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HomeMy WebLinkAbout040-1118-90-120 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552346 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: 040-1118-90-120 Melser, David . Troy, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: j 31.28.19.582J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 15~l: 64-.%0,A ii% L .J 1 I ` C~ Alt. BM Z. 5 A5,4 Wie49A. :l &0 til~ Bldg. Sewer Aeration Holding St/Ht Inlet Q'Imli 94 tlet ► etA^ i a TANK SETBACK INFORMATION a TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 76 Dt Bottom Header/Man. 4 9 5 7,6 36 Aeration Dist. Pipe 8.5 4~ Holding Bot. System T.7 cj / Z Final Grade . PUMP/SIPHON INFORMATION 7 Manufacturer GPM and St Cover Z.5 44 Model Number LOJe~.. TDH Lift EFriction ;Loss System Head T Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Mfr' Z f SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING OR Manufacturer INFORMATION CHAMBER Type Of System: 5Q 7L a UNIT Model Number: IW' 77 Jed DISTRIBUTION SYSTEM A ~'Ilo 3 Z HeaderlManifold Distribution x Hole x Hole Spacing IVeg to Air Intake Pipe(s) i .ti~S P Length Dia,_ Length ` Dia ` Spacing 6 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 7eeded/Sodded xx Mulched Bed/Trench Center 5 3 Bed/Trench Edges N__1 Topsoil 1 es No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 362 Page Lane River Falls, WI 4022 (SW 1/4 NE 1/4 31 T28N R1 9W) NA Lot 4 Parcel No: 31.28.19.582J '-k 20jALA- (}l~ s G~: ~ s J- .auk O~. 1.) Alt BM Description = { 2.) Bldg sewer length = i 1 2.4Qv ~/4 Q - amount of cover = r~7<~ 7 + tJCew Plan revision Required? ❑ Yes No IL Use other side for additional information. Cert. No. Date 411risepctofts Signat e SBD-6710 (R.3197) AV~L AL~ commerce.m. Safety and Buildings 0 County 201 Washington Ave., P. ox S Madison, WI 53707-71 tart' permit Number (to be filled in by Co.) Department Commerce 5 9:; 72q S rota a 'cation State Transaction Number In accordance with s. Comm. 8 .21(2), W' . this form to the appropriate governmental A unit is required prior to obtai 'ng a sin : Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department oral information you provide may be used for secondary purposes in accordance with the , s. 15.04 ] in , Stats. ~ n ~ 1. Application Information - lease Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address Property Location CGovt. Lot City, state Zip Code Phone Number Section -3 / / e C/ .[J i CJ.2 Q JC J L1 7 G I (circle E one T N R 1~1.. Type of Building (check all that apply) t r t~,l or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block El Public/Commercial - Describe Use dtQ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 2 1411- El Town of~~f~,i :d III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. ❑ New System (,Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) + B. El Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) gNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain ❑ Pretreatment Devic (explain) V. Dis ersal/Trea nt Area Information: 7 ; s Design Flow (gpd) Design Soil Application Ra (gpds al Area Required (s Dispersal Area Prop d (sf) S vation VI. Tank Info Capacity in Total # of Manufactur r' e o* ~tJf ~ Gallons Gallons Units c v A7 New Tanks Existing Tanks / 6 f/ da y~ 4 U W t' rn is C a Septic or Holding Tank /G~Lro~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibillty for installation of the POWTS wn on the attached plans. Plumber's Name (Print) / Plumber's Signature PRS Number Business Phone Number Gam; l ~1 Sr- /1u /N1L/('cFY Gam== ~?a7 ~5-- < Plumber's Address (Street, City, State, Zip Code) fLl -;,c1 $ /P,4 /Vu /11 un e artme nt Use Onl ved Permit Fee~j Date Is ed Issuing t Signature rppr. nal $ ~~t di ITMPMR easons for Disapproval / 1:. '$eptic tank, effluent ftlt®r and 3) pf v„t,t~p,~,~, ~ ~ 1 , dispersal cell trust all be services I maintained as per management plan provided by plumber. ~ QYl p r", Yp C, ~ 2. All setback fequifemente must be maintained' , Attach to complete plans for the system and submit to the County only on paper of less an !t z 11 inches in size SBD-6398 (R. 02/09) V s NO F ` E 1 46 'd1 41 ~4 ` 'Y Yr -Ak \ na v`h~` ~+f ~ r ~4e Fr ~ of f nJ ~f t i l 46 D w N eM' ~ n a ~J POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner yi Septic Tank Capacity /,g G9 al J NA V e, a L I17 C ~S C -10'-"~ Permit # Septic Tank Manufacturer -,a of. NA DESIQN PARAMETERS Effluent Filter Manufacturer ~0,( ❑ NA Number of Bedrooms o NA Effluent Filter Model ❑ NA Number of Public Facility Units © NA Pump Tank Capacity al (3 NA Estimated flow leverage) l elide Pump Tank Manufacturer O NA Design flow (peak), (Estimated x 1.5) q 5__L'3 a1/da Pump Manufacturer O NA r_1 NA Soil Application Rate , ?jaVda /tt2 Pump Model _ Standard InfluentlEtf(uent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg/L 0 Sand/Gravel Filter n Peat Filter Biochemical Oxygen Demand IBOD,) 5220 mg/l. XNA ❑ Mechanical Aeration ❑ Wetland _ Total Suspended Solids (TSS) :0 50 mgiL C1 Disinfection C7 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (SODe) 530 mg/L. iAn-Ground laravity) ❑ In-Grarnd (pressurized) Total Suspended Solids (TSS) _<30 Mg/L WNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10" cfu/100ml 0 Drip-Line Q Other: Maximum Effluent Particle Size ya in dia.11 NA Other' 0 NA Other. 0 NA Other: Ci NA *Values typical for domestic wastewater and septic lank affluent. Clther. C3 NA MAINTENANCE SCHEDULE Service Event Service Frequency month(s) Inspect condition of tank(s) FAtast once ever}(_r(s) (Maximum 3 pears) NA Pionp out contents of tank(s)- I When combined sludge and scum equals one-third (Y;) of tank volume O NA inspect dispersal cell(s) At least once every: ~y an( ~ s) (Maxlmum 3 vows) L3 NA least once ever ❑ nonth(s) Gt NA least y~ kyearis) r_ Clean effluent filter - Y~ At Inspect pump, pump controls & alarm At least once every; tea (s) NA Flush laterals and pressure test At lease once every: 0 month(s) NA _ © yeerlsl _ Dther. ~ - - At least once every: ❑ month(sl 0 NA O yearla) Other: [3 Ntj MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing operator, Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and ackim and to check for any )sack up or pending of eftiuent an the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levees in the observation pipes and to check for any ponding of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (l3) or more of the tank volume, the entire contents of the tank shall be removed by a Septag© Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the aervicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. A service report sha!I be provided to the local regulatory authority within 10 days of completion of any service event. 1 Soil Absorption System Cross Section / e° ~ ft Final Grade 4r Schedule 40 PVC Vent Pipe th Vent t Cap Wi Leaching ,_.i 95 ft Chamber ` gy, Elevation 3 ft S ft Soil Abso on System Plan View ft ft i ~ Leaching Trench 9 ,:L-ft Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header I-eaching Chamber l-peclfic, Manufacturer And Model EISA Rating a&' sq ft per chamber Soil Application Rate , -e gpd/sq ft s® gpd Design Flow + 7 Soil Application Rate + 5 S EISA g_.. Chambers 2 rows of chambers each. i Page of Page of chemicals other products- START UP AND OPERATION a of the p For new construction, prior to use of the POWTS thkttreatment hea' celNs) orlf h ghrconcentrat Harare detected have the contents that may impede the treatment process and/or damage of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. the excess wastewater During power outages pump tanks may fill above normal h caat celll(s andn ay eesult intthe backup or surface d scharge of discharged to the dthis.. sel cell(sl in one large dose, overloading tha or Servoperatingicing therpumpprior effluent. To avoid situation have the contents power to the effluent pump or contact a Plumber restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area oft the within 15 feet down slope of any mound or at-grade soil absorption area. the performance Reduction or elimination of the following from the wastewater swabs;rdegreasers; dental floss; and diapers; prolong the life disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; cond ; cotton gasoline; grease; herbicides; meat scraps; medications; oil; foundation drain (sump pump) water; fruit and vegetable peelings; 9 painting products; pesticides; sanitary napkins; tampons; and water softener brine. 