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040-1185-50-100
STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER & J ii J ADDRESS d r4 SUBDIVISION / CSM# C ch Ed ge A c 1e.5 LOT SECTION 36 T,99 N-R /7 W, Town of Tro y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYT ING WITHIN 100 FEET OF SYSTEM Dr,0a%-6 - G~rav /vew K)e,,e,r L} ec~ro0 750 Sep C Goss 16, old }-~©wc e ,pf iC ,O►'ain tti Id I ~/q l u l 5 I I ~ I I ~ I ~ I ScQ ~c / ~3G INDICATE NORTH ARROW kl h.Q Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Y` Sal e/l s_ ADDRESS 73 r ? I)e✓ 1-4, 1(s W~ SUBDIVISION / CSM# CMG ~ r q ~ Ac re-t- LOT SECTION J T "?!~N-R Town of / lnb V ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I r q Mlw~ fNe- J -D 5elA_e, f t7,, 4 of I I I \ v I I V 01 I I I I I INDICATE NORTH ARROti4 Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. y BENCHMARK : Lie of C -,2,L / ,Er e ✓ 1y &n ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION /00074 / 7S0 Manufacturer: A~Ai~,P~f~~ast A)Ri s•ev Liquid Capacity: T. a Setback from: Well House Other Pump: Man cturer Model# Size Float seperat n Gallon cycle: Alarm Location • I SOIL ABSORPTION SYSTEM Width: 3 Length -7 / Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: / PLUMBER ON JOB: A1C ~ C j ~T"eI ya ~r LICENSE NUMBER: Q 7 INSPECTOR: 3/93:jt r ST. CROIX COUNTY ZONING_OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the x&44 ~zJ J2n km' s residence located at: -/VE _1/4, _N 1/41 Sec. T -Ok N, R_17_W, Town of ✓~B1/ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. f / Last time serviced,< 7/J- 7/9 ,7 Did flow back occur from absorption system? Yes No /\(if no, skip next line) Approximate volume or length of time: I~~ ~A allons minutes Capacity: !oD O F4( f uiUei f Construction: Prefab Concrete A Steel Other Manufacurer (if known) : id kj es ~ Beecas, Age o //"~v f -Tank (if k own): / r t uI CJ S lemPl, (Si nature) (Name) Please Print ,4--P ~ 780 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/MPRS 5/88 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety acid Bindings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Pla JENKINS, MARK D & SANDRA KAY lk CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /d /00 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ~ 3. h TANK SETBACK INFORMATION St/Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic V' o, ) a 0' NA Dt Bottom 0 2 -7 Dosing NA Header / Man. z:z 1 ~4q•8 ' ~ G,y too.> Aeration NA Dist. Pipe .3y b Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand 1 p 103-Y ✓T ~~S ~C Model Number GPM TDH Lift riction System TDH Ft Forcemain Lengt Dia. Fi Dist. To Well SOIL ARSORPTI N SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION ,_3 1 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.36.28.19W, Lots 14 & 15, East Woodridge Drive Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date spector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: `R ? . ~ I l R i SANITARY PERMIT APPLICATION ■14.tr■Iln In accord with ILHR 83.05, Wis. Adm. Code COUNTY St Croix t ` STATE SANITA Y E -Attach complete plans (to the county copy only) for the system, on paper not less than QA 14 816 x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE FLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Mark & Sand Jenkins NE '/4 NW '/a, S 36 T 28 , N, R 19 W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 73 East Woodri Drivt- 14 & 15 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER River Falls, WI 54022 715 425-7328 Oak Ridge Acres Jnr>cm NEAREST ROAD 11. TYPE OF BUILDING: Check one ( ) ❑ State Owned jMDQUEXW: East Woodridge Drive In TOWN OF: ❑ Public ®1 or 2 Fam. Dwellin g,## of bedrooms 4 PARCEL TAX NUMBER(S) 111. BUILDING USE: If buildin (Lot 14) 040-1185-50-003 ( g type is public, check all that apply) (lot 15) 