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COVIVIERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
ST. CROIX ZONING REPORT NO.: 11775/01 PAGE 1
ST. CROIX COMITY REPORT DATE: 10/212/90
COURTHOUSE DATE RECEIVED: 10/19/90
HUDSON, WI 54016
ATTN: THOMAS C. NELSON
lqn
OWNER: Steve & Monica Sorenson
LOCATION: 240 GLen Cirlce, River Falts
COLLECTOR: M. Jenkins
SOURCE OF SAMPLE: Outside faucet
COLIFORM: 0 /100 ml
INTERPRETATION: Bacteriologically SAFE
NITRATE-N: 6 ppm
Under 10 ppe is safe for human consumption.
Conform Bacteria/100 ml
Nitrate--Nitrogen, mg/L
LAB TECHNICIAN: Pam Bane
WI Approved Lab No. 19
OE.WDEPEA,0
O A
u >
5 < Means "LESS THAN" Detectable Level Approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the serviceF of septic
and water inspections to Lending Institutions, private individuals.
Q2nn o} i cn of thin form is essential so that the c~roDer y can be_
located.
Please provide the following information, enclose appropriate
fee made payable to St. addrossy Zoning bendoneaias
alonq with form to the above
soon as ossible after fee and form are received.
WATER TESTING- -------FEE: $ 25.00
or n rates and coliform bacteria)FEE: $175.00
WATER TESTING
-------FEE: $25.00 p2~~--00
SEPTIC SYSTEM INSPECTION -
erm nes em is properly functioning at time of
inspection)f e e~ /1i1~ r ~o r~ h Se P1
Property owner's name P
y® 6~-lei,? Ctpc"le- Lew /If
Property owner's address
Legal Description X1/4 of the of Section T N-R_
Town of K r, is Lot Number -Subdivision Name
Leyli/t Sec mss- raP4Ja0h,) N6 _(k) Hof' q o- St C,~V;x- ml; 4,,ds
PYRE TD= BOX NUMB=
Color of house Realty sign by e?70 If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK,.
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: . Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary.
this is the case, please make proper arrangements with this
office to ensure time when entry may, be gained. A,tru f 12e4
Firm or individual requesting services : Tan e
Telephone Number 3 7 o~ 777 _ 76 7rl
REPORT BE SENT TO: A
Closing date y 7V
li Signature
O O 0
N M O O NUDgpNTWK °l0 G ~r O
-_MAYER Rik -~--a- - - n NIRM w OF
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13= EAST COPE R0.~°s Sal GLOVER 8040 U O
jtC~ 16 IT a '4 ,l• 16 IS 14 13 12
~ I x l~
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DOVE
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Tor P CHIMMOCK LA.
/ C GM4PM4M DRIVE
% . 23 W ROLLING MEADOW DR. i 24
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20 % 21 2 I
e` °23 U D
0 PO
PLAIMVIEM DR. s I
\ 8 200
F sy J'
n LANE
23 J i 2
29 o S 27 26 D O
a M RLEMMON Ra ~ 23by
1 N I X00
35 r 4 M
MONTH ILWACO RFUMOER OR lWfdlM 34 NO.
/ 38 35 y ' Ra d 31 32 " v'a 6 --O
33 3ya
= IUaACO RD, j z f
AQ = RYM= g ~ L _J
sDYrN 1 w M _ Y = RIVE FALLS
00
Ahrens Road C2 Dayton Road F8 Ilwaco Road F2.3 Oak Drive AS Skyline Drive E3
Apollo Road F7 Deerwood Drive A6 N. Ilwoco Road F2 Oak Ridge Drive F8 South Cove Road C2-3
Del ander Drive E2 S. It "Co Road F2 ORWa Road CS South Glover Road C6-E6
Bauer Road AS Dry Run Road F7 M. Oaahs Road C4 South Ilwaco Road F2
Beach Road El
O'Neil Road A4 Southern Pacific Road C5
Bjerscadt Lane ES-6 Jersey Road Dg
Black Bass Road E2 East Cove Road C2-4 Stag's Leap Lane B3 load Page Lane F3 S Sun Vie L.
Driv F8
Boundary Road A8.88 East Mood Ridge Drive F8 Lundy Lane AS Paulson Road E8 Sun Viet Drive F7
Brick Circle BG .
