HomeMy WebLinkAbout040-1163-10-000
M ts C
y .a 0
O
M
O N C
N V Co
! C
l4 ~C
N >
ti
a
Q4 M C
co ya
N T -p
'02 a)
O• c
ayi y r
c
a Z c .O
C
m 2 y
LL O O L N
w co
~o
3 a
2 C
a m ~ M I
Q aa#
I
' Z y
o ~ O
C-4 O
O
J ~
D
CO O III' d m
LO CN N H
O 2 a c
V 2 y M
t/) H r II C E N
a N N
N N j m
N y
7 C p
y d a'
N
a O t
o 0)
0 Z m z
N M I!I N C
(D
7 U') R N
O m
~j 06 > a « 0
~i y y y a) ED ;5 C
O O a
~ (6
U) U)
H o
E
UL LL
0 0 0
•►N~ ~ i~aaa I
~i a v
a
3 O (n
y J U l O
m CO CO M - - Z C)
ftwo- -.f N a O
fYUO (O
O Q N N
(D CD
M C,
m C d M O
Q y
° cf
0 N N
~j O '2 N G
O
IV i.+ O
O M L V j
d (o O M Cl) o = a °0 0 o
co
(D O ` m N G N _q C) N
C4 15 'O Z ad+ a O M C',
ICI N T Ili Q n 2 7 O` C d ~
•O O N H _ O Z y 2 H fn
v~ m R € a
v C~ `
~•L cam
ID r
Un.~~Ovi
U
`1 A
Form - STC - 104
1
AS BUILT SANITARY SYSTEM REPORT
OWNERG TOWNSHIP SEC. TN-R -Zd W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/o
Cs;
,coo
yon
Go I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used D,z 3/~ " G3oc ~f~ s~
-X opd
Elevation of vertical reference c'`'~ fy
point: y.D Proposed slope at site:
SEPTIC TANK: Manufacturer: ,.,/cr Liquid Capacity: pro
Number of rings used: . Tank manhole cover elevation: _
inn. /17
Tank Inlet Elevation: .7Z Tank Outlet Elevation:
Number of feet from nearest Road: Front,0 Side,[0 Rear, 0
From nearest property line Front,0 Side,O Rear, 0
1 '
Number of feet from: well 6,L-Z#
,6j&I/ building:
(Include this information of the above plot plan)( 2 reference dimensions to se,
SEE REVERSR STnp
PUMP CHAMBER
Manufacturer: ^wl~ee'~4 Liquid Capacity: ~DO 9
Pump Model: 105-3 Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: gjj , !ZZ Bottom of tank elevation:
Pump off switch elevation: & 2-3 Gallons per cycle:
Alarm Manufacturer: LAlarm Switch Type: /liar
Number of feet from nearest property line: Front,(DSide, O Rear, 0 Ft.~d ,
Number of feet from well: > SO
Number of feet from building: ~ Z
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: r/ Trench: E"`P jv9•/8
Width: Length: ?r Number of Lines: z Area Built: y,zo
Fill depth to top of pipe: ,Z9W
Number of feet from nearest property line Front, Side, O Rear,0 Ft. _
Number of feet from well: > So
Number of feet from building: 60
(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: (J Plumber on job: f •9
License Number: ;$-If
3/84:mj
EPARTMENT OF INDUSTRY; INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.0"`3OX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
10CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
~
E Holding Tank E:1 In-Ground Pressure ❑ Mound I If assigned)
NAME OF PERMIT HOLDER! ADDRESS OF PERMIT HOLDER'. INSPECTION DATE: }
Dick Hinquist 113 N. 1st St., Mpls.,MN 55401 AQ -86 a
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV..
SW SW, Section 25, T28N-R20W, Town of Troy
Name of Plumber: MP/MPRSW No.. Cou my Sanitary Permit Number'.
