale (spec house) ? Yes ✓ No t- Volume Jr- and Page Number IL4 50 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 (We) ceAti jy that att statements on this 6oAm ane tAue to the best ob my (oun) knowledge; that>< (we) qX (an.e) the owneA(s) o6 the pnopenty de s cA bed in this in6 oration boom, by vixtue o6 a waA anty ed to on 0`ded in the 64ice o6 the County Regizten o6 Deeds as Document No. 4`aaga ; and that,? (We) pnesentty own the proposed site bon the sewage des pos System (on,,X (we) have obtained an easement, to nun with the above desehdbed pnopenty, bon the constnuCti.on ob Said System, and the Same has been duty recorded in the 046ice off( the County RegisteA o6 Deeds Document No. 9AC11n ) . SIGNATURE F OWNER SIGNAT OF C -OWNER (IF APPLICABLE) r -V7 DATE S ED DATE SIGNED I DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA i(STATE BAR OF WISCONSIN FORM 2—1982 423922 -..BOOT(: : fA�i . - REGISTERS OFFICE ST. CROIX CO., W I&- A... ?.nd...i�.,...�llc.�.,...n.��5-�`....A.. and.._R...In_co_rporated--,. Roed. for Rewrd this 4th a...W.i s c o n sin_..0 or_p.q r a t;i.o n...................................................... ay of Sept. A.D. 1987 ._........................ .........------------------------...-..-----•------•---------- -- t 12:05 P A1r . ...... ................ ........ ............................................ conveys and warrants to ( ����r.I.e s-- lI.......1:r e e s_e.•at nd....................... se.,...b.u5b.aJJ.tl._an�l...sf.i.l;.c.,...a, -•--s.ux.v.i.v.cirsh-i-R-..ma.r.i.t.aa.._1�r.a.p.Cx.t.y---------------------- -•-•- obi.. of wloe,..................... •-----••---••••---•---•---•--•--•-...--••---•-•--••---•--...-----•--•---.................... Charles H . Freese ................................................................................................................. RETURN TO 933 Falcon Drive -------. ....................................................................................................... River Fa 11s , WI 54022 ............. --••-- ---------------•-•-----•-••-•-------•-•--•---•--_---.........-----•............••----........ _.....- the following described real estate in ............t.—.Cr.O.].X.................County, State of Wisconsin: Tax Parcel No: .............................. Part of SW4NE4 Sec . 4-T28N-R19W described as follows : Lot 1 of Certified Survey Map filed August 8 , 1.984 in Vol . 5 , page 1450 , Document No . 395439 . This deed is given in complete fulfillment of a certain Land contract dated April 28 , 1987 and recorded May 5 , 1987 in Vol . 777 , page 381 as Document No. 425326 . F. This .....i-.5..n o_t........ homestead 1, nerty. ) S%X (is not) Exception to warranties: Exist highways , c.. -iements and rights of way of record . r� Dated this .--------••----- ----------•.... ............ day of --- S.ep.t e;.l-her.......................�........, 19.8.7.... A and R Inc . , a Wi.sc.onsin (SEAL) -------•(SEAL) L' -- --•---••........................•----....---...................._........ ......Harley o , Presi. nt (SEAL) ........... ........ ........... ......... ... ....................(SEAL) * .................................................................. j� ..... .......... ...� . ............ .....:.._..... Terry oen , Secretary, AUTHENTICATION ACKNOWLED(i '3�iTl STATE OF WISCONSIN Signature(s) ------•----------- ......................................... x '`� 0'. ------------------------------- S_C....�r_U.i.x_.........County.'