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HomeMy WebLinkAbout022-1083-30-120 o d f c. d* 3 °' ° C .. 3 C .. 3 2 n 3 'G ID ~ CD I 3 c ► I 3 :- � �+ n d m m p o o I a d F o o ? N • CD M m £c CD m Cn co N CO tn N C A = y C. L CD = y co ' W O A W W a N >_ > CAA 3 y p f O . j. A W ►•! l CD CD - ° CD C CDD ' c CD 3 " 0 R� 0 rn Cn c° a o o! o p N 3 0 7 N 7 Ncn O O �l ' c y CD m M O C ') N W W CD Iw n 3 a0 ° co\n Co\n O a+ a <. Z w m l a W CD N N � CO fD 00 <' r n CD CD o' <' o co Cn 00 m o c Cl) CD N N (D y G7 CT1 3 M cr O o o �' I O O O y !�I • Z aQ I o C.) Z v d� vi vi vi 2 cn co) ca L a D Icr v v Er v v o i rn h � CD O C G1 'O N O d V 3 !D = 3 1D = f0 IV 3 d y 7 i,, Co �1 z N =� D �+ o D CD o O 0 v 7 0 a CD g y 3 �• CD l (n t�l m C,) N CD C j CD c CD W �• O. o. @ Cl) n 3 a 3 ' z CD CD A W r N N � n n O A z 0 m a v ' 7 W W '0 to < c a , a , z 0 3 0 3 a 3 3 " z w M y y z < CD co ? W y W m A y y D 3 S K Y D o m o CD n. �O CD mF T� CD N 7 CO O N N c �p 7 m� z a � z a o o 3 3 cch m o �c °1 i CD y :E 3 (D W A„ x C D 0 CD CD moor v 3 — x " — x m =J I I m wm' CD x y O U) -Co t I C CD CD A 7 — CD 0 A a I m °o I CD a� m= O O Q. 00 CL °—' ° ° o CD C o o CD CD b w v 0 I O iA O �o I o g o f c o m o m a a Wisconsin Department of Commeke PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405098 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Price, James I Kinnickinnic Township 022 - 1083 -30 -120 CST BM Elev: Ins p. BM Elev: BM D cri tion: P ,,� P �. TANK INFORMATION ELENATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben mark 0 ent r Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ell TANK TO P/� I WELL BLDG. Vent to Air Int ke ROAD Dt Inlet c Septic : + ! (� V E rvr Dt Bottom Dosing a it t % eader /Man. Aeration Dist. P' Y Holding Bot. System 1 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cov r �- Model Nu m TDH Lift Fric' Lo System Head TDH Ft Forcemain ength Dia. ell SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length /. ) �' No. Of Trenches P D� SJONS No. Of P' s nside ia. Liquid Depth DIMENSIONS ( I SETBACK SYSTEM TO P/L BLDG WELL, LAKE /STREAM LEACHING Manuftu r: INFORMATION CHAMBER Ty Of System: —, ! = ! Model Number: DISTRIBUTION SYSTEM/p, I �.i' Hdefold Dist uti n r ' x Hole Size x Hole Spacing Vent to it Intak Dia Leng th Dia Spacing SO COV x Pressure Systems Only xx Moun Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / Sed/Trench Edges Topsoil � Y [� No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -�� / ' / f— � No #2: / ! Location: 167 E. River Drive River Falls, WI 54022 (SW 1/4 NE 1/4 29 T28N R18W) NA Lot 3 Parcel No: 29.28.18.451D 1.) Alt BM Description = � �k �, ( 49 , �� -li i4 „(lr� Tt� � / �� y f,'. 2.) Bld ngth = j - amount of cover = �� j/� 11�r �� i7 �� "lG' �1��.� i �rs4 ii Yes Use other side foruadditional3information. No ^ v ` y L►� Zk'i SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Il t Safety and Buildings Division City Visc���,� 201 W. Washington Ave., P.O. Box 7162 S n Madison, WI 53707 - 7162 Site Address Department of Commerce S z() Z-- / 6 7 E V:✓� �/Z, Sanitary Permit Application Sanitary permit Number (� In accord with Comm 83.21. Wis. Adm. Code, personal information you provide ❑Check if Revision 7 -t-1 0 may be used for secondary vurposes Prb U-1 I. Application Information - Please Print All Inform n RECEIVED state Plan I.D. Number / A Property Owner's Name Parcel Number IA, MAY 1 3 2002 oa.a -/�83 3 /o2.v Property Owner's Mailing Address ST. CROIX COUNTY Property Location /`;t) ,/ 4 ti I r� ZONING OFFICE S 14 %: S � TI N. R� City, State I Zip Code Phone Number Lot Number Bloc Num ber Subdivision Name r II. Type of Building (check all that apply) _ ❑City 'R i or 2 Family Dwelling — Number of Bedrooms []village ❑ PubliclCommercial — Describe Use , ❑ State Owned 3" X (02 . Z Ull ! b G��ka, Neatest st Ro 4-k n ! ' a Y , M. Type of Permit: (Check only one box on line A (numbering scheme for internal us ). Complete line B V applicable) A. 1 ❑ New 2X Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use Sy stem I I Tank Only I Existift System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued 3e IV. Type of Permit; (Check all that apply)(numbering scheme is r internal use) 3 / S � 4'D ,c G dth 1 2 74 4r' 44 )!� Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand C Ap ph J g� P e /l 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Side Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other (T � y V. D ant Area Information: Design Flow (gpd) Dispersal Area Dispersal Area il Application Percolation Rate System Elevation Final Grade Retprued G_ Proposed Rate(Gais./Days! (Min.itnch) n Ele ' n ygopp 61 VI. Tank Info Capacity in Total Number Manufacturer Prefab Sate Steel Fiber Plastic Gall Gallons of Tanks Concrete Constructed Glass New Existing Taub Tanks Septic or Holding Tank _ �' ��` �, • i/+ Dosing Chamber VII. Responsibilky Statement- I, the assrmte respotuibilky for POWTS shown on the attached plans. a Planter Name (Prim) �Jvlo VAAA ' .Signaarre { MP Number Business Phone Number Plumber's Address (Street, City, Statd, Zio C �j pl)�� Ac VIII. pertinent Use Only Approved ❑ Disapproved Permit Fee (inchwes Groundwater Date Issued gem Signamm o Stamps) Surcharge ) ❑ Owner Given Imtial Adverse Detenmimdon 0 ' 13L Conditions of MA& a aaphee p� 00 the Cemq Q*) for the s3 oa paper not ku Man stn z u hr sirs SBD -6398 (R. 05101) _ TT A AT T PLOT rljHA .. .. n� r a. ma c- — vi f�'l �Y Scale 1' 30' as P 5 0� �q� _ - -- �3V1r --Z - -- \-v t I — Y`obA S - fa jt l -- . S - O 3/ l — L \7 rto • � CfZt'';' ki 1 i R. 3 U� E- Tc.t u_Lzz s- q —0 715- 425 -01 220254 CST Signature Date Telephone �To. CST No. Job PTO. Wisconsin Department of Commerce IL EVALUATION REPORT Page of Division of Safe i ty and Building s s in accordance wi Com 1QiE6o e UU County ST Attach complete site plan on paper not less than 8 112 x 1 inches in size. Plan must X include, but not limited to: vertical and horizontal referenc pointAW, d'yejo� and Parcel I.D. Z percent slo p e, scale or dimensions, north arrow, and to ion and distan goo road O ZZ. Please print all informa 'on. ST CROIx COUNTY Reviewed by Date ZONI Personal information you provide may be used for secondary purpose . g (1) (m)) Property Owner _ Property Loca ion P\ --! Govt. Lmt �--� 114 X114 S Z T Z N R 1 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 � CC• �Z� L7�Zt 3 — CS Vo (, tag 15 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road l s - iv) SLJ (� qzs z6 U Lc ��� � ►��_c N • �.(U b1z�u� ❑ New Construction Use: ® Residential / Number of bedrooms Z Code derived design flow rate 3 d GPD ® Replacement ❑ Public or commercial - Describe: Parent material SPR .fD`1 C�UTIn -R'3 h Flood Plain elevation if applicable N ')'` • ft. General comments and recommendations: tpv�yv� � 3 C�ZCS 3 '?c SD' CC" C w/ 8 U LM O r_- Y1 G N �' � yet S> D vulva L�e(j 01 ,t tGr =^RS Boring # ❑Boring 17 1 ® Pit Ground surface el v. Q - 1 •q Depth to limiting factor l b g in. v Soil Application Rate Horizon Depth Dominant Color Redox Des ' ' n Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ 'Eff#1 'Eff#2 1 0 -8 1p��z -316 - /� C�� : �� • q 3 uZ -lo8 x, 24 Boring # ❑ Boring , .---- ® pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description oots GPD /ftz in. Munsell Qu. Sz. Cont. Color d4 'Eff#1 'Eff#2 Z q 10`22 l `t5 l Cs b k v `f L C4 5R-1 ,S - o sg VW I - •s -9 7 FT Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si tur CST Number Arthur L. EJegerer C7 -- L� 3 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, (1I 54022 S _9 - OZ 715 -425 -0165 Property Owner ��Z L Parcel ID # 0 lJ �3 ' 3 � — 2 0 Z Page of 3 El Boring # ❑ Boring LL ® pit Ground surface eiev. • 01 ft. Depth to limiting factor y in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -8 j 3l(. - (! lCSbtz �� ��- es zv . �� • 6 Z $ -6) It 343 3 -1 rz - - s o s9 hn \ - S -9 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. M- 8330(R.W00) PLOT PLAN Page 3 of 3 Scale 1'= 30' I@YA j - .L00.�0'aJ - mP of S�:?nc )tNk l�sa�T"tUr�_pLPF,- - - -- 8�'tH -Z - GI, loz.S' -c- ZVrMM , of S ID,wG. _ - - -- - -- '- je-L__ �S \u ' :k-- F-7-Uwt S`--LV f lzenS . �J 2 -)a a 97 9 lb' qs N (r ev -t3 T►N c o �l i E- 2jUez C - noi�d -q -U 715- 425 -0165 220254 (3 1 3 CST Signature Date Telephone :io. CST No. Job NO. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the L ; ce S n�� (� residence 1 Gated at: 1 /, Y4, Sec. T ,) 7 N, R , �W, Town of �,/�j'? / ( j ?1(� St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No,�, (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete x Steel Other Manufacturer (if known): Age of T nk (if known): (Signature) (Name) Please Print � (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . ' 1 Name )114i J' i�'���C Signa e vv i' .f7 MP RS n cr ST CROIX COUNTY SEPTIC TANK MAINMANCE AGRLeMG -NT AND OWNERSHIP CERTIFICATION PORM Z wncr uycr 10 $ Mailing Address / r Property Address _ - �6 / l ) or (Vt ificatioa rtriwd from Pbmiog Depack=t for new w=tcue(ion) atyl uc ( 'I/' / ��S r Parocl Ideufi&t tiou Number a ld F f - 3 0 . - f � LEGAL D K CRWIION Proparty Location S�) ,, / V - y, Sac. . T 0# N R j� W Tows of A 1 � k ih4 Subdivision. Lot # Certified Satvtq Map Vobnnc .r i' c ,-� ag # Wunaty Deed 9 /-/ Y 35 - Volume _ 2[ p a g e r .�__� ag # J SM .isom ❑yes ❑ no Lot hues ideautitiable ❑ yes ❑. no s o �� � `°° eOf ''' � 9 ' acaio o at dnemttini�spacdra 4 ecxsfa�cmctobaodlevr��ste 's.P,cnperma>mb�aooe aa�e ►tocasodpmmpcc, WluttyarrPat.not�Qresystem . �c' taatias_ t �oatm , artsta�C;aQ�evautcsy�0ua, .. - • - �� p�'OPu�vaaar�occsto salamat to St. Cbaac?�D��� b9' �Y °4�dpLambaoc :Tioocasod �eaa�aad : IsmptoperoPeaftcOm"maad/oc(Zjan= aad �t(Y)tfreoa trzs0ewar0erdisp�aisyst . � � h�ne,�d Q,,� a6ore wgtaa�a the pai�ri�e sego � tbe:and�ds i. .�asatbyereU�a ��m eeand ft DVaftat of2atuIRmow tcofW - ==ia_ 0=6 3roac sYstauLas 6oc a ma iodrmnstbe000rpldodsadnbnadodto tE,e Stt�oacY?UH�oc 30 days 'c�dc� ' adato. OFAPMCANr 10D DATE CA.UON I ( ) all statcmcats an thss form am Cm to Me best of my (QUO 1MGV lodgC, I (we) am (arc) the owwnm(s) of mod by *61c of a wattaatjr flood t000cdod in ILegistcx of Doody Otlie� 7 p Zt)R$ OF �r , ! lo DATE ssssss MY ialowntioa that is mss may t=* is tl c sanituy pcm* bdmg Wvolwd by the Zoning DAL ss 4udade wtth this appiicatioa: a Umvod warranty dod Emax &c A Dopy of the occtiCtod � of Roods oiY'we cY �P if ref== is made is the wamaaty dead a'c System Management Plan ' Pu'suant to Comm 83.54, Vis.Adm. Code Sectic Tank •The septic tank shall fie maintained septic tank sank be lspose of in a an indiv idual certified to service septic tanks under s. 281.48, Slats. The contents of the V outlet Inter slink be assessed at Least once e•, NR 113. Wis. Adm, Code. The operating condition of the septic tank and ensure proper o e•/ 3 years by mspec .lon. Tne outlet filwr s. be craned as necessarf to Peradm The filter midge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its ends. -ure. If the triter is equipped with an - - „ the filter steak be serviced if the alarm is activated continuously. k temuttent fiker alarms may indicate a flows or an ' �9 rmpendurg continuous alarm. Tn - its e septic tank shale have c onten ts removed when the volume of sludg and scum as the tank if the cantents of the tank are not removed at the time of triennia assessmentt, marnte a= 113 the peersonr�� �of8 the'ovvner of when the next service needs m be pesiormad to maintain less than ma*= scan and sludge accumulation in the r g n of biological or chemical additives to enhance septic tank performance is 9eaerky not r+eGuked. such i3ut'Idtttg's O produce are used they shale be approved for septic tank use by the Department of Commetca, Safety and Pump Tank ) tank "a !reef proper opera Lion if an befltuer inspected l inst�d w� � tank it stork be bs pec;ed and serviced ash t ry., to necessary! At- rode Component and Pressure Distribution System To.trees.or s ru s s on e p ante or allove to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the m aiiaiim for this installation. design flow specified in the permit The P Osswe distribution system is provided with a flushing point at the end of each la be flushed of a � SOW at le ast once eve 18 months, When a' and ti m recommended that each pressure led i p j should to equal on wittun the raked determine ti ortiice t> w de� _ anrng is �spersat csk. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered' as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with Comm .83.52 (2). General _fs ay §Lem shall be operated In accordance with Comm *82-84 Wis.Adm.Code and shall be . maintained in accordance with it!s component manual SBD 10570- P'(R.6/99 - and . local a pertaining to system ) and state rules • _ y maintenance and maintenance reporting.. No one should ever enter a septic n pump tank since dangerous gases amy be present that quid cause death. Septic and Pump tank sera shale be in accordance wtih Comm ti3.33, VYis. Adm, Cade when the tanks sie components. no longer used as Septic or pump tank manhole risers, aress risers and covers should be inspected for water tightness and soundness. Access 0 s wumintt 0 and asses shall be sealed watertight upon the completion of service. -Any opening deemed 6 by to fariure must be replaced. Exposed access openings greater thm 8- inches in fameter shale �Y 9 device m prevent acadentai or unauthorized entry into a tank or Gin�onent. _ dirt Proper co components became defackve the tank or component elk be repaired or repd to keep the ' bnk purnp� co P *Qk alarm or maL*d whutg ores defective the defedve auriponent steak be �Y ar r+ ed wth a component of the same or equal perfortna=L If th- g =adacomponent - fails to accept �rastewater or3'sR3ri "s'o disc zge wastewater to the ground surface, it may be necessary to install as aerobic pre - treatment unit or - replace the component. Additional site had soil•evalnations may need to be done, and additional pleas may - need to be prepared and approved by the Department of Commerce,. Safety and Buildings - Division. . �Questions.abont the operatioa'or maintenance of this system should�be directed to. The Ccunty Office at Z -B- 6-7 - 7 1�1E�2.C� �-S�`(',ry 3�b > <f18D The system installer at _ '1�$_ �L2S- C tQS W ft j r The tank manufacturer at $pp_ 3ZS_8y$tn �V1�5t=1't The effluent filter'manufacturer at kkn - Z2l Slgz zrMer, ciao '1C:n 6 3 o -.87A �.g Goers y 1bV - Thomas A. Wang and Dawn G. WARRANTY DEED Wang, husband and wife Dated: August 30, 1985 - to - Recorded: September 3, 1985 at 8:30 a.m. James F. Price and Sandra K. In Volume 719, page 599 Price, husband and wife as Document Number: 404835 joint tenants Transfer Fee: $223.50 This is not homestead property. This is not rental property. Subject to easements and restrictions of record, if any. Conveys same land as shown at entry 177. �LI�Ched) - 181 - First National Bank of River ASSIGNMENT OF MORTGAGE Falls, Wisconsin, a U.S. Corporation Dated: September 22, 1.986 Recorded: October 17, 1986 - to,- at 8:30 a.m. In Volume 757, page 156 Federal Home Loan Mortgage Document Number: 418224 Corporation This assignment is made without recourse. Assignment of Mortgage in Volume 719, pages 101 -104, as document number 404552 Signed: FIRST NATIONAL BANK OF RIVER FALLS By: Paul E. Schwebach, Vice President Dellene Hughes, Cashier 182 - Timothy D. Meyer, a single WARRANTY DEED person Dated: July 27, 1987 - to - Recorded: July 29, 1987 at 9:30 a.m. Lewis C. May and Ranee J. In Volume 786, page 507 May, husband and wife as Document Number: 428582 survivorship marital property Transfer Fee: $45.00 This is not homestead property. Subject to easements, restrictions and rights of way of record, if any. Conveys Lot 3 of Certified Survey Map, recorded in Volume 6, page 1519, being a part of the SW4 NE4, Section 29, Township 28 North, Range 18 West, Kinnickinnik Township, St. Croix County, Wisconsin. Said Certified Survey Map recorded in Volume 6, page 1519 as document number 401433. Together with private road easement and cul de sac as shown on said CSM. Together with roadway easement in SE4 of NW4 of Section 29 - 28 - 18 as described on CSM in Volume 1, page 162 and including all lands lying E'ly of said roadway and W'ly of E line of said SE4 of NW4. Said Certified Survey Map recorded in Volume 1, page 162 as document number 328601. St. Croix Valley Title Services, Inc. • Continuation of Abstract No. A5283 the 23rd day of August, 1985, at 8:00 o'clock in the A.M. of the From land described as: - 177 - OF CERTIFIED , T THREE (3) OF CERTIFIED SURVEY MAP IN VOLUME SIX 6 ) LOCATED IN PART FILED IN ST. CROIX QVEY MAPS, PAGE 1519, AS DOCUMENT NUMBER 40 1985, BEIN �- OF NE a ) OF SECTION , NTY REGISTER OF OFFICE UARTER OFTHE NORTHEAST EIGHTEEN (18) THE SOUTHWEST QTOWNSHIP TWENTY EIGHT (28) NOR , ,ENTY NINE (2 o4EST, KINNICKINNIC TOWNSHIP. St. Croix County, Wisconsin. - 178 - 4 L -280 CASHMAN'S RIVER FALLS REALTY:; INC. 425 -5150 Additional 20 Acres - Wooded Possible Subdivision $40,000.00 CERTIFIED SURVEY MAP �fDly33 N PART OF THE SW 1/4 NE 1/4, SEC. 29, T28 N- R 18W KINNICKINNIC TOWNSHIP ST. CROIX CO. W1. •, OWNER' GARY a SUSAN WANG