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HomeMy WebLinkAbout026-1018-95-100 y ° 3 00 60 a � N � O r a O 6 n O N O z cl) C z ' 7 m LL C O Q O z y O w .' U) i = O O i ° a m z O 0 c U o fA P Q N z c m E - U p M _�V N O ' N N C I •� O L O a c o u-- Q I I c - a Z -z N .. z CN L cLa m to a CL •. o c c 3 z > ° I, E c> 0 0 0 • M �aaa IL 7 O N m Z M d' O O O :5 C 64 .r N N �_ wX � e co ° O CQ CL � O r O O C N C O b � CQ O " rn N O N CO 1) r \ Cn H N C Co 0 0 0 L. CO a \. y 00 CO C: N O Q7 N° CO ED C r E N N N • C r' N CO O • ?� CN O U N C, N O N U •- o Sri 2 M o z `l cn w nw E a o L a w E 0 c c R "1 A vat oU)0 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (1-163.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /MLF6911MUMTY: OT NO.:BLK. NO.: SUBDIVISION NAME: W 1lSL1/ 5 /T30 N /R l (or) W Richmond 1 n/a n/a COUNTY: OWNER'S BXX=�=ME: MAILING ADDRESS: St. Croix Halle Builders 1 1767 115 th. St., New Richmond, Wi. 54017 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESC ER OLATION TE Residence 3 ri a Cew ❑ STS: ( RIPTIONS: Replace 7 -15 -92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN-FILL HOLDING TANK :RECOMMENDED SYSTEM: (optional) ®S ❑U ®S ❑U �S ❑U ❑ S ®U ❑ S ®U conventional I ff Percolatio If any portion of the tested area is in the n Tests are NOT re uired DESIGN RATE: Q under s.H63.09(5)(b), indicate: class 2 Fl i ndica t e Floodplain elevation: n/a PROFILE DESCRIPTIONS apge 27 SIB 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.) 102.45 0 -8, 10yr4 /2, L.; 8 -60 10yr4 /4, s1.; 60-84, - B-1 84 none >84 1 r5/4 co. S. B-2 86 102.30 none >86 0 7.55yr4/ 0 4, 4 1s., L 36 -861 1 �4, stratified S. & gr. B-3 82 100.32 none >82 0 -10, 10yr3 /3, l.; 10 -26, 10yr4 /4, sil.; - 26 -82 1 r4 4 soft sl. B- 4 84 101.931 none X84 0 -9, 10yr4 /3, L.; 9 -30, 7.5yr4/4, sl.; 30 -84,- 1 r5 4 co.s. B -5 80 100.50 none >80 -10, 10yr4/2, L.; 10 -21, 10yr4/4, sil.; 21-47, - B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PER IOD2 PERIO D 3 PER INCH P- P- P- 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 98 .43 _ _ - ! _ i E i I E _ , 3 Iko y -^ / € wh 1 0, � E € € € € W , E E i w E 3 € € t a ) fv ty (P I, the undersigned, hereby certify that the soil tests re o or h r"re { made b fTte� accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the o n the test s.9te correct o best of my knowledge and belief. x NAME (print): ' TESTS WERE COMPLETED ON: Gary L. Steel it ( ' `' '' 7 -15 -92 ADDRESS: „ CERTIFICATION NUMBER: M -2/46-6200 NE NUMBER (optional): 1554 200th. Ave., New Ric1utiond, Wi. 54017 229 CST SIGN E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate sail test, your report must inCiU :ie. 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 use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for vvrifing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Diavving to scale is preferred, A separate sheet may be used if desired; $. Make sure your benchmark and vertical elevation reference point are clearly shot. >n, and are permanent; 0, Complete all appropriate boxes as to dates, narraes, addresses, flood plain data, percolation test exemp- tion, if appropriate; 103 If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11 . Sign the form and place YOM' current address and your certification number; 12. Make legil.