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HomeMy WebLinkAbout022-1028-90-000 Q o °o. O o c o ~ ~ I p I O N N L' Q r ti I C 0 N N Z 0 0 0 c c m E LL r- _ .2 -0 M E Q U M U M CL N C C-D I ~ o Z O o p U z o CO d CD 4) H to 4J Z T o Cn 00 x x r' 4-4 w w o 0 Z y_ r N C: Z O V) H T T N Z 00 c E -2 3 N O _2 M cn H H Lr) N m 00 y a co (D 1 ~ N N crf O W M 1 N C • d cn r 4 I Ln Lr) I 0 co ~ Q Z co z 1 4-1 N z .:z (141 a) Cd N O. Y aCD Qj C Z cVl1 _ N H u o c a .n > Z O P- b -C M O N N fn fn N w It IT C) U 3: d Z z H co • a a a 3 r-I O IL 0 U) 1-- LO LO U) a) OD OD 4-J .0 0) 0) 0 - Z n a1 ❑^I o 0 !~j Y a co o (o 0 O O 70 E 1 W x Cn U co c d 2 v y y M W _ v d Q } cA C o `n 7i ~ v .w O O O N N O C) L) a) d ~ C l N-2 C V LL O V 0 co 00 C C co N c lI7 U U N N 'D Z d .D O F..a N N c w M c° E • C . y O Y LL CO O Z N 2 I- (n r \ ~ ~ r III' V CC C ! L: L • C CL `Iv E c I' c Q4 M A 00 a M O U-) V 12/18/2009 13:35 FAX ST. CROIX CO. CLERK z001 ;i: sk -k ;fi :k :k ;k ;k W :k :f::k ;k :k :k ;k :f: ~::k'k• :k TX REPORT TRANSMISSION OK TX/RX NO 0233 CONNECTION TEL 919207871418 CONNECTION 11) ST. TIME 12/18 13:34 USAGE T 00'32 PGS. SENT 2 RESULT OK Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A Ld. TOWNS111P SEC. T --2$_N-R_LLW ADDRESS ~eU S" ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~j LOT ~v LOT SIZE i D Yy I k S I , Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER r, { yt :~Z~A 6, 0 TOWNSHIP _ Zrz,' ~_J&SEC. T N-RW ADDRESS (`,zv y G S ST. CROIX COUNTY, WISCONSIN V SUBDIVISION LOT LOT SIZE D 6 ' 15.3 - - I a 9> I ' , ~ 12 mow r ~,~,.at f 9, u 3Y q 5'. ate' C I 3 BEN'C RK: Describe the vertical reference point used Elevation of vertical reference point: 7z;, j,,o•~~troposed slope at site: Q i'c SEPTIC TANK: Manufacturer: / k 4 ,,g1 & Liquid Capacity: / fjf)e) q tj Number of rings used: t- Tank manhole cover elevation: Tank Inlet Elevation: gr7s Tank Outlet Elevation: C' Number of feet from nearest Road: Front,O Side,(ErRear, O rj_gjW ; 7 S- /eet .From nearest property line Front, 0Side, 0Rear, 0 feet of feet from: well building: '-formation of the a ove plot plan)( 2 reference dimensions to septic tank) rra~rTn[+T.CTTI L' PUMP CHAMBER Manufacturer: Liquid Capac ty: Pump Model: Pump/S phon Manufactur r: Pump Size Elevation of let: Bottom of tank elevation: Pump off swi ch elevation: Ga r cycle: Alarm Manuf cturer: larm Swi ch Type: Number of feet from nea st property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: S / Length: S~ Number of Lines:.. t_ Area Built:500 77- Fill depth to top of pipe: Number of feet from nearest property line: Front, (D Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). f 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: Plumber on job: License Number: 3/84:mj i ~ ~ C.i,. N,~./1•„J J i-' ~ / -7 ~-~4'`: g.:~ /f.-~-.~---~ ''r '~i''/'~/ /4~ .'~~A ' ~ To hoc- m S w > j~ 46, A) ` L-~ ,Y all - ~ ~ f Lfeat7~-".• nom'' a ~ f5 0 ! i c.~ iy1 ~G~+G7~..' 51'7trs d ~/Vo , Scat ~ i metro."' . p ; 4 k j'-:s S`o I 4 IL ~ y IVF a-) Ti., 1 + l PPV Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER„ TOWNSHIPS SEC. T N-R~ W ADDRESS ST. CROIX COUNTY, WISCONSIN ~ T SUBDIVISION LOT LOT SIZE - 75- r s3 ' Apow l v% 7w 3x' s' r i I i t E- _13EN,CHM~ RK: Describe the vert~ica~ reference point used ~c /-i l /l i4~~J 1 ~4 P✓1 Elevation of vertical reference point: `'(,_.tiL,S~r icC,EA'roposed slope at site: %G is SEPTIC TANK: Manufacturer: !i~ r k! .,6,1,xje. , Liquid Capacity: Number of rings used: i , Tank manhole