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HomeMy WebLinkAbout028-1025-10-000 4. w 0 CO) 0 3-0 0 d o f c CD CD 'D 7! o m » O 3 2 F Z o co r ;p N o 0 • N = w 0 O N !n O OD N N c\ C\ o CD ai cWii ° cn K) 9D 00 z CL. :z Oo Co CD O W ~ < v N O ^ CL 7 O O W m C~ \ 1 0 0 0 CD N cn p O CA v' m c, l~~1 7 UI N 7 0 v y c o N (n C D O a m ca' CD w ti m ~ ~ W o 3 0 to c a c s V 14 CD =4 z (D co 0 OD 00 co 0 r- (A M M M "NA• o 000 n a` rnNto"i p `~y ~ CAD CD N 1 N ~ (D z I z D co 0 O v CD N CD m .ZI 'o to C CD N D CD C D. i W a 3 3 CD c6 q 3 I~~ p Z CD ~ ~ A n A o CL z O Z N N W M m o (D CD CL z 0 3 ;o o » z I m a v I W m cCD n CD CD I ~ a ~ a 0 I n 0 o a I m ~ in a I 0 y I I ~ I m I ' I v N I qb a I O 00 i o b CD ~tAo o O oo a .P Parcel 276-1041-70-200 10/16/2006 02:28 PM PAGE 1 OF 1 Alt. Parcel 31.28.18.318B 276 - CITY OF RIVER FALLS 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-ALLINA HEALTH SYSTEM, %ALLINATAX DEPARTMENT %ALLINA TAX DEPARTMENT ALLINA HEALTH SYSTEM C - INTERNAL ROUTE #85370 INTERNAL ROUTE #85370 1629 E DIVISION ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1629 E DIVISION SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 7.990 Plat: N/A-NOT AVAILABLE SEC 31 T28N R18W PT OF NE SE AS SHOWN ON Block/Condo Bldg: DOT R/W MAP FOR PROJECT 172-05-25 SHEET #49 & CSM 472242 VOL 8 PAGE 2389 AND PT Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SE SE S OF HWY M 31-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 04/29/2002 677589 1880/286 WD 04/29/2002 677588 1880/284 WD 04/29/2002 677587 1880/282 WD 04/29/2002 677586 1880/280 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/19/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 7.990 1,600 0 1,600 NO Totals for 2006: General Property 7.990 1,600 0 1,600 Woodland 0.000 0 0 Totals for 2005: General Property 7.990 1,300 0 1,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 State of Wisconsin ' 9 APPLICATION/PERMIT FOR UNCONNECTED POND PROJECTS Department of Natural Resources Pursuant to section 30.19(1)a, Wis. Stats. C- Form 3500-92 11-91 W C Z U) p © J R in A plicant's Name (C n K Project Location f kSr1 ~(A~►T2S e`I}nfD I f 1>J wt~L 1/4, t- 1/4, Section Z L Street or Route +,y K "A Ec~~`bb Z fi T N, R- 7 (E~,~, ~ City, State, "Lip Code Ll I0 ❑ City Mown ❑ Village of Ry 5M RkQ lz 4eap,a-Telephone Number Work Telephone Number County Name of Waterway I ( &Vb) 5.31- ; 3tt 1(715 ) (-o84- 4-0 ?A, St Ceoi 10t,) Nftmeo T2i b io sSi~ I~~iJc2 I hereby certify that the information contained herein is true and accurate. I am the owner of the property or I am the duly authorized representative and may sign this permit on behalf of the owner(s) of said property. I have read and understand all of the conditions of this permit listed on the reverse side and will construct the above mentioned project in compliance with all such conditions. I understand that failure to comply with any or all of the provisions of the permit renders the authorization contained herein null and void. This application is accompanied by the appropriate permit fce pursuant to s. 30.28, Wis. Stats. I understand that failure to comply with the conditions of this permit may result in a forfeiture under s. 30.298, Wis. Stats. Printed or Typed Full Name of Permittee S nature of Permits a Date Signed FINDINGS OF FACT 1. The applicant has complied with all procedural and legal requirements of Wisconsin Law. 2. The proposed project will not adversely affect water quality, will not increase water pollution in surface waters and will not cause environmental pollution as defined in s. 144.01(3), Wis. Stats., if the project is constructed in accordance with this permit. 3. The Department has determined that the granting of this permit would not be a major state action significantly affecting the quality of the human environment. 