83 33 ollowingsin Admri shall be ~ a Code: insure that the system is ABANDONMENT steps When the POWTS fails and/or is permanently taken out of service the properly and safely abandoned in compliance with chapter Comm • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After umping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with p soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must by taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption ce and not be upon system. The replacement area should be protected from dott~i esnand wellsmFailure to np tect the replacement area will required setbacks from existing„ and proposed structure, result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. /or so ❑ A suitable replacement area is not available due to setback a d he faisl PPOWTS mitations. Barring advances in POWT technology a holding tank maybe installed as a last resort replace ad . and sits tanl ❑ T site A e •f [3 Mound and at-grade soil absorption systems may be reconstructed„ place following 'r of the biomat at theffect at that time. infiltrative surface. Reconstructions of such systems must comply < <WARNING> > INSUFFICIENT P AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/ DEATH MAY RESULTYGEN. D NO. SEPTIC, PUM ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUM. . RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name sG~ y Name Phone E??/ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY C• Name i C-G r Phone Name Phone 7/V ~ 4►~ fb CJ This document was dra ~ fted to compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. ~7 STACC BAR OF WISCONSIN FORM 2 - 1982 , i! -14i7l~ ~ WARRANTY DEED ` r d, iI FEUSTalc dFFlrE 1 DOCUMEN't NO. I t ° L ST. CROIX -VTY, W1 I~ I Richara Lynghaug, a/k/a R c F a r_ 1 George Lyn, auc; , Reed VFacc*d -a/_k/a Rir_ha.rd Lynghauq, and Francis Lyrrghaug, ( MAY 3 1 1996 a ki a Francis _I,ouise Lynghaug, a!k/a Francis L_ l Lynghaug, a k_a Francis L. Lyr-ghattgh, husband and wife I at ~ 11:00 A. conveys and wananis to ll_ y -S. Me_,y- n,3 Paula M. _ -R- L1.O _ Me:~ser,,-_ht_sb~nd and wi _Fe 76 su`-vl_v5~ _YLyn marital. i~ Register of Deeds ~l - _ - THIS SPACE RESERVED fOR REClJA01NG DATA NAME AND RETURN Ar7DD I SS the rollowing descrii:ed rea: Slate in - -_St.-~Q < County. II j ~t Lam- 4 - -1 11 ~ ' - ~ ~ 'I State of W'sconsin: I- ! II 11 ti I) ! 040-1118-90-120 - It I PANCEL IDENTIFICATION NUMr"1i (I it Part of the Siq 1/4 of the N17 1/4 of Section 31 , 1! Township 28 North, Range 19 West, Town of Troy, j~ St. Croix County, Wisconsin described as follows: It Ij Lot 4 of Certified Survey Map filed May 27, 1956 in Volume 5 of Certified Survey flaps, Page 1656 as ~ i t II sa I Document Number 412528_ ~ ~ l fl Together with Private Roadway easement as shown on above Certified Survey Mar, and in Volume 1. of Certified Survey 14aps, Page 165, as Document Number 328661. is i { This. a s homestead property I{ (is) (is ngtj it I ! Exception to warranties: !1 's Subject to easements, reservations and restrictions of record. I~ s t I I~ I ll Dated this 28 day of May - , A.D., 19 96 l L _ (SE-AL) e`4. (SEAL) RICHARD LYNGFINfJG r ~p iz. LAL) (SEAL) u ~I ,I FRANCIS LOUISE LYNGHAUG - III ~I AUTHL•NT7CA"d'1ON ACKNCDV4'LEDGivtEN"f `I ~i Sigr ure(s) _ State of Wisconsin, if II - St. Croix __Counry. j~ authenticated this _ day of Personalty came before me (Iris 28 day of }i May _ 19 96 , the above named i` !I - Richard Lynghauq, a/k/a Richard George_ ~ _ Lynghauq, a/k/a Richard G. Lynghauq, and TITI.E: MEMBER STATE DAR OF WISCONSIN Francis Lynghauq, a/k/a Francis Louise 11 (If not, Lynghauq, a/k/a Francis L. Lynq auq , a f k/ * aLUhc,rized by §706.06, Wis. tats - o me known to lie the persons wilo executed Elie foreg'i(tr., ~ JANE TERKELSEN iJOiary Public: nstni Rtcm a icknowledha ' (It me. f ' THIS INSTrtunnr:raT WAS onn Sfa4e or Wisconsin i _ slid j l• wisconsin Notary P, Ii , v_t,- _r ].:c CmInt/ Wis. 1.' 15ignatt,ns may be auth+•nt;can•e1 or ackr.-»vic•dgcJ. B, Ili are not h1y- it Rris,;ion is pannanernt (If not state expiration date n riccessary) r Lnnc.1 r I , ,.r;, at m ny shooid hv,rh,,+ 1- -d n,•!„» It1: 1. ,.