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HomeMy WebLinkAbout012-1043-70-000 p 0 ao 0. O O c 0 O co a> LO m "r O '~00 X (9 I ~ o ap w N V O ~ N w a D w C ~ .Cn 3 _ 0.2 C, co c a x E ° U m (D 0 c 'a o cu c E N U) a) 0 'Co U z rn«. Z aN N n _ N' C C O ~ X "O 7 (CS N 3 tC _ N N LL O (n lL 0 pp 'O _"O - - 0) Y N N CO 3 - C C 0 '0 N _0 N p N .O N O 'O E E C a m I m w co _ co CL n V III N ~ N E E Z _ 0 0 0 = a E 0 E 0 Z; a m a co rn ~ z p I o O z c° u c D =3 t! 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Parcel 19.30.17.286B 012 - TOWN OF ERIN PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HILDEBRANDT, GARY L & SHELLY M GARY L & SHELLY M HILDEBRANDT 1561 CTY RD G NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1561 CTY RD G SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2.270 Plat: N/A-NOT AVAILABLE SEC 19 T30N R17W PT NW NE BEING N 356 FT Block/Condo Bldg: OF E 278FT OF W 703 FT OF NW NE 2.27AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 04/12/1999 601093 1418/053 WD 07/23/1997 1206/390 WD 07/23/1997 754/74 07/23/1997 717/56 2006 SUMMARY Bill Fair Market Value: Assessed with: 155981 179,100 Valuations: Last Changed: 11/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.270 34,100 141,200 175,300 NO Totals for 2006: General Property 2.270 34,100 141,200 175,300 Woodland 0.000 0 0 Totals for 2005: General Property 2.270 34,100 141,200 175,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 519 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I I r Va 5. STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS f„if SUBDIVISION / CSM# LOT # SECTION TN_R Andy W, Town of n ST. CROIX COUNTY, WISCONSIN PLAN VIEW f SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /fir/1 Y ~C G/ f FTm f r4L4' too i INDI.CAT NORTH ARROW' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: czv/v~ ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:}C~ Liquid Capacity: Setback from: Well-.7,V_ House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM / Width:.. Length / Number of trenches Distance & Direction to nearest prop. line: ~cf Setback from: well:- House Other ELEVATIONS Building Sewer ST Inlet. - ST outlet `0 PC inlet PC bottom Pump Off Header/Manifold 9`/~ Bottom of system Existing Grade Final grade sDATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 3 INSPECTOR: 3/93:jt Wiscop;,irnDepartmentof industry, PRIVATE SEWAGE SYSTEM County: LaborandHumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI PW6 BELLE ISLE, GREGORY X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~Q® _1 / p 4 5 fin.. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic .ate Benchmark Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet 3~ gio, S TANK SETBACK INFORMATION St/ Ht Outlet - Verit TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic )0) 3 u' yam NA Dt Bottom - Dosing NA Header/ Man. g, Y~ cly c/7 Aeration NA Dist. Pipe c1 , 5 Holding Bot. System Q SS lT3 3 y PUMP/ SIPHON INFORMATION Final Grade 1537-1 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK 14 11- - CHAMBER INFORMATION Type o Moe Number: System:`'" OR UNIT j k DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 6 y 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.) LOCATION: Erin Prairie. 19.30.17W, NW, NE, County Road G HM sld sPlan revision required? ❑ Yes ❑ No Use other side for additional info rmation.`,,'f SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f SANITARY PERMIT APPLICATION Bsafetyureau o oand ff Building Systems g Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ) than 8 112 x 11 inches in size. S?'