040-1185-50-100 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. ❑ New 2. ❑X Replacement 3.E] 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑X Seepage Trench 22 ❑ 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 600 1200 1200 .4 Feet Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tan p 1 Weiser VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum Si nat re: No Stamps) MP/10110R31v 1a6.: Business Phone Number: (,jj 1 6780 715 425-5544 Plumber's Address (Street, City, State, Zip Cc dg): V NA?'A0 945th.St-rPPf-: River falls. WI 54022 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitay~ Perm* ee (includes Groundwater ate Issued Issuing Agent Si at a (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination ' X. C DITIONS OF APP L/REAS NS FOR DISAPP OV V. ?00~ toe-',) All 01 A L SBD-6398(8.08/93) DISTRIBUTIO : Original to County, One Copy To: Safety & Buildings ivision, Owner, Plumber INSTRUCTIONS f 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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 (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety. & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 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. 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 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; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) 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) Play nlre,x 911319y Marko Sandy Je~~~r~v►s Drl V ,t war "7(,8 edrioew.' F_r~`s~in~ l000•~1 lyor~re 5 rlJ~I'c TaK k 0 Tdn k New 75a~Q1 5 C. 3 I I I ► ~ i I II I ~ I ► b0, 0 * To`o o f TV Cob/,- Roy 8 A A Fl eu . /60,0* C &78G /nP Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations : ; , Division ,of Safety & Buildings in accord w' 1 83 ,6, ) dm. Code COUNTY ;r ! S~ - C'QA LX Attach complete site plan on paper not less than 81/2 : chesjjsi ,?Plan mu de, but PARCEL I.D. LLoYiy 04A_ttg5 sa_oo 3 not limited to vertical,and horizontal reference point ( 1reo~w~atiiiQ4rp of slope, r dimensioned, north arrow, and location and distance arestti' w~-tsj ot[o-~t85_so_too ° REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT INFf~R14A PROPERTY OWNER:RAC ATION ,.;mil W& N1T1/4 NW 1/4,S ~ T Zb N,R lq E(a W Y~'L PC~h S FI~1~` PROPERTY OWNER':S MAILING ADDRESS CK# SUBBD. NAME OR S M ~ C • woob-PAbisE b2- d_, CITY, STATE ZIP CODE PHONE NUMBER LLAGE OWN NEAREST ROAD ~~uL~Z ~u-S rtil S~,o Z.2: (~ls) ~ZS_ ~3z~ ~Z.O`-~ ~.woooQ.i.vsa b~, [ ] New Construction Use [JCJ Residential / Number of bedrooms [ ] Addition to existing building Replacement [ j Public or commercial describe Code derived daily flow 6bo gpd Recommended design loading rate o• y bed, gpd/ft2 ,S trench, gpcW Absorption area required \SOO bed, ft2 ZOO trench, ft2 Maximum design loading rate o .%4 bed, gpdM2 0 • S trench, gpd/ft2 Recommended infiltration surface elevation(s) SE'8 PK E- 3 ft (as referred to site plan benchmark) Additional design /site considerations em A S " x eo" L.J 6 CTS O M►-t ~ . Parent material Rood plain elevation, if applicable Mil A - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ®S O U ®S O U as 13U 0C ❑ U 0S KU O S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounclaly Roots GPD/ft Boring # Horizon in. Munsell Chu. Sz. Cont Color Gr. Sz. Sh. Bed Tench } o_~ to `-ttZ 312 - s i I ~.`FSbk wt~~ a.S - o.s o. 6 Lb `-21Q 3! si I Z,m Sbh ►n ~M cs - o, S o. 6 rk:::::::v Z Z 1 S o Ground S I tL4 o•to.5 3 32_68 t0`11Z 3~~ - sI N' t-Sbk t«,u elev. Depth to limiting factor Remarks: Boring # o _ ~3 h - s t I Z~s b k w, `FV. cS _ o. g o • 6 R-ft ' Zw. s b1c wt ~H c l Z~:€ Z t3~2.s 10`12 310 - S Z ( g o. S o. ~v#NxK'~v 1z. S 3 ZS 95 1Dv R 3/G s ~csbk wtiu~~. Ground ' elev. MI.S ft. Depth to Off fing factor '7 9sy Remarks: T Name:-Please Print Phone. 