4. The Department of Natural Resources and the applicant have completed all procedural requirements and the project as permitted will comply with all applicable requirements of Wisconsin Administrative Code and Wisconsin Statutes. CONCLUSIONS OF LAW 1. The Department has authority under s. 30.19, Wis. Stats., and applicable Wisconsin Administrative Codes to issue a permit for this project. 2. The Department has complied with s. 1. 11, Wis. Stats. NOTICE OF APPEAL RIGHTS If you believe that you have a right to challenge this decision, you should know that Wisconsin Administrative Codes and Wisconsin Statutes establish time periods within which requests to review Department decisions must be filed. To request a contested case hearing pursuant to s. 227.42, Wis. Stats., you have 30 days after the decision is mailed, or otherwise served by the Department, to serve a petition for hearing on the Secretary of the Department of Natural Resources. This notice is provided pursuant to s. 227.48(2), Wis. Stats. LEAVE BLANK - DEPARTMENT OF NATURAL RESOURCES USE ONLY STATE OF WISCONSIN DEPARTMENT OF NA RESOURCES For the Secretary Issued By: Date Signed: 5 /oc o~ Title: QC Icy 11'S1 Fee Received: $ ! /6 J~2{ r DEPARTMENT'S COPY _A!"T U~TCONNECT1~Q ;?i ~T , ~ )N1 I'I'IONS You may not material!y obstruct navigation or a>use injury to other public rights and interest including fish and game habitat or to private riparian rights and interest. You iroust tnair)t n,dition. f Yvaters. St-cpnf sary fOr construction. - . ::a` ^ °fnt rri,S Y> IR7rr~ -iy rnpor3y and t,ccr ul _s r r st;cr, is-Mete: r''iUb alendar year. You may not 10. You may no rface water or wetland. authority must al ctions at any time to assure that the activity tieing performed under 11. You of w. 12. You must k it the project is complete. 13. The Depart blic interest. 14. The Department may amend or impose such further reas ary conditions in this permit to protect public health, safety and welfare. 15. You may not connect the pond with surface waters, locate it within 50 feet of the OHWfdI of any navigable waterway, and it may not be subject to flooding on an annually recurring basis. 16. The maximum surface. area of the unconnected pond may not exceed 2 acres. You may not place the material removed to create the unconnected pond in any surface water or wetland. You must dispose and stabilize all material at an upland site outside of the floodplain. a. The side slopes of the unconnected pond may not be steeper than 3 feet horizontal to 1 foot vertical (31-1:1V). 19. The unconnected pond must be for the purpose of improving wildlife or fish habitat or recreational opportunities not associated with any commercial use. 20. The unconnected pond may not be constructed in nor adversely affect any wetland. 21. The unconnected pond must not be associated with any metallic or non-metallic mining project. 22. Other Conditions: DEPhRTMENT MINIMUM DESIGN STAN.DARDS FOR UNCONNECTED PONDS Not 'in \ upland UnCOn/ neC e l , Disposal -Pond Site 2 acres maximum Not In Wetland `100 Year Floodplain limits 50 Minimum Stream or Lake Ordinary High Water Mark(OHWM) P Iii n V iev~ F 50' Minimum ~ An dual Flood Water Level D Existing Ground Not Wetland Norme,l water-Levei }W Unconnected ,Pond°•~-__ _o rn k G S 7 t`S 3H:- Maximum i 1'.' 