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HomeMy WebLinkAbout040-1053-30-000 n cn p 3 v n d _1 o f c o v v ~ m i0 ~ A cn = v z ~ z CD h CCDD O (D O W C K N O ICI O CYl s d. Q z N N CO O M D) N W ? W N 11 O O = ((DD 0 O co O O cn 3 ! O 7 N N O ID = y a CD Us Z (n (o CD O N a W c c ` 3 m °m 1~v n N OD 0 r i m OD -n M 'D "WA o O O O r 0 a N Uri a o D `may m < I~ o O. to p ~ m w (o co (D Q. 7 Z 'Y Z OJ Z O D CD O o. ID Cr) N N (D , (h1 c CDCD `t w ~ a d 3 5 (D f0 p p Z (D N 0 A Z O v n 0 W Cl) ~ w a z 0 3 3 z co N z o n 00 ° (0 0 N ~ T "O O C I O (D N 7 O R X Cq Q (D a m t N O O O a ~ A O W 71 (D p 0 ti O O i ~ 0cno 3v0 d m ~ m v y ID ° N l , co 3 2 N Z N Z I w C, H• j• 0) ° 01 C 0 O m m ° .91 m m 3 0 m w e < iv - CD N m o 1 j a fl z a A CD W 0 ° 10 C11 N N N Q d N M N F W 0 O O O -0 n 3 C m - o O O o O 00 C, Co (0 cnn m o - w C7 0 7 N N O 0 m ~ m u z < D a° FU) m ct:] ° N d m 0 Zo a) O O m j O O t ;u O W m ! n r to CD -4 -4 00 co co N ! O O O < r "NA c o vii cnn v ii a o D •O O 0 rv O D 6 ° N w f1l m (DD m F. , T. 70 -0 - 0 O m N C OD N z W z o D OL ~ O N cn m m N ~y CD nt N N 1 C m m CL 3 ° CD 1 fn O ~ A Z A :3 A z O a Cl) --i co N < N W < co Q z 3 a O y z CD A W 3:O Q CD ~ (D :E -0 C:) o o - 'p n M 7 -n m m - m c < m N z ° m •°o ° CD m ° N ~ co o a v a N A Q X V A m ~ d (D fi N a A N O N v0 CL N 0 O ° 1o 0 N o ' CD e All N o O v O CL i o C STO CROIX COUNTY .,_.t) ZONING PLANNING & February 19, 2009 Michael & Julie Burton 812 Glover Road River Falls, WI 54022 Re: Property located in Section 13 T28N R1 9W, Town of Troy, parcel # 13.28.19.198C, computer # 040-1053-30-000. Code Administrati Dear Mr. and Mrs. Burton: 715-386-4680} The purpose of this letter is to document my phone conversation with Mrs. Burton Land Information Planning with regards to animal units on the property referenced above. As discussed in our 715-386-4674 recent conversation, you are considering placing animal units on your property for the first time. You are considering purchasing a few goats and/or sheep and/or a Real Property cow. Because your property meets the 3 acres minimum and is not located within a 715„'796-4677 major subdivision, you are allowed to keep 1 animal unit (1,000 pounds) per acre of land suitable for animal waste utilization as stated in Section 17.12 (12)(c) in the St. Rycling Croix County Ordinance. I have enclosed a copy of this ordinance as well as part of _5-386-4675 NRCS 590 for your reference. After looking at an aerial photo of your property, it looks as if you easily have .5 to 1.5 acres available to pasture for animal units, with additional area likely, depending on how thick the trees are and how well grassed vegetation can be supported. With the informational sheets that I have enclosed, I believe that you will be able to make your own onsite determination as to an appropriate number of animal units to be placed on the property. However, please be warned that if this Department ever receives a complaint about exceeding the number of allowed animal units on the property referenced above, we will conduct an inspection accordingly. Feel free to contact me if you have any further questions. I can be reached at (715) 386-4683 (8:00 A.M. to 5:00 P.M. weekdays). Thank you for your cooperation. Respectfully, x Dan Sitz Zoning Technician Cc: Town of Troy File Enclosures: St. Croix County Zoning Ordinance, Section 17.12 (12) NRCS 590 - Nutrient Application Prohibitions Sr. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAx PZ@CO.SAINTCR01X.W1.US WWW.CO.SAINTCROIX.WWS . Parcel 040-1053-30-000 02/19/2009 11:13 AM PAGE 1 OF 1 Alt. Parcel 13.28.19.198C 040 - TOWN OF TROY Current X,! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - BURTON, MICHAEL ALLEN & JULIE A' MICHAEL ALLEN & JULIE A' BURTON 812 GLOVER RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 812 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.541 Plat: N/A-NOT AVAILABLE SEC 13 T28N R19W 5.541 AC IN SW NW LOT 1 Block/Condo Bldg: OF CSM VOL III PAGE 608 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/01/2006 826513 WD 07/01/2005 799182 2834/453 EZ-U 11 /25/2002 699951 2060/263 WD 09/28/2000 630765 1546/327 TI more... 2009 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.541 75,000 208,200 283,200 NO Totals for 2009: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Totals for 2008: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 y Parcel 0440-1053-30-000 07/24/2006 12:33 PM PAGE 1 OF 1 Alt. Parcel 13.28.19.198C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date ate Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SCHWINTEK, MICHAEL J & SANDRA K MICHAEL J & SANDRA K SCHWINTEK 812 GLOVER RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 812 GLOVER RD v, 34 0b SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH L ,~'AryLh d1~ Legal Description: Acres: 5.541 Plat: N/A-NOT AVAI LE O SEC 13 T28N R19W 5.541 AC IN SW NW LOT 1 , Block/Condo Bldg: G~UfiL- OF CSM VOL III PAGE 608 ORD Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 13-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/01/2005 799182 2834/453 EZ-U _ 1//225_/_20002 699951 2060/263 _ WD 9/2(Z 8/2000 60 _ TI 837 349785 576/553 Qua y1N ti~ 2006 SUMMARY Bill Fair Market Value: Assessed with. 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land j Improve Total State Reason RESIDENTIAL G1 5.541 75,000 208,200 283,200 NO Totals for 2006: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Totals for 2005: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1053-60-000 07/24/2006 12:33 PM PAGE 1 OF 1 Alt. Parcel 13.28.19.199B 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 - NEUMAN, ARTHUR E ARTHUR E NEUMAN 818 GLOVER RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 818 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 12.703 Plat: N/A-NOT AVAILABLE SEC 13 T28N R19W 12.703 AC IN S 1/2 NW Block/Condo Bldg: 1/4 LOT 3 OF CSM VOL III PAGE 608 (MD 890/570)1 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-19W Notes: ~I VD Parcel History: r ,1 Date Doc # Vol/Page Type 05/12/2005 794750 2801/385 EZ-U 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/28/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 57,500 128,500 186,000 NO AGRICULTURAL G4 7.900 1,580 0 1,580 NO UNDEVELOPED G5 1.800 4,450 0 4,450 NO Totals for 2006: General Property 12.700 63,530 128,500 192,030 Woodland 0.000 0 0 Totals for 2005: General Property 12.700 63,530 128,500 192,030 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 CERTIFIED SURVEY MAP DESCRTPTTON i~arcel o land located in the S-; of the NWl & the TJlJ4 of the SW-,', of Section 13, T 28 N, R 19 W, I o,;p of Troy, St. Croix County, Wisconsin, described as follows: Corrunencing a e corner' said Section 13; thence N 890 30' E (assumed bearing referenced to the West line of said NW 1/4 I -wring N 00, Ol' 50" W) 449.65' along the East - West 1/4 Section line of said Section 13; thence o 01-' 50" W 13.73' to the point of beginning; thence continuing N 00 01' 50" W 502.71'; thence ?