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HomeMy WebLinkAbout026-1097-20-000 v a 0 � N C d O O h _ i O O N y N C d E N a y L i a c N ro N _ (D N U C Z y C Z m lL C t U. C O 2 O N ro 0+ a a E a ° M ° a� U 3 N CL N � N N Z co Z E E O E o Z ac ° .,w am am Cl) H z -° O O Z a c w Q' p N w N w o Z v c ° E c ° Z rn ° z c E ' c E _0 N _ N C CY •N o a nI a L O o a Q w o z m z Q Q o z z z o N n z z tp O C ' " c C c c ro E L N ro E c N N O L� .. ro L� ., ro _ Q w r+ C G w C a 000a` c ° 3oca` _' -> w E r N r N u f U U r ) E O O O a= z L o O O a Z z • a Z a a a 3 a a a O U) :3 a) f/) J (,� N m Z N O a) tr_ N N Cl) co co 0 O O '� t O 'j 7 m C 0 - m C C- n O z � ro M o m Q m m d Q Z (n Q n d Q Z (n 0 O C N N n 7 r t_ C O O m 3 V E co c E to Q C) H = croi a E m o n� ° O W O OD OC U) O N r 7 Cl) = O C.9 y 3 o E a; ° _o c_ a� y • IN N U N O N O ro U O N O C O O V l o M Y O z C Z w Y O z C Y Cn i T w E E da �a .. 3 a a � a • C4 c m u m d c m d c �1 A vat Omv 0U) Parcel #: 026- 1097 - 20-000 04/27/2005 04:10 PM PAGE 1 OF 1 Alt. Parcel #: 34.30.18.520B 026 - TOWN OF RICHMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HERMAN W SR KELLER KELLER, HERMAN W SR ' 1277 130TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1277 130TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 38.370 Plat: N/A -NOT AVAILABLE SEC 34 T30N R18W 38A NE NE EXC E 16 RDS Block/Condo Bldg: OF N 20 RDS EZ -U- 1419/468 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 30N -18W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 02/13/2001 638449 1586/246 TI 284356 423/218 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 20394 Use Value Assessment Valuations: Last Changed: 06/30/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 18,000 88,100 106,100 NO AGRICULTURAL G4 11.000 1,700 0 1,700 NO UNDEVELOPED G5 26.370 16,800 0 16,800 NO Totals for 2004: General Property 38.370 36,500 88,100 124,600 Woodland 0.000 0 0 Totals for 2003: General Property 38.370 53,300 88,100 141,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1 t INS TION REPORT Sanitary Permit No: 420440 0 GENERAL INFORMATION (ATT C1 k ERMIT) State Plan ID N Personal information you provide may be used for secondary purposes [Privacy LaO 8:1 )]. Permit Holder's Name: City VMaQe wnghip Parcel Tax No: Keller, Herman Richmond Township 026- 1097 -20 -000 CST BM Elev: I Ins p. BM Elev: BM Description: -t L ,. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing tt. B y c,.... G Aeration ETIdg. Sewer Fir 1 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet ueta TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ► " 1 Dt Bottom > I o0 Z' + 2 4 Dosing Header /Man. 4.0(3 Aeration Dist. Pipe 8 - 13 q'f• r � t k �,o , 6 . 9 •09 H: ldin Bot. System 1 • 1.1s f 11,1 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover a GPM Model Numb � f �.� M6100090 TDH Li ion Loss System Head T H Ft l For main Length Dia. SOIL ABSORPTION SYSTEM JD S BED/TRENCH Width t Length ' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (OZ � I ( SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufa tur�r: c / n INFORMATION CHAMBER OR � hh .�tehX Type Of System: 1 �-� UNIT � � � Model umber: t Ca v. Etta a 1 DISTRIBUTION SYSTEM Header /Manifold u Distribution x Hole Size x Hole Spacing Vent to Air Intake __ ! Pipes) 1 1 Length __ _ 1 MDia Length Dia pacing T SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil l I L Yes F&I No j Yes Lk No COMMENTS.* (Includ code discrepencies, pp ersons prese( t,�etc.) Inspection #1: vw DT , 1 7A02 . Inspection #2: ��j vat. eE 1 1 ..� we a �iC A.k.,Qo` L c r � a�.� . ocatio r 1 7� 7 130tj�` vvee , ue New I�ichm ond, WI 54017 (NE 114 NE 1/4 34 T30N R18W) NAI of Parcel No: 37.30.18.4206 1.) Alt BM Description = " `� VI".