. `�'`hj►.E tc� .. l authenticated this ........day of........................... 19------ Personally came before me this ....:.. .......day of -••----,�.�j1.tr.�Ji1.i2�_I.............. 19.8.7--. the above named ----------------------------------------------------------:_...---------•--•-•-- .t_._._:.a_ W i..s c.o n s i,n_._.....-•...... c . *-•-----•-•-----•----------•--•----•-----------•...--•--•-----•--------------- Corporan,_-.by_.. }larl,cy F.oen , TITLE: MEMBER STATE BAR OF WISCONSIN P r e s?_de n t._a.n d__ r e r r_y-_R o e n_t______ _________ Secretar (If not, ------------------------------------------------------------ •---•• lk .....Y T---- ------------------------------------------- authorized authorized by § 706.06, Wis. Stats.) to e n to e+ persons .-.-_-.___ who executed the fo gostr n and ackno wledge the same. / I THIS INSTRUMENT WAS DRAFTED BY ( i . "— � Attorney David J . Estreen : David �Estreen.......... '! ......... 621 2nd St . , Hudson , WI 54016 Notary Public ......... t.e.._C_roi.x___________.County, Wis. - --•--- -------- ----- --- -•----------- . -- (Sigpatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration II are not necessary.) date: 19.........) i "Names of persons signing in any capacity should be typed or printed below their signatures. _ 1 STATE BAR OF WISCONSIN Stock No. 13002 HGMiII•Icolnp•nyl!"ill FORM No. 2-- 1N82 r+ z W • H ' a STC - 105 H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x cy OWNER/BUYER T^ I"t Pe pse- f& and %nw f'Reese' M ROUTE/BOX NUMBER Coot T u..:ER Rd _Fire Number. 56 .CITY/STATE Hcxc1son LI ) i 'nccnaco ZIP J`� �(c PROPERTY LOCATION: _j , Town of St . Croix County, Subdivision4il h Qp_ 11UK1. 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 pdt into 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-eite 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 N to maintain the private sewage disposal system in accordance with x 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 Zonin Off _17A days of the three year expiration date. mm SIGNED G, 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. r - - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR HUMAN AND MADISONPERCOLATION TESTS (115) MADISON WI 7969 (H63.09(1)&Chapter 145.045) LOCATIO • SECT—ION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: NE ��V 1/4 4 /T29 H/R 19E (or)W1 TROY 1 --- High Ridge COUNTY: OWNER'S BUYER'S NAME: MAILIN ApDRESS: St. Croix Charlie Freese 1933 Falcon Drive, River Falls, WI 54022 USE one —425— 1436 DATES OBSERVATIONS MADE T : PROFILE DESCRIPTIONS:DBMS.: COMM R D CRIP0 STS: Residence 1 3 ---_ I WNew ❑Replace 4/21/87 422/87 RATING:S-Site suitable for system U-Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND•PRESSIJRE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) ®S ❑U E]S []U E S [:]U EJ S [:]U 0 S [:]U 12 x 53 gravity 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: ---- ----------------- Floodplain,indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS BORING TOTAL P H T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 7 B 2 2, > 6�i yr / ;er/'S/ .,3 ' n 41 f 1N /,/.' A"S. W2 B-3 p, �L 3 > z ) S - 8 w 1 1 'Bncs B- )/ /l q, 7 > 8 6 Y s 3 21,1-C 82, ticoil, S ' rn B- S fl ?6.6 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIQ_jjj PER10132 PER PER INCH P. 3 S P- P_ Z 3 7 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 91.01 T , SEE A4A44 SHEI?r tN i r I I I. 14M: Bore hole tree showy dr s is h ng in sail lhoiizons hence, y making tw a terieS. oFr hole' thr.e , r 1 �s to t d at he rimat f ie d while, e t i - or hi th�ee�r Pert 2 s � o�atep__t t e lt4rr>�at f' �p_ 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: David B. Fogerty 4/22/87 AD f ESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): 3233 749-3656 E: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER — 395 ' 139 - CERTIFIED SURVEY MAP _.. (b . TRUE ll' SCALE 1 N FEET BEARING J: LU =m z; i I00 0 100 200 � o � ' rn � o Ca yP.