Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-2014-40-000
It~~sn`Deflartt~r~li~y! 4.30.19W,pATT 5~iEY~E4 & 50t1? ounty: SLabor Human Relations INSPECTION REPORT Safety fety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: 'aW CST BM E ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400087 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FFii Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: OR UNIT 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.4.30.19W, NW, NW, Hiqhways 64 & 50th Street Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY oio O I O b Wpleim STATE SANITAR M -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER P P}=RTY OC TION 1'/a '/a, S T , N, R (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1776 50th. St- na na CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Sc)mPr,qt=t . WT 715)24R a 11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms 3 PAR L NU ER( ) 111. BUILDING USE: (If building type is public, check all that apply) 032 Z Q 1 5,, 46 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of LO Recoe Eiorrvf 5.0 Repair of an System System Tank Only ° -Existing Syotem Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 93.95 Feet 98.10 Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber El I F1 I Ej - 0 1 ER VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati n of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' ature: No mps) K19MPRSW No.: Business Phone Number: 3254 715 246- 6200 Plumber's Address (Street, City, State, Zip C 1554 200th. Ave., New Richmond, WI. 54017 IX. COUNTY/DEPARTMENT USE ONLY issuing Agent wgnat (No Stamps) ❑ Disapproved Sanita P 't Fee (includes Groundwater 1,2 a 7te ssu71 S~ )ffAppr0ved EL] Owner Given Initial urc ar e ee) Adverse Determination X. NDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: i98 (formerly Plb-67) (R. 11/88) 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 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. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBC) 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provic'e the legal description and parcel tax number(s) of where the system is to be installed. II. 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 in 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 in ##1-7. VII Tank inforr. ation. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and n)anufacturer'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 °3.nks 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 smaller than 13% 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 ooints; C) complete specifications for pumps and controls; close 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) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 1 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St . Croix 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 LO AT ON 1/44 1/4,S T N,R k(or)W Harvey Halverson GOVT. LOT / RZ-_ 11 30 19 PROPERTY OWNER':S MAII.ING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1776 q0t-b- St- na na na CITY, STATE ZIP CODE PHONE NUMBER EICITY OVILLAGE [SOWN NEAREST ROAD ( Somerset Hy. #64 [ ] New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 ed, gpd/ft2_ 6_trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) na ft (as referred to site plan benchmark) Additional design / site considerations na Parent material giagal d3c}ft Flood plain elevation, if applicable ft S = Suitable for system I CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system [a S❑ U S❑ U S❑ U S CU ❑ S [is U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence I Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrtdt 1 0-9 7.5 r4 2 none 2 9-96 7.5yr4/4 none sl 2msbk mvfr na na .5 .6 Ground elev. 98 ,in ft. Depth to limiting factor + Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name _Please Print Phone: Gary L. Steel 715-246-62on Address: 1554 20 Signature: Date: CST Number: / 4-2-94 cstm2298 PROPERTY OWNER SOIL DESCRIPTION REPORT Page _of PARCEL I.D. # Boring # Horizon Depth I Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft ) in. Munsell Cu. Sz. Cont. Color I I Gr. Sz. Sh. , I Bed iTu& Ground elev. i ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # iiU:C:3 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1-5-54- 290tb- Avg. Gary L. Steel Harvey Halverson C.S.T. 2298 SE4NE4 S5-T30N-R19W New Richmond, WI 54017 MPRSW-3254 town of Somerset (715) 246-6200 bm=top of septic clean out cap at e1.100' bottom of exsisting systm=93.95 system is functioning properly system appears to be 900sq., trench A 1 Z0 t~, y~Pl / - 7t" .5e o C C9 Gary L. Steel 4-2-94 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BU-Yf :R ADDRESS: j('T6Yl -S : -.~'l FIRE NO. / 7~ to LOCATION: ( 1/4~ 1/4, SEC. T ~ N-R r W, TOWN OF: J~~S ~•aC ST. •CROIX COUNTY SUBDIVISION: Aj /r LOT NO._ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste.disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the 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 the St. Croix County zoning a certification form, signed by the owner and by a master plumber, journeyman. plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating 'condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system-in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix county zoning officer within 30 days of the three year expiration date. SIGNED ' DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 STC-100 ""is application form is to be completed in . the 0W11cr s full and signed by will only (res0 ult in 1 the propestyy being developed. Any inadequacies development be intended for of the resale by permit owneracont Should this the (spec house), then a second form should be retained and c mpl ted when property is sold and submitted to this office with the appropriate deed recording. owner of property Location of propert 1 _ &1//44, /4 Section T N_R Township , ----1-w Mailing address 7~ 69 t'r) ~N~1 V-)f Address of site > 77 _ Subdivision name Lot no. y~Tfi other homes on property? X yes No `Zd/ Z~ Previous owner of property %Z11.6 m Total size of parcel 'f 4) /7 Date parcel was created Are all corners and lot lines identifiable? '/---,-Yes _No IS this property being developed for (spec house) ?.eyes „4140 Volumecl9y"~ and Page. Number ~ of Deeds. 