David Fogerty 3289 St. Croix 79174
SEPTIC TANK/HOLDING TANK: /
MANUFAVUR~i ~ LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
/`/,'/0 9% PROVIDED: PROVIDED'. 1*3 L 0 YES ENO EYES ENO
BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD: 11ROPERTY [11ELL. BUILDING: VENT TO FRESH
C! A ALARM FEET FROM ~J LINE AIR INLET
/V -1 1 YES ENO BWN ES ENO NEAREST vc
~D
67
DOSING CHAMBER:
MANU ACTURE BEDDING'. LIQUID CAPACITY PUMP MODEL PUMP;SIPHON MAN AC iIIHEH WARNING LABEL LOCKING COVER
D D PROVIDED: PROVIDED:
YES ENO YES ENO YES ENO
GALLONS PER CYCLE: 1PUMP AN NTROLS OPER ATIONA NUMBER OF PHOPEHTV WELL BUILDI (i VENT TO FRESH
(DIFFERENCE BETWEEN D O FEET FROM LINE AIR I~~'.~
EST-~ /yV C;
PUMP ON AND OFF) ) YES ENO __1 NEAR
-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing IIAMF TEH MATE HIAL AND MAHKINI,
FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.) MAIN pZ
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF UISTR PIPE SPACING.. COVER NSIDE )IA SPITS LIQUID
BED/TRENCH THEN S RIAL PIT D
H:
DIMENSIONS
Rl~ V L L L. L I' Ti l :A. LL DEPTH DISTR. PIPF UISTH PIPE OISTR PIPE MATERIAL N ,.TH NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIP S OVE COVER ELEV. INLF F ELEV. ENU P S
FEET LINE AIlAT:
FROM _71-
NEAREST-ii. 1, t~~ ~D
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-
EYES ENO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PE HMANf NT MARKERS OBSEHVATION WELLS
DEPTH OVER TRENCH BED DEPTH VFH TRENCH HEU DEPTH OF TOPSOIL is') DDED EYES SEEUFD ENO D YES MULCHED E NO
CENTER EDGES
EYES. ENO EYES DNO EYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING GRAVEL DEPTH HEL(7W PIPF FILL DEPTH ABOVE COVER
TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE UIS TRIBU 110N PIPE MATERIAL & MARKING
E LE V.. ELEV. DIA. ELEV. PIPES DIA:
ELEVATION AND
DISTRIBUTION
INFORMATION H H
OLE SIZE OLE SPACING GRILLED COHHECI L.V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
EYES ENO OYES ENO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE'.
EYES ENO EYES ENO NEAREST-
Sketch System on Ret ' in county file for audit.
Reverse Side.
SIGNATURE' TITLE'.
DILHR SBD 6710 (R. 01/82)
l
, unsconsln APPLICATION FOR SANITARY PERMIT
D IL H R COUNTY
(PLB 67)
- DEPgRT LR OF
T UNIFORM SANITARY PERMIT #
Ir;S']USTR4, LgBOR 6 MUMRn RELRTIOns '7AI
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size.
-See reverse side for instructions for completing this application, PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS 101- 3 77- ?
woof_ --Ty
PROPERTY LOCAT N effy:
cJ 1/4j,40 1/4, S
,5-- , T-.:,19, N, R-1, E (or TOWN OF dr~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROA , t-AKE O,;i STATE PLAN 1. D. NUMBER
?la S go/ I
TYPE OF BUILDING OR USE SERVED
16aM, 1W Y49 714;3 -_70 - OQ
EL*~'1 or 2 Family Number of Bedrooms: Z ❑ Public (Specify):
THIS PERMIT IS FOR A:
EV New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
19'Seepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity U
Lift Pump Tank/Siphon Chamber A/ v
Holding Tank capacity
Manufacturer: ? S
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer.
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
ET Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
e of Plumber (Print): e^ . n e: MP/MPRSW No.: Phone Number:
Q 3 ~g (7 y~) 6
I-
"er's Address:
~ Name f Designer:
ILI
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given Initial
(O XApproved Adverse Determination
Reason for Di p al:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
i.
W f
< J
APPLICA•(._ON 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
isnuance. Should this development be intended for resale by owner/contractQx,("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 Cl ,41
Location of Property ,SGcSection T N - R W
Township Zrs V
Mailing Address 4?W4- 4W4
ti
Subdivision Name
- -
Lor. Number
#-Previous Owner of Property __._...ZL<44.1y1) ,
•)t- Total Size of Parcel X L
.o-Date Parcel was Created f7L s z
iE Are all corners and lot lines identifiable? t/ Yes No
It l this property being developed,for resale (spec house) ? Yes No
-)~-Volume _ and Page Numbe ~ as recorded with the Register of Deeds
INCLUDE WITH THT► APPLICATION ONE OF THE FOLLOWING:
Q Warranty Deed
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
Map, the the Certified Survey Map shall also be required.