Bnsmel Road A7 Vine Ridge Ter F7 Swedish Mission Road FS-6
Plainview Drive 02-3 Sykora Lane E5.6
Frances Avenue AS Ma- Lane F6 Pomeroy Road F8
Carlson Lane D444 Marsan Drive AS
Chapman Drive 07-8 Gilbert Road A6 Mayer Road A3 Quarry Road FS TTower Road A3-8
ownsval Road B<-ES
Chimook Lane 05-6 Gl an Circle E2 Milwaukee Road CS
Coulee Trail 86.7, 8 Glen Lane E2 Radio Road D7-E7 Valley View Drive AS
Cove Court D2 Glendale Drive F5 Red Brick Road 03.4
Cave lane 02 Gl ensons Road EI.3 Nordic Lam A3 Islander Drive F4 West Grove Road B3
Cove Road 02 Glover Road C6-8 North Cow Road C2 River Side Drive F8 Vest Oasha Road C4
E. Cove Road C2.4 S. Glover Road C6-E6 North Glover Road 05-CS River View Drive A3 Vest Wood Ridge Drive F8
9. Cove Road C2 North IIWAGo Road F2 Rohl Road B8 Whispering Pines Road B3
S. Cove Road C2.3 High Ridge Drive AS Northern Lights Trail A6 Roping Meadow Drive D4-5- White Oak Circle A6
Nuthie Lane C6 White Oak Drive
A6
13 18 IT 3 T
14 13 6 S 8-
10 20 9 1 16
" 1212 4 2 TROY 19
PPP7
ST. CROIX COUNTY
WISCONSIN
tom" k ~'uy ~~.~+~$h1
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
r: T 7 =
t= ~ 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Oct. 24, 1990
Jane Peters
Burnett Realty
7645 Currell Blvd.
Woodbury, MN 55125
Dear Ms. Peters:
An inspection of the septic system on the property
of Steve & Monica Sorensen, 240 Glen Circle, River Falls, WI was
conducted on Oct. 18, 1990. At the same time a water sample was
obtained for testing. The results of that testing will be sent
to you as soon as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This not not in any
way warrant or guarantee the continued proper functioning or
operations of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system is totally dependent upon proper
maintenance of the system.
Should you have any questions regarding this subject, please feel
free to contact me.
Sincerely,
Mary J PJenkins
Assistant Zoning Administrator
cj
Form-STC- 104
AS BUILT SANITARY SYSTEM REPORT
r
OWNER'.py,eA 5e 1, TOWNSHIP p SEC. Tg N-R 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 Propey-+- l..;r;e
aM
over
110
0
s'
Na S~aJ~
rMn C'
T ~roPoseo~
133' W e li
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Jj <p r Liquid Capacity: /00
O aA 1.
Number of rings used: y Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side,O Rear, O
feet
From nearest property line Front, O Side,aRear, O gg` feet
Number of feet from: well over So , building: /8'
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
err DrUrDev eTn"
PUMP CHAMBER
i
Manufacturer: Liquid Capacity: 4
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: G~ es Trench
Width: ~a Length: sa' Number of Lines: Area Built:1,,Z_4Ls_tQ+
Fill depth to top of pipe: 30
Number of feet from nearest property line: Front, O Side, ORear, 0Ft./O
Number of feet from well: 0V-er- Number of feet from building: '//0
(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: d`~ g Plumber on job: ~T
License Number:d',L'"! .~.3U O
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR
LABOR& HUMAN RELATIONS SAFETY & BUILDINGS
PO. Box 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI 53707 BUREAU OF PLUMBING
CONVENTIONAL ❑ALTERNATIVE n77:771
❑ Holding Tank ❑ In-Ground Pressure Mound ❑
NAME OF PERMIT HOLDER: ADDRESso F PERMIT HOLDER
INSPECTION DATE:
Steven C. Sorenson 900 NF Virginia, ~~103,St. Paul, MN 5510 ~6 2yUo
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
REF. PT. ELEV.: IC!, T REF. PT. ELEV.:
NE'-4 of the SW4 of Section 25, T28N-R20W, Town of Troy,Lot 4,St. Croix
Name of Plumber:
MP/MPRSW No
Counry: ISanitary Permit Number:
I.Lzary Za a 3300 St. Crtf1X 79123
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY:
TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
O~0 /J G PROVIDED: PROVIDED:
01.
BEDDING: VENTDIA.: VENTMATL. HIGH WAT R f~ ~J' YES ONO DYES ONO
Fr ALARM NUMBER OF ROAD: PROPERT WELL: BUILDING: VENTTO FRESH
/I FEET FROM LINE: IAIR INLET:
YES ONO 441 l~ DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER.
WARNING LABEL LOCKING COVER
DYES ONO PROVIDED: PROVIDED:
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL DYES ❑ NO ❑ YES ❑ NO
(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING I VENT FRESH
FEET FROM LINE AIR INLET.