7 as recorded. with the Register 114CLUDE WITH THIS APPLICATION THE ]FOLLOWING; A WARIZA11Ty DBED which includes a DOCUMENT NUMBER & THE SEAL OF THE R.EGISTrit of DEEDER, VOLUME AND , a certified survey, if available; ;would be helpful so as to avoid delays of the reviewin references to a certified serve process. a If the deed description shall also be required. y' Pp the certified survey Map PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to th best of ny (our) knowledge that I (we) am the rro ert the p y described in this information form the owner(s) of warranty deed recorded by virtue of a Deed, as Document Pao. n h t office of the County. Register of ol,:n the proposed site for the s wage, and that I we obtained an easement ( ) Presently to run the aboveidesc arib dstem or I (we) record d r ctionof said of County, and the same hasp be nY, for No. y Register of deeds as Document Si 'atur ;Of ap, icant Co-appl cant r Date of Signature Date of signature jI THIS SPACI SCSI DOCUMENT No. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2 -1982s 4_66947 REGISTER'S OFFICE VOL 894, Wk:E 359 ST. CROIX CO., Wl .1 j Reed for Record Bale eran n,Tan••._.-and wife,.. erma,i~n•,••-huband•-••• I of e,-- inividualy, andeachin tl}own 11:~R15 O 1991 A M own •xqh i till. i i ~ pf d 1 conveys and warrants to _Hjax.:Y... R....Hal erzon..and.Xarla ..J_....Halveraonr_.husband..and-..wife-,...as..mar -tal.... ..suruiuarshin.-.=ouert;r Attome Title of Svow8w, Isao Greeley tte X209 Stillwater, MN 55082 f RgrURN TO GWln Law irm 430 and Street • • Hu on, WI 5401.6 i the following described real estate in .....................County. State of Wisconsin: Tax Parcel No: 032=_2115_-0_.__ j, See legal description on reverse side. ' ~gp~NS S 0-91 1. ij } This is homestead property. jj (is) vL) TOGETHER WITH AND SUBJECT TO any other easements, ~i Exception to warranties: covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any suchother ! recorded encumbrances beyond the term established by, law therefor. i twenty-eighth Februar 91 . 19......... t Dated this day of ` ..............(SEAL) ...............(SEAL) :Dale M._. Germa3.B,.--•- T~ ...(SEAL) ...............(SEAL) _.Jarn . L____Germain__---•--------------------• • AUTHENTICATION ACKNOWLEDGMENT $ignature(s Dale M. rermain and .Jane STATE OF WISCONSIN ii • L. Ge ain h' wife ~I authen ted ofFebruarv-_.••-, 1991. Personally came before me this .day of • .........................................119 the above named I, 'Hug i. Gwin TITLE: MEMBER STATE BAR OF WISCONSIN N/A (If not, ;i authorized by 706.06, Wis. Stata.) to me known to be the persor. who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 7t aci.zl._L.aw_-F-Um. • . } ..r5 tY9I)G~.., ..---54.QIE... Notary Public ..........................................County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19.........) -Names of poranna signing In any capacity should ba typed or printed below their signatures. WARRANTT DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank C.-. Ine FORM No. 2- 1982 !I,!~:aukm:, Wis. `VOL 894 va 360 30 North, 4 of the NW1/4 cf:',Section 4, Township of ii~►t that part of the NW1/ No. 64 and West the Sange. 19 West, lying South of State Trunk' Highway t of land roiii said 40 Northerlycboundaryt of which ih down Road as n ow laid out and traveled convey a triangular shaped tract o of which is the So s State Trunk Highway No. 64, the Southerly' boundary line of said NW1/4 of the NW1/4, and the Easterly line of which is the Town Road 30 North, now laid oouth and traveled All the t part of the SWl/4 of th Tow NW I/ Road as Section Range 19 west; lying West of the the described. parcels: across said 40 acre tract, except. the following. on line which intersects the . (1) Comaencing at a point on the quarter sects 80 Beet more the South lira of State Trunk Highway No. 64,x *he same being 4 of NWl/4; thence South 12 less South of the Northwest corner of said SW1/ No. 6 50 feet rods.; thence East 50 feet; thence North 12 rods to State Trunk Highway No. 64; thence West along the South line of_~State Trunk Highway more or less to the place of beginning. - ~ North 4 of NW1/4• thence (2) Commencing at the Southwest corner of. said SWl/ is 269 824.5 feet; thence East 606 feet of to saidthe1c Town enter Road of to a the point Town Road; which thence Southwesterly along the cents the South line of feet East of the point of beginning; thence West along said SW1/4.of NW1/4 to the point of beginning. i g c 3 C; w c a M a I ~ •o I o (D C: ?Ottt 3 ttt N 00 w co N 0 N t O O i v c T V) C 0.t ~~11 c M m p C -cm, y ~ U O C V~ O d N N a LL C N to a) C O N yam.. O CL -0 9 0 o d j O a~ U. O'.. a O rn rn c o .OO O.X 'f d CO d a m !d v 3 ° ff~ i o z rn Z _ o d' FM- U) d m o I O z v U U a~ O N fA F- ° d z C 'O Cl) N O O O m N a) CL C? .0 0 o m d z co z o N _ Z' o I'' c c I E N O I ~ ° LO L d C i -0 N al c 06 o a +o o a ai a~ T o o 0 CL a m N E F- co Fy- ~ U o ~,y n co o ~r v°, O O O z ° •N m aaa a 0 m 3 O O O) Vi J U G a) rn rn a> a~ C - 0 ° co v a`~i m r- m Iii - d as a (~1 C C T O ° N y C ° C O C E 13 Ic": v F m c Q n a) O _ ~N -I - Y -0 7_ to Oi E Q) a) 0 Zri N O N N CO tPt N • cm 0 m 1 ° N m E L 0 o UJ 2 0 C/) V C~ m m d EL a • CE w `~1 A uIL2 0 V)0 Parcel 032-2015-40-000 08/23/2007 04:30 PM PAGE 1 OF 1 Alt. Parcel 4.30.19.524A 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s)' O = Current Owner, C = Current Co-Owner O - ROETTGER, DANIEL H & AMY E DANIEL H & AMY E ROETTGER 1776 50TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1776 50TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 9.230 Plat: N/A-NOT AVAILABLE SEC 4 T30N R1 9W THAT PT OF W1/2 NW1/4 AS Block/Condo Bldg: DESC IN VOL 572/167 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/02/2005 793776 2794/221 WD 07/23/1997 778/398 QC 07/23/1997 572/167 LC 03/04/1991 466946 894/357 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.230 74,100 157,000 231,100 NO COMMERCIAL G2 1.000 16,000 40,000 56,000 NO Totals for 2007: General Property 9.230 90,100 197,000 287,100 Woodland 0.000 0 0 Totals for 2006: General Property 9.230 90,100 197,000 287,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 311 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 `.M FORM - STC - 104 ,5o AS BUILT SANITARY SYSTEM REPORT OWNER X c'r.5o TOWNSHIPS 5 d ~t e 1-5- SECTIONT ON-R-2 W ADDRESS_ ./77~---1.57. jf ST. CROIX COUNTY, WISCONSIN SUBDIVISION - LOT --LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM C aD0 al b~° avc~ ~sv inq Gov i INDICATE NORTH ARROW BENCHMARK: Elevation and description: r ~~z y Alternate benchmark__o~o,^^ SEPTIC TANK:Manufacturer:_ Gye-e A( Liquid Cap. Rings used:10 Manhole cover elev: !f ,/Final grade elev: /O l 7 Tank inlet elev.: , 1 Tank outlet elev.: yy No. of feet from nearest road : Front X , Side , Rear Ft. O~ From nearest prop. line:Front , SideA , Rear Ft. No. of feet from: Well ~ , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed:- V Trench: Seepage Pit: Width: 1,,2 / Length 5 Number of Lines: Area Built "O~ Exist. Grade Elev. / a-~ Proposed Final Grade Elev. ° 8 Fill depth to top of pipe: '~4 'Z No. feet from nearest prop. line:Front , Side,, Rear Ft..,2e:51~ No. feet from well: No. feet from building L 7 HOLDING TANK Manufacturer: Capacity: No. of rings used: ' Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE : c-2 - PLUMBER ON JOB : LICENSE NUMBER: 317 6/90:cj Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labdrand HuWn Relations INSPECTION REPORT Safety and Buildings Division St. Croix (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION SW',NW4,Sec. 4,T30-R19,150th St. 149230 Permit Holder's Name: ❑ City ❑ Village aTown of: State Plan ID No.: Hoffman Refrig & Heat. LTD Somerset S91-20859 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 524A 1032-2015-40-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark - I Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 99,71 TANK SETBACK INFORMATION St/ Ht Outlet 7.o3 47a 11 . Z Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Septic NA Dt Bottom D NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 8 l Manufacturer Demand , Model Number GPM TDH Lift Friction System TDH Ft LOSS Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM 1 BED / TRENCH Width j 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 INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTENkn~? 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COM ENTS: (Include code discrepancies, persons present, a c.) crn c.L~ Plan revision required? ❑ Yes ❑ No Use other side for additional information. l l O cnti SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E- DILHR SANITARY PERMIT APPLICATION COUNTVY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than El ? 8% x 11 inches in size. hec if re sion to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBS 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 22L__CZBS7y PROPERTY N t"-v PROPERTY LOCATION . It !.v'/,I/,W/a, S T , N, R E (o PROPERTY ER'S MAILING DDRE LOT # JB17746- 1/220 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER p )Lr Arc E:I 00, II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE ; - KSPublic ❑ 1 or 2 Fam. Dwelling-* of bedrooms - AR LTAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) -Ir.2 C7 3o?~- 01_5 40 00 40 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ES 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 - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 19 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION o W o 4,070 off' ~,'.,Aet D/ Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Septic Tank or Holdin Tank Tanks Tanks Lift Pump Tank/Si hon 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): Plumb ' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plu is Address (Street, city, late, Zip Well I~Z ,9 o rn IX. COUNTY, MENTRTUSE ONLY r ❑ Disapproved Sanitary Pe it Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial q Surcharge Fee) Adverse D termination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 the time of i enewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to t,-As permit must be approved by the permit issuing authority. 4. Changes in ownd'rship or plumber requires a Sanitary Permit Transfer/Renewal Forrn (SBf) 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 & 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 tobe installed. ll. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. Vlll. 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 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; 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; (Jose 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) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 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. - - - - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - Owner of Property .9 A fo ( F K A tL A UAL k-' Q .5,,c .ti Location of Property it Section T N - R W Township Nailing Address 1 Z,7Cd. .5;-6 S c~r~ E e 5' E T (,J Subdivision Name Lot Number ' r Previous Owner of Property ~6c~ J yt Total Size of Parcel GcG> Date Parcel was Created Are all corners and lot lines identifiable? k _ Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume and Page Number 36 c~2 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: i 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 Nap, the the Certified Survey Map shall also be required. f