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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
INDUSTRY, P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON W1 3707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
R C IIKJ NICIPALITY: / LOTNO.:BLK.NO.: SUBDIVISION NAME:
LO CATION:''~ SECTION.
/ S R E (or S IL r'-- V-
S:
MAILING ADD S
C N R'S NAM
,
~~Y: ire r WNE lei, th h4l 9 a ~t~ Boa N16~?il: S'yel
DATES OBSERVATIONS MADE
USE PROFIL DES IPTIONS: PER OL TI N TESTS:
NO.IRMS: C MMERCIAL DESCRIPTION:
Residence XNew ❑Replace C
RATING: S= Site suitable for system U= Site unsuitable for system
rRS ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: TLDING TANK: RECOMMEND D SYSTEM:(optional CAS ❑U ~S ❑U ❑S X U HOLDING ClU y S SAS ,a~bari'~nc g
6
If Percolation Tests are NOT required DESIGN RATE: 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 D PTH 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- ~A /I IV,)v" bV-949 ''fins TO -/*T „16 S f 6r,
l s; ) i-P 36 Qn rsi j 3"6"v8"6 h-rs
.70-Y en It S
B- d -3~'~
B- -n -3v" b If S1, 3D'-3b'"Bvi s 1' 3a "67 S
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE
PER INCH ES
NUMBER INCHES AFTERS ELLING INTERVAL-MIN. PERIODt PERIOD2 PERIOD 3
P_ I (1 .3
l~
P_ a ?
P- a it
y'
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. 'ht~'~►LC~ ~'~~u~~ 3~ jr7.s
SYSTEM ELEVATION a~io3a~ - by %f3 ` .
E
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I, the undersigned, hereby certify that the soil tests reported on this form wer made y me in cord with the procedures and methods specified n th Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, a~ i'm
NAME (pn'ot) : TESTS WERE COMP N'~~ ON
ADDRESS: CERTIFICAT O M ER: PHONE N M E (optional):
O ,~/F
U C 7
CST SIGN E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
F, OOP ET F -M 1 - s i
?a ' IF ALL
T
.t.> wiTH THE
TO THE 0..
•
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verifi{ 3tion of this soil test in the field prior to permit issuance. A complete set of plans for i_he private
;e wstem and a permit application mu-1 be submitted to the appropriate local authority in order to
c armit. The sanitary permit mus r,ne€:f and posted prior to the start of any construction.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
. St. Croix County
AVM4 ~c a S~
OWNE L'__;~bl
ROUTE/BOX NUMBER d h I FIRE NO.
CITY/STATE I7~i1 Ll S~rI~`. _ ZIP
PROPERTY LOCATION: & l/4 S1,~ 1/4, Section TLO N, R--W,
SC° 4 , St. Croix county,
Town of dD P
Subdivision c- , 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 for a MAXIMUM of
$3000 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 on
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 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 form 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 Department 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.
SIGNE
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
STC-100 -
This application form is to be completed in full and signed by
the ovaier(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
Location ofproperty ~cJ 1/4 1/4, Section T .~D N-R„~W
Township -2L, ~43P0~
Hailing address
Address of site
Subdivision name Lot no. /VW
Other homes on property? _yes- No
Previous owner 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 X 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 & THE SEAL Or 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 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
recorc~~ ' the office of County Register of deeds as Document
No.
c
r
(I'Tignaturree o applicant Co-applicant
Date of Signature
Date of Signature
. 4
DOCUNIFNT NO. WAR sR" Q w,~ THIS GPACt RES°RVtO FOn nCC ~AUIN3 DATA
w94413 STATE BAR OF WISCONSIN FO&*d 9-IM
't rat 991wx 119
- - ° REGIS I rER'S Cr* FICE
......villiam. J,., Nillman•,tsnd, Chu len • llman............................. ST. CROIX CO., W
Rcc'd for Reccrd
JAN 2 T 1993
1: ~at 10:45 A M
eonve s and warrants :o An any..VdwaXd.-~~cha1Sk1..AI4
...Ann.Marie.Michalski,..husband_.anc1 Wife.,_.as• e-jj
t Rs&1ste*cfC~~
Aurvivorahip.marital -property .
PCTURN TO
the following described real estate in 9x.:.._ - oix County,
State of Wisconsin
Tax P" No:.................
The South 519.51 feet of the west 427.63 feet of the
NW 1/4 of SW 1/4 of Section 25, Township 30 North,
Range 19 West, St. Croix County, Wisconsin.
'70-50
-u 56
FEE
This ....in ot bomestesd property.
(18) not)
Exceptiox, to warranties:
Subject to easements, reservations and restrictions of record.
Dated this 25th... . day of January 19- 93--•
.:--------------------------------------•-....__....._...............(SEAL) W%7..... tdJ r. ......--........(SEAL)
• • w MA,_.MIL
.....--•--•--...-•----•-•-•--•._.....(tEAL)--~'••'✓\i" t•••• (SEAL)
6
GENE WILLMAN
AUTRUNTICATION ACENOWLEDdMRNT
Signature (a) STATE OF WISCONSIN
St. Croix County.
authenticated this _-.___day of--- ----------r.»r__, Personally came before me this _ V day of
~7~Et70131dLY~ 18.93... the above named
-_~_~~.__..._...»r.... r
r d1.11 alll!an_as}d......................
_
.=1_ 0111P.
r-------
TITLE: ME][BE8 STATE BAR OF WISCONSIN;
(If not «.--r._._rr..«r-.«w-«-r.«- •
suth d by 406.06. Wis. Stab) p to me known to be the person s--------- who executed the
foreenS Instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED By
STEPHEN J. DUNLAP - -
-
• °
Audsori Wisconsin- - . N
S_t;...lrro3u.............. County, Wis.
(Signatures may be authenticated or acknowledged- Roth My on %7 (If not, state expiration
ars not necessary.) date: ~Q1/(o 18---
•ifaa.w of Pawns sleabe to any ear"Ift abould be ft"d w vrInU4 blow their siaaatares.
WARRANTY DSiD STATE BAR 07 WtSCONSIN Wisconsin Legal Blank Co.. Inc.
FORM Ifw f - ilia Milwaukee. Wisconsin
_ . ,r a ~