*- 2.) Bldg sewer length - amount �6J Use other de foruadditional Yes No formation. J L _ •— ir--li SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. r Safety & Buildings Division Sanitar rmit Application 201 W. Washington Ave. �' PP PO Box 7302 In accord with Comm 83.2 1, Wis. Adm. Code Madison, WI 53707 -7302 Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(l)(m)) state owned.) Attach com fete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x i i inches in size. County �� State Sani �rmi er 0 Check if revision to previous application State Plan 1. D. Number � • C�PO1 4 I. Application Infor ation - Please Print all Information Location: P rty Owner Name RECEIVED Pr e perty Location F �. Ft 1/4 4, T 0,N, R E (orQ S � P 2 3 2002 rl' op Owner's Mailing Address L Number Block Number 2, - 7 �7 0 4 X44. Cit , State Zip Code Phone umbc8T. CROIX COUNTY division Name or CSM Number ZONI G OF 444 _ ! 3©0 { � tuJ� 'G� e�✓a� O ! (7r C��l/1 �W � , (Y 0 1I Type of Building: (check one) S77/lI �.CJ City 0 Village 1� 0 1 or 2 Family Dwelling - No. of Bedrooms: il/ own of 0 Public /Commercial (describe use): 0 State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 36 - A-1-e- A) 1. ❑ New System r-.Svstem Replacement D3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) Tank Onlv Existing System 6 d 97 /Zo 190 B) I Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV,,Yype of POWT System: (Check all that apply) a5,+ ,31.0 P'Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aero is Treatment Unit ❑ Fecirculating ❑ Other: / L�40 B l/ V Dispersal/Treatment Area Information: I. Design Flow (gpd) / 2. Dispersal 3. Dispersal A va ion rade / ✓ Required Proposed Rate (Gals./day/ s ft.) (Min. /inch) Elevation ✓ VI Tank CapaeK Cap ' in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete tructed Tanks Tanks ca 1800 1 l w Cam+. 11 ❑ ❑ ',e T L L_Z&�a-z 0 VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown hed plans. Plumber's Name (print) Plumber's Signature (no stamps): PRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) 26 - 7 lP s 4 VIII County/Department4Jse Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Dat Issued suing gent Sig o stamps) pproved ❑ Owner Given Initial Adverse Surcharge Fee) �p (f7 Determination �� � l /'� �� IXConditions of Approva� R asons�a�roV J� 0�.�- o• Y w 4 ,10 _ P, 1q,. 5- y 57 � ,Q �3�,� - + pR 78/ s a� �x � N9 fie c rx r/ A4 S c''" W 1 P� 7 gs -i 0. 0.� Gin ao � co 1 ;77 l3OA �-e- 1��w 9 ("7 14 w y ' f 3 �.u, .: YO 79/ L v a-L` rx rS7'� n -10 S COP& t0 U t S J o , T 0--f vie I/ e- ate N� P." 1 � p Sys /C✓. -All 13 q 0. Y 1573 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 026- 1097 -20 -000 Please print all information. evie+nred Date Personal information you provide may be Lff or sseerCd J Law, s. .04 (1) (m)). Y 3 O Property Owner 'S roperty Location Herman & Bonnie Keller vt• Lot NE 114 NE 114 S 34 T 30 N R 18 W Property Owner s Mailing Address " L # Block # Subd. Name or CSM# 1277 130th Ave. Ib City State Z( Code P,hone1Wmb& City v village Town Nearest Road New Richmond Al 5 - 715- 246 -5413 Richmond 130Th Ave jj New Construction Use: M Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD JM Replacement J Public or commercial - Describe: Parent material Glacial outivash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at 92.00' using 20 leach chambers. Boring # ' Boring Id Pit Ground Surface elev. _ 97.85 ft. Depth to limiting factor >120" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfN *Eff#1 *E 1 0 -13 10yr3/2 none sil 2fcr mvfr as 2f 1 m 0.5 0.8 2 13 -30 10yr4/6 none sl 2msbk mfr cs 1 fm 0.5 0.9 3 30-48 7.5yr4/6 none Is 0 sg dl cw if 0.7 1.2 4 48 -55 10yr4/6 none sil 2msbk ds aw 1fm 0.5 0.8 5 55 -73 10yr5/6 none fs 2msbk ds aw - 0.5 0.9 6 73 -120 10yr6/4 none strat. s 0 sg dl - - 0.7 1.2 Fil Boring # B Pit Ground Surface elev. 97.67 ft. Depth to limiting factor >1 12" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 -12 10yr3/2 none sil 2fcr mvfr as 2f,1mc 0.5 0.8 2 12 -28 10yr4/4 none sl 2msbk mfr cs 1fmc 0.5 0.9 3 28-40 7.5yr4/6 none gr Is 0 sg dl cw if 0.7 1.2 4 40 -56 10yr5/6 none s 0 sg dl aw - 0.7 1.2 5 56-66 10yr4/6 none sil 2msbk ds aw - 0.5 0.8 6 66 -80 10yr5/6 none strat. fs 2msbk ds aw - 0.5 0.9 104" =redox. features, sl, 2med platy, dsh. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/L * E = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig CST Number James K. Thompson S.--.— 3602 Address A.C.E. Sal & Site Evaluations D e Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceda, WI 8/1/0 2 715- 248 -7767 c property owner Hernian & Bonnie Keller Parcel ID # 026- 1097 -20 -000 Page 2 of 4 F 3] Boring # Boring Pit Ground Surface elev. 96.95 ft. Depth to limiting factor >118 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WNW *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2fcr mvfr as 2f,1m 0.5 0.8 2 10 -26 10yr4/6 none grsl 2msbk mfr cs 1fm 0.5 0.9 3 26 -50 7.5yr4/6 none gr Is 0 sg dl cw if 0.7 1.2 4 50 -56 10yr4/6 none sil 2msbk ds aw 1 fm 0.5 0.8 5 56 -92 10yr5/6 n one strat. fs 0 sg dl aw - 0.7 1.2 6 92 -118 10yr6 /4 none strat. s 0 sg dl - - 0.7 1.2 D Bonng # Bori Pit Ground Surface elev. 95. ft. Depth to limiting factor >98" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sil 2fcr mvfr as 2f,1mc 0.5 0.8 2 9 -19 10yr4/6 none gr Is 0 sg ml cs 1 fm 0.7 1.2 3 19 -29 10yr5/6 none gr Is 0 sg dl cw if 0.7 1.2 4 29-48 10yr5/6 none s 0 sg dl aw if 0.7 1.2 5 48-67 10yr5/6 none fs 2msbk d aw 1 fm 0.5 0.9 6 67 -98 10yr614 none� strat. s 0 sg dl - - 0.7 1.2 t' Boring Boring # ft. Depth to limiting factor in. Pit Ground Surface slap. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 I * 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. I • SOIL AND SITE EVALUATION 1573 page $ of 4 PROPERTY OWNER: Herman & Bonnie Keller PARCEL I.D.# 026 - 1097 -20 -000 A.C.E. Soil & Site Evaluations REPORT MEMO E)asting septic tank must be inspected to verify capacity & structural stability. Effluent filter must be added downstream of outlet. Install bust -run valve after effluent filter to allow future use of hydrollically failed system. l � 2 "' 130 Ax. o '- -a ES�ma�.ed ele ys s S' E�i sbh� rc siUa/ehCe 7. $A/ e 0C'k ►Y ta//!: Top of Jow�sE -��A atbacedce, &wp. � •�1 ssc�.Kc�! 8 ■ gz elegy = /oa.GiD: I L"tXjS�ihq' Lotll d Ate a.M•: TepoFcve!/ Cas ;�n� . x 99 is opts yar d l crl /. Sy�t�.n zk&: o ` 0 a ll. OP� 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 sprving the f h residence located at: %, %, Sec. �, T R _L#_ Town of j p&0( 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 �9 Did flow back occur from absorption system? Yes No (if no, skip next line. , Approximate volume or length of time:_ gallon Capacity: "191 o Construction: Pr ab Concrete Steel Other Manufacturer ( if known) : (,��� loAO Age of Tank (if known) : q Q 3 (Signa re) (Name) Please Print o w (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). �, /' Name �J�tV t � h.F Sign re MP MPRS i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM uyer ��1�hi Mailing Address • /: / 3 0* Property Address (Verification required from Planning Department for new construction) t City /State N j /C e GA rr1 u cel Identification Number LEGAL DESCRIPTION Property Location ' 4!E V" P V., Sec. T -R�W, Town of Ri cA r d,4 . Subdivision /V i . Lot # Certified Survey Map # , Volume . .Page # Warranty Deed # 2 S 3 Volume -V 23 . Page # ;;V g Spec house ❑ yes Wno Lot lines identifiable 2 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper • What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. pr g The ro owner a to submit to St. Croix Zoning Departm ent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping i f nece ssary ), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zo ning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. x SIGNATURE OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county t ar zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- �rpp. 10567 -P (8.6/99). + u Table 1: System Design Specifications w « Sanitary Permit Number Number of Bedrooms Design flow - Peak (gpd) : Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Qpp Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) `£ Maximum