715-425-0165 Arthur L. We erer egerer Soi1..Tes.ting &.Design Service-P.O. Box 74 River Falls,WI_.54022 Signature: Date: 8 Z6 Q CST Number: 0 0 5 7 6 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 'L of PARCELIA.#r0Ttq~ 00-~klbS-.Sb-003 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz: Cont Color Gr. Sz. Sh. Bed 7-- Ground Z,o-S IkS-tIZ L cS o. o An y o. 3 Z9-4y - s 1 ~c-S Fz Mu H elev. 1t ft. Depth to limiting factor i »\4' Remarks: Boring # 46 4 i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ' L4W. } Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE I"= 3p `►~f~CR-Irz S6'upY Z1~ lrJk) S zoo' X w o 14 \z-m k vt'+~T S~'T C i -SyM,12 L,u Z- \ S LJ P~~ r1i~k.lhU~ y'z~ co~N~ o~@lZ ~ a~s11Z~8~h~►v ~~l.p~s, -lots ~ 0 ~ o \ O ~ y >w'/o ~J ~vt of st oPE Mme. ~ `Q ~ B3 LT1-\o3 y P °D s b s -tr -*L ~ Ply Zo O BM - tb0 -o' c&j \mP OF V&J%tk 6M M C-PMU TV Pe;UEsTA~-. q y_ 7,0 2 8 Z6- ~l~ (715 ) 4 .5-o1 65 _ M00576 CST Signature - Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page )i of 3 l-abor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S j . C.~2 0 (,x, Attach complete site plan on-paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. c oT ~y. 0440-1tgS.Sa.6o3 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road t ortsj o4o-tt95_Sp_~uo APPLICANT MATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE INFOR PROPERTY OWNER: PROPERTY LOCATION Y`'1 ACCt_k it S fltvb1-{ :S_1J N__1 IJ S - GOV:F. T NAa_ 1/4 N W 1/4,S -66 T ZB N,R 19 E (a' W PROPERTY OWNER':S MAILING ADDRESS LOT # ) 3 C. lg aVs - BLOCK# SIOBDN~AMrE D G~ I.voo~TZ~OGE bR- CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD V-1utFlZ 1< JAUt bVI SSA Z-Z OtS) 21s- ~Lb ~?p`-l' LS,WO~OS2lv6a bR.. New Construction Use (SQ Residential / Number of bedrooms y AdditiQn to existing buildiing Replacement Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate y bed, gpddt2 ° : S trench, gpdhll Absorption area required \-S 4O bed, ft2 V_W0 trench, 0 MaAmum design loading rate bed, gpd/ft2 o S tranCh, gpolft2 Recommended infiltration surface elevation(s) SEI~_;7 (0RG e' 3 ft (as referred to site plan benchmark) Additional design/ site considerations 3 c-til~S etyr_tt S' x 8U" Lw r. MM 1~ Parent material Flood plain elevation, if applicable N, J - It LUS = Suitable for system CONVENTIONAL. MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable for stem ®S ❑ U S ❑ U ®S ❑ U MS ❑ U ❑ S I&u ❑ S IN U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bandary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Coke Gr. Sz. Sh. Bed re & 0_6 lrzi-t2 3LZ - si[ Z,~sbiC wt~~ a.S - o.S a.6 _ to -m- 31 - s i I Z m s b1~ cs - o. S o. 6 S o s I 0- 0.q 0_s Ground 3 3 2 _68 LO It 3~ Co - s I `s b k ww r elev. ~~ft. 6$$8 1~YR - ~S o Sg wt1 _ 0.5o,b Depth to limiting factor Remarks: Boring # _ D. g o: 6 0-~3 1.b`tR:3tz - stl Z~sbk wt.~1~ cS ` Zwt s bk tin'FN cS o s o. 6 ...2:S9S o~R 3/6 ~s bs m1 3. - s tc.sbk wtv v- - o.~ o.S Ground elev. IBIS ft Depth to favor 7gSy _ Remarks- CST Name-Please Print grthur L. We erer 715-425-0165 eg rer. S.o l--Tes.ting.-&,.b.esign Service-P.O. Box-..7.4.•River:-Fa,ll's,W.i::.54022' *(Offer Date: - CST Number: M00576 PROPERTY OWNER J~U`c~-l N S SOIL DESCRIPTION REPORT Page _L of PARCELI.D4 Lor tq~ O~O_ \\f~S ..Sb-003 Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft Boring # Horizon in. Munsetl Qu. Sz. Cont Color Gr. Sz. Sh. Bed = Trends 0_8 N.0`ItIL ~lZ. - sil Z~sbk rn~~ a-S _o S, 0,6 <5><'> Z g_Z9 toyt2 31l s) 1 Z►n s b~c wi `Ft~ cS o. S u. Ground 3 2.9_4 S9 o.y o. s ~j - 5 c Iz M,u h elev. left • Depth to limiting factor Remarks: Boring # ' i'•Yvti ' ~ v ,vv Ground elev. ft. Depth to € limiting 1 factor Remarks: Boring # 1 Ground elev. i ft. Depth to limiting i factor Remarks: Boring # Ground. elev. f~ Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE -1"= 30 `~t'CR-1rL t Saroby ZlEkUkju s zoo' X w~.L 0 L4 3D\Z-m Rts1~~cC~~ kv~T S~P71 C Z- \ S L U n CJ p Wei r-t Ric l VI u M L1 Z" co o~~Z Q\s'}1Z~gv`RurJ \~tp~s, eLtots o o o ~ Zp°~o ..t i~ ~l t O F S LA N~ p to y ~a 6~3 ZTL \03 4 Q ~ t S" 5 6~ ' 6 S tt tOQ 9 S htti, . P!