~n.11,,. *Franc.i s L. Lyn,jhaugh 'IA rr IInK('t Wt St 1NSIN ~t••.;,IV,,1+~L al Park Gn.!rc Y\'A RRAN IY nl 1 -1) 1•nrm No. 2 - 1982 1.eLva~a.x1 wn ~t ® 1 R A A D ; o . ;mss t,,I Located in the SW 1/4 of the NE I /4 of Section 3 1 , 1 N t/4 1. Nl't Al ff 6T[ 14oi4' v.17xT acCTivi~ ~i Or ~t r rt;Pinri Sx:rwev vv, 5COnS]n, iDei rig ('-e t40 .2SN,Rt9W Map recorded in Volume 4, page 1083. =(n X~ 'j _-.:i-ri S('.ilinidt. vwncr APPROVED z g ~ Oak Y'-r,~i1 ~ N Hudson, Wi . 54016 Y Wi) ~3s=r r Sy 7::7 ]i e I.- 0 3B Q i,//YYL%.i T L V- - Lt1-1•`.'_o -I - ivvn Tr, LINE OF SW !/4 OF HE 1 /4.N 1 -C. 1 f (1.u.v i,Trr ~ " i. z . ~ °Z m I tt7_ I 141.bO t: u y.~v,..s- ,vN S89°31'09"E S 89'31' 9^E 585.49` 27S. O 277.32'--~ , ' srM POINT OF BEGINNING - 310.49 33, vsz 9C` 0 0 I LOT I LOT 2 atoi 1 r c Wow mN z a~ 106, 156 SO. FT. p~j M to J W `I 96,647 SO. FT. N p (2.219 ACRES) c N INCLUDING RIGHT- N d v a -t it N o OF-WAY (2.438 ACRES) o z m z 95,409 SO. FT. o p' C I EXCLUDING RIGHT- 1 ! OF-WAY (2.(90 ACRES) IW 33.00, H S 89'31'09"E 3 ,d 1 80. 5g• 07"E 08.53r -f 1 283,86 - -'541.53`- _j _ LOT 3 01 / s. M. VOL. 1. PAGE i>9 p I ) c!f t72,994 SO. FT. INCLUDING - - - - - - _ - o RIGHT-OF -WAY (3.970 ACRES) tcl Q1o ¢A FT_ FXCLUOtNG rn ~W Cu RIGHT-OF-WAY (3.716 ACRES) I c=O Cu l J Cu z1 S 89'31'09"F- - / 3G.81` O 0 z ' - 474.281 --511.09 9 O '+,,~~~!!O I~eaa •s, ~rY 1 ~ W LOT 4 o z 3 ` , JAM Z 173,612 SO. FT. INCLUDING 1 RIGHT-OF-WAY (3.986 ACRES! 3 ^ 6 E= W c~i1 157,$1'2 SO. FT. EXCLUDING ! v m RIGHT- OF - WAY (3-. 622ACRES) nm Om ry+~ ~ i 1~~ 3 I ~ 4• fp t y / I - tic 90' Su' N ! ~o , ~tlrttattc N O I,/------ PRIVATE ROADWAY EASEMENT 268.09` , SCALE IN FEET ,•'„sa' N 87'32'03"W 304. 3r / 1 L 36.21` O 400 200 350 C. S. M. VOL. I, PAGE 166 ST. CROIX COUNTY SEPTIC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM , r Owner/Buyer _ CL v e OLO SA t A tt k k"SC Mailing Address ~0 ~ S/0 Property Address (Verification required from Planning & Zoning Department for new construction.) City/State ~'NW Parcel Identification Number LEGAL DESCRIPTION f l i Property Location '/a , Sec. , T N R W, Town of T V Subdivision Lot # Certified Survey Map # u `4 Volume Page # I &:S(P Warranty Deed # Volume , Page # Spec house yes no e Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(t) and in Chapter 12 - St, Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. [/we, the undersigned have read the above requwernenmand agree to maintain the private sewage dislsosal-sy9tem-f9ill -the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify 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 described above, by virtue of a w anty deed recorded in Register of Deeds Office. Nu ber of be rooms 3 4/)o SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office. and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) t Wisconsin Depa SOIL EVALUATIO(© r~ Page of Division of Safety a d Bui s qq~~ 1'0.QMance 'th Comm 85, Wis. Adm. Code Attach complete si Ian on)W ' not inches in size. Plan must include, but not limit to: vertical _e ce po~tF(BM), direction and Paroel I.D. percent slope, scale dimer and location and distance to nearest road. / r3 . - f I nt a0 informadon. 'Reviewed b Date J) Personal information you a may be used for secondary purposes (Privacy Law, a. 15.04 (1) (to)). Property Owner Pmperty Location vapt 4 K~/~t / `C/SCI^ t"Ve ! 57W 1/4 1/,r1/4 S..~ T .28 N R I ?-&W) W Property Owner's Mailing Address Lot Block # Q~qName CSM-# 6 pfd 3- 3 C.~?- a G. G a n c t!Y F)/,?, ity Stale Zip Code Phone Nun*er ❑ City ❑ Village J K own Nearest Road 'Vcp-f M//s Cw ❑ New cdon Use: Residential / Number of bedrooms -3 Code derived design flow rate S Q GPD Repiacement ❑ Public or commercial - Describe: / 10 Z TVs ft. al is ! c . 'a. Flood Plant elevation if applicable )VA General comments " Gli C. o •07 of "f- I m-t cd C,t q " aGc r s f / S" e and recommendations: -Q d 0&1 a.h 'ti ,<',r°t t,'~n r•; 1~e I-t° .7- W a 4 /'j !r'*1 7 "-t ~ Z ~ /e» G 4 e r *I' a 4., sp -r4.., f l e- 16/ d`/G 1 f'7f f a+ti hi'L/S~. c~ •a ~ 4 f cL de~u t ci P yLd 4S O j h e 4 P&Ar f/*/ - *J7.