>le copies and distribute as required. ALL SOIL TESTS MUST BE FILED VVITH THE LOCAL. AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TES`4'ERS Soil Separates and Textures Other Symbols s — Stone (order 10 ") BR - Bedrock cola Cobhle (3 - 10 ") SS Sandstone dr — Giat;el (Under 3 ") L5 Limeston s — Sand HGVV High Grounit"falet cs Coarse Sand Pert. Percolation, Rate med s Mx.dium Silva Vj — *11 fs — Flne Ssaazd Bldg Building -- L Ksiny , >aracl j .. Gr eater Th,'m sI - ar�ciy Loaarr < Less Than I -- D=ana Bra - Brutrn "sil ;.- lilt Loarn f3l Black s — Silt G Grey c Clay Loan Y Yellovsv sc, - Swidy Clay Loam R Red sicl — Silty Clay Lo ann riot Mt ttlRs sc .._ &m iy Clay t� % -_ vvi;l Sic - I y Crl;y fff -_ fat , fin t t t; .. 0 ay cc; - cr,ra,rar0n t c .rSe pI .. Pea C lain — Many, irwd wn' n — Muck d -.- dis'tin," (3 — nronnif 1-4 `L _. High ware i 1 F;vel, Six cent t dI S €;Il . st:'Xt:r)reS surface` w it�3r foi hquid waste disposal BM Bench ('~nark tp RP Vertical i t t =freras e Poin TO THE OWNER: 1 hi, soil test reporI is the first, step in securing a sari €fury permit. The county m the Department may request vc, f:.latiori of th is soil test i n ' t f 2 e field prior tea prr alt issi.r ar�cFa, A tramp +;ti, set tai ratans fm the Private E vjqi�.' sysiern and a oemiii application must be sri[tmi ted 2 0 the appi+: p riwe ocal <r;.itI2ct.,£'+j to o1'C:or to . o 29:Wl a pe�rrnit. h e `�eliil i,:ary perroit rntW he ohtaiwa'd a € m l l ]' osled pi i € Io 'hc .,;3t of "Iny to nsii`uction. I l ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner e . Property Address / 3 7 - City /State Legal Description: Lot �_ Block Subdivision/CSM # / S t /a, Sec. s T. N -R �, Town of PIN # d z /a SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size STIPC / Setback from: House - r Well P/L >-� Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM ft Type of system: 7e- - Width Length Number of Trenches Setback from: House 72.!� Well — P/L ;;�zo Vent to fresh air intake ELEVATIONS Description of benchmark 7"�0° Fr/ 7JV4 6° Elevation / Description of alternate benchmark Elevation •r`/ Building Sewer rO G ST/HT Inlet ST Outlet 2 PC Inlet PC Bottom Header/Manifold S 7 c - ) Top of ST/PC Manhole Cover 9 4, r3 Distribution Lines 4 / y Bottom of System () 9 r G d () ( ) Final Grade () () ( ) Date of installation ' //G / gS Permit number 3 ,s - . 1 Z G State plan number Plumber's signature License number / — w Date Inspector Complete plot plan � NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW `- J M I IND CATE NORTH ARROW Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)j. 353261 Permit Holder's Name: ❑ City ❑ Village ❑ x Town of: State Plan ID No.: Town of Richmond CST BM Elev. - - Insp- BM Elev.: BM Description: Parcel Tax No.: �C� VP ell ftd4jkAL 1171196-1018-95-100 TANK INFORMATION 9LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar * 'l Dosing Alt. BM �• Aeration Bldg. Sewer Holding St/Ht Inlet 3 . TANK SETBACK INFORMATION St/ Ht Outlet 3• q0 TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic ��� 2 Z ..