-,Oo 52' 30" E 369.24'; thence North 427.80'; thence S 890 52' 30" E 1,035.10' to the Westerly r~t`ht-of-way line of present County Trunk Highway "U"; thence Southerly 133.34' along the Weste-P 1ght-of-way line of present County Trunk Highway "U" on an 879.93' radius curve concave Westerl ;~~ose chord bears S 60 14' 49" W 133.21'; thence S 790 24' 43" E 25.00' along said right-of-wa5- ne; thence Southerly 213.20' along said right-of-way line on a 904.93' radius curve concave „-sterly whose chord bears S 170 20' 15" W 21-2.71.'; thence S 240 05' 13" W 272.59' along said r -ht-of-way line; thence Southerly 356.61' along said right-of-way line on a 1195.92' radius concave Easterly whose chord bears S 150 32' 40" ?,T to said East - West 1/4 Section thence S 800 30' w 679.14' -al~n said IlrE; thence S 440 51' 19" W 37.46' to the Northerly r_ Tht-of-T%,ay line of Clover Road; thence Westerly 119.15' along a 238.00' radius curve concave oathrrly whose chord bears N 71+0 44' 28" W 117.91'; thence N 890 05' W 325.04' along said r_,ht-of-way line to the point of beginning. Subject to 1/2 of the mineral rights in the name of ~i,-ral Land Bank and also subject t ; an easement to St. Croix County Electric Cooperative. ?ames F. Rusch, registered Gisconsin land surveyor, do hereby certify that 1 have surveyed and 'c.r3;_)ped the above described property; that such plat is a true and correct representation of the ,-terior boundaries of the land surveyed; and that 1 have fully complied with the provisions of !'banter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of St. Croix County to the t ",Ft of my professional knowledge, understanding and belief. IVS _ Rusch NOTE: R denotes pr~r y rec °ta f s cousin Land S veyor 5-137 b JAMES E. ~'tevens Engineers, Inc. ° RUSCM = 07 Coulee Load S•1376 lTiAson Wisconsin 54016 v River Falls Y N SCALE IN FEET C.11 is. 'r D tjj \ U N P L A T T E D LAN 03 N O i 0, re" S U R.1 ~o~ ~z3 Q' 100 200' 300 ® _ EAST R tz=a (I"= 2000 S 89° 52' 30' E M 1035.10' co Once 84Qt'©0.10''~ iu cr~ r s EXISTING *e 511.00 524.10 T p~ i 5 M L-o z O DRAIN 9 0 OcjL 0 Ld W co LO FIELD ( I ~z~o r- ~o o SE - NW ° z~ -o Lco 265 39'32 o a S 79°24 43"E 5C I - <U) Lo 0 z m30OZ o/ 00 25.00 o`L 0 N h / Pi 0 d 0:) 5.869 4- ACRES z (nOLL_ W N /m a'r0m v o 3 l O 9 0 /S p z 'l 12.703 ACRES 2 / co EAST 368.0' R SO ~rN 369.24' M O 159.9.44, ((r~ 273.31 0 A. ~19~ S 89 52' 30" E N 89 52' 30" W ro ti 19. 539.18 , n ~;3 110, IZ A0 " / r v ~ f ff~ °Z SW - NW z r _ 0 0 w z n o cD v II v g° 32'33' S0. f~ 2 . 1r, m _ °ITW 3 N / _ Z 0 O N O 3~ o o N_ 5.541 ACRES II ° N44°51'19"E 37.46' ? 0 C z ~ /~3 / ~ 0 0 0 O / 3a 00 JJ I J z z N 44° 51' 19" E 88.07' ~I N 4 4° 51' 19" E 39.95 6`0 oh ' O J U ~o c' / I I 13.73 N 89° o5 'W S 89° 30' W 679.14' R0 i nr - 'm i0 EAST-WEST 1/4 SECTION LINE" 1 aQ TOWN zRDAD -c~~ so E I/4 I CORNER -----7~---_ _ _ ---T~-~~ Job/" J 89°30'E 91 UNPLATTED LAND - - 1 449.65 M 450.0' R WESTERLY RIGHT-OF-WAY LINE NORTHERLY RIGHT-OF-WAY LINE t e c. r~ JAMES E. In ay 8, 19' 8 Revised May 14, 197' RUSCH A S 1376 fa River Falls, p d Surveyed For: Arthur Neuman, Owner Harold Von Kuster, Owner c Wis. t~ Route 5, Box 72 Route 2 l0 004 River Falls, Wisconsin 54022 River Falls, Wis. 54022 OpoQQ 0~Q p 000 This map is hereby approved by the Town Board. Late Lawrence Handlos, Chm., Town of Troy This instrument drafted by Scott B. Lohman Consent of Corporato ilortgage_? Federal Land Bank of St. Paul, a corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, mortgagee of the above described land, does hereby consent to the surveying, dividing, :napping and dedication of the land described on this plat, and does hereby consent to the above certificate of' Arthur Neuman, owner. In Witness Whereof, the said Federal Land Bank of St. Paul has caused these presents to be signed by its Assistant Treasurer , and countersigned by its Secretary (cashier) , at St. Paul, Minnesota, and its corporate seal to be hereunto affixed this day of , 19 In the presence of: (Corporate Seal) Corporate Name Countersigned Assistant 'T'reasurer Secretary or Cashier STATE OF' WISCONSIN) SS County) Personally came before me this day of , 19 , Assistant Treasurer, and , Secretary cashierT of the above named corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such Assistant Treasurer and Secretary (cashier) of said corporation, and acknowledgec that they executed the foregoing instrument as such officers as the deed of said corporation, by its authority. (Notary Seal) Notary Public, , Minnesota My commission expires CURVE DATA TABLE Lot No. Curve No. Radius Length Chord Bearing Chord Length C,;ntral Angle Tangent Bearing 1 4 238.00' N 830 28' 13" W 46.56' 110 13' 34" 2 4 238..00' N 690 07' 41" w 72.24' 170 27' 30" 238..00' N 740 44' 28" W 117.91' 280 41' o4" N 890 05' W 3 1 879.93' s 60 14' 49" w 133.21' 80 40' 56" S 100 35' 1711 W 3 2 904..93' S 170 20' 15" W 212.71' 130 29' 56" S 240 05' 13" ~I 3 3 1195..92' S 150 32' 4o" w 355.29' 170 05' 06" S 70 00' 07" W -I egend- 0 1" Iron Pipe Found T Tee Fence Post Found 0 1" x 24" Iron Pipe Weighing 1.68 lbs./lineal ft. set ~F--- Fence - -Centerline of Road - Section or 1/4 Section Line - - _ = Existing Improvements Parcel 040-1053-30-000 09/20/2006 03:32 PM PAGE 1 OF 1 Alt. Parcel 13.28.19.198C 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 - BURTON, MICHAEL ALLEN & JULIE K MICHAEL ALLEN & JULIE A' BURTON 812 GLOVER RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 812 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.541 Plat: N/A-NOT AVAILABLE SEC 13 T28N R19W 5.541 AC IN SW NW LOT 1 Block/Condo Bldg: OF CSM VOL III PAGE 608 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/01/2006 826513 WD 07/01/2005 799182 2834/453 EZ-U 11/25/2002 699951 2060/263 WD 09/28/2000 630765 1546/327 TI more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.541 75,000 208,200 283,200 NO Totals for 2006: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Totals for 2005: General Property 5.541 75,000 208,200 283,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 216 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1053-60-000 09/20/2006 11:10 AM PAGE 1 OF 1 Alt. Parcel 13.28.19.199B 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 - NEUMAN, ARTHUR E ARTHUR E NEUMAW 818 GLOVER RD R1VER-FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 818 GLOVER RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 12.70:3 Plat: N/A-NOT AVAILABLE SEC 13 T28N R1 9W 12.703 AC IN S 1/2 NW Block/Condo Bldg: 1/4 LOT 3 OF CSM VOL III PAGE 608 (MD 890/570) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/12/2005 794750 2801/385 EZ-U 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/28/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 57,500 128,500 186,000 NO AGRICULTURAL G4 7.900 1,580 0 1,580 NO UNDEVELOPED G5 1.800 4,450 0 4,450 NO Totals for 2006: General Property 12.700 63,530 128,500 192,030 Woodland 0.000 0 0 Totals for 2005: General Property 12.700 63,530 128,500 192,030 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 REPORT Or ITISPECTION--INDIiIIDUAL SE?