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HomeMy WebLinkAbout028-1037-70-000 t7 ~1 o m o 0 3 N, M o _ v 'O CD : N (D 3 - Z' = 0 N O O N O ~ 7 w N~ py rvl (aD (D N C.J c- S O ►~"h O 0 3 7 , N p o :0 co -1 10 6 CL o w * ~ v~ 7 o p CD o F S .y tC7` CI) o N n a D 03 CD Ic O m m co z c0 n r cn 00 0 Cz~ v_ 'cab o "a T"a o nr 'I A c'-F ~ Z~ I o v o o 0 N o `i c,~ H a cn cn to 44, Q v M m CD < CD y M CD w 03 Cz) J'I p t~ y co 0 Al :r cs. cn (D D N ~CD fn _ w CD N C ' O N C CD CD OCl - a 3 j N CD --j z CL A ~ o z ~ ~ 7C) V Z -1 N m " W rn W -0 z G`► 0 3 z c CD N 1' V W 0 CL CD CL N p Q C 7 n CD < CD 0 T CL 7 N C 7 v 7 a 7oa o o_ r a ~ m m o 0 o am ~ Q o' o 73 CO m b o0D N a CD o N CD Q o ~ ~ C III N O I 2 zz H 7 A N O o b ~ A ta+ CD i ?o w O ti 00 a O CD PLEASANT VALLEY-RUSH RIVER T.28N7R.17W 19 607N I I SEE I PAGE 3/ AVE. Fr ed/lcfi b 0 w~~ ~ a d ~ ~2~ J sse £ • A l ~ U.Y/a9a ~ o Emi/U o oA " .C yVi w/cax Q Chas/e°e N v.9/i • m Baid C~ ~ jd~ m ~o q v ~a-v wv C~ r!~ian T qua n v /o/m A//es z7 N .h/q~/s1 7e • Ha/icon a b r.V~ h u5 v i n C v ~C y r cox.Cc _J Go c.~ Metes./fso Qa os Hansen Y 3 X96 E y s die /49. 9i F` a tv C `C a ~\n • ` 2,39. °,ye A~ ~ W v w o~ /q o.a~ Uohn ~ r~ B/ee efi/J// 1/875 /x9 47 7 McLa yh/o v ~Q Los~a~°e- - F Z/c_ <Tohn /ye s~ V Cfi /s/Jm7son 0. 9,Q 511 o- 19 /220/ •5 TN AVE 738a _ /dR s7 (t f/c~- 1an Da/o was l tl C I s Tfiocniosd/ /2/ a d• o s//4 C 4 v Fa/ a a C a o°dd / L e~ a v o /fetes/6-6 v~ u o a v.C a o o /iz. s➢ v ~6. 11~ err'O>i 'Cn eas/ /7f,P aCiy ~o~ Mh G /e C\~ vvx Peabody 7B z¢ z .so ~W~ is Jan~e,s- E- • l C h C a CC .Y `Cb fZRy h q Wa1149 ° e.>© ~c,F o9 so ~ o Na w v ~ o ~,Co f r/a /ye e O/scv7 lj B-oz sor Cl~ • ~S.o~ Tafn go V AVE. F Lad/e o c N G✓a✓~ f de Lend C/a/epee heyh s w~ R"` v g~ c 5/his %s /s9 .Uo/za /d n-> ;bh J f~l~so~ son „ 3~,en Ea// a ary U ~Symas ee~e H i/ ~ cSchu1149 o. y. 7s 4o ao • ae Hueriin.E 4r~ tiW ,SSZ m, Snc cScha1149 a~,o f3so s- Mac/ - G✓.P°na/d • //eon°~ H < ~°au/~ z¢ Vie if G ~M~, / /vo ~O /6o s O/san f /,3a.>n!e Tos e/son, ~/a.zde beg 6asa f//an s Zw¢/d✓ ~3o s 3 /`7 E Ti BO 60 bef9 7e 2/948 eTea n.~a fey -Da y/ s • E Owens 299 d¢h Lusena f Fa:gym onr ~-7/en iS. C d /.ss Z; ~ ~ o~ ~ %/e 77 78 f3ahnse° /~fohn 0 C /6o h ° F / e fOU~EE RO. Sri/~ 4a Farm s, Ins.y ~0 o w ` v hR° 11~/,, cc to ~y .Bom /a° /SS v~ C 40 0 ~ ~ 4~ 0 b V `C Otiens 0 3Snc. /s8 7s ~'C n „ s _ W 80 • C 3 0 tl~ ei. Ti~bm ~ 60 76.17 -o Ba ao • %h~¢~i La°.¢ J V` ~p ti` i j ..o N s ✓r7e e sh S N E N \ • o eds` o box Ah~ ~ y~~ ~v • Av~ `~i~o h ~/adv A ~sa°;e ~ ti ~ d m \ C W d o o r@ w C h !-✓./iaT ~ by h~ v °i ~ ' Newton z,~zd / f>o< .son isz.