PROPERTY OWNER CERTIFICATION I (We) ceAti.6y that att statements on fih.ia 6onm ane fitue to the beet o6 my (out) hnow.Cedge; that I (we) am (ate) the ownen(6) 06 the phopen,ty descAibed in fihia .in6o4mati,on 6onm, by vixtue o6 a waAAanfiy deed seconded in the 066.ice o6 the County Reg cs ten o6 Veeda as Document No. !!2./p 6 C , and that I (we) pnea entty own the pnopos ed 6.c to box the sewage pos 6 ys.tem (on I (we) have obtained an easement, to Aun with the above deac4.ibed pnopenty, bon the conat4ucti.on o6 said system, and the same h,66 been duty ecoaded in the 066ice o6 the County RegiAtet 6 eeds, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) f0 /7 DATE SIGNED DATE SIGNED I~- ~ o , ~q. H z rn ,H a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d ,f p I ~ OWNER/BUYER ROUTE/BOX NUMBER 1-27(- .So 411% S Fire Number 1776 CITY/STATE Sa-~- E,QS F'7` i ZIP s~©Z `PROPERTY LOCATION-, Section, TJOVN, R W, Town of , 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 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. H E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- It ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 ays of the three year expiration date. SIGNED I DATE 1 U /7- St. Croix County Zoning Office P.O. Box 9&=- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN'DUSTR'Y, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 N WI 53707 HUMAN RELATIONS ILHR 83.0911) & Chapter 145) LOCATION: SECTION: WNS /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: COUN Y: \ MAILING ADDRESS: Gra i~~ a ~vc a 7 c o S USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: esidence New ❑Replace RATING: S= Site suitable for system U= ite unsuitable for system CO VENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) S❑U WS❑u IYS❑U ❑SMU ❑SC4u If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- / ao_ © - j ,al2--3'/.3 .2 e,4_7 Ix V B- Off- o-,..~ B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH 3 P_ a y P_ r 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 - cre ~ 04, ~ H R[rEIVEO cr ~ _ sT ~F~.11x N COUNTY I, the u rsigned, hereby certify that the soil tests reported on this form were made by e c r c nd methods specified in the Wis nsin Administrative Code, and that the data recorded and the location of the tests are correct tot t y know elief. NAME (pri RE COMPLETED ON: i ADDRE 01 ~rd CERTIFICATION NUMBER: HONE NUMBER (optional): CST SIG URE. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff few, fine, faint 'c - Clay cc - common, coarse pt Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. J ~PL,~OT PLAN PROJECT 9,*a" ~/C~l~ V /A DRESS S CJ 1/4 /Yc.j1/4/S (//T 2ON/R I? W TOWN Syliy~cy COUNTY -~~>e MPRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC CONVENTIONAL)( IN-G OUND rFfWURE CONVENTIONAL LIFT_ MOUND_ HOLDING TANK SEPTIC TANK SIZED LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA G1,1,0 PERC RATE a~ BED SIZE h Benchmark V.R.P. Assume Elevation 100' Location of Benchmark qS e - L C] Borehole Q Well Scale = Feet 0 Perc Hole System Elevation Uent 12 Grndp TYPAR COVERING 2" 12" 3- 4 6' O 3- 6-1 Sewer Rock 12' b~\ f~ Ll f ypd ~ I ` o I.16v,c (o Yt- - % pNS1?E SEWAGE S STEM n~ yo 159 Q . Q ~ :a piRo ED NS 4C' , HUMAN RELTb AQDa D L t . y AN INGS GN:`;,~ GF i;~DUSTFtY, AND t,Ui1D p111S104 CF SAFEn CO t~~SPON'DENCE S 891- 20859 gel alb. = 60 ;1 / 78 tPROJE.CT.DETAIL DATA SHEET NAME OF BUS I LESS 'LEGAL DESCRIPTION OWNER. MAILING ADDRESS ZIP°~ s- ARCHItECt. ENGINEER, r^~ ADDRESS Q 0 y PLUMBER OR DESIGNER `ZIP S~oOI ie; . ...TELEPHONE NUMBtR:."" S> i' • Check appropriate building usage(s) and fill in'the information requested opposite each usage listed. Please consult Section,H 62.20. -Exi•sting °buil-din.g New building Addition . (•).Apartments-and_condominiums -Number of bedrooms ( ).Assembly -hall . . . . . Seating capacity ( ) Bare ••~lr,^!F,i•~~,..; • Seating capacity of meal s, served. J.) Bowl ing_a11,ev Number of lanes ( ) With bar Y.4 ) Campground-.and camping resorts . . . Number of sewereT sites, Number of unsewered sites -Total number. of sites.., ( Camps O Day use only Number of persons ( ) Day and night Number of persons ( ) Cat Chbasin . . Number , O Chuhch No i tchen dumber. of :persons ( ) With kitchen Number of persons ( ) Dance 'hall . Number of persons ( )'Dining hall . • • Number of meals served daily Doc kennels Number of enclosures Drive-in restaurant . . . . Inside seating capacity Car-service Number of car spaces ( ) Dump station . . . . Number of dump stations • Employees ( total.of all shifts) Number of empl ,~e s sI Hotel ( ) Motel ( ) Cottages . . . : N bj~Gf. S1($t* th 2 persons per unit - Wglr•of un' s with 4 persons per unit Medical and dental office bldgs. • h Num s, nurses,. medical staff o sonnel S (j Mobile home parks • • • . aEtAS~N O Nursing homes . . . . . . duo S Parks .A afN~~t~~•~.u Af~• ( ) Toilets ( ) Showers ORestaurant two AS t'~e g capacity ( ) Dis her isposal? ( Retail store . 6'e~of customers _ Schools . . . . . umber of classrooms Meals ( )Showers ( )..Self service laundry . . . . . . Total number of machines Service station . . . . . . Number of cars served dairy )'Swimming pool bathhouse . . . . . Number of persons OTHER (Specify) . . . . . . . COMPLETE OTHER SIDE S 9 1 ft 2 0 8 5 9 111 loll, 2. Indicate whether the following facilities are present. ' Floor drain yes _ no Number of drains i Food waste grinder yes no Dishwasher yes no i Automatic clothes washer yes no Number of clothes washers 13. Septic tank capacity Holding tank capacity j Septic or holding tank manufacturer LU-~-e i4. SEEPAGE TRENCHES: total square feet width of trenches length of.trenches depth number of trenches SEEPAGE BEDS: total square feet width- length of bed. depth 102 1 SEEPAGE PITS:-' total square feet outside diameter I depth below inlet ' total depth from'top to bottom of pit Signature of person completing form.':',`- FOR DEPARTMENTAL