--�' NA Dt Bottom ' � — — Dosing NA Header /Man. S m �Y t Aeration NA Dist. Pipe 4- -`l3 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade .e1G. 96'•� Manufacturer Demand (, y '� 6 (� St cover Model Number GPM TDH Lift Friction System TDH Ft ead _T oss Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM Z->� Bil- RENCHI Width I I Length N I Of Trenches PIT No. Of Pits Inside Dia- Liquid Depth DIME $ DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING WAln S`` - Zr INFORMATION Typeo r �_ CHAMBER Moe Numb Sy C,vvw r 7 � 3E OR UNIT DISTRIBUTION SYSTEM Header /M M nifold r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing Z dd 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1• IZ/ 14/ 11 Inspection #2• Location: 1753 105th Strom, New tc nd, WI4017 1/4 SE 1/4 5 T30N R18W) - 5.30.18.68D 1.) Alt BM Description = ( 61 d 4'� X '` °� 2.) Bldg sewer length = "' 14'_, O - amount of cover = `> It" S4)J Plan revision required? ❑ Yes K No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a 8i t 9E9 ii # w 2 S 1 # F # # P E # s 3 F Safety and Buildings Division *I scons i n SANITARY PERMIT APPLIC 2 01 W. Washington Avenue w 9; P o Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. 6ae r , , � Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on r not r than 8 v2 x 11 inches in size. I�,`s my f --r {. , ' - • See reverse side for instructions for completing this application # it I S" vita Pehnit Number t i ,G< Personal information you provide may be used for secondary purposes heck If r to previous application [Privacy Law, s. 15.04 (1) (m)]. 7-OM G la umber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORM tI .� Propert w Name Prot N, R /?' E (or) Off Property Owner's Mai png Address Lot Number Block Number /i' ( y Ci y, State Zip Code Phone Number Subdivision Name or CSM Number ),2 yG. C Fa C - S*1 S/ FF 6I v./ S P IRIS II. TYPE BUILDING: (check one) ❑ State Owned !tr a rest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 O Town OF �OS Sr 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) S. 3 o. 1T. (-8D 1 ❑ Apartment/ Condo 0 (o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. E1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - _____System ________ System __ ___________Tank Only______________ Existing System - -------- Existing System - B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 30 ❑ Specify Type 41 ❑ Holding Tank 12 nSeepage Trench 2 ❑ In-Gro n ressur 42 E] Pit Privy 13 E] Seepage Pit _� 43 ❑ Vault Privy 14 ❑ System -In -Fill , 2 'Le,, 7i-e�e�aS VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. L ading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/ (Min. /inch) Elevation 73 1/f ©. • Feet Feet Cap acit y VII TANK in Ca g Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin strutted Tanks Tanks eptic Ta or Holding Tank DOO /o00 —7— ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ 1 ❑ 1 ❑ 1 ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews e s stem shown on the attached plans. Plumber's Name: (Print) P Signature: tamps) M R O.: Business Phone Number: 11�h 4 ; ZZ /S'7 / Jw - 6,x'3 Plumber's Address (Street City,State,Zip •7,Z y6 /.z S� /� W —e,- IX COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signat re (No Stamps) 'j Approved ❑ Owner Given Initial �oZ-S surcharge Fee) Adverse Determination .Z -� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: C SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by "a iicensedpumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. - 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling_ III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. , IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not small1r.than 81%2 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; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. fib r �� N scs s r3 0 N/?1r w- LdT 0.