cover elevation: 91 ~.1 Tank Inlet Elevation:~ Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,(Z~Rear, O 7S- /feet From nearest property line Front, 0Side 10Rear, 0 feet of feet from: well ly building: _ -Formation of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE a PUMP CHAMBER Manufacturer: Liquid Capac ty: Pump Model: Pump/S phon Manufactur r: Pump Size Elevation of let: Bottom of tank elevation: Pump off swi ch elevation: Ga r cycle: Alarm Manuf cturer: larm Swi ch Type: Number of feet from nea st property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: L Width: Lenith: f~ Number of Lines:. Area Built:, Fill depth to top of pipe: Number of feet from nearest property line: Front, ;f Side, O Rear O Ft. Number of feet from well: d j' 3 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj 'DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RE'_ATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE statePlan LpNumber . * ❑ Holding Tank O In-Ground Pressure ❑ Mound nfa 9 ~I DAME OF PERMIT HOLDER. 11 ADDRESS OF PERMIT HOLDER Reuben Fritsche ~ INSPECTION DATE BENCH MARK (Permanent re term ce points Hwy 65, Roberts, WI DESCRIBE IF DIFFERENT FROM PLAN. I SW NW, Section 10, T28N-R18W, Town of Kinnickinnic REF. PT. ELEV. [~lREF pT ELEV MP/MPRSW No. Henry Nechville san,ta,Y Perm„ Number. 3258 St. Croix 64902 'SEPTIC TANK/HOLDING TANK: '.MANUFACTURER LIQUID CAPACITY TANK INLET ELEV TANK OUTLET ELEV WARNING LABEL V D . LOCKIN CO PR aEppING ~ ~ J ❑ i VENT DIA.. VENT! MATL- HIGH WATER WELL NO BulLDING. V,SEN ONO FRESH ❑YES ❑NO ALARM FEET NUMBER FROM F RPROPERTY YES ( 11 / LINE. AIR~1 N{E ❑i~ S ~❑NONEAREST DOSING CHAMBER: (MANUFACTURER BEDDING LIQUID CA PACITV + PUMP rNPUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED PROVIDED GALLONS PER CYCLE: MPa D, oNrao s pERgnoNAL ❑YES ❑NO ❑YES ❑NO 1(DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING (VENT TO FRESH PUMP ON AND OFF) ' FEET FROM LINE AIR INLET SOIL ABSORPTION SYSTEM. Check thesoil mo tureatth~epEh m plowing NO NEAREST 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 SYSTEM: BED/TRENCH WIDTH LENGTH NO. OF DISTR. PIPE SPACING COVER DIMENSIONS TRENCHES r. MAT j?IgL INSIDE DIA -PITS LIQUID .J. , PIT DEPTH. GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE w DISIH. PIPE MATERIAL. IN STR, BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END NUMBER OF PROPERTY WELL. BUILD( NG. VENTTO FRESHI I(.y' i PIPES FEET FROM LINE + r - ^ AIR INLET: NEAREST-,I 7 : J) / i MOUND SYSTEM: , S Mound site plowed perpendicular to slope and furrows thrown upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS . OBSEH NATION WELLS DEPTH OVER TRENCH; BED DEPTH OVER TRENCH BED ❑YES ❑NO ❑YES ❑NO CENTER EDGES. DEPTH OF TOPSOIL SODDED SEEDED MULCHED ❑YES ❑NO ❑YES ONO ❑YES ❑NO i PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LEND TH OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES: FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV ELEV DIA ELEV. PIPES DIA [DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. COMMENTS: PERMANENT MAR--OYES ONO _ 71 YES ❑NO OBSERVATION WELLS: (NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE I ❑ YES ❑ NO ❑ YES ❑ NO NEAREST l' 7L Sketch System on Reverse Side. in county file for audit. SIGNATU TITLE: ~ J ILHR SBD 6710 (R. 01/82) r wisconsin APPLICATION FOR SANITARY PERMIT COUNTY L R 1t.OEPgRTTEnTOF (PLB 67) InOUSTgY,LIBOR 6HUTgn RELRTIOnS UNIFOOR/MyL7SSA(/JNNIII TT'ARYY P/ RMIT # lL J / / V~ I -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CIT : E (or)',W VILLAGE: LOT IyI)MSER BLOCK ,Nt~MBER SUBDI1~510 NAME AREST OAT~ LAKE OR LANDMARK I STATE PL/ N,I.D. NUMBER j tff, 3 f ) Ifs TYPE OF BUILDING OR USE SERVED L•7 1 or 2 Family Number of Bedrooms. ❑ Public (Specify):'r THIS PERMIT IS FOR A: ❑ New System ` Yank Replacement ❑ Repair ?'Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Q 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber n. ' Holding Tank capacity 7 r1F nufacturer: TH IS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: L "Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. -7 Name of Plumber (PrintSignature: "MPRSW No.: Phone Number: t~ Plumber's Address:; 1 2NameffDessigner: j COUNTY/DEPARTMENT USE ONLY Signaturg of Issuing Agent: Fee: Date: 4 ~ ❑ Disapproved ❑ Owner Given Initial A 1 4Approved Reason for Disapproval: r F Adverse Determination 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. Form - S `1' C 100 Owner of Property J .Location of Property-•-K-~-~ ,;,jij/ 4. Section 0 T ;S N R ~a W Township' f Mailing Address /Qt - ~ 7/ Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel o Date Parcel Was Created /r 1 3 Are all corners identifiable? Yes No Include with this application one of the followin : .Certified Survey Map .Deed .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty de reco ded in the Office of the County Register of Deeds as Document No. lol:V ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been Ouly recorded in the Office of the County Register of Deeds, as Document No.LLI~ ) SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 47 DATE SIGNED DATE SIGNED H Cn H a S T C - 105 r" r a H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d OWNER/BUYER -t.i~-C~ nn rn ROUTE/BOX NUMBER - / Fire Number s J CITY/STATE j ~tr(t,, ~t « ZIP 3 PROPERTY LOCATION:, 14, Section T N, R W, Town of z ~t St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- i sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank What you put into pumper. ! 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. ti 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ~ I DATE / l.r St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-223S) or 715-425-8363 Sign, date and return to above address. v r y S y C L v 1D vw =r w~c ~O N CCD (D J- (D n ° ° 3 D ? SW' ° K ~o c0w o -0 C :-T lD 'O a (D CD - p ~ x m° CD ~..cn g i CL 00 0 (D U) co = ID ° v ~w N A O lD (D Co O , a O c° w O O w O S O = O W W I C o S. Q' m a O w CD o ~ ~wCD O a ~(D co 70 D m A, CD C: a m(nc vii' °vo~. O n ° D C i' N cn ~ w ° o - a M ° ^.CCDD(a ° aa- w O pp p W fn Vm cn-,w .~mW5D Z N ~l w 0 cQ' D a " CD ° _Z CL CD 0 3 N O O m 3 S a ~ca 0w~os' =r m w a o acn~N~ N 'D v n'Nww C m ► CD C~ o Q CD OL 0 CCD 0? M m ti 3.CD n C) OL a:) CD ° NM m o 0 a:)_ a G N p~ O CD n N N CL 0 f 0 C C a w o R1 CL CL CD aaa - ' w L7 y, ° O 3' f = a,' cc w m 0 3 v, aoj occa 0c-1 o c 0 CD a a o w (D -I CD C (D m CL w +n OL C3 o~cDOO° w a3 am ° € CD o z 0 RL?~DYSTENTOF SAFETY & BUILDINGS L)' IP ST M ME REPORT ON SOIL BORINGS AND LABOR AND HUMAN RELATIONS (115) PERCOLATION TESTS DIVISION P.O. BOX 7969 (H63.090) & Chapter 145.045) MADISON, WI 53707 LOCATION: SECTION: TOWNSHIP /o /T SIN LOT NO.: BILK. NO.: SUBDIVISION NAME: /R ~ (o MAI/. COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: US~oi ~PEU//3E,v 5CX_ f/~vy. S- NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE [?~Resiclence : PROFILE DESCRIPTIONS: PERCOLATION TESTS /V ❑New Replace e~/ /,f~ ~~4s 2 F s =mss 7Y OA) S%TF UfiPifc~fTio V ort Soil SviTi►/j.