USE ONLY Address / zip Telephone Number 1 Date - p i S'91- 20859 . f -'/1 Approved 05aeV4, 600 t~ 4#1 C. Vent Pipe Minimum /Final Grade f Approved Joint ~18" Minimum e SPECIFICATIONS f 1 TANK New Existing - - - Manu cturer: Approved Joint Tank Size: / C .I, Pipe ons'-' wExtending 3" Onto Solid Soil S: GALLONS PER DAY:_ 3" of Bedding Under Tank . SIS" Owners Name : ~~S1Ts s"AG Address: S Legal Discription: - owns I Municipality: 30 4Z o nty: - ) I? I I E1A Z10WS C U HUM R pN { AND BW►A1"S PLUMBER/DESIGNER~Pp,R~eA4t~~ t~1S ~N OE SAF DyV 000, Signature: p0~yp~11CE License Number• SSE RRES Date: • S91-20859 y ' Form- S T C - 104 s AS BUILT SANITARY SYSTEM REPORT OWNER ~r~~ TOWNSHIP SEC. T <-~0 N-R W ADDRESS JL 41 ST. CROIX COUNTY, WISCONSIN r SUBDIVISION LOT / - LOT SIZE tl PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM , A\ i I _ I I V) r, INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used % ~y`i,y~ / Ly_, Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Z,(-- (_4'✓~`; Liquid Capacity: Number of rings used: ? Tank manhole cover elevation: J~. Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, ~C Side@Rear, O- feet .From nearest property line Front,Q Side,0 Rear, O J c~ feet Number of feet from: well `ZP- building: -2, - -I' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) ~ r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet- Bottom of tank elevation: Pump off swit elevation: Gallons per cycle: Alarm Ma facturer: Alarm Switch Type: Num r 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: 00 ` Width ( _2 Length: Number of Lines: 7_ Area Built: Fill depth to top of pipe: 7 Number of feet from nearest property line: Front, Side, O Rear, Ft Number of feet from well: i Number of feet from building: (Include distances o plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid dep Bottom of seepage pit elevation: Area ilt: Has e' her a drop box O or distribution box O been used on any of the above soil a orbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used- Elevation of bottom of tank: Elevation of inle : Number of fee from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: i of feet from building: Number Nu Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: c G-_ Plumber on j b: License Number: 3/84:mj i I DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BON 7969% BUREAU OF PLUMBING ,MADISON, WI 53707 5ikCONVENTIONAL ❑ALTERNATIVE JState Plan l.D. Number: ( El Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: ale Germain R. R. 1, Somerset, WI ~ ~-f~ N MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW , Section 4, T30N-R19W, Town of Somerset am of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Gary Steel 3254 St. Croix 54960 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLE ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOM R P OV ED: PRY , t& 97 ES ❑ NO ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WIBUILDiNG: VENT TO FRESH ALARM FEET FROM LINE C C AIR WL~~ ❑YES NO ❑YES ❑NO NEAREST ( } /J DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OP RA ZONAL. NUMBER OF PROPERTY WELL. 1BUILDING.I VENTTOFRESH (DIFFERENCE BETWEEN FEET t7~ LINE AIR INLET: PUMP ON AND OFF) ❑YES N INEA.EST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of p owin FN(,TH DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cea a unti FORC the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO. OF DISTR. PIP PACING: COVER JINSIDE DIA.. #PITS. LIQUID BED/TRENCH TREIt ES / M IAL: PIT DEPTH DIMENSIONS ~ / ` GRAVEL DEPTH FILL D PTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D TR. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIP S ABOV C R: E E/V. INLET E V. END. r LIN~{ ~f ! AIR INLET: c G~- '7G.2-', 2 1 NFEET EARESTO--► " L) / S MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to ma certain A it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for m ium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PMARKERS OBSERVATION WELLS ❑Y S ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SItY SEEDEDMULCHEDCENTEREDGES❑ 0 ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH. TNO,OF RENCHES: LATERAL SPACING:? RAVEL V BELOW PIPE? FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE NIFOLD MATERIAL. IN DISTR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.: ELEV.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on in in county file for audit. Reverse Side. SIGNATU TITLE: DILHR SBD 6710 (R. 01/82) T~ uJiscor191r1 APPLICATION FOR SANITARY PERMIT Z DtPFIRTmEr'IT OF (PLB 67) rOUNTY UNIFORM SANITARY PERMIT # n.y{ . 1/-1OUSTRV,LgBOR 6NUTRrIgELRT10r15 ,5"y 96D -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING AD PRESS r2c► ' ; -zs PROPERTY LOCATION ClTy: Lk I/4 u./1/4, S , T-4, N, R I~ A(o0 W TOOWN o SDI c~ycS LOT NUMBER BLOCK NUMBER SUBDIVISIO_N/ N~ME NEAREST ROAD, Lam-- )-R LA*9MARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: 3 ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair ~K Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed 0 Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 419 Q / L-- Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer. IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 90,0 9"d n Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam f Plumber (Print): Signature: MP/MPRSW No.: Phone Number: 3 4 (7/S )Z~6-Gzan Plumber's A ress: Name of Designer: 1 COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved El Owner Given Initial / ~~~j Approved Adverse Determination SWWA~ Lai Reason for Disapproval: Alternate course(s) of Action Available: DI.LHR$1313-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. I ~ ° f 30 A). )(2 l 1 r,J ° L i (ago rs C~ u b'~3 Zz0~ I a ~ v~f 30' s~ Yin, H, 3 0 k K ~r 3p4 ~cY~ P'Z 7Z9 II fir. 0'/ ~ APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 14. Cume^ N Location of Property ,S~h/ AI, jtJ '4, Section T 36 N - R W Township -s"nr" ete.S X39 A Mailing Address T~ 0 u T e a 0 x C,rl.ecse ' CJ Loo as Subdivision Name ----f-= -ems Lot Number ¢1~yti Q-- Previous Owner of Property V~'AL i ~-'ft ra ~101e~ Total Size of Parcel Date Parcel was Created 72~ Are all corners and lot lines identifiable? L-- Yes No Is this property being developed for resale (spec house) ? Yes f No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (We) eelrti6y that aU statement,5 on this botm ace t1Lue to the best ob my (ou r.) knowledge; that I (we) am (cute) the owneA(S) ob the prcopehty de,6cAibed in thiA inbonma ion botm, by virtue o4 a waAAanty deed neconded in the Obbice ob the County Regi-6teA ob Deeds as Document No. _ and that I (we) (.