* 7` 'c c6, rrs fe i-r Ca0ers . w,'t cL1` Ole r c Boring # F-11 Boring > Z/ fa 6-7, Pit Ground surface elev. ►CQ _3 ft. Depth to Rrrtidng factor Sol Application Rate in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 o ,/a /or-e 313 - s 2 JC 2,4- 04' • O A"A q- F -47 Boring # I4~f2 Boring Pit Ground surface elev. /&O, cS ft. Depth to limiting factor > 10 0% in. Sod ADpkation Rafe 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 Z 6.6 ! o a -i q /O Pw ? / - 5-.e a ' " O- S, A If /Cl "I& J7 147 F i v.2 ,t 10 ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < rrv ` Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/L CST Name (Please Print) "Signature CST Number Cot /cs Wc..4.f'fe- c;:;17 a l O -7 6`3. Address Date E Conducted Telephone Number s _ 3 3 p Xs~i X70 t,~ s3~ 611r v. 4 64<7 s- 0 3,4- 71 p4 v d~ 1 `LL"fq 1%l' cle- C ! U ' of Property Owner Parcel ID# p Page Boring # ❑ Boring Pit Ground surface elev. X00,. ft. Depth to Nmiting factor > /0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxxture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 MJr Gz 2)C1-,-,2C C'-,i(- l 0 s8 /oy S _ s .Q / S / a.6 A0 zA I/ ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx fire Consistence . Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz: Sh. *Eff#1 *Eff#2 Effluent #1 = BOO. > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODs < 30 mg/L and TSS < 30 nVL 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. SBD-8330 (R.07/00) • F P'{ B h'~a p x^ ra N`k n 1. li 'Pik o o„ r T R T Vs ~L7 ' n o 4 0 3 CD a v p rn '7 d 00 ~-0 I N O 0 C ^a s I N N u ~ x (D 0 o I I rn CD aNi ° I a z a c U. N ~ m O 3 ~ a) I a ~ I 3 M v a) z w E rn z = c Ix ` co d in 04 In I M H o Z c d Z c fn H r O N c d y N y N I ~ a c O I Z F- Z ~ 0 0 N `O ° U) 16 E z e a~ a I~ a }mil (O in N GI N Q p LL N N T Z v>> 3 3 3 a 2 wooo •N ~aaa c a J 3 c N 4) I,- co co 00 m U rn rn o z a r- 7- M ° a~ _ O N N N c,) M C14 T ° ~ v 1 CD M N 4 m N 2) .N+ 01 O N N (D y df Q } U) N p ' 13 ° Y y r.+ CV w C O E N (O O M_ O O CO O > N C C U a 0 0 0 0 r 1 it O C N N N (on rm- -s N N N N v O V ` N N C a O M W CFy i'' a+ = Z Z C r O d 0.4 co co E 'R t • 7 0 O N O O U N ~y C. M m O z_ F- H 2 cn V C~ L: CL • ees CL m m E t c c r rw as r A 0CL2 oaiti t i It Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Cr"~~ TOWNSHIP SEC. T S N-R f ~W ADDRESS T- ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT 7a~ el/ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3E p 2cs0M, i 8 3 .22 ~G M 5 I yr G w U , I r-d Im - INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used n ')Art' e e'd Tl rir Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: ,1,:'~ ~.?tft? Liquid Capacity: Number of rings used: 0/ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side o Rear , _~j feet From nearest-property line -Front, 0 Side,oRear, O (1-91.5 feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE Y ~ v PUMP CHAMB ` Manuf turer: Liquid Capacity: P p Model: Pump/Siphon Manufacturer: Pump Size, Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:_ Length: ' Number of Lines: Area Built Fill depth to top of pipe: Number of feet from nearest property line: F(tont, O Side, Rear,O Ft. _ i Number of feet from well: 7:J Number of feet from building: (Include distances on plot plan). SEEPA( PI 5i Number of pits: Diameter: L/i'q id depth: Bottom of seepage pit elevation: ' / Area uilt : L' Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manu ct rer: Capacity: Numbe of rings used: Elevation of bottom of tank: El atton of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: j) ) 4~ 3/84:mj , p PUMP CHAMB Manuf. `turer: Liquid Capacity: P p Model: Pump/Siphon Manufacturer: Pump Size, Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenth: f^ ` Number of Lines: O,+( Area Built: Fill depth to top of pipe: r Number of feet from nearest property line: F(tont, O Side, Rear,0 Ft. Number of feet from well: ZZ Number of feet from building: (Include distances on plot plan). SEEPAGE PI ~i Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK j„ Manu ct'rer: Capacity: Numbe of rings used: Elevation of bottom of tank: Ele atop of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: /e)' Dated: A.. Plumber on job: r• y. 11 r f 1 License Number. 