RIVER FALLS, WI. O 200' 400' __ -- j BEARINGS ARE ASSUMED AND SCALE: I "= 200' REFERENCED TO THE EAST 1/4 LINE, SECTION 29 EXISTING MONUMENT, Roc. ExISTING MONUMENT, Rec. NORTH 1/4 CORNER NORTHEAST CORNER TN. R w SEC. 29 SEC. 29 w -- -- J o 66' PRIVATE N O ROAD E9M 'T. U N_PLATTED LANDS , "',� o° o �� r n��� O hl ►AI 41 O 1�1_ IV t� w IV rr ILL O (11 O. 33' 33' O' p N O Q' O �I Q0 0% S 90 0 0'00" W 26 11.94' QI 33.00' • NORTH LINE SW NE 809.,32' ^ 1769.62' p - I PRIVATE 13 O 0 0 Q I ROAD r 10 p )E SEE PAGE 3,.SHEET 2 0 ul M ° UNPLATTED LANDS_ T�ioNE SA DESCRIP w �I DWI N O p 0 - - - - -- — - Z I- amI � O v J 1 W W 1 13 , Qo ° S 90 0 00 ' Co" W 875.32' C 60 � ti Z Z1 I_I - - 609.32 (-- P ROAD r---- - -`c; m 0 68 1 F - M ED �) 33.00' �' X 132.32' 215.00' 215, .00' 247.00' o o O In u I� I �0. •Opp v Q I N N 33 ID' t0 �6 O 9 � p a O E9M'T. I M _+I ; �n - 0 o ON W p l w 0 ; Q:m 00 W ° C 1 2 3 4 `��, N o zo I -I S N� M �' `l% (Z ', )) �{ L C���� A O ° Q o OW - ° I z_ V t = 1 ( �� 0 PRpP O O 00 fY >fJ 'A 1L1 J O po z O fn � � Q° 165.32 215_00' 215.00' O 247.00 b - (\j N 90 ° 00' 00 " E 842.32' 0 0. U) iL rn a g w U) - L) _ C ;• UNPLA_TT ED LANDS �j1414 ' EXISTING MONUMENT, Rec. LEGEND EAST 114 CORNER, SEC. 29 • -- - 3/4" X 24" ROUND IRON BARS SET WT. 1.50 L13./ LIN. FT. �- - - I" X 24" IRON PIPE SET W T. 1.68 L(3./ LIN . FT. G 0 /VS AREA SCHEDULE MARTIN E. 't LOT 1 1.521 ACRE (66,293 S.F.) INC. R/W HALVORSEN LOT 2 1.979 ACRE (86,215 S.F) INC. R/W ` S•1302 LOT 3 1.979 ACRE (86,215 S.F.) INC. R/W 0 HUDSON, LOT 4 2.2.73 AC R E (99,047 S. F) INC. R/W �� WIS. A TOW N S 111 P APPROVALS '�� ......••••' ��i�NO suR`� CHAIRMAN _ _ e CLERK /TREAS. — OCT. 15, 1984 REV. NOV. 14, 1984 REV. APRIL 20, 1985 OVER Page 1 CERTIFIED SURVEY (CONTINUED) PRIVATE. ROADWAY STATEMENT The roadway shown on this map in, a private readwa Any maintenanCe c *sts, of the by the Private roadway af County Zoning er its shared ng Administrator as a standard read approval root Pro -rata by the ad v hall be oining property owners on afr aQe basis. 8.hould the private readwa be municipality as, a public read, maintenance kthereaftey a would be a public eYpens COSte r CUL DE 8AC DEjCRIPTION ncing at the Northeast corner Of Comme said 8 act.ion 2 t 8 00 00' 00" E 0 Of said NE 1 ) (assumed bearing referenced to the East line 1 /16th line 1322 -51 ft. Thence. S 90e 00' 00" W SW 1/4 HE. j 26 hence a o n " thwes t corner of said the of the NW 1 4, 223.26 ft. Thence N00 90* 0' along the West line North line of private read, , 828. 90 00 00" E, alon 14.00 ft. and the point of 32 f t . Thence N 00 00' tOC ►+ w cul de sac; havinP A dji _ . a 80.00 ft. 3;_ said TL.i =• ou de sac contains�20, 1s q. 160.00 ft. Part of the 66.00 ft. right of wa more car less e private read. including � y th ��w L . Q m' - � Martin E. Halvorsen, HLS fi April 20 1985 r Tj * a- * -*k I � O HALVORSEN ^lI s �� N O S U R X00 �� Page 3 SHEET 2 r WANG, TOM , 1609 'IQ �J �rl� ��e SW NE, Section 29 River Falls, WI T28N -R18W Town of Kinnickinnic San.Permit#64858 4 -23 -85 T. Wang Conventional, New INSTALLED 5 -24 -85 �'� Parcel #: 022 - 1083 -30 -120 02/08/2006 11:26 AM PAGE 1 OF 1 Alt. Parcel #: 29.28.18.451 D 022 - TOWN OF KINNICKINNIC Current ' 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 0 - URHAMMER, CORRIE S CORRIE S URHAMMER C - JACKELEN ROXANE L JACKELEN ROXANE L 1055 E RIVER DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1055 E RIVER DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.979 Plat: N/A -NOT AVAILABLE SEC 29 T28N R18W 1.979AC LOT 3 OF CSM Block/Condo Bldg: 6/1519 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 28N -18W Notes: Parcel History: - Doc # Vol /Page r /r� Z 06/1 2/Type 200 681510 1908/517 WD 7 719/599 2005 SUMMARY Bill # : Fair Market Value: Assessed with: 143872 248,000 Valuations Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.980 40,000 210,800 250,800 NO Totals for 2005: General Property 1.980 40,000 210,800 250,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.980 20,000 151,600 171,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 218 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 / q�S • Form- STC -104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP /' SEC. �` T �2 c p N -R W ADDRESS fou Pr r 1l S' ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILIIR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM '7cJ'& .9� e 1 INDICATE NORTH ARROW f N j BENCHMARK: Describe the vertical reference point used &ax QC,44e!j i Elevation of vertical reference point: `1} Proposed slope at site: g SEPTIC TANK: Manufacturer: j q dW (!