%~ RATING: S= Site suitable for system U= Site unsuitable for system O,,- 13 ,3 lel nNVENTIONAL: MOUND: IN-GROUNPESURESYSTEM-IN-FILHOLDINGTANK: RECOMND ED~S~M:(oonal) ❑U ©S ❑U ZS ❑U ❑S L11U ❑S U 7-A° -1v44 PS w ,Ped/o S' /Yd~ If Percolation Tests are NOT required DESIGN RATE: under s.H63.09(5)(b), indicate: G'L,~ss If any portion of in s the tested area is the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS I,J ~£ciML ~f, C BORING TOTAL DEPTH TO GROUNDWATER- HAR ACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) B i~f v ~cr.P S . w Aa NX100 W / ",8,r vo s /~.J / /S , Z B 2 ~v Sy /~-0' •607 .2.oP'ido. /o.lti J. '74V O CJ / Jp N Q V J O ~J C~ JIV Sd''A~~r`,e~wtiv6- 7ti~:~ y RANDS o~ y x B 144 3 W- 74a f&4 S ~ foc0 r 4-Z4 7 7--W-1,-1r,0%,, n r B 7o e ./0 /.p' him D a. i o G o, C C'6At /ail M w D" S l%d cT- Z'1 ZY Y_ 15 B- Uol Q /3 o,P. k 67's 4 r 3. 01.0 ' 14 v~y ?rc.: o ho rY/-s~ ~G sus -t~ N PERCOLATION TESTS o NUMBER IDNE T AFTER SWELLNG IN HOI E INTERVAL MIN. DROP IN WATER LEVEL-INCHES Z' PERIOD 1 RATE MINUTES PERIOD2 PERIOD3 PER INCH P_ 0 P- P- L 3 P- ~yttr- 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 II borings and the direc i nd percent of land slope. TildEti ui oZ~p ~~OF ~Q3~ Gj 1 7 SYSTEM ELEVATION Z&W ,TOPE-uc-A- = PO -r. aM-~U T iPfF ~T, . ToP i x ~o ~ --T P, , s C 61,EP 7-100 = /op, 10 ¢ ~3 /Xv fTivN o • _ i' : F )90/70,14 O'f C•9-• SHooT 6AcKPi TS Go Q ~ ovI~Rff' l l tN _ y - - a M • e~xiSTiay 6XfS7. w wE~J h SEOTi G ,eVVV1;V OA/ Svit`ilc~ f _ P-2ivF w.11 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): ~oQF~T ~G~/Pi,C y/_ TESTS WERE COMPLETED ON: ADDRESS: ZS r i D NE%L J~~ ~(J~sj~~~ (J/s f CEFj~ICATION N MBER: PHONE NUMBER (optional): S7T of ~L 3P -N .2 7 W64ef ,fa (NI~E K Y/ LOU~j- (v IOW ~UGL CSSIGNATU (tai DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 3 t, .Lt, art£i ar, N1 t i ,6'c£aLL c t o .FzSC> ar' e r 1 i t r _ I t ~4'' at I a > ` 0, } d 3.. a` S} t a c t } Y if AA ? L L) c 6 i s . t. c .?.,tes ' t o a3l4. 3t3 the plot p f it tr a„F A LEC'I 1 filr'lf~t'33.1 a=,cu.aF.-d iz~a.si;4.aa~ you< 4 ,at to al,,o t5. D a"whn, to Scale is, pI,""'L.t.oo ~ tai£ aE~V aa~ Lt:££' tie= a!{ri r r L)a.tr be C n t < t. t# ` LI E3 I€. t 1 € E P1C 7!t -71 a Cl arl al Sot lt,£ 1, di) -d are, pet roan, J£r,t. t+ all clppIop fate [-oxes as to ~c34t,S, El:rnes, uildres~ez, flood latri da°at,Is pelcol ation "est t pt`C p!alfr n T _ rj lt,nwj plain k r aE LEt l '-i s the appropi Slone 10-~ RR F haws i= v , I'S - J ,3 VV ~,A pe, C' 1 e5 S, , ty' ' L pt (p ~E-£ } 3 ~,xat phe 3. p t 1 , t i he n, z- t>?{ua 0 U _3aC2? J ~o t Parcel 022-1028-90-000 01/25/2007 10:27 AM PAGE 1 OF 1 Alt. Parcel 10.28.18.151 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner MARVIN J JOHNSON O - JOHNSON, MARVIN J 457 HWY 65 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 457 HWY 65 SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 10 T28N R18W SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 839/330 2006 SUMMARY Bill Fair Market Value: Assessed with: 178812 Use Value Assessment Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 3,500 0 3,500 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 16,000 73,100 89,100 NO Totals for 2006: General Property 40.000 19,600 73,100 92,700 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 19,600 73,100 92,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 314 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 r- r y.. x^Lr_ ~i -71 r .i