� c- .e n r A s '7:t ' Loo se I 36Y,� 7 Lu Hit 3 z- i Wisconsin-Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page / of,,� Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach tompiete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S� f . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 " 6 / Propeu Owner Property Location k Govt. Lot �,f/ 1 /4S� 1/4,S 5 T 3d ,N,R fr E (or),e Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /n J City State Zip Code Phone Number City ❑ illage ® Town Nearest R114 ?I New Construction Use: 1!9 Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 �.SC gpd Recommended design loading rate , $ bed, gpd/ft , trench, gpd /ft Absorption area required bed, ft >S - e trench, ft Maximum design loading rate -gy bed, gpd /fi ' trench, gpd/ft Recommended infiltration surface elevation(s) �S� ' ft (as referred to site plan benchmark) Additional design /site cons' erations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 0S ❑ U `®-S ❑ U ❑ S E3-U ❑ S 0`U El au El 4 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground 3 2 A yfw l ft. Depth to limiting factor Remarks: Boring # 21 C?W i -95 7. W 4 //4 /S Ground elev. ft. Depth to limiting fa for 7 in. Remarks: CST Name (Please Print) ',-- &N ature Telephone No. Address Date CST Number /� SOIL DESCRIPTION REPORT 7 PROPERTY OWNER �^"` — Page Z of s.L PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 ;.y in. `•� ( Mu f (J Qu. Sz. Cont. Color / Gr Sz. �r Bed , Trench V'. l V• �/'e 2 Ground bt' . �� /t 1�1� S !J �'! C .�. / S 9 � lev. • 2 ft. Depth to limiting ac or �0 7 �in. Remarks: Boring # Ground J 49� ele ft Depth to limiting 71� fact r in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # C 7 Q.Z.T // ._ L ��8 11'IUF� ccGcl �� i -3Y ,s s/ S'/ heh 9A"' F/1 a s — ,Z , 3 I in S'Yk'�/ Ground elev. 9 Z ft. Depth to limiting factor 7/0,1'1n Remarks: Boring # Ground elev. ft. , Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) ` Y Ncv sCs�7'36 N1? 18' tv -7 LoT z 4,) TwP, r r in I 3eg<37 y 33 30` 3 L.� o .,/A3Z xa1101414 WbV 10:43 YA; 7I5 380 4680 ST CRX CO ZONING It 00"'i PA'apt VIP r hash AI. !Half AM O►aarvatloa Pipe 20. „' Above Ploo w.. 4' Cost Irso To Pool 4rose V•nr Pq• Mae fur of tafMr Cmem All" Oval Aiar•Nfa astrlo•1 �N to• r ►lav • bwai�a Il +a Parfr•ted Itpa avow 0 4w0144 tor•,rnarha as 4snoor 01 !/•t•w. Q�upo�c� L�IV•:T Ipn $OIL FILL 013TR101lYiOl.f PIPE l�hROVEo sWIIrMETfG cavuk Ok 0G sT awW "'or A44RUSAIE - --�' �00L N hitsw NAB DIS'r0tIf.