~4- v bt o e.Da /ane s 7- A ~ ~N l3 d ~ ~Co oob~ •<5t~ye/ \~o ~~0 /6° Y W (ay L • 1' \ oo I\ (~'J, twb~ Iy~ /GO V2~ QI, 238 3~ Find- //6 \ /60 `l 0Cl~ /zo ,y • ~ 35 TN AVE. ~V h 49/¢/ ~ F .cmanr Mss ¢ _/e /e Y ao y z v La.ldQai>k sms, r a / » tl h Li FEie¢n° of ~Sf/-eau/ C ~ 0 /°o /20 _ l S ~ G./ebe/- .P/o.Sa d Kam n W F7 0'¢ D Tnc. r y o ` < .Syo/fi \ Cl Q _ _ f ~TOan Smif/~ U f W Go 6a /SO A Ud W//am f 0'Cy - G✓¢/Lan N Q G/enM /da~ba~- . Coyds s p~~ /ao hss zoo ~ es /y C O GUiese l'asey ✓-a,~ne V0 » N /seas ~'su W 9 TN 1~ zo • • ~o ~ acob • 78° s ' • q5 Q /rich ~ZJoc - 0 • •b _ < m 4 o C- n ~ ~C0.hsa/7 W °J h 'd /~l/c~i neR ~10~ hear/e /s /i9 8o.i Jo.~-De-Farm ~ C 7~O cJChu1149 ? 61 0 L2' on Fai/many Lac. 234,18 ~ V ~ 3 Bo ~ ~ _ ~ Farm s, Srrc STN wvH 0~ /ss Cp • / /4s UfNo /s99 ~o ' AVE. ~ w c o • ~ ~ v h o /asence~ C v@ o~ 6i Fen C He/en \ a Euga~e • Law°ence b~° ' /-/owa/d 'cx/7f UQCOfzson /2O ~e gh~ o d c 4Ma_ume Li// a A z~~ane v~afrns°n V ,Bak Ile ,P s - E 4 x /ae/%z Lya¢ J h r a • /ioo of ~o - H 1zs'en ie -s°~ C ~ v ~ hnson 40 tau/e~5' a ob (hn New. ann `s°" Go.-don F.3¢kk_ AVE. /6o et~x l h /ba p~ y 7 ¢O o ¢ cTamas ho/ta R Nahe, nde Le°n + • o'v Tiro a/ /ntTof>n - - ~o ssa ~ eobo ~ etC1/ We//s m arae v yj ti P sa s o o "h TN /oo n i 9 - • 40 "L 40 ~O -so h%n` j eo C ' ~s P 79 B S / ~ 7r7E- v Lowe// o - l • Ms / - eT -j _ < D~/Q v d e a v Dun/i fapPe//noo 00 0 :W~.C ono/< d _ c f /y Cfia es•~T L¢.9P.- FQ /'/11S - VCI~n~ ~ h :'.1~h~ 40 / S q /C . je.> 40 /63 i/ f x Inc. /20 ~ C~ ~ ~ Cn .~S 235 C 4 3 v ~ • ~'o~~~~ 4951 ~l ev n d . s ci/a / 7tia y .ryc /an N 280.06 V l F. a /z° t C ~W L • /o GB g~ C/a ~e~~c'e° 40 H/.'1/° C'/a;~- o ° cS~•enson o/a„ G/! B° /6o e79-S f tTohn rt - P v'cl~.y !✓a ~d ~ 0 b~ F5 ba a 26 ~/✓¢.r °o ,d C 4° /SO ( 8/8 cSu/B/i°v¢n st ~~sn C ~ V0 i / a~ Jacobson /hen on nod f ZO 07-H Bo 4o i/~e/Y E e/ cs u o Th<11 Ke// S o Bona/d w o ~c, - /la / E. ,y ,e en 9 n°/d fr> y,~ o Fay/n rocwb Fe,~s -v f • y C Pech¢ce% 7B.7z en Fi sasr~¢ ,eJ - T - Y x .49TH ,s JC h des 'S G~zf Gy cs' "so o z° v.C zoo • h:i/ye b /zo S 76 7.~ \3yh ~/s is/dam _-O no ee/i /zo v M 6 Q e tox 'crn~,° •c. 0 v 71a /s so y Moa bEer/ R G✓i//acd f Macie• ti y ~eya p - He°~£ • oEf p ~C -/sa ia° _ Via.- y Char/e,sS Off o k o.1 ~J /ooa Nanc y C • v fKa en mac iC¢inc YY • ¢ \ A l/T! L AVE. -Danie/ on ~,Co r/1495 ass o h To~.St qo ; c o o C NTERV I E w,62' I er W ~zs.6/ a ira.,e l C Lo f C'a i E ti\ o d p F//an e- chi ~d ern go c5ly_ son d 0 iP h /zo h C Jf'a nne •F7 e ~y 4i u/ 63 4v zO P:te.so., f k£6e~ ya ~J Uen -/zo Z~ Owens 5¢ ke Th°e¢ 4° .9 h~:. /9BSR c.Efo~d /`7ajo u6/s~I/c. ST CRO/X • q P/ERCE COUNTY ix C_ °~nfy o✓ s. PL EASiI NT VALLEY TWP. -}I BRUSH RIVER TWP. WANG & SONS Tom's Electric INSULATION Motor Service o DWIGHT ALWIN