• 5 22�• a z co � � r r M _O 1u r N Lf) _ IN /06, -0 0 s� 2 O M �, Ico ACRES 3.72 ;; T (D IM i TO *, ;^ rr Q _j 1 co �O 186°5118��.w i 0 1 ca SW - NE _00 N 1 J� 0 1 0 rn r Z: co Q: z 1 �' =co 398.21 1 Si- 1 Z Q 0D J: r; _O ' j: N °' 6 6' w: 0- Ki Ld w 1 z: \ -, - 2.72 ACRES N N ~ M 1 11 X2 m co z ' ti FAD 1 1 CO , bti r AUG 8 198 ti W 4 � ' o zl D W 00 �� �`�'° J r may, S 85.04�W .� `'p v 3 224.64 5.41 50.21 S 6°001W �- 01 POINT OF BEGINNING =u = `� _ 0 UNPLATTED LANDS N [r N 1/4 CORNER a w SECTION 4, 89° z w T28N,R19W 09, _ 2542,20 x 11iis instri rent S 0°23 W z d tf Qd by WEST LINE OF NE 1/4 OF SECTION 4 -J./1?� " — CENTER LINE OF STATE TRUNK HIGHWAY "35" �;�; Volume 5 Pape 1L,50 DL'SCF;I PTION : A parcel of land located in the SIQ /4 of the N1:1/4 of Section 4 , T28N , 11191',', Town 'of 'Troy, St. Croix County , Wisconsin, described as follows : Commencing T r Croix Section 4 , T'LBN, 111919, ; thence S0°23 'W (true bearing) at the h1./4 corner 2542 . 20 ' along; the West line of 'said NE1/4and the centerline of present State Trunk 1Iil;hway "3S" ; thence N89°32 ' 45"E 415. 91 ' along the Northerly right-of-way line of Tower Road to the point of beginning; thence ;N39° 32 ' 45"L 453 . 90 ' along said Northerly right-of-way line of Tower Road; thence Easterly 1.67. 50 ' along said Northerly right-of-way 'line on a 70U. OU ' radius curve concave Southerly whose chord bcars S83°3S ' S7"L' 167 . 10 ' ; thence N88°03' 33' E 240 . 061 ; thence N32°30 ' 39"1V S56 . 9`7 ' : thence S74°01. ' 18"'V 85 . G2 ; thence 56° 00 '11 224 . 6+ ` to t. 558. 52 ',; thence SO°C ! ' VJ ?Ie point of beginning. I certify that the above survey , description and map are correct to the best of my knowledge. and belief and that I have fully complied with the provisions of Sec. 2`36. 34 .`of the Wisconsin Statutes and Se o S . 4 . 2 of , ;St: Croix. County Zoning Ordinance. Dated: September 27 , 1976 —� , o , - 1, ' Francis H. Og en Ogden Engineering Co. 123 E. Elm Street River Falls Wi . 54022 ee LEGEND ' �/ •° I-RAI`:CIS H. 0 1 11x24" IRON PIPI: WTIGIIING 1.6811/LINEAL FOOT SET. OGDLN t �: ,, c S•�S2 : I. ° Q FOOT SET. �= <• Rl"F R 2"x30" IRON PIPE IVEI01ING 3.651 /LINEAL wls. .t0 ::'J, Q� ® ST. CROIX COUNTY SECTION CORNER MONUAt xr, L'EItNTSE.N CAP, FOUND. ` �0•►. � ..• G��`o 1u i l Lam` S. R NCIS H! OWNERS : A R INCORPORATED OGprN 833 OAK KNOLL AVENUE ' T'~ RIVER FALLS , WI . 54022 + ` RIVER FALLS. jr.7 • WIS. r APPROVED .01sUR;,�`� �s% NOV 18 1976 ..p� ST. CNO,X COU>:TY M%4V,,EHER'JVc PAPKS PLANNING tNa EQNI1tG CO�h1LLLEP APPROVAL O^ 1 N-"!`iOR SUSYMVISION DOES ?vC�'; i,': ! %:1':',:OVAL FOR SEPTIC SYSTEP-A. i;L ,_H: TO H62.20 Volume 5 Page 1450 j. JCIL wr , i I � w i 4 Y - tk wm Z 0 i J 1 � 3 I I V ~ d r -n �. A ZWx H v VNA '4 �OX ` oz �� r 31 � o i M w -.a W y 4 t c� 0 i i i t I J # t7 .P 'TJ 1 w co rnr so `' a n u, #m u 0 171 CO 0 00 fD 11 t0 'd (D Fl O In ~i \ N O b` I En M cr r. LO r � �, � � c r � f, Y� � ��- � ;��� w- .' � 1 1 I��, °:> �_ � .� e f � � '�. ��,� � j 3 '� ��. ,� I i �-� r� 1 �� ►.Y __._ ___ _, i - � � � � � (� �� '� �,., � � �` __: ��_..�:�__L_--�.-._ I -� ( _, � v r Ic �j� ,� � i � � I � ��