%UTI'.1JJ PIPi TO Dr AT L,EABT 4A7C.1.E3 OCLOW ORI(.fAJAL WtAtUE AIJU AT LEAS IUCHtS SSUT ►.10 MORC tMAt" Wt IW(.NtS bfLOW FS41AL GRADE IIIWn^ WN OF EXCAVAT'160 FROM OalbWu 6KA9r W ILL ac V "uc MM141MUM WM o f SMAVAr(om PROM CA441MAL 6rR4VF W I LL at -312 WC+4tS SIOUCO: ( LIC C W SE k]UMBE Ft f _JUN- o24 -99 01 :33 PM P.01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Halle T-K. Owner/Buyer — Mailing Address I W (oq Ne u C h MCa n X44 t Property Address I —1 4A (Verification required from Planning Department for new construction) I o4 City /State Nel�i �`Ckn�oc� d kh 97 Parcel Identification Number ©� �S � _ LEGAL DESCRIPTION Property Location iV W '' /., Z I /l, Sec. _,� TaLN - RRW, Town of �• 6N MO II Subdivision , Lot # -� Certified Survey Map # Volume Page # asy(D Warranty Deed # 9 3yd . Volume 9So . Page # � /�� a . Spec house 0 yes 0 no Lot lines identifiable 0 yes O no SYSTEM K,&IN7'E�, NANCE 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. Wbat you put into the system can affect the function of the septic teak as a treatment stage in the waste disposal system. The property owner agmli to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank fa less than 1/3 full of sludge. 11wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Department of Cotumerce and the Department of Natural R"oumes, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix bounty Zoning Office within 34 days of the three year expiration d te. . ew qci SIONATUURE OF APPLICANT DATE OWNER CERTIFICAT T N I (we) cerdfy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property dome d ab ore, by virtue of a warranty dead recorded in Register of Deeds Office, C SIGNATURE Of APPLICANT DATE "' •" A11y Cs ortaaarion that is ants- represented may resuh in the sanitary pamilt 6eiae revoked by the Zonine Department. 009008 •• Include witil this application; a atamned warranty deed fYom the R.e,tiatar of Oeeda omoe e &r Pjr of t11e cor ifted aurvvy map If referenoe 1a ft nd- 1n 93— wnrranty deed k • 7 DOCUMENT No. WARRANTY DEED VT. St•ACC RCSERVCD •OR RECOROrNG DATA p STATE BAR OF WISCONSIN FORM 2- 19821 jft ka M _4 j REGISTER'S OFFICE J is ST. CWWCO.,VA Douglgs_,E.. Blackman and Kathleen C. Blackmati, husband !i t�fOfR «Ofd _. . and wife as joint tenants ........ _ . -..._. _ _... .... .. ............... j MAY 141992 ......... 8 30 A M conveys and warrants to ...Halle_ Bui lders,..Inc_ I ' Roo* of D"& the following described real estate in .- ..SC.t_CIgiX...__ - ......... .•._. County, State of Wisconsin: Tax Parcel No: .............................. The North Half of the Southeast Quarter (N} of SE}) of Section Five (5), T- wnshin Thirty (30) North, of Range Eighteen (18) West, EXCEPT th- fo'lowinq Parcels: 1. Cnrtified Survey Map recorded in Volume "2" of C-rtified Su-w.V Map, page 536, being a part of the NortImest Quarter of Vie Southeast Quarter (NW} of SF.}) of above Section, Trwrn and Range. - 2. Part of the Ncrthwest Quarter of t'.x- Sout'iPast Quarter of above Section, Town and Range, (Ipsr•ribr?rl aG fol lat•ia: Ccrrnnncinq at t* c rmt' mast r•orne- o` t' , pa - described in r ertifierl Stl•vev Man, Vo'urre "7 paq- 536; t' ^ncP Fist naral'A' wit": t " South Line of said parcel a r;istanr of 120 fe^t; t ^lort'l, p- i ~a'' ?' wit t' Fast Line of sai -il parcel, a distance of 240 fnPt; t' +enrn W.+ t, nca ralI -' T•/it" t' - Aln.t" Iinr• of said parcel, a distant- of 120 `s t S out'i, a'nna t''P Rast ' inr o° sai +' parcel, a distance of 240 feet to t'-- point of hPginninr; o` t' Or!- cription. 