9 t f ~tl x a a19 ~t9~3Slope~ Cross-Section view Form-STC- 104 • AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Q //CT/~( SEC. T 22 N-R /7 W ADDRESS ~Qf ST. CROIX COUNTY, WISCONSIN _171 -yooz SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ® a~ y„ en ~/o e h 12 70 ~I INDICATE NORTH ARROW 71 BENCHMARK: Describe the vertical reference point used '~e Z V A Elevation of vertical reference point: wee /6S S• o x/~, ~ /ODO~ Proposed slope at site: : SEPTIC TANK: Manufacturer: ~e S Liquid Capacity: 00 al d. Number of rings used: u r Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Q Rear, O 7 feet From nearest property line Front,0 Side (D Rear, O 7 feet Number of feet from: well Z12", building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Cap city: Pump Model: Pump/Sip n nufac er: Pump Size Elevation of inlet: ottom tank elevation: T Pump off switch elevation: all'ns per cycle: Alarm Manufacturer: Ala 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: Len$th: 70 Number of Lines: 2 Area Built: Fill depth to top of pipe: .22 J Number of feet from nearest property line: Front, O Side, Rear, -Ft Number of feet from well: 2d~ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pi ADiameter: Liquid depth: Bot of seepa e it elevation: Area Built: Has either a drop box O or d'stri tion b O een used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Eleva n of botto o tank: Elevation of inlet: F oft, Side, O Rear, O Ft. Number of feet from nearest proper 1Jne Number of feet rom Number of feet fr bui Number of feet from nearest Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number : 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR WHUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION F+.O. BOX 7969 BUREAU OF PLUMBING MAD'iSON, WI-53707 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank O In-Ground Pressure El Mound ( l f assigned) NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION OAT : Heather Zandin 5560 Bold 'o? BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. NE NE Section 22, T28N-R17W Town of Pleasant Valle Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Dale E. Hudson 6629 St. Croix 88435 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER 1 1` PROVIDED: PROVIDED 0 ,;.Z) OYES ONO DYES NNO BEDDING: VENT MATL.HIGH WATER NUMBER OF ROAD: ROPERTY WELL: BUILDING: VENT TO FRESH ALARLINE AIR INLET FEET SOM `D DYES LDYES 54-NO INEARE FR DOSING CHAMBER: 25 1'~~ MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL'. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER _ PROVIDED: PROVIDED: DYES ONO DYES ONO OYES 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) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: IND. OF JDISTR. PIPE SPACING: COVER JINSIDE CIA. #NTS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. R. NUMBER OF PROPERTY WELL BUILDING: V NT TO FRESH BELOW PIPES: ABOVE COVER'. ELEV. INLET- ELEV. END PIPE LINE AIR INLET. I NEARESTO-► ~50 a.~ 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- D YES O NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED D YES SEEDED DYES MULCHED O NO CENTER: EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOWPIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIP ELEVATION AND E DISTRIBUTION PIPE MATERIAL & MARKING ELEV.'. ELEV.'. CIA.. ELEV.: PIPES. CIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ONO COMMENTS 1 PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY W UILDING ~1 ~ FEET FROM LINE: DYES ONO DYES NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) Z.On;n C~~ SANITARY PERMIT APPLICATION COUNTY C3 ILHR In accord with ILHR 83.05, Wis. Adm. Code S ;A- ' STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for system, on not less than J y) paper 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 sa e r /1,,C '/a f %4, S Z T.Z , N, R It (or W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME S"aG'D 0/0/ v fr , /f/X CITY, STATE IP CODE PHONE NUMBER CITY /2/eo_ro7 NEAREST ROAD, LAKE OR LANDMARK 4R.e Bea,- I A/I 1525//0 1(111/2 w VILLAGE : ~e 30 ~ II. TYPE OF BUILDING OR USE SERVED: / ow - (7 9 ~ lUo?5'- /~-i~OO Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): IfIX 111. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ❑ New b. M Replacement c. E1 Replacement of d. ❑ Reconnection of e. E1 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. Z 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-0 seepage 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): ~7 p i 920 t7 o Feet ® Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in al Ions Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete stCon glass App. Tanks Tanks Septic Tank or Holding Tank 1AW0 ❑ ❑ ❑ Lift Pump Tank/Si hon 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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Sur harge Fee Adverse Determination 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 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 whenevar necessary, usually"every-2 to &ybiars; 6. If you have questions concerning, your private, sewage syste ccntact your local code administrator or t6::s State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address, Provide the legal description where the system is to be installed; 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; 111. 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 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 Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wiscori i'd's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Measure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. ; .,e i, on:f?s collected thri~lagl"t these 1r6e< rgfs Ere the gr; uncswa(er fisnd adrrir!! S terec by he'Department of Natural F~,a ±rce These fun is are used for n?on,tcri g a ou-d "01C* ,Atater, grourAwafer contamination in,est;gat: ins - est~blishrnent of st&ncla ds f3roundvjate, y s worth protecting. SBD-6398 ;RM/86) 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. - - - - - - - - - - - - - - - 1- - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property? ,G lr'/~ Location of Property Section a T 012 8'N - R 1_-7 W Township Hailing Address Iq 177 Subdivision Name Lot Number Previous Owner of Property ZdAt,1-0-y7 Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable?~ Yes No Is this property being developed for resale (spec house) ? Yes _lc__ No Volume and Page Number - as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed G~' P r 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Hap, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti6y that a t 6tatementa on thia 6onm an.e tn.ue to the but o6 my (ouh) hnowtedge; that I (we) am (ane) the owneh (d) o6 the pn.openty dea embed in .thiA .in6o4mation 6onm, by viAtue o6 a waAAa.nty deed n.ecoA d in the 066.ice o6 the ('ni.rytt~ 1?o~ixtnh n~ 17~nzJ~ Doew- mcnt ,No. ~ and that ~ I (w j AWL' ) pheaentey own the pnopoaed e•ute bo& the aewage poa ayatem (an 1 (we) have obtained an eaaemen_t, to n.un with the above deat bed open.ty, bon the cons tnu n o `d a atem, a the ame had been dui. Aeeonded in the 066.iee o6 the g•iet o6 De , Document No. SIGNATU OF ER SIGNATURE OF CO-0 ER (IF APPLICABLE) r G DAT SIGN DATE SIGNED l z N H 9 ST C- 105 r r SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d ~ a OWNER/BUYER za "t.otrr ROUTE/BOX NUMBER ~/j~- ~c~X X77 Fire Number CITY/STATE /~av~riCw~tn ~SC. ZIP I PROPERTY LOCATION:L/ Section -,-?-;L T Z N, R/,7 W, Town of ,1 St. Croix County, yeQ,.•s~i~ J 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 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. H E I/WE, the undersigned, have read the above requirements and agree m to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisco sin Depart- d ment of Natural Resources. Certification form mus a compl d and returned to the St. Croix County Zonin ffic wi hin 3 ay of the three year expiration date. a SIGNED DATE d St. Croix County Zoning Office P.0. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOFPAND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: E 1/44-1/4 ,2,2 /Tj9N/R/7[ (or W rte/ s~~ ~ i11~9 ~f/' COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRE : -VI USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ~Ty rO FI L E C IPTIONS: FER-CO A ION TESTS: Residence a ❑New 11Replace ~,+1 ~Q -Z~_ [W-2 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IIN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U ~ S ❑U ® S ❑U E:] S [2U ❑ S TIC f, If Percolation Tests'are NOT required/ DESIGN RATE: If any portion of the tested area is in the A/ under s.H63.09(5)(b), indicate: A Floodplain, indicate Floodplain elevation: /1,4 PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HUGHES TO BEDROCK IF OBSERVED (SEEr~/ABBRV. ON BACK.) 13- 9 L S"! B'!w ~S, / ~~10j, ~ ~,'O/ /f~ r~ S✓~ SU i" /~/L"Ti~ J B B- B- PERCOLATION TESTS TEST DEPTH- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER }!deHE AFTERSWELLING INTERVAL-MIN. P R D1 P RI D PERIOD PERINCH P_ 3~i~2 fl „ 2 " s P_ P- i 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 `77•oool - - I ~ - I ! ! I ! ~ i 111 i ~ r 1 E i 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: -DQle so /D-Z - ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): )9 CST SIG,~T//URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - j AO c N ~ ff Llo I G s t1 "e v~ }I' Q1 j Q O O v c, Ct, . o -44 { i i a U 1 ✓`J 47 G p i1 w ~-~4y ur 1 ow a 4 ~ Co ~ a ti Parcel 028-1025-10-000 10/16/2006 05:05 PM PAGE 1 OF 1 Alt. Parcel 22.28.17.145 028 - TOWN OF RUSH RIVER Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner KURT D& HEATHER V LANDIN SCHMIDT O - SCHMIDT, KURT D& HEATHER V LANDIN 298 190TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 298 190TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 22 T28N R1 7W 40AC NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1092/177 QC 07/23/1997 1088/359 WD 07/23/1997 759/349 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/02/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 30,000 121,700 151,700 NO UNDEVELOPED G5 38.000 66,500 0 66,500 NO Totals for 2006: General Property 40.000 96,500 121,700 218,200 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 96,500 121,700 218,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 O W ; a x U (D ro a r• 0% z n N ( D (D O H rt H r•~ ~ tdz O r• cn td O \ rt (D ~ F~ 0 , 000 0 n a 4- cn w y Ul m rt ~ (D (D pd W I Ul td c In H m \ to rat o r-L rt N C i- FJ. r I \ ~ td OD 5C I ~ 00 a~ v U, v 0', NO H H O N Lii OD _ zz tj O z MF- G F% ms ('s U) w r• 0 Co o rt r-.> Iv ~ W H N i I PLEASANT VALLEY- RUSH J I RIVER T28N:-R.17W 19 607H Stevens a • / I SEE PAGE ~rn e Kenton v C w\ v Y fi'e hbuc~ Honsor/ o y 0 ° o, u U tl h • f one • f ssa g • • AVE O b C p y3v\ a C~j C~ J v h x -19 T(.. 137 Q Chor/e.~e zS L7//o • i// f00 C7ao ye /4572 v~ aJ h~uo ° n u~y N h .wto, y h Merr:tr zs^' o/ 9Haniisen • JefF /i y cS ti W wCw C d n GNU, wayne~ ao lNah/qurst R v ° 63 Th1' De%res crhn .B/-ee ela/ Tw,. 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A/ a 'a m/.4o .Re. -i Tr. .mss ~7 \ ° /oo^ u F C /sa 73a.-1- C. 9 YY • W ; 9/eKande ~¢n o% Toost m C J e v C N T mare v Char/e ey r s so 7 [ay e H (a y ERV I }vE Da :e%sa s f eo'~ d cTen /eo Orvin f7/an f 4 9 n ~r- e/ter Wbar4 4O /zo ~~J n Pete son ~ ~ p Ueanne Y Re qrd J~'fry gO /99/ c.Efo~d ~.6/s I/-rc. 4o r20 Q a@F OWens f/ Thoen 4o Bruce F) Hopp ,ei. 63 P/ER(C COUNTY sr. cAO/x/zo • R 3G 1500 1600 PL EAS.1 NT YAL L E)- TWP. --~I-e-RVSH R/YER TWP, 0 1700 y ws. 1800 1900 2000 t~~o PUg7jr~ 2100 MAP f" S & N LAND SURVEYING SYMBOL OF DEPENDABILITY AND QUALITY IN PROPERTY SURVEYS PLAT BOOKS TOPOGRAPHY SURVEYS ~s SUBDIVISIONS & r, RU[KfUk9 SINCE 1944 CERTIFIED SURVEY MAPS ROCKFORD MAP PUBLISHERS, Inc. ALLEN C. NYHAGEN, R.L.S. 4525 Forest View Avenue, P.O. Box 6126 PHONE: (71$) 386-2007 Rockford, Illinois 61125 108 WALNUT STREET -HUDSON, WISCONSIN 54016