3/84:mj I'L F7-- DEPAFJIM5jilT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ~►"ION LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVIS BUREAU OF PLUMBING ' P.O. BOX 7969 MA1DISONr WI 53707 ~4'7 ALTERNATIVE Sassigned) Number: SW~,NE54,S31,T28N-R19W )MCONVENTIONAL (if assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure D Mound Lot 4 CSM CTH F NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: alvin Burton 314 Pleasant Street, Roberts, WI 5402 3 o o 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: yle J. Myers I6219 St. Croix 102845 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. 77; WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES ONO DYES ONO BEDDING: VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROADTY WELLBUILDINGVENT TO FRFSH ALARM FEET FROM AIR INLET DYES ONO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER JWARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES NO NEAREST SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthe depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (lf,soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO. OF DISTR. PIPE SPACING COVER INSIDE DIA SPITS LIQUID BED/TRENCH TRENCHES MATERIAL! PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF JPROPERTY WELL BUILDIN VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLET ELEV. END. PIPES FEET FROM LINE AIR INLET NEAREST °1/ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 ONO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED DEC) SEEMULCHED CENTER EDGES. , DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL. & MAHKIN6 ELEV. ELEV.. CIA ELEV.. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY r COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO ❑Y S ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PRIOEERTV WELL'. BUILDING. FEET FROM DYES NO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. i Zoning Administrator DILHR SBD 6710 (R. 01/82) I SANITARY PERMIT APPLICATION COUNTY (~MI`LHR In accord with ILHR 83.05, Wis. Adm. Code /r (f~ vX STATE SANITARY PERMIT # -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 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO PROP5RTY OWNER PROP RTY L CATION I '/4 ~t5'/4, S T , N, R r E (or(o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER S BDIVISION N CITY, STATE ZIP CODE PHONE NUMBER 77 CITY NEAREST ROAD, LAKE OR LANDMARK l , S 0 VILLAGE : 11. TYPE OF BUILDING OR USE SERVED: S (SPecifY): Number of Bedrooms if 1 or 2 Family ~~~~oevo OR El Public III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. gNew b. E1 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. El Seepage Bed b. Seepage Trench c. ❑ See age 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? Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. Con- INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass Plastic App. Tanks Tanks ❑ Septic Tank or Holding Tank Ddp ~(1t7 C ` ~ Lift Pump Tank/Si hon Chamber ~L' ❑ ❑ El I ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system show on the attached plans. Plum er's Name (Print): Plumber's S' ature: o St am s) P/ PRSW No.: Business Phone Number: -55- 3Zsr Plumb 's Address (Street, City, State, Zip Code Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Na a CST CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) 5~Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: n 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 SANITARY PERMIT 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 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. 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. 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; III. 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 more 7 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 bill Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure is used in your building is.returned to the groundwater through your soil absorption 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- f water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) • I APPLICATION FOR SANITARY PERMIT STC - 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Amer of Property A \(t a Location of Property Section , T N-R l C1 W Township Mailing Address Q`' L 7 1 Address of Site ~ Subdivision Name Lot Number Previous Amer of Property 1 LL Total Size of Parcel Date Parcel was Created (A 12 Are all corners and lot lines i1e ntifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _C0 and Page Numberl(D 5 6 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant Deed which includes a Document number, volume lume 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 CERTIFICATION I (We) c".ti.6y that atf. Atatementrs on thf,6 Bohm aAe. tAue to the but o6 my (ouh) hnowtedge; that I (we) am (ahe) -the owneh.