~ Zop~ 9M - kT~-.1 b0 -O~ GDJ o i v~..~~~6[:.OUNp CPf8Lt; _ TV P~ESTiR~-. q9- Z.0 Z (715 ) 425-0165 m00576 CSTSignature Date Signed Telephone No. CST # 1 i i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Mark & Sand Jenkins MAILING ADDRESS 73 East Woodridge Drive PROPERTY ADDRESS 73 Fast Woodridge Drive (location of septic system) Please obtain from the Planning Dept. CITY/STATE River Falls, WI 54022 PROPERTY LOCATION NE 1/4, 1Wd 1/4, Section 36 , T 28 N-R 19 W TOWN OF Troy ST. CROIX COUNTY, WI SUBDIVISION Oak Ridge Acres LOT NUMBER 14 & 15 CERTIFIEDSURVEY MAP , VOLUME PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed d returned to the St. Croix County Zoning Officer within 30 days of the three year expiration dates, Iz SIGNED: ~~i/ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 8 T C - 100 This application form is to be completed in full and signed by the bginer(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. i Owner of property Mark & Sandy Jenkins Location of property NE 1/4 NW 1/4, Section 36 ,T 28 N-R 19 W Township mroy Mailing address 73 East Woodridge Drive River Falls, WI 54022 Address of site 73 East Woodridge Drive subdivision name Oak Ridge Acres Lot no. 14 & 15 Other homes on property? Yes X No Previous owner of property Richard & Fran Fox Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature o Applicant Co-Applicant Date of Signature Date of Signature POCUMENT NO. STATE I3AR OF WISCONSIN -rind if T' TH S Z?A_S RtaRRVXU Pon RK..oRO "o oArA Ij WA,-M ANTY GEED • • 43705 BOOK 810 FACE 12" - REGISTER'S OFFICE i! This Deed, made between Ra.11 ilg--Hi1-s--_--.-•----.---_ ST. CROIX CO., W1 . Jlevet.ttpmenG,...Inc...}..a_.Wiscan_si.-sraxpQx_at_ia~_ Recd for Record I SAY 9 19$ Grantor. and----- Mark..Ek --jenkins-----and Sandr.a__-Kay.--Jenkins,- of 8:30 A M Pusbpaandyand: wife li.a_ssurvivorship marital / Grantee, ..69isterof Deeds Witnessetl1, That the said Grantor, for a valuable consideration. conveys to Grantee the fol ng describcd real estate in __.-S.t_.._ C1L Qi-_...._ RtTUR.i ro i, County, State of W' sin: Lot fourteen (14 ' Oats Ridge Acres, to the - - Town of Troy Tax Parcel No- sF ~ S:3~ FEE This AS---U0-t:......... homestead property. (IS) (is not) Together w1h all and singular the hereditaments and appurtenances thereunto belonging; And. 1Z.ot_1-Ing._iti-t_l,s._ Dev_e_l op(n~nt Inc - I warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of record, if any, and will warrant and defend the same. Dates this S say of Apr..1----•--------------------------------- -------------••---------------(SEAL) - - s D •._.,chex.d__N._o.x,...Fresdent..._ (SEAL) !a . ...........(SEAL) • a .-Frances_J.__ Fox:-..Secretary--•- AUTSBNTICATION ACKNOWLEDGMENT Signature(s) -tixchALzd_._N-.._.Fox...alad STATE OF WISCONSIN Frances J. Fox as. County. aut ti daq of.__ _ 19.88 Personally came before me this ________________day of ! . . 19-------- the above named ' L.•_ Gay- or------ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by $ 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY .f~.---La---Gay_1.o.rd-,A.tt_gz)aey------------------------ -13 iy.er.. Falls.}- W1----- 5-40.2.2 Notary Public _-----------•-----County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: 19-.-...... ) sNamea of persons aiming in any eapacity should be typed or printed below their siYnaturee. IIGM+necCar. rye IsTATE BAR OF WISCONSIN FOPH No. 1-1992 Stock No. 13001 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1888 THIS s►ACC Ra•cRVCO /OR Ra OROINO pATA WARRANTY DEED f 141i, 40PA,E ~3 _ AEGISTERS OFFICE I This Deed, made between ...RING HILLS DEVELOPMENT ! ST. Mix CO., WI& CORPORATIONa Wisconsin Co ration + xP° Ret'd kx Record this 19th . . . - - d Grantor}' 11. D. ly 86 If and---MP ?K..R.._97F ??S__s a.. . K _JENKINS....Husban------•---•---- :30 A r II - i~ WW ~_.