EXCAVATING CELLULOSE BLOWN MOTOR CLINIC Rural Route 2 ATTICS & SIDEWALLS (715) 698-2421 Baldwin, Wisconsin Brian Wang TOM VANDEBERG - Owner (715) 684-2517 (715) 772-3186 BACKHOE & CAT WORK Rural Route One 111 River Road East Fill • Gravel 0 Lime Rock • Black Dirt Spring Valley, Wisconsin Woodville, Wisconsin 54028 Parcel 028-1037-70-000 12/30/2005 10:27 AM PAGE 1 OF 1 Alt. Parcel 27.28.17.229 028 - 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 O - JACOBSON, LEE D & BETTY LEE D & BETTY JACOBSON 1850 CTY RD N BALDWIN WI 54002 Districts: SC = School SP = Spe l Property Address(es): Primary Type Dist # Description 1850 _QTY RD N SC 2422 ST CROIX CENTRAL SP 1700 WITC 47 " ~ A2/--t-,----- Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 27 T28N R17W NE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-28N-17W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1043/398 SD 07/23/1997 777/521 07/23/1997 768/554 07/23/1997 681/288 2005 SUMMARY Bill Fair Market Value: Assessed with: 82994 Use Value Assessment Valuations: Last Changed: 08/30/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 6,200 0 6,200 NO 05 UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 10,000 11,900 21,900 NO 10 Totals for 2005: General Property 40.000 16,300 11,900 28,200 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 10,500 11,900 22,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 JPLEASANT VALLEY- RUSH RIVER T• 28N7-R.1 7 W 19 Edwacd ✓ • n EE PAGE 3/ 1 HT- C • Lino l 11 % OR. ,F(~,~e,Eho •b 0 h\ xs.>i P h'ac y 0 y. 0 uo0`Z' W l %~a,l wy y r/cox hariere v Pieo ao 0 /oge° a . yQ,J,so~ E~ '~~q c5C C F~ X09 4o T Wayne M .c.ft v C vew C a i s.e ~Ba/o'w.n , 6 C>eo 9e 0 ~ W h C BO ~ d .SR oh/ _R 'r /49 9/ J) v \~~Q1 ~ ` 0~ % /d Looc,F • /Q~"~ ~ E.;d , e k a tl v a h na. ° o o f ~m r c. 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RUSH RIVER TIYP. 2812 MALL DRIVE OFFICE 717 MAIN STREET EAU CLAIRE, WISCONSIN ST MENOMONIE, WISCONSIN AABY "j FEDERAL SAVRJGS Business: 273-4945 113 True Value T-- - AND LOAN ASSOCIATION Residence: 273-4155 REALTOR' Hardware - - Car: 792-2732 .i,. DAR-RAY Realty© 319 EAST GRAND AVENUE Raymond Huppert Authorized PAINTS EAU CLAIRE, WISCONSIN Dealers 207 NORTH BRIDGE STREET 372 WEST MAIN STREET 332 West Main Street 698-2377 CHIPPEWA FALLS, WISCONSIN ELLSWORTH, WISCONSIN Ellsworth, Wisconsin 54011 Woodville mop, i MENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS R & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BOX 7969 BUREAU OF PLUMBING DISON~ WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number, (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER'. INSPECTION DATE Jahn Hinz