-j, P V' CQ3 Liquid Capacity: 6d Q. Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Frontk Side,Q Rear, O 5 feet From nearest property line Front 1 0 Side ,O Rear, O 1 © e feet Number of feet from: well building: (Include this information of the above plot plan),( 2 reference dimensions to septic tank) SEE REVERSE SIDE r PUMP CHAMBER Manufacturer: Liquid Capacity: 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: 1 Trench: Width: ! Length:_35 Number of Lines _ Area Built: Fill depth to top of pipe: ay w Number of feet from nearest property line: Front, Number Side, O Rear,0#t. _ Number of feet from well: �',�C�� Number of feet from building: � (Include distances on plot plan). SEEPAGE PIT Size: - -Nigber 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: 4 / , l Dated: Plumber on job: License Number: a 3 l 3/84:mj ,DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HU RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI ,3707 CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number: ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Thomas Wang River Falls, WI 54022 -' 4 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. SW NE, Section 29, T28N -R18W, Town of Kinnickinnic Name of Plumber: MP /MPRSW No.: T y: Sanitary Permit Number: Thomas Wang 3231 t. Croix 64858 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER z / P OVIDE D: PROVIDED 11 02-- 2-) / C-2 • YES ONO I [!]YES ❑NO BEDDING: VEN_TD I A., VENT MA HIGH WATER NUMBER OF ROAD: PROPERTY WELL: J BUiLDING VENT TO FRESH / ALARM i c LINE A FEET DYES ❑NO L �/ DYES ONO NEAREST / l /b(�) 7 S 2a DOSING CHAMBER: MANUFACTURER: 7 S ING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ONO DYES ONO DYES ONO GALLONS PER CYCLE: rND CONTROLS OPERAT IONAL: NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH J DIAVFTER 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. LENGTH. NO. OF I DISTR.61E SPACING: COVER INSIDE DIA.. #PITS: LIQUID BEDIREt+ICH TRENCHES / M PIT DEPTH DfMENSIONS -- GRAVEL DEPTH FILL DEPT - DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D TR NUMBER OF PROPERTY WELL: r; TO FRESH BELOW PIPES AB E ER: ELEV. LET ELEV. END PIPE Sy LINE: AIR INLET: (/, 2 FEET FROM d 0 - � /? 0 NEAREST ��� S 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- 1:1 YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS. ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED JEDGES EPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: CENTER : DYES El NO DYES 0 N 1:1 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER .N7I"I TRENCHES: E7�IIUtE�IO MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE INf DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELE V.. DIA.. ELEV.' PIPES. DIA.: E LEV ATIOIN - AND 110 RMATIC) RI,4UTI* HOLE SIZE HOLE SPACING' DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED CI PLANS: DYES 1-1 NO YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMUIER, 01 '. LINE : ERTV WELL: BUILDING: �P, - op DYES 1:1 NO [:]YES ❑NOIEAE3 C, c? Sketch System on - Main in county file for audit. Reverse Side. -" DILHR SBD 6710 (R. 01/82) � APPLICATION FOR SANITARY PERMIT H R (PLB 67) OUNTY UNIFORM SANITARY PERMIT REIRTIOnS — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPER ER MAILIN ADDRESS / �S Ll PROPERTY LOCAJION CITY: �f 1/4 1/4, S ( , T &h, , R E (or) W To N oF:' LOT NUMBER BLOCK NUMBER SUBDIVISION NAME REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑Public' (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair J Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. NJ Seepage Bed ❑ Seepage Trench 0 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 DUB X Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: A $ 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): � 1 � b 3V l�k�S Q Private El Public O C � 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.: lPhone Number: o (Y• in 5 Plumber's Address: Nam o igner: 00 0 9 a f � 1 lc�' . -/p COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �/ y —�� A roved ❑ Owner Given Initial o pp 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, OILHR, State of Wisconsin. r q a "rk ►fie c�uer� Per' m;h prd p — i® n i° _ j,00v t t S oil �l� iC •�o• �fo�ose w 1 __ __ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, GG DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCA ON: SECTION: NICIPALITY: TOT NO.:BLK.NO.:SUBDIVISIONNAME: /TPFN /VE (or)W C 3 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS A // r � � /t �u eY l S . USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER 0 ATION TESTS: Residence 3 &New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system 5 J CONY S TI ❑u . M N S❑ � IN G © � P ❑ � RE: SYSTEM -I ©U L HOLDING©�' : RECOMf/I�� D SYSTEM: (optional) L S F S C If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodpla i n d icate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ! 6.a� dl. 0 76.46 Y60 /3 -7.A) b/I 1 19 B- a oo �a�.a� 0 ��. oo a,00 e Oo t B- 3 6.00 ,�S' X6.00 �.�d�/ /T 7.!5'0 B4 Soh // 3 5. ?3 ,6 B- 6. i 3, 3 o > oo a, o o fills A6,0 B- b b,w 1c) 3. 6ol 01' >6 .6e (9 0o 46 !ls y. m 16,�? 3q�d PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ .$D 6 o a � � P- P- ��o i a a '� 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. SYSTEM ELEVATION /Do. 6 I � P tN . 3 i.. E E z E a t � t t x t I I 1 d i .. SE.�t�ct_ (�, PL, 3 o� 3 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): / TESTS WERE COMPLETED ON: ( / �(/ I s ADDRESS: CERTIFIC T ON UM ER: PHONE NUMBER (optional): ao / e j er v 5�4y CST SIG E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — J 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; , MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systern; . Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 0. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 70. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St -- Stone (over 10 ") BR - Bedrock cob Cobble (3 - 10 ") SS - Sandstone gr - Gravel (under 3 ") LS Limestone * s - Sand HGW - High Groundwater cs - Coarse Sand Pere Percolation Rate coed s - Medium Sand W Well fs Fine Sand BIdg -- Building Is - Loamy Sand -- Greater Than '`s) - Sandy Loam - Less Than �l - Loan) Bn - Brown * sil - Silt Loanr BI Black si - Silt Gy Gray �cl -- Clay Loam Y - Yellow scl Sandy Clay Loam R Red sicl - Silty Clay Loam mot - Monies sc - Sanely Clay wl - with sic - Silty Clay fff few, fine, faint c _ Clay cc -- cornnnon, coarse or - Peat mrn - Many, medium m - Muck d distinct p - prominent HWL High water level, Six general soil textures surface water for liquid waste disposal BM Bench Pjsark VRP -- Verticai'Reference Paint TO THE OWNER: This soil test report is the first step in securing a sanitary permit, The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of }clans for the private sewage system and a permit application must he submitted to 0w appropriate local authority in order to obtaki a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I Form - S '1' C 100 Owner of Property Location of Property /��r= -�, Sectiuu _O� ,`l'_; N 1t W Township---I/k, 1 A11 f lo ` a Mailing Address /Q(9 V4 -- Subdivision Name Lot Number Previous Owner of Property G Ce J ,1 G' Total Size of Parcel Date Parcel was Created Are all corners identifiable? Yes No Al Include with this application one of the following .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 deed r corded in the Office of the County Register of Deeds as Document No. �A �(O ; and that I (we) presently own the proposed site for the sewage disposal system (or 1 (we) have obtained 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 Co my Register of Deeds, as Document No. ), SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE IGNED DATE SIGNED z Ln H . a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d l y OWNER /BUYER x ROUTE /BOX NUMBER L' ,9 ZQ l Fire Number CITY /STATE tfi e _X) ; ZIP PROPERTY LOCATION: J 1 4, Al 5 1 4, Section c9 / T d d N, R _W, Town of ,ry /�,/l �rh St. Croix County, Subdivision , Lot number_. 1 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 H three year expiration. 0 E I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ro 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. S I G N E D r -� • DATE 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. o H � w x � s a ^cf iD �c c N3 O N Co C M CD n A> t- z I- 3 mC °�? o o IR C (D N (D n 6 N N > 0 0.0 7 w 00 ^w 7 ODD - n CD A M (D (�D N w w ? cc m �m � o CD oO CD Ain o .