•TAGE DISPOSAI, SYSTE Sanitary Permit State Septic •,!A1.1E T0MISHIP St. CrKa County SEPTIC TA*T1Z' Size gallons. "lumber of Compartment , Distance From: We 11 ft. 12% or greater slope ft. Building ft. Wetlands ft Itighwater ft. DISPOSAL SYSTE14 Tile Field or Seepage Pit(s) Distance From: Well ft. 12% or greater slope ft Building ft. Wetlands f:. FIELD Righwat er ft. Total length of lines ft. Number of lines Length of each line ft. Distance between lines ft. Width of the trench --f t. Total absorption area sq. ft. Depth of rock below tile in. Dp-pth of rock over tile in. Cover .over.rock,, Depth of tile below grade in. Slope of trench in ner 100 ft. Depth t;o Bedrock ft. Depth to &round dater ft. PITS . Number of pits Outside diameter ft. Depth below inlet ft. Gravel around pit: yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of seepage nit area required ' Inspected by: Title': Approved Date 1970 Rejected Date 197. 1 EH 1f 15 • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS 0 LOCATION: Section /3, TAN, R /9 ) W, Township 9F MWF4+-i1-, ty / Lot No. 4__-1 Block No. CaiZZ-1F ,SL)IZ-V M,+ County AIZZ Subdivision Name Owner's Name: ~tJ Mailing Address: iZr. 17- Vac S / S TYPE OF OCCUPANCY: Residencey No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT 6 PERCOLATION TESTS DATES OBSERVATIONS MADE: SOIL BORINGS + 7 SOIL MAP SHEET SOIL TYPE R-OS-KMAI V(,' PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- Z SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK OBSE VED) 4101% f-' 5' B- iLa A1nr~t AW /V0 z4; 3~ 81 T5; i8, a, +z B f2_0 NON C.- > /Zv tai , tZ~ `g S~ 1~4 l tar p S ~ ~ ~ 4- fz:: I~~nrF /2v i iz B Sit b~~ 4 Bpo 5 449 B_ N0^jA:F- l~ 2.0 Ato (L~i - i Z i (z 1, t3 5, roc- ` S . PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. IIZ7 &Q F`-%- aeCA,) 1R-d-F> Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. zt+te'C) 5c-{= i j_a~- { f tA4 I { f I i ~ i i I ~ ~ I j I 1 J I ~ ` ~ ` i ~ s f ~ f I I ' r 1 }pit. _ - - -__x---_' A 41", I ~ I f , 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 location of test holes are correct to the best of my knowledge and belief. Name (print)) JA04105 a vSCs14 _ Certification No. Address &4!_-/ 4+7_ ,~!L- S7 R I V0V 1'~4 U-45 -.5- ~Ko Z Z_ Name of installer if known COPY A - LOCAL AUTHORITY CST Signat State and County State Permit # PLB67 Permit Application County Permi i ~~`L for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: SV '/4 '/4, Section L3, T N, R / W Lot# _.---City Subdivision Name, nearest road, lake or landmark Blk#_ Village SJ V~ ~A 7 Township 740/ C 1 ~P FX i" 144,> 67 L. o Y Aro T C TYPE OF OCCUPANCY: 'Commercial 'Industrial 'Other (specify) 'Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES --NO # of Bathrooms Automatic Washer ;""YES NO Other (specify) _ P SEPTIC TANK CAPACITY /00 Total gallons No. of tanks 'Holding tank capacity Total gallons No. of tanks _ ?Jew Installation Addition Replacement Prefab Concrete - 'Poured in Place Steel Other (specify) FFLU NT DISPOSAL SYSTEM: Percolation Rate 1) Z-4-2) Z4-3) Total Absorb Area /(Z'S -sq ft. ew Addition _ Replacement 'Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Z-4 Depth Tile Depth Z- No. of Lines Seepage Pit: Inside diameter Liquid Depth _ Tile Size T Percent slope of land _I] Distance from critical slope i, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, '';+isconsin Administrative Code, and that I have sized the effluent disposal systen^ -~m the El; 115 prepared by the Certified Soil Tester, !AME j A MCS C.S.T. # `f'_ and other information obtained from (owner er). _ .'lumber's Signature P/MPRS _ Phone # Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). I ~ 24 . 3. in / StcuF%~ +49, ~x L7r'ST WGIj -4- ~t C CaC' rOpc~ FvAL 5d~f77 t T-,FN 'et t~ yvtzc~ Do Not Write in Space yBe 4OW- FOR DEPARTMENT USE ONLY Date of Application Fes Pai State Count , Date Permit Issued/,B~eetod- (d e) -Issuing Agent Name • - Inspection Yes No Valid# Date Recd -4 1. county (white copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy)