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032-1059-40-100
pulp' ny 3m 0 C `r1 o m m m » m v • •7 c G m T m X (n '= 7 Z in Z ° A 0 Z - I N Z ° W II, O N W `� • 0, N CD O C O NO A 7 C „O„ N w N 5. rn 7 m CD 3 I �n� �m - y WTI (D �y �_�� `1 p CA N n 0 Q y N O N 10 3 m N ° o�A c m n NoI = n a�i' o W° A� O rn o m CL O 7 pJ y °O y O Si c °O O C lD °' l e m a = I L m m a m a co a o c m o W I n O O 3 n ° � oo8 Cl- p m » °O- o! �r z N N U) 07 m ° o ° 0 3 o C coo — n r CA w w m ° co 3 c I c O v o n OOO�I OOOt m 'n °:• Z CD a I a4 O J ° c v v v N tO CD "M _I I m C - ID T N lT D) d y Cn O N m 3 m CL = m 3 N CL =+ D o o y m o O O p O a o m m "me CD =. N N ' �f CD c CD W CD �, O z CD CD t0 z O a CL CO -4 N m I W N a a Z o R C 3 3 tD y y z I � I CD I a` cn m w I � I Calm C r, m Ln D 3 = o m= °/ n>3�.m D m °co3 Cn a =r CD dx°�° -.� a I m y= g< O n� c °1 i m Cnm v Fy y m �< O N f V D) 7 3 C p� 3 E y 'O CD N C i y m c 3 o a o a� ° o a � m m v; o° o `- -R 5 , 0 s co (G CO (D n 01 to y - CD y Q N cn CD I o3 m� Cn c ;� nAd ?°o ft O - 01 O 7 <fD O ty O " W � O O O N — (D m C � I o= - 3 o a m y •� 1 co a� m WO O 7 N N S C N A O CJ O D= =- I cfo9aim Ve 90 m o oySc mb'iom�m CD a d 3aWn a < a n 0 N O y O m O m 7 O N N �•"' a i m O am y fD N d N m N N m O C O z (p �° O (D m = p I m I� 77 j CL O O g CD O O A b CD CD Cro ° o CL i Wispnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sat`dky and Building Division INSPECTION REPORT Sanitary Permit No: 420634 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: Cich , Lisa Somerset Township 032 - 1059 -40 -100 CST BM Elev: Insp. BM Elev: BM Description: \ coo •(b' t-LOA sly ` TANK INFORMATION E VATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark . ' `O IS am ,0 Dosing Q � Alt. BM on Bldg. Sewer t �AS '� St/Ht Inlet TANK SETBACK INFOR ATION St/Ht Outlet A C1 • Zo TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /A 'O.`OI g •9� f 1 s LAS ► 2® 'R • D ' Septic .0 t �7S r► Z ^ f � Dt Bottom Dosing f / 1 1 Header /Man. srco 3$ >SO 13ie� -P►�•• T Holding �� Bot. Syste t J � t oo > V�o•r+9t�j PUMP /SIPHON INFORMATION h. al Grade \ Manufacturer Demand St Cover GPM Model Number �SZ— � ?� � •3n o3.60� Lift 1 Friction Loss System Head TDH Ft / . �t a . 6 ----"• Z . 3 r Forcemain I Le5th �� Dia. It Dist. to Well f pp SOIL ABSORPTION SYSTEM ) �{ BENCH idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3t (3) SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR % IOO 16: FL4 6IILS Type Of System: 1 UNIT Model Number: k 0- 6 KO. ^(. 1 y(" .0 l 5O > ZaD �l DISTRIBUTION SYSTEM •b ` Headeer//M a � ( u Distribution x H le Size x Hole Spacing Vent to Air Intake Length � a Le Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No �t Yes [g No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # . / P3 Inspection #2: Location: 2001 County Road I Somerset, WI 54025 (SE 1/4 SW 1/4 22 T31N R19W) NA Lot Par a 22 1.19.295 1.) Alt BM Description 6 = /1�+� °P� S *, 2. Bldg sewer len th = ` ^ I. 30 " ) 0 2.60 `i• �d' lo�•L+ amount = ,"" .�i�7K d +.it`• y 14(00 �� l0•20 S ��'� (r.zp;, 9`1 'iO ' P n revision Required? Yes No Use other side for additional information ©3 _ _ _ 4 SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 100000 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: Unknown I Unknown CST BM Elev: Insp. BM Elev: IBM Description: TANK INFORMATION 1 DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi ( Benchmark Dosing vf ` 1�i� 5 � Alt. BM Aeratio Bldg. Sewer Halcling St/Ht Inle 2 �✓ O X (r f t TANK SETBACK INFO St/Ht Outlet ATION 0) q•7.4 W TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet (®� �� -90 .E Septict4 / 1 ► Dt Bottom 14-zo 53.9v Dosing � t ' � CD 3 '- ► Header /Man. Dist. PIIS� Bot. System S TT�3 Final Grade PUMP /SIPHON INFORMATION 17J (,mac Qu Manufacturer Demand St C °s GPM C5 Model Number I S Z — � �cs�• 7;o l 3 • (, o TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dial a Dist. to Well r Z SOIL RPTION SYSTEM a -w �a ENC idth t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM SETBACK SYSTEM TO JBLDG IWELL LAKE /STREAM LEACHING Manufacturer- INFORMATION CHAMBER OR Type Of stem: / �f , S� , r UNIT I -> 2- � Model Number: DISTRIBUTION SYSTEM w b - CAS /L Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No Yes :[N ]No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: _ZUO3 Inspection #2: Location: Unknown (Unknown 0 Unknown) NA Lot Parcel No: 1.) Alt BM Description = :� 2.) Bldg sewer length i _j 'f •Q.K S 7 r (p.Vq NIfDC . I - amou q,t7 10 ( (p S ► nt of cover - STst Z��' O�'� 30 9 Z �`* � 0 6 i p.05 � IOt� OgS ► Plan revision Required? Yes No 11 J _ Use other side for additional information_ —_J _ _____ Date Insepctor's Signat a Cart. No. SBD -6710 (R.3197) Safet and Buildings Division County N Visconsin 201 w. wesb;ngton A ve, P .O. Box 7162 Madison, WI 53707 - 7162 Site Address Department of Commerce / AX Sanitary Permit Application �'°"�'' P«mir N ,, In accord with Comm 83.21, errs. Adm. Code, personal information you pro ms `E 3 my be used for secondary vauroses Privacy Law, sis. 1 m 0 Check if Revision I. Application Information - Please Print All Information Sate Pla I.D N u m ber Property Owner's Name Parcel Number 32 - {oSq -- 4-(0 Property Owner's Mailing Address Property Location AA; SOZ- T -3/ N, R City. Sane Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number IL Type of Building (check all that apply) 2 Family Dwelling - Number of Bedrooms ❑ Pubiic/Commer� Use Lrti �- o'- y e.,- earescRaad (� 3 F(. zr III. Type of Permit: (Check on line A (Bum scheme for internal me). p e B if applicable) A. 1 ❑ New System V3 0 Repiac =; of 6 0 Addition to For County use sty Tank B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued 1V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) -)t r 4 -Pressurized In-Ground 210 lvlouad 47 0 Sand Fifter soonsaveaa 22 0 Pressurized bWAvund 41 D Holding Tank 48 0 Single Pass 510 Drip Isere ' S • I . 45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 O over V. DispersalfIlreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Race Sy seem Final Grade Required Proposed Raoe(Gals./Days/Sq Ft) (l n ilnGtr) , dd. ,S Ele vation 2:5c) �� �� 2f /' C) © VL Tank Info Capacity in Toni Number Mamdacdtec prefab Site Seed 14ber p> Gallons Gallons of Tanks Concrete Constructed Glans New Tads Tents y�,� Das ie m Ho Talc 7.s0 % 7-50 / ° 1 � S %' DoaicK t�anber � , VII. Responsibility tement- L the ardesiMiek assume responsibllRy for installation of the POWTS shown on the attached plans. N ame s MPIMPRS Number Business Phone Number Aunber's Address (Street, City, s ) ` me Partm Use Only �2 �AW,�O 1 0 Disapproved SanitaryPern it Fee (mchtdes Groundwater Date Issued 7: nature (No Stamps) rcharge Feel 0 Owner Given Initial Adverse _ C onditions Determi�om 2 ��_ o f- O Z -0 ` , of Appno2� for ' ppr - N o ��ti�i�trtJPtAI� o�,,,t� �y r. '��).j e d� ate. r a9� f r S 1 5p e t ch �i D� `'°°a w= paper ad l d= SM U iwhes to dze BBD -6398 (R.. 05101)) r PLOT PLAN PROJECT Lisa Cichv ADDRESS 2001 ctv rd I Somerset Wi 54025 SE 1/4 SW 1 /4s 22 /T 3 N/R 19 W TOWN Somerset COUNTY ST. CROIX 1/2/02 5.5 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL IN -GR UND PRESSURE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 1000/750 LIFT TANK SIZE1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1306 # of chambers 42 BENCHMARK V.R.P. Base of Garage S iding ( t#�` *q ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 102.5/101.4/100.3 Alt. BM — Base of Garage @ 99.0' Apple River Vent Plans Designed Using >6,. Standard Biodiffuser Conventional Powts Of er 11" 100 ST ST Leaching Chamber Manual Version 2.0 with 31.1 ft2 of Area • _ ong 34" Grade at System Elevati n 60' 20' 30' Existing 5.5 40' Garage Bedroom House 3 W ell B.M. 30' Weeks LT All. 180' 65' .M. 3 -3' X 88' 10' Old system ent Cells with >3' spacing 230' 4% Slope 2 S0' 50' B� Vents 106' 107' 1~ B -3 108' To Cty Rd I PLOT PLAN PROJECT Lisa Cichv ADDRESS 2001 ctv rd I Somerset Wi 54025 SE 1/4 SW 1/4s 22 /T 3 ^N /R 1199 W TOWN Somerset COUNTY ST. CROIX V 1/2/02 5.5 MPRS Shaun Bird 226900 ' r DATE BEDROOM CONVENTIONAL IN- GRUUND PRESSURE CONVENTIONAL LIFT )00 (HOLDING TANK MOUND SEPTIC TANK SIZE 1000/750 LIFT TANK SIZE1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1306 # of chambers 42 BENCHMARK V.R.P. Base of Garage S iding b�4 *1) ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P Same as Benchmark SYSTEM ELEVATION 102.5/101.4/100.3 Alt BM - :- - - Base of Garage @ 99.0' Apple River Vent Plans Designed Using >6„ Standard Biodiffuser Conventional Powts of Cover Leaching Chamber Manual Version 2.0 with 31.1 ft2 of Area 1199 ST ST , 6' Long 100 34" Grade at System Elevati n 60' 20' 30' Existing 5.5 40' Garage Bedroom House 3 W ell B. M. 330' Weeks LT '`fit- 180' 65' .M. 3-3'X 88' 10, Old system V ent Cells with >3' spacing 230' 4% Slope 20' � 50' Vents 106' 107' 1~ B-3 108 ' To Cty Rd I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C_1 e Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must c�7� include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evie by Date Personal Information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot S 1 /4 .5 N SOU T ?/N R J E( Property Owner's Mail Address ss Lots Block # Slid Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ATown Nearest Roe /2 sYdwr (� 0 `� S ❑ New Construction Use: Residential /Number of bedroom Code derived design flow rate GPD Replacement 0 P lic or commercial - Describe: Parent material ©tali Flood Plain el lion if a icable /d/�� ft. General comments and recommendations: S�'' tltr��Z /�� � JG� J l(�o' , 3 Boring # Boris Pit Ground surface elev. �o g R. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. L Munseell Qu. Sz. Cont. Color / Gr. Sz. Sh. 'Eff#1 "Eff#2 - V V ✓� / L. war. G C. nn 2 �— / / -0 _j ra Ong # ❑ Boring ' Pit Ground surface elev. J05 -9 ft. Depth to limiting factor . XJ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •E 3 Zx a�' Oo •3� • Effluent # - BOD > 30 < 220 mg/L >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L Name (Please _ Signature CST Number PAfl-LI Z'z Address Date Evaluation Conducted Telephone Number • J Property Owner _ Parcel ID # Page of Boring # ❑ Boring .Pit Ground surface elev, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /t •Eff#1 I •Eff#2 0-/7- -1 /,�3 - -1-Y /O F-1 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 a 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 GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. • Effluent #2 = BOD 130 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. SBD4330 (R.6=) Soil Test Plot Plan Project Name Lisa Cich I Y Shaun Bird,!' - Address 2001 Cty Rd I Somerset Wi 54025 CSTM 26900 Lot - ---- Subdivision -- - - - -- Date 1/2/03 SE 1 /4 S W I /4S 22 T 31 N /R W Township Somerset Boring Q Well PL Property Line County CROIX BM or VRP Assume Elevation 100 ft. Base of Garage Siding System Elevation 102.5/101.4/100.3 *HRPSame as Benchmark Alt. BM B ase of Garage @ 99.0' Apple River 100 LT ST 20' 30' Existing 5.5 Garage Bedroom House 30 * B.M. well 30' Alt 180' 65' .M. 210' Old system ent 4% Slope B- 20' 50' 50' B-1 _ � lOb' 30' 107' B -3 108' �- To Cty Rd I .y►s.. .,,�,,,. w• *urnP _ r�+;,�a,>L eatoas SCG� aut±_ SlLG��iCATIGUS3 .�+YCtrIT CAP � W!J►TKCltP1�00s i wt /Rtl, 1/!a i�OCNti►t6 s �if�1C' =OAi �4Y ! %NWII�IOLC i."DV�R • i>ir s401% 01I1iR. ,t'M•ai. A-mow OR +'R • i dicwmc 4 f" J A i i Htl. � CdbOYiT � + aal. � �► wROviCi i W ON 7 AtR1+bKr flt�►i. t f I � A46AILI 1 � - f f •APi<ROV90 ; ON 4 joins tiff" --•� �t liplAWa PIPE ' - 3 , oLtr�! ••` .•"i pie SOLID Solt ~` Co�lt.lTl[ �K RI�Oft ItflaT riRwt'fl'ti'� ayfr� //"llaYlt IrCriNtl.R s�ti tYQ�MI A�IMtOY+si. _flECfi�fGLTIlrifO PAMUlrAOT --- - << tea" o► oosss: Fitt as TAM SM Do" V06111019 AhM PM 61"aSm.- - vd 4er V< _ o „�v0 ivG.Ylltl�r i�NCK�iiwt a oe' V tl► Aom /4 rr4p A t/ Olt rams T G- S S Ii= an ft MA air �. • q1i +iidF OA MLiRM awmig wt Ave ..�. "Writ! NOW W to &A StMA11Tt Ot�iWtTi Ammon am"Ast-- �. -- 0 - GPM III m�rsttewat aMCT:ltssa rtrqr If►n +wo uT:oU >•►rg.. q C' .. >rsT l �o�! 76 U Iw,tvft olcswaRu supfty pusufltc ....... �!l� fteT 6 1 ,0, s� ,. .�...� f'tiT 4W i►Or149 erulW x ��. �esear near _ fit. owwwouG 449AD s c � IPL8 t►TiRYRt. dtMtfJ of ty► itdbTk w ,.; _- $ WIDTH .�..,. T LIQUID Dcp ri4 asset;• Z ��� ov r TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 UJ MODEL 152 153 50 Feet Meters Got. Liters Got. Liters 153 5 1.5 69 261 77 291 12 40 10 3.1 61 231 70 265 152 15 4.6 53 201 61 231 20 - 6.1 44 167 52 197 v 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 r ° 35 10.7 -- -- 22 85 20 O 40 12.2 -- -- 11 42 ~ 4 Lock Voive 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 — 014306 0 2 40 60 80 100 GALLONS 6 1/4 LITERS 0 80 160 240 320 �7 3 27/32 4 5/8 FLOW PER MINUTE - 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ • Timed dosing panels available. ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. I • Over 130 °F. (54 °C.) special quotation required. I 152M53 Series_ 12 1/8 1511153 DELS Con of Selection Model volts-Ph Mo Anys S ex Duplex 5 1/8 N152 115 1 Non 115 1 2or3 ON152 115 t Auto 8.5 Uxkxled 2or3 E152 230 1 Non 4.3 1 2or3 RE152 230 1 Aub 4.3 Included 2or3 N153 115 t Non 10.5 1 2or3 SELECTION GUIDE 8NI53 115 1 Aub 10.5 indlxied 2or3 E153 230 1 Non 5.3 1 2or3 1. Single piggyback variable level float switch or double piggyback variable level float 6E153 230 1 I Auto 1 5.3 1 Included 2or3 switch. Refer to FM0477. CAUTION 1 2. See FM0712 for cared model of Electrical Alternator E Ali Insheation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed eh cdiclan. AO electrical and safety codes should be followed Including the most a ( float system. recent Nationd Electric Code 1NEC) and the Occupsttoad Safety and health Ad (QSHA) RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. WAIL TO. P.O. BOX 16347 LouavNe,KY 40256-M7 Mmullic(urersof A .. SHIP TO. 3649 Cane Run Road O W. La&vi8e. KY 40211 -1961 Qraurr a L*M 'Arf BUY w (502) 778 - 2731.10 928-PUMP hap //www zoeller corn PUMP IO FAX (502) 774 -3624 © Copyright 2000 Zoeller Co. All rights reserved. Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. I 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. D o not trees nor park rk nor drive over system. P 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. if system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900\ I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify . that I ave inspected the septic tank presently serving the , Sc residence located at: Sectio �- , T�N, R 1 / W, Town of 5� Upon inspection, I certify - th at I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: �- C2 ?`'V Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Cap acity : 1 27 0 0 25 o l Construction: Prefab Concret Steel other Manufacturer: (If known) : �YZiCL�t,U2d' Age of Ta k(If known).: -5 OA (&: J ('' ature) (Name) Please print XPle 2- Z 6q 0 (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, s. Adm. Code (except for inspection openi g over outlet baffle) G z e"9 Name Signatur MP /MPRS SBPTIC TANK MAINTENANCE ACIREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer n Mailing Address Property Address (Verification required from Planning Department for new construction) Cityistate Parcel Identification Number 03Z. - LEGAL DESCRII QN J ftWerty Locatio� %s, %, Sec. T.: W, Town stfi division. Lot # Certified Survey Map # Volume . .Page # Warranty Deed # 5" 3 7 Z T , Volume Z� . Page # Spec house ❑ yep�no Lot lines identifiably' PECXes ❑ no SYSTEM MAINTENANCE Improper use and mamteeanoeof your septic system could resent in its premature Blue to handle wastes. Propermaintenanee consists of pumping out the septic tank every three years or sooner, if needed by a lioeased pumper~ What you pert into the system can affect die function of the septic tank as a treatment stage in the waste disposal system. The properly owner agrees to submit to SL Crony Zoning Department a certification. form, signed by the owner and by a mastorphanbe r, journeyman plumber, restricted plumber or a licensed pamper verifying that (1) the on -site wastewater disposal system is is pr+olm operating condition an/or (2) aim hmpecdon and pumping (if miry), the septic tank is less than 1/3 full of sludge. Uwe, dw undersigned have read the above requirements and agree to maintain die private sewage disposal system with the standards set fordi, herein, as sit by the Dgmtoient of Commerce and die Departanemt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maims must be completed and retumed to the SL Croix County Zoning Office within 30 the tbree a xpira ' n date. I 6z CINATgRE APPLICANT DATE OVVI�ER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (oar) knowledge. I (we) am (are) the owners) of above, by virtue of a warranty deed recorded in Register of Deeds Office. G11A F APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Departnent. * * « « ** «« Include with this application: a stamped warranty Bleed fiom the Register of Deeds office a copy of the certified survey map if reference is made in die wauanty deed �.. Y�F' MQ '7�R:*mis+aa.'Se:;ysc+ru- ...�a• xwwe.v�nwessara�flrsre u'.�.+a �en -+»ay. au. s:+s- .w..+. �.r '�.. s.A...� . ay.- ......r -..,�- DOCUMENT NO. WARROM OWD ?His oaea rsesevm, Igor aseeaeiNe Sara STATE BAS OF WISCONSIN !'OSIt 2-16118 . � 50392`7 - REGISTERS o�FIC 9T. co.. %1 4 ,, - ttla+a . . S94Phe1}.'1 Cishy,, _M4 .......... wife as aurvivo ;shag marital groyartr, _ AUG 1 03 ■ ... -.. .................................................... ....�....__....-..--- ....._.... and warrants ._.......... �� .. I oonw to . �xiI F�IAA ...� �...G1thy..d..bidd..Asl f Ei�Ay.it.. 44 )x.. Nair ix fll. pxQpo xxx. ........ ............. ___....... ...... j ......... ............... .. ....................................................... .................................. _ ............... j .............................................. ............... ...... ................ ._.____.............. '"" .o Sebastian J. Geraei i ......... ........................................................... ..................... .. .. . P.O. Box 187 .. ............................................................................ ............ - - ............... Eau Claire, V1 54702 -0187 the following described real estate in .... +4th, ... CAT.Q .X ................ w - -county. State of Wisconsin: TaxPared Not ...........»................ 1219 part of the MIA of the SW -'t, Secticlr 22- 31 -19, Town of Some�et, � Cm" of St. Croix, State of Wisconsin, described as follows: Commming at the SouWwest cornet of the S&% of the SW 44 and the plot of begbining of the had ft be dam* bed; thwoo North 00 Em slag the West line of said S& It of the SW 1 A a distmoe of 1.137.47 beet, move or kat, to an iron pipe monan mt ad at the top of the bawl; of the Appk River; tbmoe continuing along said Wededy line a distance of font fleet, moue or low 10 the Southerly lboreliae of tfie Apple Rives; thong SwtbM"ly along said Southerly shoreline 10 its intersecttoa with the East life of the SB-% of the SW- %; thence South 00 west alas said at line tD the southeast corner of the M tiof &' SW -%; dtenoe Saoh 89 Weal alms the South line of um M% of the SW -% to the Southwest corns and the pain of begtaning, together with all ripa ion, rights, aocmtions, 1911Ct10nt and right. Of access to the Apple River int raft tD oomMy all that part of the S& W SW-%, Section 22- 31- 191yifg MOM of din Shorrtile of the Apple River. Alm, the Southerly V feet (p nW N the South life) of the SW % of the SW M of Section 22- 31 -19, St. Croix - County, State of Wisconsin. Th1a ... .. .. homestead property. Euoeptim to warraetier: Municipal and zoning ordinances, recorded easements for public utilities serving the property, recorded building and use restrictions and covenants and general, levied in the year 1993. . - pp ie+ Dated this 1�!� b « t day of . 11 i .............., 11.. .. .. (SEAL) _G - - _ &.. ' - - - -... (SEAL) r • .... _ .. g • Ph�l._,�,...�eiiby .......... .. .... .................. _.(8>lIAL) . ........ (SEAL) . 0 • a..Asill_ Clehy . �. AIISD>118 ?IO�lIOlr - - ACKNOWLSDfil[RNT ti ai{�atore(it) _ .«.::...._.._ .................. ...,..., $?t?i!Q OF WISCODJSIN NIL . andmdeatd this — .11101 eZ .,---- .w .............. 11...,. came besoro me thin .._�.�..._.d+s of ..... ., 19 abom lamed _......... . ».. . Sse�bsA.., 1....£. t, cl1�T •�euad_1�is,R.At�fJ.L.GiCh7r TIm: 3111mm STATE BAs OZ WI866N8IN ( ae�tbaed . y_i 70lel, �►ii.. 8tateJ - t� ore - to .. _ who eseeatei tM E iriseEeisg the same. 'nas INarRUwa W WAS DRAM= eY } Linda M. Danielson Ndary Pmbl Coont�y, wig. ( many be authenti aced or 8otb M7 sot. state empiratioa •xeam .e ...... dew to m ew•ft dmM be IrW or .rwd w.a tut m%podo m wws_sausi ssss erwsa Soil ore wssoosasns Wisco LOON ean11 M&, BURNES, MICHAEL 2 SE %, SlV4, Section 22 , -90*-44" 13IN-R19 W, lown oj SomVEYe Someue t, WI 54025 Appte- Riven - adAess o4 site: Pe&m t No. 112696 7 -12 -88 Jack A. Bowman Conv. New I� Parcel #: 032 - 1059 -40 -100 01/11/2006 03:39 PM PAGE 1 OF 1 Alt. Parcel #: 22.31.19.295B 032 - TOWN OF SOMERSET 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 STEPHEN J &LISA DRILL CICHY O - CICHY, STEPHEN J & LISA DRILL PO BOX 279 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " CTY RD SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 22.000 Plat: N/A -NOT AVAILABLE SEC 22 T31 N R1 9W SE SW DESC AS FOLLOWS; Block/Condo Bldg: COM AT SW COR OF SE1 /4 SW1 /4 & POB; TH N ALG W LN SD 1/4 1137.47 FT M O L, TO Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) IRON PIPE, TH CONT ALG WLY LN 4' M O L 22- 31N -19W TO SLY SHORLINE OF APPLE RIVER, TH SELY TO IT'S INTERSECTION WITH E LN OF SE 1/4 more Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1028/124 WD 07/23/1997 901/182 07/23/1997 884/295 07/23/1997 806/480 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 77076 751,000 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 60,000 506,400 566,400 NO UNDEVELOPED G5 19.000 38,000 0 38,000 NO Totals for 2005: General Property 22.000 98,000 506,400 604,400 Woodland 0.000 0 0 Totals for 2004: General Property 22.000 98,000 504,400 602,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 114 Specials: u User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 III 1 Parcel #: 032 - 1059 -30 -001 01/11/2006 03.40 P M PAGE 1 OF 1 Alt. Parcel M 22.31.19.294C 032 - TOWN OF SOMERSET 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 STEPHEN J & LISA DRILL CICHY O - CICHY, STEPHEN J & LISA DRILL PO BOX 279 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE SEC 22 T31 R19W 1A SW SW THE S 30' OF Block/Condo Bldg: SW SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 22 -31 N-1 9W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 9011182 07/23/1997 884/295 07/23/1997 806/480 2005 SUMMARY Bill M Fair Market Value: Assessed with: 77075 19,900 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 16,000 0 16,000 NO Totals for 2005: General Property 1.000 16,000 0 16,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.000 16,000 0 16,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r DrPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS I LAB H DIVISON OR & UMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7969 MADISON, WI 53707 11��.