(,5 o6 the pAopehty deAcAi.bed in .thiA in4clmafAon 6o4m, by viAtue o6 a waAAanty deed neconded in the 066.ice 06 the Coy u+-ty Reg•us.teA o Ueed~s ah Uo um t 6 c ent No. and that i (we) pne~s en,tey aun the phopoSed site 6oh the sewage d ,6po~s Sy6s em (on I (we) have obtained an easement, to nun with the above debcxtbed ptopehty, bon the conS.thucti.on 06 aai.d System, and the Same haS been duty neconded .Ln the 066.tce o6 the County RegiAteA o6 Veede, aS Document No. LAiZ5 2_5? 1. -0 n ~ _n SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 91 SPAGE 7J REGISTER'S OFFICE This Deed, made between Kirk T' S' h-mi dt; ST. CROIX CO., WI Ree'd for Record Grantor, DEC 11987 and Gil vin Rurtn-n at e~'e 0. M ReOtsfa of D.ac~ Grantee, Witnesseth, That the said Grantor, for a valuable consideration Q f V 1_ and other. - RETURN TO w-T C 0.t ut n 13-k r 57 conveys to Grantee the following described real estate in St,. Croix 3 114 P lea County, State of Wisconsin: R°p¢~fs Syoz3 Tax Parcel No: 482, Lot 4 of Cer•tifiec? Survey Map filed 27, 1086, in Vol... 6,, page 1'56 as Document ;`'412528, located in -tl-e SVi of NE3- of Section 31, T'2SN, R1~? Torn of Trod, St. Croix County, Vlisc;onsin T'R SF FEB This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Ki rk T Sc -n'r i C, - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except Twether with and subject' to gin,,,,- ot'rer ea~,e:;:ents cove :marts, reserves' Lions, or- restrict -on o record ~.f an Y, 'hut G. _s' s all not be deemed o extend any ruc of-:er. recoMc?ed" encl1inl r aces , e<ron t1 e term estab- and will warrant and defend the same. lis!^~ec? 'hST 1a:r -t' ere:,.or. Dated this ~0 day of Y~9 C)~1 e tv~~n .C' 19 ° /04!k (SEAL) (SEAL) Kirin T Scl- it?t CgIV in Mirtnt (SEAL) (SEAL) x r AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix ss. County. 30th authenticated this day of 19 Personally came before me thi day of NOV. 19 the above named Kirk T. Sc 1 an Calvin Burton TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be l40person.who excuted the authorized by § 706.06, Wis. Stats.) foregoing inst umen4nd acknowledge me same. THIS INSTRUMENT WAS DRAFTED BY or . ren E;,, S now T_ Sr'',1 i c~ t: Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission "i {I not, state exp. tion are not necessary.) date: _19 y 'Names of persons signing in any capacity should be typed or printed below their signatures. NF 3573 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms, P.O. Box 10208, Green Bay, WI 54307-0208 FORM No. 1-1982 o~ • c~ ~~M . , , ,:,~C~ h. •'+~1 f . -:CERTIFIED R.-VVEY MAP .1,14 0' V'1ie,NE1/4 of~Section 31, s Lc~.cated inkhe SW j N 1/4 CORNER TZLIN g 19W, Town of I' oy, ;St, Croix County,_. I"01 SECTION 31 Wisca`Ain, bapl g also t' t' l of that Certified Survey 00'00° T28N,R19W + Map recorded in Volum 4, page 1083. ♦~o e 1 E N L. < O - V • S _ IJNPLA I;l;~;._ h - _ NO" LINE Of SW 1.%4 OF-IfE.1/4 _ ow X 1 41.65 5.40' 33.17` _ e S89°31'09' S 89'3!' 9'E 88 .A9' I 278.00' f`.32' eC, POINT OF 13EGINNIN 6$ -310.4 35 , M 44 Z' AI Z LOT I T 2 N 4 W i Y1 O W IV " we i ~ . t I _ I ° 96,647 SQL FT. N ~O m d. - 5Q. FT: j i N (2.219 ACRES Y, l in o RIGHT # J J j~ss * u . 74436 ACRES) _ 49 Z- '98,409 SQ. F T. p I O EXCLUDING RIGHT- -OF- I ti .3 n WAY (2.180 ACRES) ~W 33.00' W H 49 89'31'090E W 2BO' 8686' E 308.83'... z 283 1 - 341.03 j I - LOT 3 i V + ( p • RIGHT- OF - WAY ( 3.970 ACRES) J/ W I61,912 SQ. FT- Yi ,UOING' • < W RIGHT-OF-WAY' C3~,¢i1'16 ACRES) Aa I a 7 0 •3 ZI S 89' 3! ' 09" , o 36.61 t0 Z ' - 474.28 fs Y • / (3 M - aI 1 og a .a % 9 It I W LOT 4 ► ° z 173,612 80. FT. Jict kat.Ki RIGHT-OF-WAY z98.bf~r~ W IS 7 4 u +812 SQ. FT. EXC of RIGHT - O F -WAY (3.. LUQIN6 622 ACRES) ♦ t~7 31 90, h o / N I y' i• 3J~ / 01 sn i • 268.09' / WALE IN ItET N 87 32' 03"W 304.30 / 1"" i10' goo U) H t ' a r ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z a a ~o,' f OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE ZIP PROPERTY LOCATION"' ~4, !4, Section T N, R~W, Town of ! y' ON St. Croix County, Subdivision Lot number. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into (I the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo I/WE, the undersigned, have read the above requirements and agree Ln to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ~v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED C Z jr,,, ,tiJl tfv DATE Z-~- St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LA bR ADD. PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N W1 5370 HU AN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: W SHIP/MUNICIPALITY: LOT O.:B K. N SUBDIVISION NAME: (~71/4A) ~/4 31 /TQYN/R19E (or TO . 5urw. CMa-P OUNTY: OWNER' BUYER'S TEA AILING ADDRESS: 1-77-M, C USE / <3 DATES OBSERVATIONS MADE - NO. B DRMS.: COMMERCIA DESCRIPTION: PROFI E DES ,R✓IPTIONS: PE/R O ATI Residence New ❑Replace I7/ / y17 / Y7 RATING: S= Site suitable for system U= Site unsuitable for system O / -PRESSU r ONVWIO~NAL: MOUN IN-G US ❑U RE: ~SYSTEM-IL4-FIJA_HOOsLDING TA :RECOMMENDED SYST~FM:(optional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the &A under s. ILHR 83.09(5)(b), indicate: /VA Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED SEE ABBRV. ON B CK. B- -7 r7 0F7b-n---.iT-j 13 8o k If r7 !3 C w 6- B 7(p t o OK Bn s; ~ i dt-3 n s s n s~ ~o B-3 7~n C16,6 9 > 13 OA'Sn ( 310 n g LA-) G Q /.s, 40s/ 9 OKBnsI~,~ /I 1 ni s~ /9 8n s B-44 69 S ,.L G t, B:5 9G 5 I~ he n s;L, 1 8 418, 4 e~ s d 10 O K f7 3,11.5 / 3 e,, Q R, B- ~p ?~o ~9•~a d~ r PERCOLATION TESTS 4NUN~BER DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCHES AFTERSWELLING INTERVAL-MIN. PER kQ0 1 P IOD2 P PER INCH 3 6- A0 1;2 yllp Q / d 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 t a - r E o - - 0-0 4 - 4 IN j c a ~ O E I, the undersigned, hereby certify that the soil tests reported on this for a by me in accord with the procedures and methods s e Wisconsin Administrative Code, and that the data recorded and the I t e tests are correct to the best of my knowledge and NAME (print): TESTS WERE MPL TED ON: 1q, c a-roe & ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIG T RE: 0 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - J INSTR NS FOR COMPLETING FORM 115 - S 3 - To 1a re soil ~i~st:, yt +a rsr ri 1 . Ci .n 3. The use sc ,f indicate whether this is a residence of corynner~cial t)roject; 3. Il>`3AXIM „ )ms or commercial use planned; 4. Is this a ne system; 5. CC ing boxes. A SITE IS SUITABLE: FOR _DING TAN ALL LITHE _ l-,~ D OL- h BASED ON S _ .:,N~ IT 6. 'LEI corr,r'e-, a, p' m; 7, MA16 locating y: r ~ Jots ~ ,..ving to s I ' r~ ~d, A S, its ' ical elevatio r ~ point are clearly Shown, ar srmanent; 9. Co p - boxes as to dates, naiaaes, ; -iresses, flood plain data, pe Kernp- ti , 10} if dood plain, elevatao=i) does not apply, place N.A, it) the ap 11, Sign I ~ - your current address and your ceitificatlon number-; 13. Make distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE LOC,,,AL VJITH IN 30 DAYS OF COMPLETION. A BI EVIATI', R 'CE iTI, 3 SOIL TESTERS Soil Senpraates and Textures Other symbols col: 3 - 10"I ~e gr - :i ,,.Ender 3-1) S HG' High Car =a; _ Co sand P - Percolat Rate fined s Me,, n Sand Well fs F; Is L I T an l L€ +-n Bn F a:m Ski ana Bi Y G y Loarn Y Yellow sc -y Loam 1 sicl ("lay boa€ra 1 ,c s>"")Cry Clay :It sic - Silty Clay fino, c Clay cormno° pt - P(" at r-nn I Many, n-i i%icl,, d distin( P r HWL -H Six ge,>€ a soil trxt€.ire:; su f", ;o, Ir_ u d ~,Jaste d shosal _ Bench N V 1lart€c<rl TO THE OWNIER: This soil 1.,s is the first step in securing a sanitary permit. The county or the Department may request verification c` oil test in the field prior to permit issuance. A complete set of plans for the private sews';, s~ ° , ~)l a a c 'M application must be submitted to the appropriate local authority in order to obtain a tv=i t. The ~ y pert-nit must be obtained and posted prior to the start of any construction. I 4 3 ~ t _ I. F mot- o 3 1 Q l G '.1