~s... [iyorship_mar tal..P.rcpertY Grantee, s ~I Witnesseth, That the said Grantor, for a valuable consideration-..... 14 ' conveys to Grantee the following described real estate in St.. _6_0 R[TURN TO County, State of Wisconsin: i! Tax Parcel No: 1 I i i. LOT FIFTEEN (15), OAK RIDGE ACRES IN THE TOWN OF TROY. ~I ~i ~l t5ctu` I" EM This __lS_.M?t homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... Grantors........................ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except This Deed is given in full satisfaction of that Land Ccntract between the parties, recorded June 5, 1984 at 8:30 a.m. in Volume 689, page 450, 451 as document number 393(30 . and wi warrant and defend the same. Dated this 1.5............................ 0day of . 1~4Y. 6-.... RO H L2DF VFfA RATION - - - - -----..(SEAL) ..Fox .Px - --------------(SEAL) . . --Fox,--.Secre ' ' BY:-3 WI AUTHENTICATION ACKNOWLEDGMENT Signature (s) zC-H l~___j~!!r___ 5 .Y......... STATE OF WISCONSIN __/IfWJ Zt__F.t 4.A AO Fps sa. -of -------County. authenticated this j)--day of--___19_Jr_ Personally came before me this ................day of M? 19R6 the above named - A- _ TITLE: MEMBER STATE $AR OF WISCONSIN _J__-Frances--FOX (If not- authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Joseph--D-.__ BolesLRVDLIA _ _BESKAR. • &-•BOLES, S.C., 219 North Main Street, River Falls, ..Wisconsift---54422----•-----•----------------------------------• 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 persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN N.GM IIN,co.'P y~ FORM No. I - 1992 Stock No. 13001 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~4i TOWNSHIP _ SEC., T J-?N-R2W ADDRESS ST. CROIX COUNTY, WISCONSIN 4 tlSUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • oL~ ~ d INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Pro sed sl pe at site: SEPTIC TANK: Manufacturer: iquid Capacity: 16 6o Number of rings used:- Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 10 Side 0 Rear, O feet ` From nearest-property line : Front 10 Side,O Rear, (D feet r Number of feet from: well , building: (Include this information of the above plot plan)( 2 refer ce dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length -A~ / Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Pt. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: 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 Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: , f Dated: Plumber on job: License Number: 3/84:mj NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS OMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION ~9 BUREAU OF PLUMBING N. 1 53707 LYCONVENTIONAL ❑ALTERNATIVE State Plan l).O.Number: El Holding Tank ❑ In-Ground Pressure D Mound (If assigned NAME OF PERMIT HOLDER! JADDRESS OF PERMIT HOLDER: INSPECTION D AT Mark Jenkins 423 W. Cedar, River Falls, W1 54022 -/g 44 Q-3b BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.- SE SW, Section 36, T28N-R19W, Town of Troy,Lot#15, Oak Ridge Name of Plumber: MP/MPRSW No.. Cnumy Sanitary Permit Number. Tom Wang 3231 St. Croix 79168 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. T KIN}ET ELE. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER 76" PR SIDED: PROVIDED YES ON OYES [YNO BEDDING: VENT DIA.. VENT MATT HIGH WATER NUMBER OF ROAD PROPERTY WELL: BU IL DING . VENT TO FRESH ALARM FEET FROM ! LI AIR I LEETT~ DYES NO C t DYES NO NEARESTT~ Zip DOSING CHAMBER: MANUFACTURER . 