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN61 H DIAMETER 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 YSTEM:
BED/TRENCH WIDTH LENGTH NO. OF
DISTR PIPE SPACING COVER
A-2 THEN INSI DD EE DIA.-. #PITS. LIQUID
DIMENSIONS tN PIT DEPTH:
GRAVEL DEPTH EBOVE DEPTH DISTRPIPE DISTRPIPE ISTR. PIPE MATERIALBELOW PIPES C VER. ELEV. INLET ELEV. END. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
FEET FROM LI"E: AIR INLET:
NEAREST
~j
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 NO meets the criteria for medium sand. TIONS MEASURED.
O
SOIL COVER TEXTURE.
PERMANENT MARKERS OBSERVATION WELLS.
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DYES ONO DYES ONO
CENTER. EDGES: DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED:
DYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE
TR ENCHES FILL DEPTH ABOVE COVER:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.. DIA.. ELEV.. PIPES-. DW
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERI AL
VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
DYES ONO DYES ONO
COMMENTS; PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF
PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO OYES NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SE. TITLE:
DILHRSBD67101R.01/82►
Luis`or,sv, APPLICATION FOR SANITARY PERMIT
'Z~DILHR COUNTY
~ OEPRRTTEr1T OF
(PLB 67) UNIFORM SANITARY PERMIT #
1n0USTRV, LRBOR 6 HUMRr1 RELRT10nS /11? 3~
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
PROPERTY LOCATION
Y-
IVE 1/ 1/4, S oZS , T -9t, N, R o`ZDE (or TOWN OF: _faa
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, KE OR LANDMARK T TATE PLAN I.D. NUMBER
R cps. 42-01V
TYPE OF BUILDING OR USE SERVED
X 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify):
THIS PERMIT IS FOR A:
X 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.
X Seepage 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 O f
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: \AIZESEIL r, Orv
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):
L 1119 q
b ®Private El Joint El Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number:
,~ov 1(2).!T),?e6-AesE
Plumber's Address: Name of Designer:
9
1TX7W P7 A-/. 4f ,v
A 4F
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
r 7 Of ❑ Owner Given Initial
gild, O~~% Q v Approved Adverse Determination
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
t
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.
APPLICATION FOR SANITARY PERMIT
S T C - 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 CVr V 12- EAl SF- Al
Location of Property ENE 3% s L*/ k, Section a$ , T 7g N - R a O W
Township 12- Q -1
'Mailing Address ?0 /4 G ! Al 14- /O 3
s c . pA~~ MAI 5 S~io~
Subdivision Name T C IZ.Q / X A/ l 6 AIL /4 A/ 6 S
Lot Number -
Previous Owner of Property Ci_iFroaD A. Pj5Te25oA1,Wr1-LiAM S MYE/ZSi LANCk 19 /VoADE2NU,5
DEL. y, E/NE$S, PAUL T. PJ~E LL MAN
Total Size of Parcel a. 'l 9 r-A ES
•Date Parcel was Created 0 C;L 9 / 9 8
Are all corners and lot lines identifiable? y Yes !JO'O' No
Is this property being developed for resale (spec house) ? Yes No
"Volume cand Page Number y / 3 as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. 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.
PROPFRTV OWNER CERTIFICATION
I (We) eekt 4 y that a.U Statement6 on th.i,a bonm ate true to the best o4 my ( oun )
knowledge; that 1 (we) am (are) the owner (s) ob the p4ope4ty de,6c ibed in this
inbonmati.on bonm, by vigtue ob a wa4Aanty deed teco4ded in the Obb,ice ob the
County Regi6teA o4 Deeds as Document No. and that I (we)
presently own the proposed 4 to bon the sewage ct~s sat system (oA I (we) have
obtained an easement, to nun with the above desn bed pnopeAty, bon the
condtnuction ob said syste nd the same has been duty %eco&ded in the Obb.ice
ob the Co y Reg-uste~ D ds, as Document No. )
SIGNATURE OFF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
/ N
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
a
OWNER/BUYER S TE VF-,A' C. 3OR, EAl SE k/ ~
''ROUTE/BOX NUMBER Fire Number
',CITY/STATE ZIP
PROPERTY LOCATION:jVE 114, si k, Section o2 5 T 8 N, R W,
Town of %Ao Y St. Croix County,
SubdivisionST CRojx r1/6NLRN'bS 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. 'j
0
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- I'd
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office with' 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 9a:~
Hammond, WI 54015
715'-796-2239 or 715-425-8363
Sign, date and return to above address.