Hammond, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV. NE NW, Section 27, T28N-R17W, Town o6 Rush Rivets Nan,e of Plumber. MP/MPRSW No Counry Sanitary Permit Number_ Everett Ba.2d 4489 S Cna~ x 54913 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED'. OYES ONO DYES ONO BEDDING. VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUIL DING. 1VENT TO FRESH ALARM LINE. (AIR INLET. FEET FROM DYES ONO DYES LINO NEAREST DOSING CHAMBER: MANUFACTURER JBEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL PLOCKING ROVIDED OVER PROVIDED OYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PHOPERTV WELL BUILDING IVENTTOFHE~,H LINE AIR INLET. (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) OYES NO NEAREST SOIL ABSORPTION SYSTEM. Check thesoil moisture at the de th of lowin EN(,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, constructions all cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH ~VWVIDTH LENGTH TRE~cHES DISTR PIPE SPACING COVER NSIDE DIA !__F1 lrs DEPTIo MATERIALDIMENSIONS GRAVEL DEPTH L EPTH DISTRPE DISTRPIPE DISTR. PIPE MATERIALNODISTR NUMBER OF POPERTY WELLILDING. VENT TO FRESH BELOW PIPES ABOVDE COVER. ELEV INLET ELEV. END. PIPES FEET FROM , LINE. AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WF LLS OYES ONO OYES ONO DEPTH OVER TRENCH FED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES'. DIMENSIONS ST. PIPE DISTRIBUTION PIPE MATERIAL & MARKING MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. JDI ELEV. ELEV. DIA.. ELEV.. PIPES. DIA.: ELEVATION AND DISTRIBUI ION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS OYES ONO DYES ONO COMMENTS: PERMANENT MARKERS'. JOBSERVATION WELLS: NUMBER OF ~PROPE RTV WELL: BUILDING. FEET FROM LINE OYES ONO OYES ONO NEAREST _ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE. DILHR SBD 6710 (R. 01/82) I Wisconsin APPLICATION FOR SANITARY PERMIT DILHR sf• CRO "X COUNTY / (PLB 67) UNIFORM SANITARY PERMIT # OEPRRTTT1EnT OF InOUSTP V, LRR0R ..UMRn RELRTIOnS Y 913 -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 MAIL~"r"je"dpjql DDRESS do d w N~ (.J A S PROPERTY LOCATION CITY: NE1/4Nld 1/4, S a .29 177 V o I~ uSN 1` IG 7,T , N, R E (or W OWN OF LOT NUMBER JBSUBDIVISION NAME 77TI-EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER Will INA /YA, /97 Ave. TYPE OF BUILDING OR USE SERVED A 1 or 2 Family Number of Bedrooms. 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair X Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. J 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 D G O Dove. Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 40eQe. Xs 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): ~J Ifl d 9~f /~T X Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for in al tion of the private sewage system shown on the attached plans. Name of Plumber (Print): nature: MP/MPRSW No.: Phone Number: Eve-ee,4-1- / oLdp P 4(49 (7/S-)65el-33-7 Plumber' ess: Name of Designer: Lc/ w i COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved /.Cj _~T~j/ ❑ Owner Given Initial A_ 1_a e,. t,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 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. - - - - - - - - - - - g- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~1 A/V !`I fA/ 7- Location of Property A,/=_'- t7 7 17 Township A" S~/ Mailing Address ~d Xo c2 Subdivision Name Lot Number Previous Owner of Property C6 eA 6e Total Size of Parcel ~,2D 4cg e S Date Parcel was Created Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number 9 q 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) eetut i 6 y that a.(X 6 tatement/s on this 6oAm ahe t Aue to the best obi my ( ouA ) knowtedge; that I (we) am (cute) the owneh (,s) oA the pAopeAty dacAi.bed in ,thin i.n6on.mati,on 4oAm, by viAtue o4 a wa4Aan,ty deed neconded in the O~6ice o6 the County Regis,tele o6 Deeds co Document No. o ?-1- ; and that I (we) pALnenVy own the proposed bite boA the Isewage dizposat /system (oA I (we) have obtained an easement, to Aun with the above d"cA bed pAopenty, 6oA the eon,stAuct%on o~ 5aid /system, and the (same hays been duty AeeoAded in the 046ice of the County Regii teA o4 Deede, a/s Document No. ) . ~aL -a SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED , H H y S T C - 105 r y y SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z r~ OWNER/BUYER do I-1, W "1V "nI ROUTE/BOX NUMBER i4f. ¢ Fire Number CITY/STATE Rmr VV C/ Z IP PROPERTY LOCATION: NE n„ .SW 4i Section.27 T N R 7 W Town of Rt>s'/V R,Ve'Q St. Croix County, Subdivision N Lot number • I 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, it needed, by a licensed sep is 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. _ 0 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- u 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 ,s ~J C./ DATE `1' E fca C St. Croix County Zoning Office P.O. 'Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. Iii NT OF REPORT ON SOIL BORINGS AND SAFETY AND PERCOLATION TESTS (115) MADISP. 0. BOX 7~169 ON, W153107 t'iJ^,AN RPLATIONS (H63.09(1) & Chapter 145.045) O AT ION ECTIO TOWNSHIPHVIUNfC-I4 -L-tT-Y: ~LOTNO.:BLK.NO.: SUBDIVISION NAME: - `1 - - - T N/R ME (A* (COUNTY: N S/BUYER'S NAME: MAILING ADDRESS: ^ (f J D ' .'_J N Z X 3II O \t-1 t~ v J!J ✓J ) . S 4~ i S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence ❑New Replace N/fl 6-18- £?y-19- y RATING: S= Site suitable for system U= Site unsuitable for system ANK: RECOMMENDED SYSTEM: (optional) C O [AS NVENT ❑ION C MOUND IN GROUNDS PRES'S-URE SYSTE(~M-IN-F-FII'LL HOLDINGF_ I.. V ~i- V J V ~J 1 V S ~v' Y S~ '°-IJ'JCTJ' JJh C g E: If Percolation Tests are NOT D ES IG N RAT eauired I if any uortion of the tested area is in the (under s.H63 09(5)(b)indicate. !v i ft Llooopl2ln, Ind tale Floodplain elevation 1 A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-lNk, E8 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH l (NUMBER DEPTHif ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Yr0-, 0 1.6 O.6 i~ l.0' y S`1 j~•jL+vl B b g` 90-3 t o.g' o.--I' COY a `j r, Sl ;y 2r~q _ C S' 9tl.p' Vv OT 61 1r 1 ' b 3n S)f ~r_ `S B •3` 53 c' rr,oT a Z, g' Ir 1.3' I ; z.o' 3r: cl 3' ~8 b' 7 .3' o•~' 2-Sr 4 i-a S-J_J ~t ~rrS) LB - 3.3' Lin ~r-0 1~ I45 ~B _ - i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER l AFTERSWELLING INTERVAL-MIN. PERIOD( PERIOD2 _PE_R10D3 PER INCH P_ y.3 ' r~ o o Z'%io f S 9' N t o 1 ; 10 1 P- .5 P_ ~E,.,c p ! 9~3 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 hon 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. J~.'Jl✓ h.93 c~~~I~VA, SI SYSTEM ELEVATION OF ~U'rn~3LE L L t 1S'. LXt rJG. I -U c. ~Q t•. i ~ I IS ~ .:,tzo ) r;` 1S 1So X90 ,N.oF B`0 ' { y IS 200 & lSo'M.cF 88 _S0,4 I.Ot 88 ,r C~ctST. S-PC._~-rvlt_.-l5 ov atiy wet Tv i i Lv C P ~ o ~J S'rc e?'c t' \~I ~ ~ uF V\~RV~L _ 4 I _ tJF!/lt/• NW'i~ 33 t SPI'aE !N r-1ett.?T?i ~ ~ F' ~ 0 1100 - 1 ' LL 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 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): ``T`~ dux =?e LLSwJ ? 1. Syo1J 570 `?1S-yZS-o16~ - CST SIGNATUR~ DISTRIBUTION: Ot imna' and one cnpV to Local Authority. Property Owner and Soil Tester. ir- Sb[_ ..3,~r; 02 'S2) - OVER - PACE OF C,rc~SSz~~l~I F144h Alr InLel► Ana Ubcervoilon pipe C -APPruved Venl Cap MlNmum i2" ADave Fin°I grade .0 42" Above Plpe 4" Cast Ifur, la Final Graae Vent Pipe Mores Hoy Or 5 nlMllc Caveilny 41n 2" Appre{)ale Over Pipe - UieulGunun Pipe 0 u u ° ° -Tee b" AQaregole soneolb Pipe ° Perfuralua Pipe b.". ° -'Cuupling Terminalir,y Ai bollum Of Syclem SOIL FILL GI;TKI(3UTIOVi PIPE APPRGVEU SIMI-•IETIC COVER 2"oFAGGRIEGATE r '*--MATER1/\1 oR 9" of sTaAw OR /MAE.SN NAy EW. of 93 / a~ vIOF;~ /z AGGREGATE. (40' -3 UI`iTRlf5'JT1,7IJ PIPE T(-) Ij(_ AT LEAST /O AK0 AT LEASTZO WCHE, BUT kin MORE THAl`I y2EWCHES BELOW FllfJAL C;RAGE MA MUM W rH OF EXCAVAT100 F'KOM MiiGwi u 6XADF- WILL BF- NUMIMUM ®EP rN OF FACAVATt ood Ffi nM C41t,11e I IJ C H E S • qL CaRAVE WILL BE Lh INCHES 5IGKIED: LIC E 1,J SE: AIUMBE i?: rn p ~`I d J DATE: oZ O ~c/ t ' {y a~ vi F ~ U f4 A f , tcA -P z tiff ~ Cry 4 4 3 g 01 4 3 7' 7-