7ING L IQUID CAPACITY PUMP MODEL PUMP:SIPHON MANUF ACTIIHEH WARN ING LABEL LOCKING COVER PROVIDEDPROVIDED: ES ONO OYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL N(~ OPEHTV WELL JBUILDING JVENT TO FRESH (DIFFERENCE BETWEEN F M uNE AIR INLET PUMP ON AND OFF) OYES ONO A T_ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 11,T11 11,1,11,11 TEH 1111AT I R JA L AND MAH K ING or excavation. 0f soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: _ WIDTH. LENGTH INOOFDISTH PIPE SPACI N(. COVER J INSIDE DIA SPITS LIQUID BED/TRENCH NG E CiES ~ CO RIAL. PIT DEPTH. DIMENSIONS - GRAVEL DEPTH FILL DEPTH UISTH PIP UISTH PIPE DISTR. PIPE MATERIAL NO ISTH tN UM BER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELE V.INLF I ELEV. END PIPES LIN~~/ Ajp IET'.FEE FF ~ Ito J~.~'4~ J~ 2 7 L`~ r1 NEAREST Os 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- O meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER TEXTURE PE HMANF NT MAHKF HS OfiSEH VA TI ON WELLS OYES ONO OYES ONO DEPTH OVER TRENCH BED DEPTH OVER THENCEI 1111, DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES OYES. ONO OYES ONO OYES NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH THE NCH ES LATERAL SPACING GRAVEL DEPTH BELOW PIPI- FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL N UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV. DIA. ELEV. PIOPES DIA'. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CONNECT LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO OYES NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: / FEET FROM LINE: i ° /0-0 OYES ONO OYES ONO --]NEAREST --z- S a~ Sketch System on Reverse Side. SIGNATURE. _ J TITLE. Of LHR SBD 6710 (R. 01/82) ' moommmi wisconsin APPLICATION FOR SANITARY PERMIT ` ~ DILHR COUNTY (PLB 67) UNIFORM SANITARY PERMIT # ~ OEf~fiRTTErIT OF mmq~ InouSTR4, LR60R 6 HUMRrl RELRTions 7 -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 WNER , MAILING ADDRESS r d/ sa3 ar f' / l> 20 _k Tetikib_s PROPERTY LOCATION CITY: .7451146 /4's TORN, R19 E (or W T WN VJ.LLAG-6-E: / (D LOT NUMBER BLOCK NUMBER SUBDIVISION NAM NEAREST ROAD LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED et~ A6 0 X 1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: F New System f ~x ❑ Tank Replacement ❑ Repair Il Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. X Seepage Bed 1 Y'),- 3 ❑ 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 dp(~ Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: E Y C $ 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): &/~Q ] Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatur MP/MPRSW No.: Phone Number: ofit of 'T d Lair 3V?/ I ► Plumber's Address: Na f Designer: ~e COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agen Fee: Date: ❑ Disapproved Q ❑ Owner Given Initial Approved Adverse Determination Reason Di pp al I Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber 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. 1 1 Form - 5 T C 100 Owner of Property Ar'k SOIs7~ym ~h 1 Location of Property ///W ~4 Section Township Mailing Address Subdivision Name ~ G Lot Number--- Previous Owner of Property Total Size of Parcel ~V_ Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other i+egal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said ystem, and the same has been duly recorded in the Office of the County egi r of eeds, as Document No. SIGNATURE OF ER SIG A URE D F CO-OWNER (11F, /1/95W DAT SIGNE DATE SIGNED L DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1962 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 1x9: sVG! .140 PAGE 83 'HEGIS i ERS OFFICE This Deed, made between .-_ROLLING--HILLS.