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Parcel 040-1186-20-000 12/15/2005 08:14 AM
PAGE 1 OF 1
Alt. Parcel 36.28.19.776.777 040 - 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 - STENEMAN, RUTH V
RUTH V STENEMAN
98 E WOODRIDGE DR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 98 W WOODRIDGE DR
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 0.918 Plat: 2237-OAK RIDGE ACRES
SEC 36 T28N R19W NW NW LOTS 23 & 24 OAK Block/Condo Bldg: LOT 23
RIDGE ACS AND COM NE COR LOT 23 N 89 DEG
W75 FT S 200 FT S 89 DEG E 75 FT TO SW Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
COR LOT 24 N 200 FT TO POB INCLUDES 36-28N-19W
P565E
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 871/498
07/23/1997 861/276
07/23/1997 689/395
2005 SUMMARY Bill Fair Market Value: Assessed with:
103470 355,300
Valuations: Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.918 74,200 267,800 342,000 NO
Totals for 2005:
General Property 0.918 74,200 267,800 342,000
Woodland 0.000 0 0
Totals for 2004:
General Property 0.918 74,200 267,800 342,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 137
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP SEC. -T ;N-R W
ADDRESS PIERCE COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H63
SHOW WITHIN 100 FEET OF SYSTEM
1
I
i
/
j
s,
:LT-
I di a e o~thl Arrow
SC LE:
BENCHMARK: (Permanent reference Point) Describe:
Elevation of vertical reference point: Slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings on cover : Tank manhole cover elevation:)-
Tank Inlet Elevation: Tank Outlet Elevation:
PUMP CHAMBER
Manufacturer: Number of gallons
Number of gal. pump set or a cyc e gallons; total capacity o
distribution lines gallon:. size of pump head;
gallon per minute horsepower ran name of pump
and model number ;
Type of warning device
HOLDING TANK: Manufacturer Number of gallons
Elevation of manhole cover
Type of warning device _
SEEPAGE PIT SIZE: , um er o pits feet diameter
feet liquid dept seepage pit in e ipe-elevation
bottom of seepage pit elevation feet.
SEEPAGE BED SIZE: number of lines width length tile depth
SEEPAGE TRENCH: width length
PERCOLATION RATE AREA REQUIRED KR-EA AS BUILT
HEADER LINE ELEVATION DIST. PIPE ELEV. INLET ELEV. END
DATED PLUMBER ON JOB
LICENSE NUMBER
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR at HU11i RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
XX CONVENTIONAL ❑ ALTERNATIVE State Plan I ,D Number
~ (If assigned)
E:1 Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER'. INSPECTION ATE.
Round Steneman Hwy 65 N., RiveA FaM , W1 9-64# l/R3p SQL
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
NW NW, See.36, T28N-R19W, Lat6 23 9 24,Oak Ridge Aetc.en,Tvwn a6 Ttoy
Name of Plumber. MP/MPRSW N... C- my Sanitary Permit Number_
Eugene Gnvve 5569 St. C)Loix 49453
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. / LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
,./.ago /0-0 L} ❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA VENT MAT L. HIQH WATER NUMBER OF ROAD: IL ROPERTY_ L LBUILDINGVENT TO FRESH
ALARM FEET FROM I JAIR INLET
❑YES NO 1 ❑YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER J BE DUING. LIQUID CAPACITY PUMP MODEL jP11MP,SIPHON WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED'.
C ❑YES NO ~ ~❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: 1PUM P AND CONTROLS OPERATIONAL. F PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing - 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:
WIDTH. LENG TH NO. OF DISTR. PIPE SPACING COVER JINSIDE DIA SPITS LIQUID
BED/TRENCH TRENCHES /T MAr~rt*ALL, PIT - - DEPTH
DIMENSIONS Z CO /
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
.
BELOW PIPES- ABO E COV R 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.
❑YES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL SODDED SEEDED. MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISFF3IBUTION PIPE MATERIAL & MARKING.
ELEV.. ELEV. DIA. ELEV.. PIPES. DIA.'.
ELEVATION AND
DISTRIBUI ION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL pLA NSCAL LIFT CORRESPONDS TO APPROVED
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: 7NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
❑YES ❑NO ❑YES ❑NO NEAREST
717
'1 n
/ 1J S
c In g3
Sketch System on 'cj, Retain in county file fgrlI
Reverse Side. I .
`1~ ~ ,{^yyv SIGNATURE. TITLE
DILHR SBD 6710 (R. 01/82) J jjjy/ J1► ~jy
I
7InDU-7m consln APPLICA TION FOR SANITARY PERMIT
®I L H R t+-1 COUNTY
(PLB 67) UNIFORM SANITARY PERMIT #
S1RV,LRBOR&HumRn RELRTIOnS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER [1 MAULING ADDRRESS _z
.f7 ; 91 t
/V A
PROPERTY LOCATION e1-T-Y:
E
11 /4'k'~14, S T"/t. N, R E (or W~ VILLAS'i
TOWN OF:i/o?