� I S,,,, Plan 1 D. Number: L�CONVENTIONAL ❑ALTERNATIVE SE-4, SGI -, S22, T31N -R 19G1 Holding Tank E:1 in-Ground Pressure El Mound (If assi Town o4 Some�use Avvte RiveA N ME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Michaet BuAne6 Rowe 1, Box 608B, Someuet, W1 54025 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber : MP /MPRSW No.: County: Sanitary Permit Number: Jack A. Bowman 5875 St. cuix 112696 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY TANK INLET ELEV.. I TANKOUTLET ELEV_ WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. [ ONO OYES ONO BEDDING. VENT DIA. VENT MATE. HIGH WATER NUMBER OF ROAD. PROPER TV WELL. J BUILDING IVENT TO FRESH ALARM FEET FROM LI "E' AIR INLET ❑YES ONO ❑YES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER ACTURER WARNING LABEL LOCK( NG COVER PROVIDED. PROVIDED: DYES ❑NO I ❑YES ONO I OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL B FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1 YES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH J DIAMITIH 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 DISTR. PIPE SPACING COVER INSIDE DIA #PITS LIQUID BED /TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH I DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PR OPERTV WELL BUILDING VENT TO FHESR BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END'. PIPES FEET FROM LINE AIR INLET NEAREST --► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 1:1 NO SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WE LL 1:1 1:1 ONO ❑YES 1:1 NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ONO ❑YES ❑NO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MAHKIN6 ELEV.. ELEV.. DIA.. ELEV.. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED 1:1 YES El NO 1:1 YES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. TN BER OF PROPERTY WELL: BUILDING. T FROM LI "E ❑YES ❑NO ❑YES ❑NO REST Sketch System on Retain in county file for audit. Reverse Side. , SIGNATURE. TITLE. DILHR SBD6710 (R. 01/82) ZaVUn� AL{m(VLtJShQo1L ( �° SANITARY PERMIT APPLICATION co TY L.1 'LNR In accord with ILHR 83.05, Wis. Adm. Code ' �..... . STATE SANITARY PERMIT # p —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES K N O PROPERTY OWNER PROPERTY LOCATION Michael Burnes SE '�4 SW X S 22 T 31, N, R 19 X W W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER 1 11LOCKNUMBER SUBDIVISION NAME i Route 1 Box 608B N/A N/A N/A CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK Somerset, WI 54025 715 247-511 VILLAGE: Apple River II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. 1�1 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously Issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. © Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. M Seepage Bed b. ❑ Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): r ,Z' /- /-I y 961"2 Feet T Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total ## of Prefab. Fiber- Exper. Manufacturer's Name Con- Steel Plastic INFORMATION New xisting Gallons Tanks Concrete strutted glass App. Tanks Tanks El Septic Tank or Holding Tank d /� od ` B- © ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ✓ R ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's a re: (No St a ) MP /MPRSW No.: Business Phone Number: Jack A. Bowman 5875 715 235 -3650 Plumber's Address (Street, City, State, Zip Co Name of Designer: 2819 Knapp Street omonie, WI 54751 VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # 3484 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: 334 Fif IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) A roved b Surcharge Fe pp ❑Owner Given Initial 4 Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: ' f A079 .. SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A .aA,NITARY PERMIT 4 APPLICATION ` TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the tinie of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------ - - - - -- --------------------------------------- i GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is mere commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bil Ground a --- included the creation of surcharges (fees) for a number of regulated practices whic -I Wlsco M-s e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water t?iat buried [ecESulB is used in your building is returned to the groundwater through your soil absorptior o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring; ground- 1 water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) p Bowman's Plumbing Michael Burns Jack Bowman - Proprietor Route 1 Box 608B Master Plumber No. 5875 Somerset, WI 54025 2819 Knapp Street St. Croix County Town of Somerset Menomonie, WI 54751 SW4SW /R19W (715) 235 -4634 t i I 7� 0 / 1 � I/top u� i r Bowman's Plumbing Michael Burns Jack Bowman - Proprietor Route 1 Box 608B Master Plumber No. 5875 Somerset, WI 54025 2819 Knapp Street St. Croix count Menomonie WI 54751 Town o Somerset , SEtSW%4S 22T31N/R19W (715) 235 -4634 f I oeo t %c � O � 0 a lum, 2 ea dO/,.r 61: f 1 1112 H ;-n BURNS 13 27.14 msP F AFM MATEY ELECTTzicAL \ I(o00 2vER FQONT*6E SE1ZV IG� `�\ z 0 HOUS �� r _o ✓. `t E 1 /4-SW 1/4 ' c OD I7RIVEWA`( * AREA UE � ■' 0/ _ 1; C_n � W . 