influent Particle Size (in) 1/8 ` Maximum BOD (m /L , e ( /L) 220 Maximum TSS (mg /L) 150 4 , L Table 3: Maintenance Sched Septic Tank ice once every 3 years y Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 3 ' i Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 4E The operating condition of the septic tank and outlet filter shall be assessed at least �ry once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure } t proper operation. The filter cartridge should not be removed unless provisions are made to t'etain solids in the tank that may slough off the filter when removed from its enclosure. If the "., s , Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service ` needs to be performed to maintain less than maximum scum and sludge accumulation in the " tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by �q 4 I an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for "t any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a f ` person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the t tank is no longer used as a POWTS component. (( fq y Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic ¢ wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage w from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. ? 2 r p F„ Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. f, "Q, e- R ol a Y nfi V i AOt PA Y y`_ 3 No. S-L Warranty Osed—Common Form (STAT& OF WISCONSIN) Soa 166.16, Win. Statutes. Fora No. 1 Published by tau Clslre Hoot ! StatlooM ro. This Indenture l j� •Madethta day of February , A. D., 19 66 . between C!.ris'_i *_e G. Ekstrom, a woman, part y of the first pan, and Ke Iler rind Connie Keller, ,_asbar_d and wife and as 'oirt part iesof the second part I! MitnrOOrtb: That the said part of the first part, for and in consideration of the sum of i 00 - I, 1 �•�a -rx r�ra :.r� ,� ------------- - - - - -- 1�oi ars to :.e,• in hand paid by the said part es of the second part, the receipt whereof is hereby j confessed and acknowledged, ha s given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ; e: of the second part, e'_LL' heirs and assigns forever, the following described real estate, situated in the county of Croix and State of Wisconsin, to -wit: e-: a_l_. (E- , f ,E ) ol Jrr 0) or i e tee:. (1 ) .�e�. ex�e}�:. _.:e eas_ 'or _,ea ,-. u:Ir e. of .no sec r ' ' o -- �4 Tovs ?Q, .j , ry 11 I� r" _ �� �� ►� • 1 I 1 11614' 11'i second part, r heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, " ° will forever WARRANT and DEFEND. Att LA#tntM5 Zl; btttof, the said part " of the first part ha=' hereunto set hand and seal this day of iI e.l , 'u it :, , A. D., 19 Sighed and Sealed in Presence of (Seal) J ............ _............................ _ ........... ................. ...... ............ ........... _...._....__..� _.. t........ s.: s.. w_................_ ...... _ ........ ......... .._.:.5... ............ (Seal) l ..... ..... ................................_............. ........._...._.........._..._. ........._._.............(Seal) _ (Seal) t�tatt of LUfotnns5tn, ss. ........... y) Personally came before me, this day of "° A. D., 19 rho' above namcrl h; to me kno,vn to he the person who executed the foreg l nr� /: strurpent a acknowledged the same. , (J— Notary Public, ............. Cdtlttt;c Wisconsin dJ AS BUILT SANITARY SYSTEM REPORT r OWNER TOWNSHIP / SEC .�T3G�1 - r ADDRESS I 4 — ST. CROIX COUNTY, WISCONSIN. i SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 I dilate N r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: �j(/ _ �k S _ Liquid Capacity: Z/ Number of rings on cover : , _Tank manhole cover elevation: Tank Inlet El Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand 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; Number of pits feet diameter feet liquid depth seepage pit inlet pipe - elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile depth SEEPAGE TRENCH: width_ ,s' length PERCOLATION RATE ,.Z AREA REQUIRED � ti AREA AS BUILT