~S177z peesentty own tAe p~Lopased site bon the sewage po.aa]Fsystem (on 1 (we) have obtained an easement, to nun with the above de,scti..bed ptopeAty, bon the con6tnuct:on ob said b yste.m, and the same has been duty heconded in the Obbice ob the County Register ob DeeA, as Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE. SIGNED DATE SIGNED F IWA parcels: (1) Commencing at a point on the quarter (4) section line which intersects the South line of State Trunk Highway No. 64, the same being 80 feet more or less South of the Northwest corner of said Southwest quarter of Northwest quarter (SA of NW4); thence South 12 rods; thence Fast 50 feet; thence North 12 rods to State Trunk Highway No. 64; thence West along the South line of State Trunk Highway No. 64, 50 feet more or less to the place of beginning. (2) Commencing at the Southwest corner of said Southwest quarter of Northwest quarter (SWh of NW4); thence North 824.5 feet; thence East GAG feet to the center of the Town Road; thence Southwesterly along the center of said Town Road to a point which is 269 feet East of the point of beginning; thence West along the South line cf..sht quarter of Northwest quarter (SW4 of NWT) to the point of beginning. amount may be prepaid without premium or fee upon principal at any time, and interest shall be calculated at all times on the unpaid balance on the daily rate basis at 1/360 of the annual rate. as the unpaid In the eyent of any prepayment, this contract shall not be treated as in default with respect to payment so long a to bitofi rar* nnr4t«ip6 intarettt fr'nm 'month to month shell be treated 6s uhOOld -principal) is less DOCUMENT NO. r~~," STATE BAR OF WISCONSIN-FORM 11 ry/►y/,./y VOL 1 PA~~ LAND CONTRACT-individual and Corporate THIS SPACE RESERVED ;FOR RECORDING DATA 767 f I ( Waster J . Trombley and RECASTERS O~~CE CONTRACT, by and between ST. •CR®!X CO-, WIS. Emma M. Trombl+ , husband and wife, as joint tenants ' _ steed. for Record Hs__uth herein called Vendor, whether one or more, day of mil A.D. 19 78 and Dale M. Germain at I •'i herein called Purchaser, whether one or more, WITNESSETH: That the Vendor, in consideration of the payments to be made and the e j covenants and agreements by the Purchaser to be performed, as hereinafter set forth, hereby sells and agrees to convey unto the Purchaser, upon the prompt and full perform- RETURN TO ance by the Purchaser of the covenants and agreements of t As contract to be by the Purchaser performed, the following described real estate in_ St . Croix County, State of Wisconsin: Tax Key M_- ..4 This is homestead property. All that part of the Northwest Quarter of the Northwest Quarter (NW4 of NW4) of Section Four (4), Township Thirty (30) North, of Range Nineteen (19) West, lying. South of State Trunk Highway N. 64 and West of the Town Road as now laid out and traveled across said forty (40) acre tract, meaning to convey a triangular shaped tract of land, the Northerly boundary of which is State Trunk Highway No. 64, the Southerly boundary of which is the South line of said Northwest Quarter of the Northwest Quarter (NW4 of NWa), and the Easterly line of which is the Town Road. All that part of the Southwest Quarter of the Northwest Quarter (SWk of NW4) of Section Four (4), Township Thirty (30) North, of Range Nineteen (19) West; lying West of the Town Road as now laid out and traveled across said forty (40) acre tract, except the following described (See attached sheet) together with all buildings, improvements, fixtures and appurtenances, now or hereafter erected thereon, including all screen and storm doors and windows, attached mirrors, fixtures, shades, attached floor covering, hot water heater, furnace, oil tank and light fixtures which shall be a part of the real estate. i i The Purchaser, in consideration of the covenants and agreements herein made by the Vendor, agrees to purchase the above described premises, and to pay therefor to the Vendor at ---Somerset, Wisconsin the Sum of Twenty Five Thousand and N_0110.0 ($25s00.0.00) Dollars, in manner following: $ ___3_,_O 00 • 0O at the execution hereof, the receipt whereof is hereby acknowledged, and the balance of $ 22, 000.00 together with interest on such portions thereof as shall remain from time to time unpaid, at the rate of 7 per cent per annurp tilp id in full, as follows: Said and interest shall be a able in monthly - installments of not less than $ L~~' u~ per month principal beginning on the 1st day of May . 119-78 provided the entire purchase money and interest shall be fully paid within Fourteen (14) years from the date hereof. Purchaser further agrees, unless excused by Vendor, to pay monthly payments sufficient reasonably to anticipate the payment of t taxes, special assessments, fire and extended coverage premiums and such other insurance premiums as Vendor may require, and Pur- chaser agrees to make such payments to the 'Vendor and hereby authorizes Vendor to apply the same in payment of such items. I i 1 I i S id.payments, shall be applied first to interest on the unpaid balance at the rate herein specified and then to principal. Any amount tnaye prepai3witiidut premiwn a:ee upon. principal at any time, and interest shall be calculated at all times an the unpaid balance on the daily rate basis at 1/360 of the annual rate. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than tb* amount that said indebtedn"o tI pUld have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded .heritfrom. °,a„, K 1 T lR'~ll1[E[e svebrfted -wtttrthetitre-Mo-&herwrr°• b5'°0 e a "t7et17 l4le l;rai, lt~t "ltlAgr/R4Me•aO~aaliltNaAi+~3i1 ttBLi.tA h7TArrwnxffff&ffTt'1~Zll tfre alfaZYTat t~iit3~^fYtSIrrQYSCt"` , tv""the-F"t+re{+eraer- whesM •ttre•°fel#• ptKeheea ltvti~-y'•" "SM''t!e heremWer•tshell °•}-°e-fies.-psi+i ~l►e. Wissliaav-ayewss ta.pr~yilwwsua.of .la~ar.rwti4iAesaiiona sf-airstra•t-#i11►Jr+4wsanaw. )R ( )The Vendor shall furnish the Purchaser thirty days prior to the date of ultimate closing, and the Purchaser shall accept as a sufficient showing of title either (1 a title insurance commitment for an owners policy of insurance title in the sum of the purchase price, the Purchaser to be named as the assured, to be written by a title insurance company, and guaranteeing the Vendor's title in the condition called for by this agreement, or (2) a merchantable abstract showing the Vendor's title in the condition called for by this agreement. If an abstract is furnished, the Purchaser shall notify the Vendor, in writing, of any objections to title within ten (10) days after receipt of such abstract, and the Vendor shall then have a reasonable time within which to rectifythe title or furnish a title policy as above described. The Purchaser shall be entitled to take possession of said premises on, April 1 19-M. In case possession is to be obtained by the Vendor, he shall have a reasonable time after such date in which to remove any occupant. The Purchaser shall be entitled to remain in possession as long as he performs all covenants and agreements herein mentioned on his part to be performed and no longer. HGYFINrCpnpwy -7,DCr~)TMA t"r - i vl$i1AL" AN cb'R15tSt2k1'E -STATE $/k17 OF WI3CCYlVSix, FORM NO. 11 - 1971 w"•°'•' VOL 57? `pk';0768 The Purchaser coveniffla and agrees as follows: 1. To pay before •they b ome, d#IiA Gent all taxes and assessments, now or hereafter assessed or lvi against and on the real ea t described in this contract and to dibliver to the Vendor receipts evidencing due payment ins thereof. irae T_U V to pay the k2 To keep said premises insured for fire and extended coverage for at least the inssum urf $ companies approved by the Vendor with is me t.horeon when duo, and to comply with coinsurance provisions, if any, loss piyftlle to the Vendor as'fntereSt may appear, and all policies covering said premises shall be deposited with and held by the Vendor. 3. TO keep the premises in g*94;condition and repair. 4. To keep the premises free from liens superior to the lien of this contract, or the rights of the Vendor in the premises. 5. Not to commit waste nor suffer waste to be committed. 6. Not to do any act which shall impair the value thereof. In case any such taxes or assessments remain unpaid after they become delinquent, or in case of failure to keep the premises so insured, the approved policies deposited, or the insurance premiums paid, or to keep the same in good condition and repair, free from liens and waste, the Vendor may cure such defaults, and all sums so paid shall immediately be repaid to t'.ie Vendor and shall, unless so repaid, be added to and deemed part of the purchase price, and bear interest at the rate aforesaid. The Vendor hereby agrees that in case the aforesaid purchase price with the interest and other moneys shall be fully paid and all the conditions herein provided shall be fully performed at the times and in the manner above specified, he will on demand, thereafter cause to be executed and delivered to the Purchaser, s good and sufficient Warranty Deed, in fee simple, of the premises above de- scribed, free and clear of all legal liens and encumbrances, except any liens or encumbrances created by the act or default of the Pur- chaser, and except: 'runici al zonin ordinance The Purchaser hereby covenants and agrees that time shall be deemed to be of the essence of this contract and in case of default ant in the payment of any principal or interest when the same shall become due, or in the performance of any of the Oconditions, coven then the or promises by the Purchaser herein to be kept or performed, and such default shall continue for a period of Ys Vendor may, at his option, declare the contract at an end, all rights of the Purchaser under this agreement cancelled, and the amounts paid by the Purchaser hereunder forfeited, the same to remain the Vendor's property as rental of said premises and as liquidated dam-ave the re- ages for the failure completely to fulfill this agreement; and the Vendor shall forthwith expressly without notice the wholes amount of ntunpary; at the option of the Vendor and without notice to the Purchaser, notice being hereby p e slY waived, principal shall be deemed to have become due and payable; in case such option shall be exercised, the unpaid principal and interest together with all sums which may be or have been paid by the Vendor as herein authorized with interest on such disbursements at the rate foresaid shall be collectible in a suit ipal had been due at the time when any such default foreclosure the indebtedness shall embrace w with said unpaid principal e prrinc and P interest, all the sums so disbursed with interest as aforesaid. abat exp , all incurred, and inhcase of judgment shall be included therein .reasonable incl In case s, shall be added to the principalibeco remedy hereunder, attorney's feee Upon the commencement or during the pendency of any <,-tion of foreclosure of this contract, the court may appoint a receiver of the! premises, including homestead nterest, and m emowe~ e receiver to cct the rents, issues, and prs of said during the pendency of such action, and may orderasuch rents, (issues, and