5CO� / 662 rn rn - 132.448 � SW CORNER S 8cP23 0 W SE -SW * SE CORNER DRIWWAY To COUNT( ROAD SE — SW Appr, 1 AcIz �� ALUM MON. DEP T OS REPORT ON ►OIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, 9 C P.O. BOX 7969 69 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN R�LA3`IONS (H63.09(1) tat Chapter 1€5.045) LOC ATION: �- � TOWNSHIP /MUNICIPALITY: 0.. E NO.: SUBQIVI 10 NAME: - S F , /"S�/4 2Z /T 3 f N/ /5 75 COI,fIVi Y: OW NA :S— TCP &jAkK OLMIrEA -4 USE DATES OBSERVATIONS MADE J,1�iResidence ,�! diJew �Reptnce I X47 , ? � tom— " „aO C. A6W 1 b <.,pIt,S — mC — PL4 /JF16L& RATING: S- she suitable for system U- Site unsuitable for system ONV N !N GFIOUN E: - -F L O DIN TA K: RECOMMENDED SYST,M:(optional) S ou CCU ❑ S lU S ❑ S 1 �..l, 6g -ric AL o if Percolation Tests are NOT required DESiGN RATE: If any portion of the tested area is in the /) under s.H83.t9(S)(b), indicate: G SS � Floodplain indicate Floodpiain el ev a tion: A 1 ROFiLE s`3'ESiCRIFTiONS BORING A R•INCHE I A R SOIL WITH H N SS, COLOR, EXTURE, AND DEPTH NUMBER lllr, ELEVATION TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.I 4 L 0.4-/.6 S L gCObf6R B- i 6 +c .s3' rsoKli > 6.6 1 , 1 S8Ga eab Cart 33 ,Ntcj S * 6R- B. Z 5.6 °JS• 8 No..l,>` > S,C �_� 3 - 6 „ d S 'SAL LS 194E /.6 -4.3 St R ® - o•4 & L 0.4 -1.6 SL cokl�tl R /•6 -4 .3 S �Gt B 3 5 97.95 No>s� 5.3 0, 1A 'S �s 8 Q e- 4 6 99•g'a > 6. 0 - ©,6 $c L ©.� -!,7 SL scab tGe 1� -6.0 •►Kd 5 �G� ' B- 5.9 39.53 NeN Ir > a••o> �L� ©. -z.o SL�GR -s.9 <-, �� CA6C:ow. B- PERCOLATION TESTS WATER IN HOLE - TEST NUMBER Nt AFTER SWELLINQ TES TIME RAT MINUTES PER INCH P- 1 4 r ? P- P� 114 a a w SRL. S N U04fia& TO & E% ) PLOT PLAN: Show locations o percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe w at are the hori rontal 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 •A land slope. SYSTEM ELEVATION A PPLtr Iv��2 _ _ � I 1 i i a4 i I , BM;- SPt�.. W„I .ft�RAel6►Lr t lsi' : � LIN€ P!Qltc'/ ' pe1TR 1'� IZ`I � �i� b' i . ;.;�� � � ; 5 ►T ♦r i o 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME 1print : �Z N7�1 saC►sll ' -.! _.. __ _ TrS S W ERE dOMPLET ZCON___ �r __ __ ��_������� ""'” —" CERTIFICATION NUMBER: PHONE NUMBER(j tional): DORE§ _.�. t 14 t r "1 _ 41 �I` 1•) ;^Y L1>d, a JPd WA s '� � n i C+ _ _ _ _ :~ 64 CST S{ ( UR 'E::J� *�/(�� DISTRIBUTION: Original and one ropy to Local Authority, Property Owner and SAP 'Tester, '7f I HR X r39ri (R. 02.182` — OVER -- J �I STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER M iMAl2_ ' Boyf.1S AN J ILJ— :>U"S ROUTE /BOX NUMBER 2, Boy (0� 13 FIRE NO. CITY /STATE ao _me_m s wr ZIP 5402..5 PROPERTY LOCATION: SC 1/4 SO 1/4, Section T N N, R /g W, Town of , / , St. Croix . County, Subdivision / / , Lot No. 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office Ji H , —W " 015 (715) 796 -2239 or (715) 425 -8363 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT S T C - 100. This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only - result in delays of the permit issuance. Should this development'be intended`.for resale by owner /contractor, ( "spec house "), then'a second form should be retained'and; completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Location of Property �. sGcJ ', Section Z- , T 3/ N -R W Township Mailing Addres �, 6CF3 1:3 SoMETaS T 1 Address of Site �1 Subdivision Name /01 > .Lot Number Gi . Previous Owner of Property C M Z& Total Size of Parcel Date Parcel was Created /1J Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes x No Volume got and Page Number YS 6 as recorded with .the Register of Deeds. r ' INCLUDE WITH THIS APPLICATION THE FOLLOWING: { A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified'Survey Map shall also be required. PROPERTY OWNER CERTIFICATIO I (We) ceAti that aQt 4tatem on thin 6 0, m aAe tAue to the bat o6 my (ours) know.tedge; that I (we) am (ake) the owne><(d) o6 the pnopenty descAi•bed in this .in6onmati•on 6onm, by vi- tue o6 a waAAanty deed heco in the 0h6-ice 06 the County Regi,6terc o6 Deedh ais Document No.: S 1%' ; and that I (We) pnesentty own the p4opo•6 ed 6 to 6oA the .6 ewag e dL6po.s .6 ya em (on I (we) have obtained an easement, to tun with the above de,6 cA bed p)<open ty, 6ox the con6tAuc ti_on 06 said system, and the .same has been duty kecotded in the 066.ice o6 the County Regi4te>< o6 Deeds, a6 Document No. 35 j ) , " 2'A_� S11ATuREtdi,.0WNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED I' WARRANTY DEED it `i STATE BAR OF WISCONSIN FORNI 2-1 II �. 43579 � 06PAI ISO = = REGIVER'S OFFICE $7. CROIX CO.$ WI ,LeRoy. S_...Murphy__and_ Marie_.C... Murphy : _ nd . husba . and wife as..... RO��� #AF Rseerd joint tenants ........................................................ ............................... ................................................................................. ............................... APR 1 198 I .................................................................................. ............................... Mlchasl.. &..T.1�J...