• rb j 9C • See reverse side for instructions for completing this application State Sanitary Permit Number a 33 41,o The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner. Name Property Location G or e~ Z Alv, 1/4,S T30, N, R17E(or Property Owner's Mailing Addre Lot Number Block Number 0 City, State Zip Code Phone Number Subdivision Name or CSM Number l I (I IS> Xyx- II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road !7 Public 56 1 or 2 Family Dwelling - No. of bedrooms ❑TVoIIwnageof 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 F-1 Apartment/ Condo 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. ❑ New 2. replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _ _ _System___________ __TankOnly ______________Existing System Existing System ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 1 1)d Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro os d sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation < ~ 1 or ~ -s Feet 67 7 Feet TANK Capacity VII. NFORMATION in gallonTotal # of Manufacturer's Name Prefab. Site Con- Steel Fiber- Plastic Exper. Gallons Tanks Concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank 161,040 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum Ignature: (No St mp MP/MPRSW No.: Business Phone Number: 4 _3/ 4 Plum er's Address Street, City, State, Zip Code . IX. COUNTY / DEPARTMENT USE ONLY ❑ Disappeoved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Age t S na ure o Stam Approved ❑ Owner Given Initial / Surcharge Fee) Adverse Determination( X. CONDITIONS OF OAPP VAL / REASONS FOR DISAPPR VAL: SHD-6398 (R. 05/94) - DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS F, 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 licensed pumper 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 >eptic, 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 -iame, 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 smaller than 8 10 x 11 inches must be sut. ttf>.l t- 0 e :cirnty The plans must +~,..i . 0w fo;iowing: A) plot plan, drawn to scale or with complete tank(s), septic t,i !~I i ar „;Iher treatment tanks, building sewers; wells; water m in;iwae _>r <<< f lakes pump or siphon t 3~k riifution (boxes; soil absorr~lion systems; replacement syst. ark- 6; ti >r f the building served- and vf-"hca P_I'V,1!JOI" 00IntS; CI complete : Icalioiv,'or f.ur Ont'G S; dose VOIUme; li'f-e ences, friction loss, pu!Tlp p(_-rforrnance :urve; pump' li - r'" tc:.' Ure r; D) cross section o _ ._tiorptlon systen.;f Cl'ul Uy c :_Cl iap, soil Lestd t~ 11`. anla ) Jzir:g Information GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater The monies collected through these surcharges are used for monitoring groundwater contammalicn investigations and establishment of standards. PLOT PLAN PROJECT Gregory Bellelsle ADDRESS 1561 Co. Road G New Richmond Wi 54017 NW 1/4 NE 1/4S 19 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 5/22/95 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 BED SIZE 12'X 75' BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 93.5 12" GRADE COVERING 1'9 ' tiTYPAR, K County Road G 0 0 15' B-2 00 Vent 45' I I % I lope 25' B- I 50' 30' *B.M. ILI 5' 35' Existing 3 30Bedroom 35' T House sue' ' Well B-1 sZ D ~CA ~~G/ucl Old Drami field 18'X 53' Wisconsin.Deppaartment of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Hufhan Relations - Didision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY .Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT V 1/44 1/4,S/ T e N,R ,o-,Z E PROPER~TYYO N R':S I~ A ES~S LOT # BLOCK # SUED. NAME 0 CSM # < CI ATE ZIP.CODE PHONE NUMBER ❑CITY VILLAGE [04(N NEAREST ROAD Qcd ~ ~ o/JK7~,s1a y6 ¢So r tea. d /1 [ j New Construction Use [,4 Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow T~L gpd Recommended design loading rate bed, gpd/ft2 i~ trench, gpd/ft2 Absorption area required ~ bed, ft2 7 50 trench, ft2 Maximum design loading rate bed, gpd/ft2 , trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material d 1A. C, G.~?• Flood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL MOUND ROUND PRESSURE A RADE SYSTEM I FILL HOLDING T NK U= Unsuitable fors stem S❑ U S❑ U 70's ❑ U )RZ S❑ U ❑ S ~y 11 ❑ S 4U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxldary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench h4ti a Y C2 6L -2 Ground J -112 o r -31~4 I Depth to limiting factor 2 Remarks: Boring # Ground v. ft. Depth to limiting y~ Remarks: tc. CST Name:-Please Print jar Phone: Address: Signature: Date: CST Number: PROPERTY OWNER Z4:::n SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft . in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground - -'S l n^- ✓Y!-~" ' e. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # k Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Gregory Bellelsle Byro Bird Jr. Address 1561 Co. Rd G New Richmond Wi 54017 C M #3479 Lot Subdivision Date 5/22/95 NW 1/4 NE 1/4S1 9 T 30 N/R17 W Township Erin Prairie Boring O Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of Siding System Elevation 93.5 * H R p Same as Benchmark Count Road G 0 0 15' B-2 'r 45' Slope 25' B- 50' 30' *B. M. 5' 30, Existing 3 Bedroom 35' T House Well B-1 Old Drainfield 18' X 53' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT ' FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the trj ~yd-y 4~z residence located at. ~l/9,1/4, Sec. T N, R 1/ W, Town of p~~r jd!~~'/ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes,><,No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : Age of T k (if known): (Sig re) ( N a e) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle) r Nam yf^d/J__!~~/'%Lr Signature MP/MPRS - 5/88 f STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVVNER/BUYER d ~1s~ MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION !yw 1/4, 1/4, Section Ty , T N-R~W TOWN OF fr h d'i r~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME , PAGE LOT NUMBER 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 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. o Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost, of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: kaL~ Y111 . DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • 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 e Location of property! 1/4 1/4, Section ~,T~rZ N-R_ZW Township _r~`i ra ~v Mailing address Address of site Subdivision name Lot no. Other homes on property? Yes_~_No Previous owner of property Total size of property >41,2T15' Total size of parcel 02 Date parcel was created ~49 Are all corners and lot lines identifiable? -.,,X_Yes No Is this property being developed for (spec house)? Yes __Z No Volume Z~ and Page Number as recorded with the Register of Deeds. 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. 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. 114 7,.),6q , and that I (we) presently own the proposed site for the sfewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the ef1f f the County Register of Deeds as Document No. Signature of Applicant Co-Applicant 5-/a - 95 Date of Signature Date of Signature ` tNL IiTATlf. BAR OF WISCONSIN FORM 1- IM =tee OF"= na ai vss Iva reaoem eArAl Faa _ Keith T Hal. rson fr. 0KMmX , fled. tot no d in .'Mlle IaZe aid•~eifse-hC-•Belle'Ys~ ~y~ aid w3fek as s~av~wriU,P__ r Mal.. e;._.... J ..F N r ' ......da................. . ya9 Qrantae, 1b1181the O ~V81 Ye CCtl.9idC'YSco-npidesati0a...._ L10[1 ' 4a'4 iTaatee the toBowins deeeribed real estate in .......t-•-..~~ - t y 21, TI1Cli£EIl1ESd ~81ty, {~l.9lats ofWlseon.in: I( New Richmond Wisconsin 54017 t - _ Ta: Parcel No:..~...._ C110lIYSFAR ~r R The South •306 feet of the North 356 feet of the East 278 feet of the West 703 feet of the NWk of the NEk of Section 19-30-17. Subject to recorded easements, reservations, and rights of way. E This is ...s n homestead property. ' (is) (iot) Together with all and~~sin~ular the hereditaments and appurtenances thereunto belonging; I And........ Keith T. H81 vers~n.--•------------------------------------ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except no exceptions and will warrant and defend the same. Dated this day of 19..... (SEAL) . .......--•--.._.....-...(SEAL) . Keith T. Halverson ...............-_-...--------..........•-•-.......•----.......(SEAL) (SEAL) t • I i r AIITH=NTICATION ACBNO W LEDOMBNT S(s) STATE OF masommm*k TEXAS H ft County. (~7H authendeated this day of 19 Personally came before me this . ~l yi~„~,„,4aaiyofof °.LL~------------------------------ . 19.L. j~phl~r~bove~T 1 • ..._L)iea4lefli.. a~w_.flSefi-[:rfif[M........... 7 ~N~~~•y~,~ S f - Ti M ETLE: MBEB STATE BAB OF WISCONSIN 3 f (if not. at authorised b } sf. Y 7 708.06. Wis. State.) to me known to be the person t- o 4 i it foregoin instrument and acknowledg t in THIS INSTRUMENT WAS DRAFTED BY t Eris J. Lindell Box 157 «F.~ ! 1----......•---...•-------•--•---••- .~~t= sTi-e~Z i New Richmond Wisconsin 54017 i_O~ . . Notary Public (Signatures may be authenticated or acknowledged. Both My Commis!j9n is permanent. (ice not, state expiration ` an not necessary.) date:.......'' 4'4!4 ~J. I~ eNaer or pamns sianine In any capacity should be typed or Printed below their sisnstures. - ® STATE BAR OF WISCONSIN FORM No. M-Iyu Stock No. 13001 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ADDRESS ST. CROIX COUNTY, WISCONSIN. Ale- .K9 ~l fr ~j !7~ l7 / SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 A` EVERYTHING WITHIN 100 FEET OF SYSTEM ` i I di ale Notthl Arrow SC L M BENCHMARK: (Permanent reference Point) Describe: -r Elevation of vertical reference point: / Slope at site SEPTIC TANK: Manufacturer: Liquid Capacity: _ Number of rings on cover : Tan manhole cover elevation: -Tank Inlet Elevation: -,Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle. gallons; total capacity o distribution lines gallon: size o 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: um er o pits eet diameter feet liquid dept seepage pit in et pipe-elevationi__-_-_ bottom of seepage pit e evation feet. SEEPAGE BED SIZE: number of lines wi th _lerigth the depth'2P SEEPAGE TRENCH: width length PERCOLATION RATE, 7 REA REQUIRED REA AS BUILT 9 5'~ INSPECTOR -,r DATED PLUMBER ON JOB w-~~► LICENSE NUMBER _ r . 1 ,9 ` EM~S 115 Rev.9/76 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVIC V s P.O. BOX 309, MADISON, WISCONSIN 53701 OZo LOCATION: 1/j±/a,~/a, Section__ j2d_N,RLZ (or) W, Township or Municipality Lot No. , Block No. County Subdivision Name Owner's/Buyers Name: ll ~ TI, ~ --e r 5 ea in Mailing Address: Q w i e-- k I~2 TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT v ALTERNATE SYSTEM OTHER DATES 06SERVATIONS MADE: SOIL BORINGS S _ V - Y/ PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT TZ w -C-M lT~ ~U4 J PERCOLATION TESTS Eq TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- l 3 f'r 2~ -30 t t / .2 PP`3 -2 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 72- B- 7;2- 7.z L B- ~ G 01,4 Ae- 'g, B- B- 113- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and sq re feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Z66 E=g!X , ndicate scale or distances. Give horizontal and vertical reference points. Indicate slope. we, y 1 e 3 1 i I I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified,,n the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. l Name (print) 1 ~/v &P /T Z *7 Certification No. c~ Address - 4 O Name of installer if known /ey/4-'-ei~~-) Copy A -Local Authority CST Signatur . ~ ~ l / r ~ I~ ~ 3 ~ ~I Y 1\~,~ t l1 4 ~ ~ ~ 1 \ \ ~ ~ ` l \ t ST. CROIX COUNTY WISCONSIN ` ZONING OFFICE NOUN_ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 26, 1996 Cindy Heggernes 1561 County Road G New Richmond, WI 54017 RE: SANITARY SYSTEM INFORMATION FOR PROPERTY LOCATED AT 1561 COUNTY ROAD G, NEW RICHMOND, TOWN OF ERIN PRAIRIE, ST. CROIX COUNTY, WISCONSIN Dear Ms. Heggernes: Per your request, please find enclosed information on the above- referenced septic system. I hope this information will be of help to you. If you have any questions regarding the enclosed or if we can be of further assistance, please give our office a call. Sincerely, /0~ 414~ Denise Boron Secretary St. Croix County Zoning Office Enc. C CO) '