prof tslwhen so collected, to be held andtapplied as tthem`N preen shall, from time to time, direct. benefit enand do promises the herein r sehalllb bid ognupon of and inure to the he spouse ofh he virs, legal of t All terms, conditions, covenants, warranties d assigns of the thin in the execution of the representatives, successors an r a valuable consideration joins heron to release homestead rights in the subject property and agrees to 1 ~ deed to be made in fulfillment hereof. NeW Richmond, Wisconsin - this 3rd day of April 19 ~8" Executed at - / - ~ ' (SEAL) SIGNEI AND SEALED IT PRESENCE OF Walter Tromhy l (SEAL) O E aM P (SEAL) Dal M Germain' (SEAL) AUTHENTICATION signatures of Walter J. Trombley, Emma M Trombley and Dale M. ~Prma~n authenticated this 3rd day of April '1978 i _ G. E Norman Title: Member State Bar of Wisconsin or Other Party Authorized under See. 706.06 viz. STATE OF WISCONSIN N/A County. } as. NSA 19 Personally came before me; this_ NN/A day of the above named NSA to me known to be the person- who executed the foregoing instrument and acknowledged the same. This instrument was drafted by Doar, Drill, Norman, Bakke,_ Bell & Skow Notary Public County, Wis. New Richmond, Wisconsin 54017 My Commission (Expires) (Is) The use of witnesses is optional. Names of persons signing in any capacity should be typed or printed below their signatures. LAND C :TR.AC" -INDIVIDUAL \ND COI'PORKrE--STATE BAR OF WISCONSIN, FORM NO. 11 H • C!1 • r • r 9 H SEPTIC TANK MAINTENANCE AGREEMENT H 0 St. Croix County z d 9 OWNER BUYER ~Q. ~L Csfy~~ ii ROUTE/BOX NUMBER ~au~e Q , !3ox Q.39 A Fire Number X40 .CITY/ STATE ~C3 S~ j W 1 ZIP -1 o C-I PROPERTY LOCATION: S0, 4, NAJ 4i Section Y TL3N, R /7W, Town of ~6~y,B~Se St. Croix County, Subdivision Lot number I Improper use d'nd 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 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 _s~stems 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 les.s than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- "d 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 DATE St. Croix County Zoning Office P.O. Box 227 Hammond, WI 54015 715-796-2239 Sign, date and return to above address. flflflflflfl•~e~, SANITARY PERMIT DIL R County - GROUNDWATER SURCHARGE rtious c►aa.rr,w..w.~or+~ Sanitary Permit No. 9 D On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly 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 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption 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- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground* Signature of Issuln9 A ent: Groundwater Fee: Days: WISCO {l"t' jly b buried DILHR SOD-7289 (N. 05184) • f 'r, DFPAR`iM OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'WOUSTRY, • DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/LAIC-HIAMITY: 12ZIBLK. NO.: SUBDIVISION NAME: 1/ W'/4 q /UAIR NX (or) W S 0 n-) ~ _ /d 4zd COUNT OW-N(EERR' NAME: MAULING ADDRESS: p c3~ 01~ 1`•12• S orn t° YS f- ~i (7Z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence ❑ New ~ieplace I RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) QS ❑U 101, ❑U SOS ❑u ❑ S uEIS If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, A/ Floodplain elevation: V&S A I PROFILE DESCRIPTIONS Z 6 '4 Got BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF Sol WIT THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT44-14. ELEVATION OBSERVED EST. IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B_ L7 '~7 z5 1v.S, z ,5,~,. $3 $3 4Z. zS Z5 B- No /V ~o -9I.L. 6n.51 n.L•S. 3"R. f3, 6. L, B- 0 o r~ • ~ ia- C._7 -f2. ~ 0 N > 7 .,6 3 A/1, S,L. B- B- B- I~~$ImA I PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LUCJkkE6 AFTERSWELLING INTERVAL-MIN. -PERIOD 1 PERT D2 P R PER INCH P_ I Sys © 3 7 .5 3 0 P_ Z 3 /VC) 3 0 P_ 3 3 ao 0 1 Yz- 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 al borings and the direction and percent of land slope. / Z J l SYSTEM ELEVATION 9 yC.~ 0 Zti_ F-F E , o _ r?1 r 1 E r 4-41 1 1 01 Z, 3 F [ ~C I i 3 i 0 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print / TESTS WERE COMPLETED ON: ADDRESS:d CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNA R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - e r A' s, INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 6355 To be a co yid accurate soil test, your report must include: 1. Complete le-,' ription; 2. The use section clearly indicate whether this is a residence or commercial project; 3, MAXIMUM nurn = bedrooms or commercial use planned; 4. Is this a new - cement system; 5. Complete tl' ,r ty rating boxes. A SITE IS SUITABLE FOR A HOLDING TALK nNrl Y IF ALL OTHER SYSTEAS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and cor plan; 7. MAKE A LEGIBLE diagram accurately locati,ig your test locations. Drawing to sc,' red. A s rate sheer may be used if desired; e sr=re your benchmark and vertical elevation reference point are clearly shown, and are l)rmanent; 'e-;e all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- ropriate; It =on (such as flood plain, elevation) does not apply, place N.A. in the : r box; i ; id place your current address and your certification number; 1: `b a copies and distribute as required. ALL SOIL TESTS MUST BE F D VITH THE L' !'P AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stolle (over 10") BR - Bedrock cob Cobble (3 - 10") SS - Sandstone gr Gravel (under 3") LS - Limestone *s - Sand HGW - Nigh G : r_ ; ater cs Coarse Sand Pero - Percoladuri ' ne med s - Medium Sand W - Well fs Fine "rand Bldg - Bui' r g Is - L Sind > an 4sl - Sandy Loam < L T ran *1 Lo- Bn -B> *sil Silt Loarn BI si - Silt Gy Gi *cl - Clay Loam Y scl Sandy Clay Loam R sicl Silty Clay Loam mot - se Sandy Clay w; sic ty Clay fff e, faint *r cc - i n, coarse p1. mm rn uck d p - prr..,, it HWL - Hi level, soil textures eater i -,":e disposal BM V RP VF -ice Point T(