C� INSPECTOR F DATED `- - ✓ PLUMBER O JOB LICENSE NUMBER /p 9 ., -1 i DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUll RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 11 CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Numb er: ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE Herman Keller RR# 4, New Richmond, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV. NE NE, Sec. 34, T30N —R18W, Town of Richmond Name of Plumber: MP /MPRSW No.: T7� Sanitary Permit Number: Richard Hopkins 1059 Croix 38478 SEPTIC TANK /HOLDIN TANK: MANUFACTURER: LIQUID CAP iTY: TANK I LET ELEV.: TANK OUTLET ELEV.: WARNI G LABEL LOC G E S I� < PROV ED: PR D 'J `� YES ONO njYES NO BEDDING: VENT I .: VTML: I HIGH WATER FU BER OF ROAD: PROPERTY EL B : UILDIN VE TTO RESH ALARM. LINE:/ C pr AI NL ❑YES ( NO ❑YES NO C ((/ 74 - 7 DOSIN C AMBER: 1A ii I f MANUFACTURER: BEDDING: [LIQUID CAPACITY. MODE UMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO [:I YES ONO ❑YES ONO GALLONS PER CYCLE: P c T LS OP I NAL NUMBER OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM- LINE AIR INLET: PUMP ON AND OFF) 1:1 ES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowi g LH DIAMETER J IMATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease u it FORGE ENGT the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH LENGTH: NO. OF DISTR. PIPE SPACING. COV INSIDE DIA.. #PITS: LIQUID NC ���� �� TREN HES ER PIT DEPTH: CfIV11lONS GRAVEL DEP FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: O. R NUMBER CAF ZPREPT�L WELL: BUILDING: VE ESH BELOW PI E AB COVER. ELEV. INLET ELEV. E D. PIP ) �/ AI LET. FEET FROM ` S (� N €AREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PRO E A DIAGRAM OFSYSTEM and furrows thrown upslope: mound system to ake certain that it ON VERSE SIDE. SHOW ELEVA- meets the crit ria r edium sand. T S MEASURED. OYES ONO SOIL COVER I TEXTURE PERMANENT MAR 7 j cr7 :7� f[EDYES VATION WELLS. ❑YES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOSOIL: I SODDED I MULCHED. CENTER. EDGES. OYES ❑ n Y ES ONO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO. OF LATERAL SPACIN GRAVEL DEPTH :7 FILL DEPTH ABOVE COVER: a - TitGt / TRENCHES:/ 1 !_. MANIFOLD PUMP MANIF DISTR. PIPE M NO DISTR. STR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV.: DIA.. ELEV.: PIPES: IA.'. I.EAT�ON ANt�! b0 k1T1O(1 HOLE SIZE =RKERS: D LED CORKECTLV COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: ❑YES ❑N DYES 1:1 NO COMMENTS[ OBSERVATION WELLS: Nt1MtE ,R PROPERTY WELL: BUILDING: FEET' FRt�NI LINE: ❑ YES ❑ NO I ❑ YES ❑ NO NEAEF S 1 � '0� Z Sketch System on �1 Retain in county file for audit. Reverse Side. �� SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION low—Val SAFETY & BUI LDINGS INDUSTRY, *' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: e Property Location: G&&vLillage.et-+ownship: unty: / VR s iT O N/R O (Or) W sT (5ee Lot Number: Blk No.: SubdivisiXname: Nearest Road, Lake or Landmark: State Plan 0. N b / (If assigned) x- TYPE OF BUILDING Number of Q Public ❑ Variance* ❑ Other (specify) — Bedrooms: 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: g EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE I ABSORPTION AREA (Minutes per inch): PROPOSED (Square feetl: Alew ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑Alternative (specify) Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private 1:1 Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of Plumber: Signa re: A►/MPRSW No.: Phone Number: Plumbee A ress: (7/5) -Z yd sy 4 Name of esigner• f COUNTY /DEPARTMENT USE ONLY Sig t re of Issuing � 7 nt- Fee: Date: ` GGZZ Sanit ypPerrmmitnNu bar: o /` mod✓ ❑ DISAPPROVED 7 / Reason for Disapproval: i Alternate course(s)•of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) Form - S T C 100 Owner of Property _ r� �� r o���� Location of Property, Sectio T N R_4,e W Township M'& r, Mailing Address t� Subdivision Name Lot Number Previous Owner of Property 7�i► %; Total Size of Parcel 3 9 c�:C Date Parcel Was Created 5 �( Are all corners identifiable? No Include with this application one of the following .Certified Survey Map .Deed .Land Contract, or her I:egal 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. ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an .easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. ), SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) Y J DATE SIGNED DATE SIGNED 1118 SIH1 ONIAVd N3HM XV1 Coo C961 UnOA AVd 3SV31d H03HO UnOA HIM 11 3SO13N3 HO S3XVJ ONIAVd N3HM 1118 SIHI 1N3S3Ud ld13038 XVl V lON ONV 1118 XVl nnONVbOW3W V SI S1H1 x a W W 1 < m W O I Q f' Z W Z Q W , Ir W W~ Q 2 Ix W a y w 1 WO I.- ~ ` Z N t Q Inn W ki � E J U. a O ¢ J j W $ J x o � � n m� 1 o� U � as J oii W 8) rt ' - Q bd F4 1 c� ioo �a i €�. r QQ p� . s°gs z � a aG a € sE tc to ` o �• t� M 04 a .a E It r / fir • 1v1�3rt : dw SXNVt 11V 03NV319 SVH X93N3 11INn 011VA ION 1 SI 1I13OM XVl 'X-13H3 Al DOWN SI IMMAVd !1 Ir t UMUOW M S S9 N/!OA S43A09 N0I141Ig9a0 3M1 1WIL 7tlf4 00 IISMtMA1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, ,� CC DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATION: ff SECTION: TOWNSHIP OT NO.: BLK. NO.: SUBDIVISION NAME: '/4 g'14 3 ` /T,&; N/R 11 W ,¢ COUNTY: OW R 3 'S BUYER'S NAME: MAILING ADDRESS: o Gr n USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: P LAT ON TESTS: Residence - 3 d - New ❑Replace �' ,T iq o duo /O- 8 RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIO . U . IN- GND- URE: SYSTEM- IN- FILLHOLDING TANK: RECOMM� �E� yS�M:(optional) SS SEA S a %U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Flo i n d icate Floodplain elevation: AI -Z-1 PROFIL DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- 5 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-01, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 A'o 1 4 V 5 B- 5 5 4-5 _ r- B- I V p V j 7 — 7S /- 7 6 n 5, 1 �S S # 7 6v s L S B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER IASOPES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PER PER INCH P- r 1127 7 P- ,2 P- ? 3 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 , 1 ©� mm ? , t i � tN Fi F , i , g r 1 ..- .__} , , E I E E k , , te a, ...... _ . ... _... -... W.. _........ ._ .w. _ _..._ _... [ i 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 ( lint): WERE COMPLETED ON: C_ G / y — 8 _�3; ADD S: CERTIFICATION NUMBER: PHONE NUMBER (optional): 5 P V / -,> 1;7- _r, CST SI TU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ' —OVER — LHR -SBD -6395 (R. 02/82) r y 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; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. 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; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; J. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be, used if desired; �- 8. Make sere your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not 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 Perc - Percoiar.ion Rate need s !Medium Sand W - Well Ps Fine Sand BI< g - Build ;nq Is Loamy Sand > - Greater Than 'Fl Sandy Loarn < - Less Titan I - Loam Bn - Brown . sil - Silt Loarn BI - Black si Silt Gy - Gray , "cl - -- Clay Loam Y - Yellow scl Sandy Clay Loam R - Red sic[ - Silty Clay Loam mot - Mottles sr-, Sandy Clay wi' with sic - Silty Clay fff -- few, hair , faint c - Clay cc -- common, coarse pi ._ Peat rnm -- Many, rne&um rn Muck d - distinct n __ prominent HWL High watt.= level, Six rgeneral soil textUres surface water for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The coat %Y orthe Department may rearrest verification of this soil test in the field prior to permit issu<Wce, A compkate set of plans for the private sewage system and a permit application must he subnrritted to the appropriate local authority in order to obtain a permit. The sanitary perr - nit nikrst bf obtained and posted V)i for to `hr° start of any construction. ppppp w p- D !v +� AT d 3 S� f � d T M,P PS U hp,Ow) ff V g rl k6 C . rb