-DEVELOPMENT..... Si. CROIX CO., WIS. CORPORATION, a Wisconsin Corporation _ _ Reed. for Record this 19th day of May 86 Grantor, ---A. D. 19 and---MW__D ___JENRINS__and--SANDRA- K. _ JENKINS,-_ husband- and_____ 8 : 30 A O M _ wife _ as _ survivorship - marital- _ property-.................................... - "W'w Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... - _ conveys to Grantee the following described real estate in _St...CrQi.lx RETURN TO County, State of Wisconsin: Tax Parcel No- LOT FIFTEEN (15), OAK RIDGE ACRES IN THE TOWN OF TROY. -MNSFNIR -6 This _is_-no homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except This Deed is given in full satisfaction of that Land Contract between the parties, recorded June 5, 1984 at 8:30 a.m. in Volume 689, page 450, 451 as document number 393830. and wil warrant and defend the same. 0_c Dated this j-5-----------------------.._- day of M`!y------------------------------------------------------- 6 ROLLING H LS DFVFIA RATION ----------(SEAL)~y~ d-N Fox,- .Px (SEAL) - ------.-.(SEAL) * *BY•--J -I' ances--Fax,--Secre AUTHENTICA TION ACKNOWLEDGMENT Signature (s) ---!R Rrt,EEef!SP FoZ! STATE OF WISCONSIN cEf SS. V-t --------------------------------------County. authenticated this __13__day of..... 19. kfe. Personally came before me this ................day of 19-------- the above named ..Ric hard_N__-Fox-------------------------------------------------- TITLE: MEMBER STATE $AR OF WISCONSIN -Z-Frances--Fox (If not- - authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Joseph D_.__BolesjRODLI,__BESKAR__& BOLES, S.C., 219 North Main Street, River Falls, Wiscon-s-in---54,022 Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: •Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN H.QMdIerCompary rvs w~.c.«.~. ~ FORM No. 1-1962 StOC1C NO. 73001 f H Y STC - 105 r H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER/BUYER S~ty1~Y~ h ~l k I s ROUTE/BOX NUMBER 1P0gTe_ v!~ r' ,P~ ✓)✓Q~ Fire Number S~O7i~ CITY/ STATE 41,11el ZIP PROPERTY LOCATION: A/ Section ~j T 09"9 N, R _W, Town of St. Croix County, Subdiviaion~,_210 le, 1Gr,el', Lot number 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 t.hat owners of all new 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 less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho E I/WE, the undersigned, have read the above requirements and agree Ul to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b 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 lop DATE 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. v y i m cn r:gm~ w~cnCOr,,3 V (CD (D A A (D 7 cL 3 S, S, w o~ao c3: pwwu,x c < c o co ` O m ~ c N N N* O! D OM -P- i 03.00 0 OD wi 0 -0 W w m N w A r. = r CD =M" 'COO A 3 Q. O n co w O m c O w 0 7 :0, ° w-~-. °wC 0 cc 3 cc- Z ? cps cr f 0 O N m w ODD C N Cr A~ O < C4 CD 'C+ -O C r L/ o A % - w n N ,A. O ter? •v°9 , 0 o w• p co c w' m C N 0 D Z C ~ M- J o am 3 Ch N oa D mcm o=r A R1 ..°a ,mow?°~o wv n > N m ~n'w a ac =r g rn~ C rn a Z CD =r CD a Fr 0 CD U) CD Q) If N o - - cam D p o N• O (D w~c mCf°ZO Nw aof chcQcnwo' m W o w a d a (D CO O a =r CA y, 7 <cn w ° to n ~c EN L7cc :3 C O (D A (D O 7 C A O CL Z a°,. °ct°w m=o _ a c a =r C CD ::r= 0 A0 10 ° 3 ° o ~Oo 'a * a 3' a cn :3 O m ti n C 3 0 o INDUS DEPARTMIEP". OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS NDUSTRY,,A DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN' RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 3; 5 - 1/` 1/ 3 /T2F N/R 19 E (or I~PoY )e eA CO N Y: OWNER'S BUYER'S NAME:. MAILING ADf~SS: 1y,0 12-- USE DATES OBSERVATIONS MADE NO. BEDRI: ICOMMERCIAL DESCRIPTION: P OFI LE DES RIPTIDNS: ER O AT ON TESTS: Residence _3 ,f / ,®New ❑ Replace / / fj ,V sC S(!/) p/0 t S; w/ sA,uD RATING: S= Site suitable for system U= Site unsuitable for system S vB r;rM74 !F r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM: (optional) ©s❑u ES ❑u asou ❑sQU osau If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: )N DEc;mA1_ f4 • PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-IN- T• CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) p CT/ ' , off'j3/~ s: /y'2 "6W' y,d'~+ir• . )ih-V If 6- Q D > 0 •2.0 ' M; BVI. S w X-f- Sf. sn2 B- Z 9 loo-65 > • oap' -4 902 ' Ae aa. S;1, If •,B0 S•;/ .33 ' /3,,, s' . JP? ' /I/>- S*/,/ . 