3. Part of t'le Sout' QLuirte~ o aYmp '— +:i ^r., Totr1 an' Ranq, doscrih as follows: Comwncing at the Nortl corner of t'if parcel. describe* by the Warrantv Deed recorded in Volume "596 ", page 33; thenr-p East, parallc-.' wit' the Nort' 'in: o` said parcel, 176 fe(-t; tnr'nce Sout`i 560 fr-pt, par>>'n' with t` F. ^t 1 inn of sai -' parcel; thence ?•;est 66f) foPt, Para' lP' wit t'" Sot•t° 'in--- o f sai narrp1; t' Nort 420 foe't to t'va �t1t':F7°�t corner of t'•e narr-c ��Ascrih 0 by CPrti`iP' Su v­ Map This iS not hon"e property. r -mrrl-- in I'o - "2 ", page 5'6; t' once Fast ( is► Ai riot) 484 feet to t' ° f outl� Last corner o t`P parco' rt-srrih^+1 ')v Warrants' DPI' in Vo' urr_ I*:xrel +tion to warranties: "696 ", page. 33; t -nr•E? N .o — t" 240 F eet to t''^ point of br'Qlrnira of t''ic r?escrintinn. ►4ttt,l 0 1, 11th d.ry May +92 - �r' �►e SEAL) ��•�� Douglas E. Blackman ISEA1.1 Y ' / - ISEA1.1 Kathleen C. Blackman AUTHENTICATION ACKNOWLEDGMENT WASHINGTON Si naturcis) __ STATE'. OF %1XQMX N 1 authenticated this .. --- day of .._ _ - _ - 19.. _ Personally came before the ti;:.-; da> of May , 19 92 . the above namt d Douglas_ E, Blackman - and Kath C. • Blackman TITLE. MEMBER STATE BAR OF WISCONSIN (If not, __. _ .. _.- . __. authori- A by 1 701:.06, Wis. Stats.) to me known to he the per -on .S .. tchn PXeented the - _ yin_ ... > "r.:"prt\ \ :Yhl ;u';ffWN'}a• {ate 1.x'0 ... Reinstra, Van Dvk .. Needham, S - C. :i : �,�� v Q` 201 South Knowles Avenue, Box 127 '.� e C I Q New Richmond. Wi 5401; t• .. I v J I 1 t'r .r XtXhwA. X •.;4jR.. �� st:.tr' tNI � ' WARRANTY Dk£D aINthe BAR OF I-ORM No 2— 1. ...' " ... ..... � r 488;1,4 CERTIFIED SURVEY MAP Ns �o Located in part of the NW4 of the SEk of Section 5, ° M T30N, R18W, Town of Richmond, St. Croix County, y Wisconsin. o ; ��9Ca ^Sfld�ic ., ° o Ni Corner 4- Section 5 1 .�fi° , ` V- *�M APPROVED = i � C . 'A o+ 7 e H u }y � u, 5 =1407 P ., _ — b L N NUDSC�i 1, C = A SE ...s�.,. �as*,- w„u•;a... :.M... rlv✓. , .lu i.. ,r - .d u�!>+ t/ 1 ... - �+�la�•ird CLF.t�.,7".(P}.A. r h c: r -, ! �T . CROIX COUNTY �n . ;ompreh Plann" Zoning and Parks-Committee I ti nS 'U EL HTTEQ - ^Hi�VJ if n recorded within, record within 30 .'days of s s l S. East -West } line of Section 5 approval-date , T S89o53' " 311.32' s' 2255.91' E} Corner appsoval•shbgbe I LOT 1 C/) r�i S89o53'32 "E Section 5 nuli'$'•void 2.20 Acres Sq. F • `_' 60 Foot Wide Z ti i —Priva a Road Easement ;l ir i'p � o = ► o � -C 12> cn �Z> ' " i311.32' S89 32 "E 316.77' '- ifrI y� i� o� 0 32" 628.09 rn �-� a , OUTLOT S89o53' 32 "E 628.09' 1 c ;CJ ::: C W (311.32' 316.77' iF LOT 2 c LOT 3 ice'- 'l� - 'a 2.19 Acres c °, 2.19 Acres w it U� i Ln 0 95, 347 Sq. Ft. � 95, 347 Sq. Ft. ^' r fn W I33' 33' � Sao' —«•� 311.28' 316.72 � OUTLOT 1 AREA I.. S89008 "W 628.00' , 41,448 Sq. Ft. F'LE CI i 0.95 Acres 6.� 33.001 �11��s� T�t�•i.�r_L ; p SEP I 61992°- 4 N89 ° 08 1 47 "E 90zl/ 31'3 JAMES O'CONNELL = 6 t eed *sfOfD u n o OWNER LEGEND CM& Co., Wl Ln ►. LO Halle Builders 0 Aluminum County Section Monument 6> w o 1767 115th St. Found 3'c °- New Richmond, WI 54017 0 _ 1" x 24 Iron Pipe Set, weighing 1.68 lbs. per linear foot — - F e n c e l i n e ......••• - Roadway setback line => - Proposed Drive Location S} Corner Section 5 SCALE IN FEET This instrument drafted by Craig Paukert Job no. 87 -27 -192 O 100 200 Vol. 9 Page 2540