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
Af Al
TYPE OF BUILDING OR USE SERVED
f 1 or 2 Family Number of Bedrooms. 15 Public (Specify):
THIS PERMIT IS FOR A:
LIT 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.
lk 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 f),Fi j ✓
Lift Pump Tank/Siphon Chamber /
Holding Tank capacity
Manufacturer:
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):
IJ Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the i to sewage system shown on the attached plans.
Name of Plumber (Print). Signature: MP/MPRSW No.: Phone Number:
Plumber's Address: _ Name of Designer:
COUNTY/ DEPARTMENT USE ONLY
Signa u e of Issuing Agent: Fee: Date: ❑ Disapproved
Qr1 / El Owner Given Initial
"7 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
f
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 T C 100
Owner of Property_ /V,/-71 9'A
Location of rProperty &jQ `4_,y(~ Section 1V~, ,1'_,W_N R_I~IW
Township-._. (1%'' - - . -
Mailing Address
-Af
T--
Subdivision Name l ~w
Lot Number
r7
Previous Owner of Property_ S(
Total Size of Parcel '
- ~ f i X
Date Parcel Was Created
Are all corners identifiable? Yes No
Include with this application one of the following:
.Certified Survey Map
VID e e d
.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 deed recorded in the Office of the
County Register of Deeds as Document No. 9.- and that I (we)
pre- ty own the proposed site for the sewage disposal system (or I (we) have
obt,imed an easement, to run with the above described
property, for the
construction of said system, and the same has been duly recorded in the Office
of the County Register of
Deeds, as Document No.
SIGNATURE OF OWNER '
SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
DArE Sl ~tt U
r~
U
L-:
S T C - 105 r
y
H
SKI'T I C TANK MA I N'1'ENANCE. ACh I-:FMI?N'1'
C)
5l . CCU IX Coullt y
u
0 W N 1? k / 1111 Y 1S l: _ ~~E! h-~' J~ls►l!~-r~~~/~~ _ rn
ROUTE/BOX NUMBER - Fire Number
C1'1'Y/:;'fA'I'1j_u L11'
YR0PERTY 1,0CA`1'10 N: Y 7 14> t4 Suction L N, 1t W,
Town of SC Ce'u}x CounLY,
Subdivision__.__DAY ~ Do, F- LoL number23+24.
Improper use -,and utainlenance of your Sopti-c Systeut could result in
its premature failure Co handle wastes. Proper uutiutenauce cun -
sists of pumping out the Septic tank every three years or sooner-,
if [seeded, by a licensed s- t•plic t ank j-ulitper. What you pttt into
Cite SyStent can affect the tuncCion of the Septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County I S i d C nts uuty be eligibl -e t o receive a grant Cur
a Ilia xiIll it Ill of 60"/„ of the cost of repl.acemunt of a failing systelit ,
which was in operaLioit prior to July 1, 1978. St. Croix County
accepted this program i-u Au1;uSt 01' 1980, with the reyuiremunt that
owners of all new systems agree to keep their systems properly
maintained.
The 1>rol)e rty owner agrew Lo subutit to St. Croix County "Lon -fng a
certification brut, signed by the owner and by a masLcr plumber,
journeyman plumber, restricted plit Ili ber or a licensed pit lit per verf-
tying C has (l) the ort - site w astewater disposal- sysleIli is in proper
operating conditlon and (2) after inspection and pumping, (ff tlec-
essary), ttie septic tank fs less than i_/3 full of slu(ige and scum.
Certification form will be sent approximately 30 days prior to
three year ex1tfralfon.
0
ti
OWE, the undersigned, have rr_ad the above reyuirewents and agree U)
x
to maintain the private sewage disposal system in accordance with
r-+
the standards set forth, hcrei-n, as set by the Wisconsin Depart- n
ment of Natural kN_S0UFCes. Cet L it icat ion Iorill, must: be completed
and returned to the St. Croix County Zoning Olfice w-LOI iu 30 days
of the three: year expiration dale.
DAT L:
St. Croix Courtly •l.oniug i)1I i(e
Y.O. Box 9ij
11 anunoad, Wl 5401.5
71.5-796-2239 or 115-425-8363
Sign, (late and return to ;ihovu ,tddrur;s
DWARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969
HUMAN RELATIONS
` (H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/M-IJ*fCfFA4t4-TY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
1/ 1/ /T N/R E (orl - x ;
COUNTY: OWNER'S/B-EIYER'S NAME: MAILING ADDRESS:
USE DATES OBSERVATIONS MADE
NOi BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
❑Residence a ❑rNew ❑Replace I - _ a .
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®S EIU EIS~U QS DU DSZU DSEU
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: F~.• Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-hS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHtBt, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
!
1 ~'h
71
B- J:
yy
y
B-
PERCOLATION TESTS
ETEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
I~+IES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH
bb~ JJ S~%b i
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. J, j SYSTEM ELEVATION
l„ Nth ~ G
• ; 'fir _ CSI l1fJ ,1 l? E Q*
ELI-
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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) e TESTS WERE COMPLETED ON:
fl PHONE NUMBER (optional):
ADDRESS: ^ PRTIFICATION NUMBER:
ty
0H1#S T SIGNATURE:
Offl i
DISTRIBUTION: Original and one copy to Local Authority, Property Own y
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