'j, 9,v. si / . S; / 6 •,Pj " A.; B- 3 q0 `l ~9 y - >/O. v .ate. ~•'s ,e . -i gx"S:2 IS . 15"'/31e. SI/, •33'&. Si/, /0' B4-S;/, .64'00 IT, B- ) 2 CI•O 4) C644-st S dW . 184, S/ . , .00. /l-. . C 7 ' De 134 . JS ' BAl . T i7, 1. f2 B- S / • / 17 / ~tr- > / • Aix . I.3Au . / s 4--at 13nv • . S • 3. B- PERCOLATION TESTS R •///%Q TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN T , AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH P_ / S"• / Z Z 14 2 /G 2. ~o • IPP- P_ L Z 2- 7 13 r / P r P_ L 1 777/6 Z7 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. Aj ~oM n ~,n _ / SYSTEM ELEVATION 4.10 ODl /~`(J~ L 7^Gt(X, /L[.E' ~S ~T I I D ~/P i s x L t/1I / I~icl I S'7- AA91~15_: ill 42 all,- 72_~ 0 r7_ 1 d,p sGi ,ter ,pE . I.. 3 tN _ rti 3 f s~ E o~ s~@ 4 qnt o Ap r i E , E _ 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.(prirktL:.. TESTS WERE COMPLETED ON: ADD APPROVED SITE EVALUATIONS (PERCTESTS) CE Ill 0)- NUMBER: PHONE NUMBER optional): 01 ~ CST SIGNATUR i _ WISCONSIN LICENSE 140.55-02482 RZ 3, Ow m RD., HUDSON, WI 54016 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 71LHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRO - 6395 r To be a complete and accurate soil test, your- report must include: i 1 . Complete legal description; 2. The use section must clearly indicate whet!` ~lis is a residence or commercial project; 3. MAXIMUM number of bedrooms or comet use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TAN C Y IF ALL OTHER SYSTEMS ARE RULED OUT B;'.'' ')N SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here f ing profile descriptions and completing the plot plan; 7. MADE A LEGIBLE diagrarn accurately locatir your test locations. Drawing to scale is preferred. A separate sheet. may be used if desired; S, Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, h the appropriate box; 11. Sign the form and place your current address and your certification 12. Make legible copies and distribute as repaired. ALL SOIL TEST:; 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 - Sandstone gr - Gravel (under 3") LS - Limestone Ms - Sand HGW Nigh Groundwater cs- Coarse Sand Perc Percolation Rate coed s - (Medium Sand W - Well I's - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than `"sl - Sandy Loam < Less Than "I Loam Bn - Brown "sil - Silt Loarn Bl Black Si Silt Gy - Gray 'cl Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl Silty Clay Loam mot Mottles sr: Sandy Clay wr' - tnrith sic Silry Clay fff - fow, fine, Pa nt Ic - cc - common, pt P mm - Many, n m - Mw;"!- d - distinct p pronline. HWL - High Div s !extures l . ri disposal BM - B ir- VRP - Vert- TO THE OWNER: ,it. "''le co' n St A a Y vate to oh, icto r l rst i. REPORT ON SOIL BORINGS PERCOLATION TESTS i IS Poor ` PI.AM PRo3-EC T Z'• D. /d f 1304k J HOMESITE TESTING CO. T s - 3, 0,NE . ROAD BOB ULBR C , A allDSON, WIS..._ 54016 C5T SS_ 02 Ye2- 44 alz& 4~j~ PROPOSED HOUSE mosr LtE MORE "oM ALt- TEST ",e.. 5. PRO POSE 0 WELL M vsr LIE So r-T a,Q Ae.*, ° iPOr! At[ TEST • = l3,4c,Yfi/oE P/TS O = E,~'isT~.t1 G- [~EtL X = ~E~G /vC,~T~owf A = f/Aa~ g~~E~Eo op sovft l3c~fs • s z . Btu VF,pric~►t ~Ef6,pt~4JCE° Poi,JT 9,PEfv ,S`f.~.Q. 7" A T if/w Lo T Ca,P,)-"_ - LEGEND /~v~row 0,4 110x. ~Ef Pr. 7o ~o s 7- F7-. - ' Gd f t3M P ,e P 1Tfo~r~,.P~f fo,y~ aim ~ fj/~6 ~ /~14.c w c c l No o fG, /o7c- vim 20 - 132, 12- Ze ?4 0 ! ~ M SLOPES f P*, J63 pRopos&P f 2 a ~~G s ?3 x • •/3 Seu Lo7 .4 i.V c ! or7-his t~-st site AP ! cnvent1Qn~1 Se R0 i septic system E i Syf7~'`'t / o Lit syfT weir T • SEAR ~oG 10 OAK RIDG". 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