_.--------------------------------------------a-
• tr
PROPERTV OWNER CERTIFICATION
1 (We) een.ti,6y that aU 6tatemenu on .thi.6 6onm ane tAue to the but o6 my (oun)
k nowtedge; that I (we) am ( cute) whe owner (e) 06 the pro pvt.ty des eh.i bed in th"
in;, onmatiOn 604m, by viAtue o6 a waAAAn ty deed neconded in the 06 6ice o A the
County Reg•idten o6 Deeds u Doeu.ment No. - ; and that I (we)
p.l:.1 s en.tey own .tke- p!w poe.ed b.i. ~ c I .the. A eua.ga driA poa 4Z A ye:tem (04 1 . I we 1., . 4ave ~ a.. .
obtained an eaeement, to nun we tJi. Ae above deeeA bed pnopenty, bon the
cons Uiction o6 pid dy tem, and .c'ie eame hae been duty recorded in the 066ice
1~e unt t eede, Document No.
,w 5 S4W
-ST.bNATURE OF 0 ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DA.'E SI ED DATE SIGNED
a
STC-105 r
r
9
' SEPTIC TA1,1K MAINTENANCE AGREEMENT ►y+
?St. Croix County z
t7
O W N E R /$tJtR'R % H
ROUTE/BOX NUMBER Fire Number
CITY/STATE ~'y~ LtJl ZIP SSIOl2
PROPERTY LOCATION: Section TN, R W,
Town of / /ge , St. Croix County,
Subdivision crLot . 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 eptic 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 ii'August of 1980, with the requirement that.
owners of all new systel.1,1 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, resf:r.icted plumber or a licensed pumper veri-
fying that (1) the on-Ai ce 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
O
E
I/WE, the undersigned, have read'the above requirements and agree t4
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources. Certification f rm mus be ompleted
and returned to the St. Croix County n wi n 30 da s
of the three year expiration date.
SIGN D
)E-DATE 1/h 1114
Croix County Zoning (ffice
P.O. Box 98.
Hammond, WI 54015
715-796-2239 or 715-425-8363
.A.0n, date and return taZ above address.
i
• o
r L
m _•1 N N
650 e
G C fA w p m O m c ~0~ ~
0 a 7 w' K
O c O w w w
'a 0 ' c m 'o amm°Oa' N i
=r 3 R13
m a 00 w oO m tD
~.wv N
n m (D CO C w A i
M CD
N m -+O ? (O n
n 3 a o° m m W
~Owoc°
w
3 c ~c N
jw M' c Q c o
=cr cn='mw~cn
cu w o ~o am I'
Vl = (p -w
:U m w . f-'D C n
mmc 0)D~Qo
'0 - CL
C w A o O y'
\'O O 0 O
°i m4 O O aQ.:3 w O
w ~n a w vi C CA
w~`_r f --i m z CD CD --q (D 0 W (o D n
~ a ° w~ 0 m
a=: .~c O
cr
aa04EM CA ~
v 3m0 v,'~ww C fl1
bum m c = ° a~ m
CO CD m
w o o w o ca D -1
c
m'~0'NN.
n.of cci,ccc~~
IT!