�»��� w O N .. 0 M O > > m o b � 0 .�C- c°.'�N c oS3oao C -Z(o c� :FOM 0 M °•�° n� o m 0 Am O r- < � N a � a o N O D C A N W 43 N O fD c m l- C CL On E; O N O N O p) (D w w Z CA �w �f o o Z $ (D 3ocDm ?a a D . CD A 0 to -♦ wpm o c°A 171 C O M o a ?A" ? w a wa CD w ?a F N as m C 171 �CD o v; w w �m �a oa��cnN C1 a N CD p> > a O Q; 0 1 °ac woC) cam O ~ O co , (D -� A N N w �3n cvocf= 171 �awo w _� cnc W c D a CD N M a ,. r- na a o vO ^` <� � (D a► O G7Q O o N A N O > a0M o4n � �mS n c-9 w =r fl) A .. n o o 0 3 3 > > o . w m < op 3 CD Co .. O z 0 0 - A i- • DOCUMENT NO. T } STATE BAR OF WISCONSIN FORM 1 - 1982 THIS SPACE RESERVED FOR RECORDING DATA ._ WARRANTY DEED i 401466 uo:1�PAGE j RE GISTERS OPFICE ST. CROIX CO. Wis. This Deed made between _ ii d► for Record this 23rd i d4 Of il 5 . --- -- ------ • G - ar_y__ , -- • Wang_ - and__ Susan - M. - - -Wang, _husband...___ Y ._ 19_ a--- n ife ---- ---- - - - - -- pf 12:35 P �. - - - - - - - -- ---------------------- - ------ - - - - -- ----------- - - - - -- ------------------- - - - - -- ----- - - - - -- Grantors James O'Connell and .___Thomaa__Ar__Mang - and_D_ awn._ G_1 --- Kanl, ... husband....... ar�d__ wi.fe--- as-- -J-oint nan - ---------------- - - - - -- -- ;= --------------------------------------- --------------- - - - - -- -- -------------- - - - - -- - - - -- r Grantee, L deputy I i Witnesseth That the said Grantor ; for a valuable consideration...___ — - - -- - .__.________ _____ ________ ______________________ _ ______.____ ___. ._ ______________.___.__: __ _____._____ ' RETURN TO .... 1: conveys to Grantee the following described real estate in ..S.t_.-__Cr__Q2.X.__._.____. County, State of Wisconsin: Lot 3, Certified Survey Map filed April 22 Tax Parcel No ----------------------------------- 1985 at 1:30 p.m. in Vol. 6, page 1519, as document number 401433, Office of the Register of Deeds, j! St. Croix County, Wisconsin. j ii i S FEE i i i is not e This _______ ______ _____ _ _ _ _ __ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_.._g. antors herein r warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions, if any, of record j '. i and will warrant and defend the same. Dated ------------- 23 .rd--------------------------- day of --------------- Ap- ri ----•-------- --- --- •- ---- •----- -••- - -r L �J - - - -- -- - --- (SEAL) I -------------------------------------------------------- (SEAL) - - - - - -- i --- - - - - -- ` --- Ga- ry -- - C W- - ang -- - - - - -- --- - - - - -- ,, / - -- (SEAL) -- -. -4U. �� -- -� f,� (SEAL) Susan M. Wan LxJ ---------- - - - - -- ------------------------------------------- - - - - -- ---- - - - - -- -- - - -- - -- --- '- - - - - -- - - - - -- AUTHENTICATION ACKNOWLEDGMENT Signature(s) _____________________________ _______________________________ STATE OF WISCONSIN -------------------------------------------------------------------•------------ StAt._ C rs�ix .......... County. authenticated this - - - - - -- -day of------------------ --- - - - - -- 19 - - - - -- Personally came before me this . - _z_$X CZ__.day of ........ A ): X.il- _---- _------- -- - - - - -- 19-.8.5. the above named i -------------------------------------------------------------------------------- - - -- Gary - - = - Wang -- and -- -Susan- M_- --- WAn - husband _• and_. wife------------------------------ - - - - -- TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not- ------------------------------ --- - - - - -- -------------------------------------------------------------------------------- authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the forego instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY L /l? -� /--. _'-___'__"._'_-______ ____ ______ _ _ : Merry Nelson - - - - -- -- ----------------------------------------------------------- 219__N_.__ Main._St_d,. - -- Notary Public ___ Pierce County, Wis. --------------- - -- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: - -- February 1, , 19__87_..) *Names of persons signing in any capacity should be typed or printed below their signatures. H.Q ilIerComplym STAT FORM No. WIS SIN w Stock N O. 13001