�u. h sb . 9:50 A conveys and warrants arrwarrants to ..- . rs,,, and..wife ai M t ' .................................................................................. ............................... 9 .... .... ... ........................................ ............................... .......... ........ RCT ultN 1p - I..... ... ................................................ ............................. -. — - -- -- • the following described real estate in ...... S Z, ... Cx.4?i•X .................... .....count y , State of Wisconsin: Tax Parcel No: ......... ..................... That part of the Southeast 1/4 of the Southwest 1/4, Section 22, 'township 31 North, Range 19 West, Town of Somerset, County of St. Croix, State of Wisconsin, described as follows: Commencing at the Southwest corner of the Southeast 1/4 of the Southwest 1/4 and the point of beginning of the land to be described; thence North 00 deg. 11' 42" East along the West line of said Southeast 1/4 of SW 1/4 dist. of 1,137.47 feet, more or less, to an iron i pipe monument set at the top of the bank of the Apple River, thence continuing along said Westerly line a distance of four feet, more or less, to the Southerly shoreline of the Apple River; thence Southeasterly along said Southerly shoreline to its intersection with the East line of the Southeast 1/4 of the Southwest 1/4; thence South 00 deg. 18' 59" West along said East line to the Southeast corner of the Southeast 1/4 of the Southwest 1/4; thence South 89 deg. 23' 20" West along the South line of said Southeast 1/4 of the Southwest 1/4 to the Southwest corner and the point of beginning, together with all riparian rights, accretions, relictions and right of access to the Apple River. Also, The Southerly 30 feet (parallel to the South line) of the Southwest 1/4 of the Southwest 1/4 of Section 22, Township 31, Range 19, St. Croix County, State of Wisconsin. This conveyance is subject to easements and reservations of record. S FER This ............. .......... homestead property. is (is not) Exception to warranties: 18th March 88 Datedthis ................................................ day of .................................. ........... ...................... , 39 ......... .................(SEAL) ...- ..5...::. ...... (5 EAI,) ................................... .................. ............. ................................................. .......... .,..... ..(SEAL) '.''. {Gc%� ...v.'._1. ?1. qr!�� ...... ........(SEAL) ... ...... ......... ii AUTHENTICATION ACKNOWLEDGMENT Signature(s) ............................. ............................... STATE OF WISCONSIN I SS. ... ............................................................................. x �x .County. / authenticated this _ .......day of ....................... 19...... Person Ily came before me this .I(Q........day of �• GG _.. ]9.Q.. the above named .....----•-•--•--•----•-•----• ................... .................••............ a p • .. . . ............................ .. . . .. .• -• -- .... ...... .._...._...._.. TITLE: hIEMBER STATE BAR OF WISCONSIN . ...•• ...................... .•-• •---••••---...... ......-- •- •--- ••-•......-- -• - -. (If not, ............................................................ i authorized by § ?OG.OG, Wis. Stats.) to me known to be the person who executed the for •oing instrument an ack wledge the same. THIS INSTRUMENT WAS DRAFTED BY Doreen L. Protz �. cam.. U{ �? �` � . ......................... ...... J NOT - PUB LIC ...�� -- -.: ... - ...S.t�te..4t.1�Ylsconsin Notary Public (.0 .... ......County, Wis. 1 (Signatures may be authenticated or acknowledged. Both T1y Commission is permanent. 1f not, state expiration are not necessary.) date: ... .. Y C ofitr Toit Ex p�es Na _veinb ; w _r _1 M *Names of persona sicninc in any capacity should be typed or printed below their aisnatures. t " "WENSON HETFELD & ASSOC. AND SURVEYORS St. Croix Falls, WI. NW C0Rr1ER NE CORNER NE SW NE-SW \ � N 89 °57'49 °E \/l r� 1 1329.84' ti O 0 0 J Z O N O N o o M -- NE 1 /4 -SW 1/4 C N - M r� O O 0 c � m m z c � o � m rn w _ ^ r• _ -\ cl° o e4 NK S89 W 13 2 7 14' 4 rri J) O +' n jr- p t 0 C O o� N SE: I /4 -SW I/4 • f • $*turnr&s 4P m o P g c� COI�S••� = D •' • \ .'� r WAYNE A. * ••• = z SWENSON _ S-1496 e o CD 'sST. CROIX FALLS. s • � ♦i •. .• ,{ r • N 01 SW CORNER S8: "" W I E -Sw SE CORNE, SE —SW ALUM MON. 1 , 4ayr1E W' , " F 'e 3 yanC ;ury y cr, ~do hc }',- that the MAP OF SURVEY above map is a i, ruc repro s "nt 3tio : of the la.-ius surveyed are+ i�3• correct to OF THE NE -SW and the SE-SW, ti,n bra :)_, m �:n '> l�d�e and belie . SECTION 22, T.31 N., R.19W. , TOWN OF SOMERSET ST. CROIX CO. 4ayne A. Swenson, R.L... No. 1 496 •r o c� a `� gD