w3_w m-O a mca w o
a m a n a a
C) cr c N < n SD mr m
m~c° 3 m 0
a0:3 O(oa c° v ~ 74 0 cmn° '
a a0w ~c~m=m
a w
A► p: O _3 O (D O 0 0 y
w a a m > 0 3 m
CD CP I CL o < 3
(a m
o O Z
0
A F F I D A V I T
i
STATE OF Wisconsin )
)SS
COUNTY OF St . Croix )
Richard M. Magraw and Shirley S. Magraw as
undersigned, hereby acknowledge that (he/she) they have been
granted certain easement rights, as hereinafter described, with
regard to the real property legally described as:
A parcel of land containing 1.2 acres located in Government
lot One (1), Section Twenty-five (25), Township Twenty-
eight (28), North, Range Twenty (20) West, further
described as follows: from the Northeast corner of said
Government Lot One (1) go South a.0istance of 50.0 feet;
thence West Parallel with the North line of said Government
Lot One (1) a distance of 400.0 feet thence South 24'30'
West a distance of 325.0 feet; thence South 10 45' East
a distance of 486.8 feet to the point of beginning for the
parcel to be conveyed herein; thence South 10 45' East a
distance of 150.0 feet; thence South 57 00' West a distance
of 338.0 feet to the shore of Lake St. Croix; thence North
30 10' West on a meander line along said shore a distance
of 150.0 feet; thence North 53 09' East distance of 230.3
feet; thence North 66 53' East a distance of 153.9 feet
to point of beginning; together with all riparian rights
and land lying Southwesterly of the above described land
and within extensions of the above property lines; subject,
however, to an easement for an access road over and across
the East 50 Feet as now opened and travelled and to all
existing recorded easements and reservations. Together
with an easement consisting of the right of ingress and
egress, over and along the existing private roadway
extending from the above described property over and across
the East 50 feet, of adjacent property now or previously
owned by the above named grantors in a general North-
westerly direction a distance of approximately 486.8 feet;
thence Northeasterly a distance of approximately 325 feet
and thence straight East a distance of approximately 400
feet to connect with a public highway consisting of a town
road, as now travelled
I G consent to Richard D. Hinquist, owner of the
above-described parcel of land, being allowed and permitted to
run a sewer line that will pass under the existing private
roadway that we have the right of ingress and egress over and
along, as above described.
ACKNOWLEDGMENT
STATE OF y/;41Z_
COUNTY OF SS
Personally came before me this day of
19P6, the above named
° me known to
be the pe son(s) w executed the foregoing document and
acknowledge the same.
x ;r'1 THEODORA E. COENEN
l NOTARY PUBLIC MINNESOTA
zLn'~ - r .1/ .1 .
&604e~w I
Notary Public 4! HENNEPIN COUNTY
pity commission Expires Oct. 13, 1990
r
This instrument was drafted by:
Morry N. Rothstein
Attorney at Law
1515 Midwest Plaza West
801 Nicollet Mall
Minneapolis, MN 55402
(612) 339-6561
A F F I D A V I T
STATE OF WK-) )
)SS {
COUNTY OF St . C30,-
'4 )1e 4 t~, 9,4 P2N~F5
as
undersigned, hereby acknowledge that (he/she) (they) have been
granted certain easement rights, as hereinafter described, with
regard to the real property legally described as:
A parcel of land containing 1.2 acres located in Government
lot One (1), Section Twenty-five (25), Township Twenty-
eight (28) North, Range Twenty (20) West, further
described as follows: from the Northeastcorner of said
Government Lot One (1) go South a istance of 50.0 feet;
thence West Parallel with the Nort line of said Government
Lot One (1) a distance of 400.0 feet; thence South 24 30'
West a distance of 325.0 feet; thence South 10 45' East
a distance of 486.8 feet to the point of beginning for the
parcel to be conveyed herein; thence South 10 45' East a
distance of 150.0 feet; thence South 57 00' West a distance
of 338.0 feet to the shore of Lake St. Croix; thence North
30 10' West on a meander line along said shore a distance
of 150.0 feet; thence North 53 09' East a distance of 230.3
feet; thence North 66 53' East a distance of 153.9 feet
to point of beginning; together with all riparian rights
and land lying Southwesterly of the above described land
and within extensions of the above property lines; subject,
however, to an easement for an access road over and across
the East 50 Feet as now opened and travelled and to all
existing recorded easements and reservations. Together
with an easement consisting of the right of ingress and
egress over and along the existing private roadway
extending from the above described property over and across
the East 50 feet of adjacent property now or previously
owned by the above named grantors in a general North-
westerly direction a distance of approximately 486.8 feet;
thence Northeasterly a distance of approximately 325 feet
and thence straight East a distance of approximately 400
feet to connect with a public highway consisting of a town
road as now travelled.
I/We consent to Richard D. Hinquist, owner of the
above-described parcel of land, being allowed and permitted to
run a sewer line that will pass under the existing private
roadway that we have the right of ingress and egress over and
along, as above described.
ACKNOWLEDGMENT
STATE OF 1145
)
COUNTY OF Pi&,ec.6 ) SS
Personally came before me this -310 day of
1986, the above-named GLEN ~i'_S
to me known to
be the person(s) who executed the foregoing document and
acknowledge the same.
o a rde Pal &d. Roiasinski
Notary Public, State of WIS.
My Comm. Expires May
This instrument was drafted by
Morry N. Rothstein
Attorney at Law
1515 Midwest Plaza West
801 Nicollet Mall
Minneapolis, MN 55402
(612) 339-6561
A F F I D A V I T
STATE OF ~G )
)SS
COUNTY OFJ, C:•j(f )
J
r as
undersigned, hereby acknowledge that (he/she) (they) have been
granted certain easement rights, as hereinafter described, with
regard to the real property legally described as:
A parcel of land containing 1.2 acres located in Government
lot One (1), Section Twenty-five (25), Township Twenty-
eight (28), North, Range Twenty (20) West, further
described as follows: from the Northeast corner of said
Government Lot One (1) go South a.Oistance of 50.0 feet;
thence West Parallel with the North line of said Government
Lot One (1) a distance of 400.0 feet; thence South 24 30'
West a distance of 325.0 feet; thence South 10 45' East
a distance of 486.8 feet to the point of beginning for the
parcel to be conveyed herein; thence South 10 45' East a
distance of 150.0 feet; thence South 57 00' West a distance
of 338.0 feet to the shore of Lake St. Croix; thence North
30 10' West on a meander line along said shore a distance
of 150.0 feet; thence North 53 09' East a distance of 230.3
feet; thence North 66 53' East a distance of 153.9 feet
to point of beginning; together with all riparian rights
and land lying Southwesterly of the above described land
and within extensions of the above property lines; subject,
however, to an easement for an access road over and across
the East 50 Feet as now opened and travelled and to all
existing recorded easements and reservations. Together
with an easement consisting of the right of ingress and
egress over and along the existing private roadway
extending from the above described property over and across
the East 50 feet of adjacent property now or previously
owned by the above named grantors in a general North-
westerly direction a distance of approximately 486.8 feet;
thence Northeasterly a distance of approximately 325 feet
and thence straight East a distance of approximately 400
feet to connect with a public highway consisting of a town
road as now travelled.
I/We consent to Richard D. Hinquist,'owner of the
above-described parcel of land, being allowed and permitted to
run a sewer line that will pass under the existing private
roadway that we have the right of ingress and egress over and
along, as above described.
~~t n
ACKNOWLEDGMENT
STATE OF Ct11 S )
)SS
COUNTY OF
/C~GG )
Personally came before m this 0day of rn/~
1986, the above-named E G
M. ogeR(Lz to me known to
be the person(s) who executed the foregoing document and
acknowledge the same.
arGYeralld J. Kolasin41~~i
ski
Notary Public, State of WIS.
MY Comm. Expires May 4(1-)9 ?q
This instrument was drafted by:
Morry N. Rothstein
Attorney at Law
1515 Midwest Plaza West
801 Nicollet Mall
Minneapolis, MN 55402
(612) 339-6561
A F F I D A V I T
STATE OF l SC v.✓~,~ )
)SS
C',~~ , r )
COUNTY OF
as
undersigned, hereby acknowledge that (he/she) (they) have been
granted certain easement rights, as hereinafter described, with
regard to the real property legally described as:
A parcel of land containing 1.2 acres located in Government
lot One (1), Section Twenty-five (25), Township Twenty-
eight (28), North, Range Twenty (20) West, further
described as follows: from the Northeast corner of said
Government Lot One (1) go South a.9istance of 50.0 feet;
thence West Parallel with the North line of said Government
Lot One (1) a distance of 400.0 feet; thence South 24 30'
West a distance of 325.0 feet; thence South 10 45' East
a distance of 486.8 feet to the point of beginning for the
parcel to be conveyed herein; thence South 10 45' East a
distance of 150.0 feet; thence South 57 00' West a distance
of 338.0 feet to the shore of Lake St. Croix; thence North
30 10' West on a meander line along said shore a distance
of 150.0 feet; thence North 53 09' East a distance of 230.3
feet; thence North 66 53' East a distance of 153.9 feet
to point of beginning; together with all riparian rights
and land lying Southwesterly of the above described land
and within extensions of the above property lines; subject,
however, to an easement for an access road over and across
the East 50 Feet as now opened and travelled and to all
existing recorded easements and reservations. Together
with an easement consisting of the right of ingress and
egress over and along the existing private roadway
extending from the above described property over and across
the East 50 feet of adjacent property now or previously
owned by the above named grantors in a general North-
westerly direction a distance of approximately 486.8 feet;
thence Northeasterly a distance of approximately 325 feet
and thence straight East a distance of approximately 400
feet to connect with a public highway consisting of a town
road as now travelled.
T/We consent to Richard D. Hinquist, owner of the
above-described parcel of land, being allowed and permitted to
run a sewer line that will pass under the existing private
roadway that we have the right of ingress and egress over and
along, as above described.
i.~ .Q V sue'-c-c~
ACKNOWLEDGMENT
STATE OF (jUS )
)SS
COUNTY OF PicRCG )
Personally came before me this QT day of
1986, the above-named 1010) Q_ a tf
t G~ A, VA-beco to me known to
be the person(s) who executed the foregoing document and
acknowledge the same.
ota '
U ey ral Jb(b
. Kolasinski
Notary Public, State of Wis.
L My Comm. Expires May j 91 1110
This instrument was drafted by:
Morry N. Rothstein
Attorney at Law
1515 Midwest Plaza West
801 Nicollet Mall
Minneapolis, MN 55402
(612) 339-6561
A F F I D A V I T
STATE OF
~1 )Lc'51 ) z
)SS
COUNTY OF COQ )
undersigned, hereby acknowledge that (D/she) (they) have been
granted certain easement rights, as hereinafter described, with
regard to the real property legally described as:
A parcel of land containing 1.2 acres located in Government
lot One (1), Section Twenty-five (25), Township Twenty-
eight (28), North, Range Twenty (20) West, further
described as follows: from the Northeast corner of said
Government Lot One (1) go South a istance of 50.0 feet;
thence West Parallel with the North line of said Government
Lot One (1) a distance of 400.0 feet; thence South 24 30'
West a distance of 325.0 feet; thence South 10 45' East
a distance of 486.8 feet to the point of beginning for the
parcel to be conveyed herein; thence South 10 45' East a
distance of 150.0 feet; thence South 57 00' West a distance
of 338.0 feet to the shore of Lake St. Croix; thence North
30 10' West on a meander line along said shore a distance
of 150.0 feet; thence North 53 09' East a distance of 230.3
feet; thence North 66 53' East a distance of 153.9 feet
to point of beginning; together with all riparian rights
and land lying Southwesterly of the above described land
and within extensions of the above property lines; subject,
however, to an easement for an access road over and across
the East 50 Feet as now opened and travelled and to all
existing recorded easements and reservations. Together
with an easement consisting of the right of ingress and
egress over and along the existing private roadway
extending from the above described property over and across
the East 50 feet of adjacent property now or previously
owned by the above named grantors in a general North-
westerly direction a distance of approximately 486.8 feet;
thence Northeasterly a distance of approximately 325 feet
and thence straight East a distance of approximately 400
feet to connect with a public highway consisting of a town
road as now travelled.
DWe consent to Richard D. Hinquist, owner of the
above-described parcel of land, being allowed and permitted to
run a sewer line that will pass under the existing private
roadway that we have the right of ingress and egress over and
along, as above described.
h
ACKNOWLEDGMENT
STATE OF (,t11 S )
COUNTY OF ))SS
Personally came before me this 0 dacr of
1986, the above-named v - J .f c
to me known to
be the person(s) who executed the foregoing document and
acknowledge the same.
14r -4 y
y , t L'"
Gera Kolasinski
Notary Public, State of Wis.
My Comm. Expires May Yj.
This instrument was drafted by:
Morry N. Rothstein
Attorney at Law
1515 Midwest Plaza West
801 Nicollet Mall
Minneapolis, MN 55402
(612) 339-6561
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, ~ - DIVISION
LABOR AND PERCOLATION TESTS (115) MAD P.O.ISON, WI BOX 53707
HUMAN RELATIONS \ / 7969
3707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/M IA+fe+P
`T-r LOTNO.:BLK.NO.:SUBDIVISIONNAME:
1-541) /a w/ s /T.4 N/R,~a E (o T,=,~
COUNTY: OWNER'S E: MAILING ADDRESS:
4e jr /h
USE / 3 /1/
S o
a416 'Wo.
NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
Q't esidence PROFILE DESCRIPTIONS: PER OLATION TESTS:
Z lew ❑Replace y//,
S' Z7
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
DS ❑U CAS ❑U C ❑U EIS C D3 ❑U w
[If Percolation Tests are NOT required DESIN RATE: [FIcodplain, n
y portion of the tested area is in the
der s.H63.09(5)(b), indicate: indicate Floodplain elevation:
PROFILE DESCRIPTIONS 4k, 8'9
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST, HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- _Zoe_[. T 3'*& .s'' s %_c w z. 1.2'Qn rri5
B- /vo o3 2- 43' S' s/ ZZ,cr t, sr' he
73 Z. 7 z s z,6 " 9 13., 15
7 5- z .
z. ' /
i
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH
P-
P- 2-
~G N•rre 3 s
s
P-.
P- e H s y
S
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
t
Jd = i
- t
{ t
t .
3( =
-
-
IN
E
3 j i 7 7
3 s
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.
----LE (print): TESTS WERE COMPLETED ON:
c>UtC~ o Pr 7
ADpSESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
O-e I W SIf Q Z3 CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R.;, 2/82) - OVER -
L
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 ,
To be a cc.or,.,, -;i test, Your report MLL
1. Camplet
1 The a this is a re 'c' - cial project;
3. MAXIP )
4. Is this
5. Carr Moxes. A 'ITS F{ R a TANK ONLY IF ALL
0 ~ -.)OUT'' 1L :~llJL76TIC
6. P1 7s show I d plot plan;
7, gram accurately I locatio is preferred. A
E ad if desired;
3. -ind vertical fprer nnint are clearl, e permanent;
c 1.. _ xes as to flood plain data, , st exemp
1G. as flood pla } es ~x,
11. sr r current a,
1 _'istribute u ..'ITl1 7111
F` VITHI 30 DA' '-Of ~I _ 1..
{IATI NS FOR CERTIFIED SOIL TESL
1
co
I L
N
s
{s - I rr
oam
s iy Loam
si - L -am
pt 1776'11
t >
f
TEt".t
To THP
it try nt may
th r
in ord
_ _ ~tiean.
Q; .
~ F ~ ~ ~i ~
~.5
4
~ ~ . I
ti ~ ~ ~ , ~
~~r~ ~ ~ 1 , ~i!
~ ~
~ r
i 's
r
t t I
~ I
+n ~
t A
t iti~s r
I
T D H ' HEAD CAPACITY CURVE
1 ~..w
30 . TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE
EFFLUENT AND DEWATERING
95 SERIES 53-55-57-59 97 137.139 163 165
28 T M _L LTRS GAL' LTRS GA LTRS L. LTRS LTRS
50 5 , 52 13 163 ~5 248 394 1 231 231
EFFLUENT AND DEWATERING , + 30505 141 129 216 -s' 300 1231 , 231
fi 57 972 43 163 64242 0 227 ~ 227
26 SEWAGE AND DEWATERING J 10 104 % 133 -9 223 227
.62 _ 8 30 216 ; 1 223
ry
24 to?J 9.14 - - 55 206 L~t220
12.19 46 172 `.J 206
A v \ _
75 \ 0 15.24 - 33 125 , 91
1829 15-1 57 3 i6t
22 70 2134 304 114
1
d0: 24.38 74 53
MODEL\\ MODEL Lock Valve 19 246 zs ss er
20 ~ 163 \ 165 TOTAL DYNAMIC HEADICAPACITY PER MINUTE
\ SEWAGE AND DEWATERING _
\ SERIES 267 268 282 284 293
18 \ FT M GALJ LTRS GAL LTRS GAL, LTRS CAL,' LTRS , SAL I LTRS
S. 1.52 ;dj 408 21 386 130 . 492 18q 681 -
55 ' 0 3 05 0 227 273 9 360 598
\ \ i 4 57 76 -3 ' 163 c3 238 511
50 \ 20 6.10 8 30 125 A 401
\ 25 7.62 - 7( } 288
\ - -er
30 9.14 ; 43, 163 292
14- ' 45 \ as -1o 6767 - - - - eo z2i_
40 12 19 a6` 174
-
\ 45 13,72
12 . L; 0 - - 106
1 50 15 24
12: as
MODEL Lock Valve 18 z,- z6 - 35 - sa
35.
10 - \ I 293
30
8 MODELS
25, 137 139 \
6 2fl
MODEL
4 15 284
MODEL MODEL
10 268 ' 282
2 MODELS\
5 53, 55, '
MODEL MODEL
57, 59 97 267
GALS. 10 20 30 40 50 6Q 70 '80 90 100 `110 120 .30 140 150 160 170 180 190
LITERS 80 160 240 320 400 480 560 640 650
FLOW PER MINUTE
3280 Old Millers Lane Man f
Box 16347 u acturerS Ol .
PO.
nrZZZ-h' TZ7. ILOUlsville.
Kentucky 40216
(502) 778-2731 QuA[/TY PUMPS S%vrL- /939
8
` PAGE OF
PUMP CHAMBER CROSS SCCTIOM ARID SP[CIFICATI0kJS
VCWT CAP
VENT PI PC
WEATHER PROOF APPROVED LOCKING
> JUAICTIOAl BOX MANHOLC COVER
Zg' FRCM OOOR
,
WWCOW OR FRESH 12"MlIJ.
AIR INTAKE I
I
GRADE
( y" MIAJ. ,
' I
CoNpUIT -
16"MIN.
I~II_.I: l' PROVIDE
A10.TIGHT SEAL_ I III ~
I I I v
APFROVEC JOINT I4 I III APPROVED DINTS
W/C.I. PIPF.. I III W/C.I. PIPE
EXTENDIKII( 3' I II ALARM EXTENDING 3'
ONTO SDI.10 SC;:. B I I ONTO SOLID SOIL
I I
I I oIJ-
C I i
` PUMP -_J OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED QAILtl IF TANK MANUFACTURER HAS. SUCH APPROVAL
5PC CIFICATrOA]S.
SEPTIC AND
DOSE TANKS MAWLIFACTURRER: ~2r{'tS MUMBER OF DOSES, ~ PER DA3
TANK AZE : k06 GALLO.IJS DOSE VOLUME=
ALARM MANUFACTURER: ~ rvh. INCLUDING-8ACKFL.OW; _?eo GALLONS
MODEL WUMpER. ~k1 CAPACITIES: A==
11JCNE5 OR 296 GALLOWS
SWITCH T:P[..:
B = INCHES OR 21" GALLONS
PUMP MANUFACTURER:--.Z~slir- INCHESOR 2 f9 GALLOl15
MODEL NUMBER: f3 4
INCHES OR 70• GALLONS
SWITCH TYPE: /7i~Grrw>+~'"
1J07F.: PUMP/AND ALARM ARE TO BE/
PUMP DISCHARC.C RATE GPM._ INSTALLED ON SEPARATE CIRCUITS -I
VERTICAL DIFFEKEIJCC birYWEEAI PUMP OFF AWO DISTRIBUTION PIPE:. - FEET
+ MINIMUM NETWORK SUPPI.y PKCSSURTTE//, a 4-4- FEET
+ • SB -FEET OF FORCE MAIN X F/pofr.FRICTIO&A FACTOR-L93 _FEr_
.2 i
TOTAL ~E)~ tt
NAMIC_ HEAD / FEE_T
IMTERNAL DIMEIJSIONI: OF TANK: LENGTH'---~;WIDTH J2- ,.;1_lgwll DEPTH
.LICLWSE:: KIUMBER: DATE: c/
r
y
Parcel 040-1163-10-000 02/07/2007 10:37 AM
PAGE 1 OF 1
Alt. Parcel 25.28.20.631J 040 - TOWN OF TROY
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 D HINQUIST O - HINQUIST, RICHARD D
120A BLACK BASS RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE
SEC 25 T28N R20W 1.2 AC IN G L 1 COM NE Block/Condo Bldg:
COR GL 1, TH S 50 FT, W 400 FT, TH S 24
DEG W 325 FT, S 10 DEG E 486.8 TO POB: Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TH S 10 DEG E 150 FT TH S57 DEG W 332 FT 25-28N-20W
TO LAKE, TH N 30 DEG W ON A MEANDER LN
ALG SHORE 150 FT, TH N 53 DEG E 230.3
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 787/533
07/23/1997 698/425
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.200 354,200 205,100 559,300 NO
Totals for 2007:
General Property 1.200 354,200 205,100 559,300
Woodland 0.000 0 0
Totals for 2006:
General Property 1.200 354,200 205,100 559,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 10/30/2006 Batch 06-18
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
'HI1QUI'ST', DICK SW SW, Section 25
113 N. 1st St. 3gv T28N-R20W, own f Troy
Mpl8., MN 554*13S - 112F4
San.Permit#79174 6-4-86 D. Fogerty
Conventional, New
INSTALLED 10-2-86