NOR
DE'PAR""MENT OF REPORT ON SOIL BORINGS AND SAFET UILDINGS
USTRY, DIVISION BOX LABOR AN
AN REDATIONS PERCOLATION TESTS (115) MA[ WI 53707
(1-163.090) &t Chapter 145.045)
LOCATION. SECTION: OWNSH NICIPALITY: OT NO. f3LK. NO.: SUBDiVIS10N AA`
t f s41 z S./Tz6N/Rz W -7~ k2.O - 1 -.1
4- - Cam, Il, 4r~
COUNT Y: - ~fSdVNER'S U ER'S NAME: - MA1 IN ADD SS:
~;/o C6nlTVR+Y Zf - S -C-ou ~t
LST !X-...i L} l^~ _ c- z } 1 v D S Q nr~ (1-kit
USE DATES OBSERVATIONS MADE
NO BE'1M . COMM CIAL DESCRIPTION: PROFILE
D S: T STS:
I /a
Residence New Replace
?5€a-~i~ } t s'j Sc')/ LS. 9 Li C IC.4.4 K'.OT -
RATING: S_ Site suitable for system_ U= Site unsuitable for system
ONVENTI( NAh:- MOUND: N-GROVNDPR YSTEM-IN-FILL t~OLLDING TANK: RECOMMENDED SYSTEM:loptional}
S ❑.~_~L!S 0"T~~I EIS Ous~u Ny~NTL0,y4L_ IZ X5?
If Pe+c)l it ion T sts iri NOT ie q uiied dESIGN RATE:
r It any portion of the tested area is in the
under s.1-163.09(5)(h), indicate:~ Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL 'y P H T R UND ATER- CHARACTER OF SOIL WITH THICKNESS. COLOR, TEXTI 40 DEPTH
NUMBER DEPTH ift ELEVATION OBSERVED EST . ST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
r 0.33' 13(. S. L- 0,611 PaN S; L; O.4Z' (s Pt r
B-
B L f /.0., ANJe0aAr/ /6 5°'.s t~7.~)~ O ~3.s~'tj U• ' DL [3S.u ,'Lv~ S cn, 7 uL~/G' ~
3 0./7' C, n/ i S' 2.~3' w C-r I
*aI at_ S 4- ,01 r 5•~• ,r0' no 3./ , c7x;D.sa
B S B.og /0o,59 vd a g-j Mao S CS• 0.63'BNGS•1 s'a'w r '~r ~1r~ ~3.~ CS
0.83r 8L 1. 7' 8,j S iL 3 B• 13'8N SLi 3N 0 S
B-a -)"5 NO "46 > g.53~,z
B-
C!K PERCOL TI N TESTS ACME TO
WO&ZU C N is
TEST DEPTH WATER IN HOLE TEST TIME I A TER L V - H S Rt N(1TES
NUMBER S AFTER SWELLING INTERVAL-MIN. p t "p Rig 0 - ^'NCH
P- Z'
bewe~ A I2_ L~_ 14, to COW
P_
♦ P'E NC."L " L.ln V. 000-00
PLOT PLAIN: lucaiiuns of ~rc:n!,i±ion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Descrik ar a hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the t nn:f pt.rce..:
of land slop &-W . 'L_1_
SYSTEM ELEVATION
bOC.-w- 40LE TESL
` 4- 1 z.a'
L&x- -r (o ,,j S:7- Y ETC.-1-4 _
eZ .j« Vii!- • ' ` .
oc s _ ;
r D sM \
d++ ep !
k*: Iwo 0
5 Z' g>D
'A .ss v~d ~ I Z X
p e/o,Gk s em
°O P-1
P - z. o l
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and method specif :e Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
7 2.•
NAME pririiF_ TESTS WERE COMPLETED O
ADDRESS: CERTIFICATION NUMBER: HONE N ?(optional):
K i d '.7 /1l ry r# ^'.1 U c71s1 ~ , ` a - -7l r !Sri-50 -
~C~S I G N A T A~
~'4 A
5 L o T `,-mss
DIS7R11307IONr !),iuuial ful one color' pry Local Aaihniily, ('ioPerty Owrter a-I Soil (,faro.
w 7oo OF
PLx3 67
0
PLOT ANO nqGZ041
3 F~Lev. =J00.00
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' ' ' Parcel 040-1209-40-000 02i07i2007 10:41
PAGE 1 OF I
F
Alt. Parcel M 25.28.20.989 040 - 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
O - PETERSEN, MATTHEW D & NICOLE C
MATTHEW D & NICOLE C PETERSEN
240 GLEN CIR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 240 GLEN CIR
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.700 Plat: 2495-ST CROIX HIGHLANDS
SEC 25 T28N R20W NE SW LOT 4 OF ST CROIX Block/Condo Bldg: LOT 04
HIGHLANDS
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-28N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/04/1999 611433 1460/536 WD
07/23/1997 885/126
07/23/1997 728/413
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.700 53,000 152,300 205,300 NO
Totals for 2007:
General Property 2.700 53,000 152,300 205,300
Woodland 0.000 0 0
Totals for 2006:
General Property 2.700 53,000 152,300 205,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 222
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00